1. Introduction

Climate change, characterized by long-term shifts in temperature, precipitation, and extreme weather, poses major risks to human health [1]. Rising global temperatures, sea level rise, and heatwaves contribute to over 150,000 deaths annually, with projections of an additional 250,000 deaths per year between 2030 and 2050 [2]. Climate change affects health through direct impacts such as heat-related illnesses, respiratory and cardiovascular diseases, and vector-borne infections [1,3] as well as indirect impacts including mental health disorders, sleep and eating disturbances, displacement-related violence, and long-term migration burdens that disproportionately affect vulnerable groups [4–8]. Given these wide-ranging health consequences, attention has increasingly turned to how climate change shapes everyday behaviors that influence long-term well-being. Physical activity, in particular, is both directly and indirectly affected by changing environmental conditions, with climate-related factors altering opportunities, safety, and motivation for participation. While rising temperatures may extend opportunities for outdoor recreation [9,10], these are outweighed by health risks such as heat stress and cardiovascular strain [11,12]. More frequent heatwaves impair performance and increase heat-related illnesses, especially in outdoor or poorly ventilated indoor settings [11,13]. Air pollution further discourages activity by reducing lung function and increasing cardiovascular risks [13–15]. Extreme weather and natural disasters can damage sport infrastructures, limiting participation [10,16,17], and severe winter conditions promote sedentary behaviors [18]. These growing climate change threats underscore the need for health professionals to implement adaptive strategies that protect well-being, enhance resilience, and reduce exposure to climate change health risks [19,20].

Despite the urgency, many health professionals, including physicians, nurses, physiotherapists, and physical activity professionals, remain insufficiently trained to integrate climate-related knowledge into their practice [20–23]. For physical activity professionals in particular, whose expertise lies in sports performance, rehabilitation, and health promotion [24,25], climate change introduces new challenges. Rising heat, poor air quality, and unstable environmental conditions directly affect their clients’ ability to engage in safe physical activities [13,20,26]. Physical activity professionals are uniquely positioned to integrate mitigation and adaptation strategies into their practice, working across diverse age groups and populations to promote climate-conscious physical activity. By equipping them with the knowledge, skills, and attitudes to respond to climate change, the profession can ensure that physical activity-based interventions not only support individual health but also contribute to collective resilience and environmental sustainability. Yet, current physical activity curricula rarely include climate-related content [26]. For instance, only 13% of German outdoor sports coaches reported receiving formal training on heat-health risks during their certification [20]. Schneider et al. [10,13,27,28] highlighted the growing threats climate change poses to athlete safety and performance, proposing preventive frameworks including education, but without specifying required competencies. Even recent existing professional frameworks, such as the Essential Competencies of Practice for Kinesiologists in Ontario [29], do not mention climate change. This leaves physical activity professionals underprepared to safeguard health in clinical, community, and outdoor contexts increasingly shaped by climate-driven hazards.

To address this gap, several medical disciplines have started integrating climate-related issues into both initial and continuing education program. However, similar initiatives are still lacking for physical activity professionals. Defining the competencies required to recognize, prevent, and mitigate climate-related health risks is a crucial step. Such an effort first requires identifying the specific content that could inform education programs, namely, the knowledge, skills, and attitudes that physical activity professionals should acquire to better integrate climate considerations into their practice. In recent years, many authors [20,27,30,16] have highlighted the bidirectional links between climate issues and physical activity, underscoring the importance of preparing professionals to address them. The Delphi method offers a particularly valuable approach for gathering expert consensus on this topic. Therefore, the objective of this study is to identify the educational competencies (knowledge, skills, and attitudes) that physical activity professionals should develop to effectively integrate climate change into their professional practice.

2. Methods

2.1 Study design

Considering the limited empirical guidance on climate-related competencies for physical activity professionals, expert consensus methods offer a rigorous avenue to integrate insights and define key educational priorities. Accordingly, we employed the classic Delphi method to engage professionals from physical activity and health fields. This method supports a systematic process for identifying, refining, and prioritizing competencies crucial for incorporating climate considerations into professional practices. The Delphi technique was chosen for its ability to enhance the validity of findings by fostering consensus that transcends individual opinions and builds on collective expertise [36]. By combining qualitative and quantitative elements, it enables the discovery of novel insights and the clarification of complex data [37]. The study was structured into three distinct phases, as illustrated in Fig 1. This manuscript was written according to the recommendations for the interdisciplinary standardized reporting of Delphi studies in social and health sciences (DELPHISTAR). The DELPHISTAR checklist is provided in supplementary material (S1 Table). This study was not preregistered.

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Fig 1. Flow diagram of Delphi study process.

https://doi.org/10.1371/journal.pclm.0000812.g001

3. Results

3.1 Demographic characteristics of panel members

Throughout the three Delphi rounds, the features of participants showed considerable stability. The predominant age group of experts was 40–49 years old. Most experts were based in France and Canada. In terms of academic position, professors consistently represented the largest share. Regarding professional experience, nearly half of the participants reported more than 10 years of experience, ensuring that the panel was composed of highly experienced experts Table 1.

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Table 1. Demographic characteristics of panel members.

https://doi.org/10.1371/journal.pclm.0000812.t001

3.2 Round 1

A total of 54 responses were received, comprising 21 responses in English and 33 in French. Of these, 49 responses (20 in English and 29 in French) were deemed complete and suitable for analysis. Five responses were excluded due to incomplete demographic information, lack of an email address for contact in the second round of the Delphi, and failure to answer some questions. Analysis of first-round Delphi responses yielded 18 themes and 40 sub-themes presented in Fig 2.

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Fig 2. Analysis of the first round of the Delphi that yielded 18 themes (boxes) and 40 sub-themes.

https://doi.org/10.1371/journal.pclm.0000812.g002

3.4 Round 3

In the third round, application of the two predefined consensus criteria (i.e., stability and improved consensus) resulted in the exclusion of 23 competencies (7 knowledge, 9 skills, and 7 attitudes). They are presented in red in S2 Table. These items were all excluded because they did not reach the improved consensus criteria (i.e., at least 70% with a score ≥8). No items were excluded based on the stability criteria. Ultimately, consensus was reached on 18 competencies, including 7 knowledge, 8 skills, and 3 attitudes, as presented in Table 2.

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Table 2. The 18 competencies that physical activity professionals should possess to better address climate change related issues into their practices.

https://doi.org/10.1371/journal.pclm.0000812.t002

4. Discussion

To our knowledge, this study is the first to identify the educational competencies that physical activity professionals should develop to effectively integrate climate change into their professional practice. Through a three-round Delphi process, the expert panel reached consensus on 18 key competencies (7 knowledge competencies, 8 skills competencies and 3 attitudinal competencies) that can guide the development of specific initial or continuing training programs. Overall, the competencies identified cluster into three overarching themes, for which we propose practical guidance on how they can be integrated into training curriculum and professional development programs.

First, the highest agreement was on competencies related to identifying and managing health risks from climate and extreme weather events (items #3, 5, 13, 14 for knowledge; items #26, 27, 31, 33 for skills in S2 Table). This shows that the priority for physical activity professionals in a changing climate is ensuring patient and client safety in changing environments. In particular, the ability to identify (knowledge) and analyze (skills) risks related to outdoor physical activity (e.g., heat stress, dehydration, heat stroke, pollution-related respiratory issues) achieved the highest consensus (median scores of 9, 94–97% agreement). These results align with recent literature showing that professionals consistently identify heat-related risks as a major challenge for outdoor sports requiring systematic recognition and monitoring [13,20,27,30,46]. Health professionals also anticipate greater vulnerability to heat stress under climate change, calling for stronger training in risk assessment and rapid response [2]. Current guidelines emphasize structural strategies (e.g., cooling infrastructure), organizational protocols (e.g., early warning systems), and individual-level strategies (e.g., acclimatization/acclimation, hydration, protective clothing) [27,16,47].

To address this, education programs should incorporate: (i) tools like the Climate Fresk workshop (https://climatefresk.org/world/) to help professionals grasp systemic connections between climate, health, and physical activity, while empowering them to take action, (ii) presentation of the current guidelines for safe physical activity in hot weather and during air pollution events; (iii) practical simulations and case-based learning (e.g., climate chamber sessions, use of monitoring devices for temperature and pollution); (iv) introduction to the development of emergency protocols and decision-making scenarios (e.g., what to do if a client shows signs of heat exhaustion); and (v) training on how to communicate clear, evidence-based recommendations to clients during pollution or heat alerts.

Second, experts also emphasized the need to adapt professional practices in response to climate-related health risks and educate clients (items #12, 15 for knowledge; items #28, 36, 37 for skills; items #41, 42, 48 for attitudes in S2 Table). In particular, the ability to modify and adjust exercise elements in response to climate-related health risks achieved the highest consensus (median scores of 10, 94–97% agreement). Such adaptability is critical to ensure safe participation in physical activity despite rapidly changing conditions, and mirrors the shift in healthcare professions toward flexible, context-sensitive practices. Importantly, the attitudinal competencies that reached consensus were strongly oriented toward flexibility and a willingness to adapt professional practice in response to climate extremes. Another key finding was the emphasis on understanding how climate-related health risks disproportionately affect vulnerable populations, such as older adults, children, persons living with disabilities, and low-income groups (items #22 for knowledge; items #32 for skills in S2 Table). This aligns with broader discussions on the insufficient integration of marginalized populations in physical activity curricula and the limited attention to social justice frameworks in professional guidelines [48]. Vulnerable populations already face significant barriers to physical activity (e.g., chronic disease, obesity, mobility or cognitive limitations), which are likely to be exacerbated by climate-related risks such as extreme heat, air pollution, and reduced access to safe spaces [49,50]. As such, physical activity professionals must develop a nuanced understanding of how these intersecting factors uniquely affect vulnerable groups. Without this awareness, practitioners risk delivering interventions that are ineffective or exclusionary, potentially leading to disengagement and adverse health outcomes [49,50].

To better prepare future physical activity professionals, curricula should include: (i) specific information about who are the most at risk of hazard-related health problems and why, (ii) design of adapted intervention strategies for high-risk populations, such as safe indoor alternatives during heat and pollution events, and (iii) organizing interdisciplinary workshops (e.g., with public health, urban planning, and environmental science students) to design holistic interventions.

In comparing our findings with prior Delphi-based research, our study occupies a distinct position. While Alsop et al. [36], achieved a narrower consensus (11 competencies) with a broad health professional target group, without addressing climate-related risks, our study produced a richer competency framework specifically developed to address the unique problems of climate change, particularly designed for physical activity professionals. Similarly, Schneider et al. [13,27,28] identified climate-related risks in sport and proposed prevention models but did not specify the professional competencies required to address them. Our work extends this literature by moving beyond risk categorization and prevention frameworks to articulate the professional competencies that physical activity professionals must possess. In doing so, we bridge the gap between identifying risks or preventive measures and equipping physical activity professionals with the competencies to respond effectively.

5. Strength and limitations

An important strength of the study lies in its inclusion of a diverse cohort of international participants with relevant expertise, enhancing the generalizability of the findings across global contexts. Additionally, the use of the Delphi method constitutes a methodological advantage, as it facilitates expert consensus through the generation of group-level rather than individual-level insights. However, this approach may also introduce potential bias, as the validity and robustness of the outcomes are highly contingent upon the careful and representative selection of panelists. Furthermore, although we have diverse participants from five continents, we did not have any experts from the African countries. Consequently, the findings should be interpreted as reflecting perspectives primarily from the regions represented, and caution is warranted when extrapolating to under-represented contexts. Future Delphi studies should prioritize strategies to enhance participation from these regions (e.g., multilingual administration, targeted recruitment through regional professional societies and institutions).

6. Conclusion

This study established expert consensus on 18 competencies, comprising 7 knowledge, 8 skills, and 3 attitudes that physical activity professionals should possess to better address the challenges of climate change in their practice. These competencies underscore the need for a comprehensive understanding of climate-related health risks, the ability to adapt exercise protocols, ensure client safety under extreme environmental conditions, and the capacity to promote pro-environmental behaviors and sustainable practices. They also highlight the importance of supporting vulnerable populations. Attitudinal dimensions emphasize flexibility and the need to promote physical activities that align with climate goals. These competencies provide a foundation for embedding sustainability and climate resilience within physical activity education program.

Supporting information