What is adapted physical activity?
Adapted physical activity (APA) is physical activity whose type, intensity, frequency and modalities are tailored to a person's condition, physical abilities and medical risk. The French Public Health Code defines it as practice based on the abilities and motivations of people with specific needs that prevent them from exercising under ordinary conditions. What sets it apart from simple advice to "move more" is its structure: initial assessment, defined program, personalized progression and long-term follow-up. The French National Authority for Health (HAS) describes it as a therapy in its own right, and since the law of March 2, 2022, any physician involved in a patient's care can prescribe it.
What adapted physical activity is not
Three misconceptions come up often.
- It is not performance sport. APA may draw on physical and sporting activities, but it targets a function: climbing stairs, sustaining a thirty-minute walk, reducing pain.
- It is not wellness. Under the French Public Health Code, its purpose is to reduce the risk factors and functional limitations linked to the disease, not simply to provide comfort.
- It is not general advice. A recommendation to move without dosing, follow-up or adaptation to the condition does not qualify as APA.
The French legal framework
The framework for exercise on prescription was built in several steps. The 2016 health system modernization law allowed the primary care physician to prescribe APA to patients with a long-term condition (ALD). The law of March 2, 2022 on making sport more accessible in France broadened it: prescription now belongs to the physician involved in the patient's care, not only the primary care physician, and it extends to people with a chronic disease, risk factors or loss of autonomy. The prescribed activity must remain adapted to the patient's condition, physical abilities and medical risk (article L. 1172-1 of the French Public Health Code).
Two decrees of March 30, 2023, in force since April 1, 2023, specify the chronic diseases, risk factors and situations of loss of autonomy concerned, as well as the prescription conditions: a dedicated form and a duration of three to six months, renewable. Unless the physician indicates otherwise, a physical therapist may renew the initial prescription once or adapt it.
Conditions covered
The HAS publishes prescribing guides by condition or situation, which physicians rely on where they exist. They cover, among others, stroke, osteoarthritis, asthma, chronic obstructive pulmonary disease (COPD), several cancers, depression, diabetes, hypertension, chronic heart failure, chronic nonspecific low back pain, Parkinson's disease, multiple sclerosis, overweight and obesity. A few examples of documented effects:
- In type 2 diabetes, regular endurance training, resistance training or both reduces the risk of micro- and macrovascular complications and improves glycemic control (HAS).
- In coronary heart disease, a 2021 Cochrane review of 85 trials concludes that exercise-based cardiac rehabilitation reduces the risk of myocardial infarction and all-cause hospitalization at 6 to 12 months.
- In COPD, a 2015 Cochrane review of 65 trials concludes that pulmonary rehabilitation improves quality of life and exercise capacity, and considers further trials comparing it with usual care unwarranted.
- In breast, colorectal and prostate cancers, physical activity can be practiced during and after treatment; it helps maintain or improve physical fitness and tolerate treatment better (HAS).
- After a stroke, regular physical activity, combined with control of other risk factors, reduces the risk of recurrence and cardiovascular mortality (HAS).
Who delivers adapted physical activity
The French Public Health Code lists the authorized providers: health professionals (physical therapists, occupational therapists, psychomotor therapists), holders of a university degree in adapted physical activity and, under conditions, certain sports instructors and holders of sports federation certifications. For patients with severe functional limitations, only health professionals are authorized. As autonomy improves, APA instructors work alongside them, based on the functional assessment carried out by the health professionals.
Referral remains a sticking point: in a 2020-2021 survey for the French National Cancer Institute (INCa), 67% of general practitioners who had not prescribed APA did not feel sufficiently supported to refer their patients.
How a protocol is built
Assessment
Before prescribing, the physician carries out at least a minimal medical assessment: cardiovascular risk, usual level of physical activity, motivation. At the start of care, the provider then assesses physical fitness, functional capacity and motivation. Without this baseline, no dosing is possible and no progression can be demonstrated.
Dosing
The prescription specifies, among other things, the type of activity, its duration, frequency and intensity. The HAS guides mentioned above most often combine endurance and resistance training. The regulations require care to be personalized and progressive in the form, intensity and duration of exercise.
Progression and engagement
Progression follows the observed responses. But a well-dosed protocol that the person drops after a few weeks has no lasting effect: engagement is decisive. According to the Inserm collective expert review, the effects of a prescription are reportedly even greater when goals and modalities are discussed with the patient. Setting goals with the person is also among the factors of long-term adherence most often cited by literature reviews.
The French paradox
In a survey conducted by BVA for INCa between November 2020 and January 2021, 88% of general practitioners surveyed had heard of the APA prescription scheme, but only 41% reported using it with their patients with a long-term condition. The barriers they cite: insufficient training, lack of visibility on available services and their funding, consultation time and difficulty motivating patients.
The stakes are real: according to the Inserm collective expert review (2019), a written prescription is on average twice as likely to be acted upon as verbal advice, based on work carried out notably in Denmark and New Zealand.
Frequently asked questions
What is adapted physical activity?
It is physical activity whose type, intensity and frequency are tailored to a person's condition, physical abilities and medical risk. It differs from leisure sport through this tailoring, and from a simple recommendation to move through its structured, monitored nature.
Who can prescribe adapted physical activity?
Since the law of March 2, 2022, the physician involved in the patient's care, no longer only the primary care physician. Unless the physician indicates otherwise, a physical therapist may renew the initial prescription once or adapt it.
For which conditions is it recommended?
The French National Authority for Health (HAS) publishes prescribing guides for a wide range of situations. They cover, among others, diabetes, several cancers, chronic heart failure, COPD, hypertension, chronic nonspecific low back pain, overweight and obesity, and depression.
Who delivers adapted physical activity?
Physical therapists, occupational therapists and psychomotor therapists, holders of a university degree in adapted physical activity and, under conditions, certain sports instructors. For severe functional limitations, only health professionals are authorized.
Is it reimbursed?
Not as a general rule. After cancer, the global care pathway may include a physical activity assessment leading to an APA plan. Since April 2026, a two-year pilot also allows sessions within this pathway to be covered in Brittany, Nouvelle-Aquitaine and Provence-Alpes-Côte d'Azur.
How does it differ from sport for health?
Sport for health also covers primary prevention: it targets healthy people who are not physically active. Adapted physical activity is for people with a chronic disease, risk factors or loss of autonomy, and requires a medical prescription.
How long does a program last?
The prescription covers three to six months and can be renewed. The program ends with a comparative assessment of physical fitness, functional capacity and motivation, used to gauge progress and propose next steps.
Is an assessment needed before starting?
Yes. The physician carries out at least a minimal medical assessment, and a dedicated consultation is recommended for higher-risk patients. The provider then assesses physical fitness, functional capacity and motivation, which serves as the baseline for measuring progress.
Editorial review in progress by MYA's editorial committee.
Editorial content intended to inform health professionals. It does not constitute individual medical advice and does not replace assessment by a professional.