What is exercise on prescription?
“Exercise on prescription” (in French, sport sur ordonnance) refers to the medical prescription of adapted physical activity, tailored to a patient's condition, physical abilities and medical risk. Introduced in France by the 2016 health system modernization law for patients with a long-term condition (ALD) and their primary care physician, it was broadened by the law of March 2, 2022: the physician involved in the patient's care can now prescribe it, and it extends to people with a chronic disease, risk factors or loss of autonomy. The official term is “adapted physical activity”; the word “sport” creates confusion with leisure or competitive practice.
What the legal framework says
The law of March 2, 2022 amended article L. 1172-1 of the French Public Health Code on two points. First, prescription is no longer reserved for the primary care physician: it now belongs to the physician involved in the patient's care. Second, eligibility is no longer limited to long-term conditions: the law includes chronic diseases, risk factors and loss of autonomy. The text keeps the requirement that the activity be adapted to the patient's condition, physical abilities and medical risk, which sets it apart from general advice. The same law allows physical therapists to renew and adapt initial prescriptions unless the physician indicates otherwise.
Two decrees of March 30, 2023, in force since April 1, 2023, specify this framework. They list the chronic diseases, risk factors (including overweight, obesity, hypertension, undernutrition, sedentary behavior, dyslipidemia and addictive behaviors) and situations of loss of autonomy that qualify for a prescription. The prescription is written on a dedicated form, specifies among other things the type of activity, its duration, frequency and intensity, and covers three to six months, renewable. A physical therapist may renew it once or adapt it, with the patient's consent, and informs the prescribing physician.
The paradox: well known but rarely used
In a survey conducted by BVA for the French National Cancer Institute (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. For most of them, encouraging physical activity still relies on verbal advice.
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. Physicians themselves agree that written prescriptions are effective, and the prescription is described as a driver of motivation and engagement in physical activity.
The main barriers cited by physicians
- Lack of training. Physicians consider their knowledge insufficient, particularly on adapting activity to the patient's condition, physical abilities and risks. In the INCa survey, 43% of general practitioners did not prescribe it for lack of training.
- Lack of visibility on available services. Among physicians who had not used the prescription, 67% did not feel sufficiently supported to refer their patients.
- Difficulty turning guidelines into practice. Guidelines from public bodies provide a general framework, but do not translate into effective practice standards for clinicians.
- Cost and time. The lack of financial coverage (the reason for not prescribing for 16% of the general practitioners surveyed) and lack of consultation time complete the picture.
The funding question
APA sessions are not covered by French national health insurance as a general rule. This is seen as an additional barrier to prescription and a risk of social and geographic inequalities in access.
Targeted schemes exist. The global care pathway after cancer treatment allows the oncologist, pediatrician or primary care physician to prescribe, up to twelve months after the end of treatment, a set of services that may include a physical activity assessment leading to an APA plan. Since April 2026, a two-year pilot also allows this pathway to include a program of APA sessions in Brittany, Nouvelle-Aquitaine and Provence-Alpes-Côte d'Azur.
How to put it into practice
Write a useful prescription
A prescription that only states “physical activity recommended” changes nothing. The regulations require the prescription to specify, among other things, the type of activity, its duration, frequency and intensity, and the physician to rely on the HAS prescribing guides where they exist. Adding the precautions related to the condition allows the professional or facility taking over, such as a Sport-Health Center, to work in good conditions.
Set the goal together with the patient
According to Inserm, effects are reportedly even greater when the goal and modalities are discussed with the patient and rooted in their wishes, motivations and care pathway. A concrete functional goal can serve as an anchor, for example climbing stairs again or walking for half an hour.
Organize follow-up
The initial prescription is not enough. The regulations require the provider to produce an initial assessment, periodic reports and a final assessment, shared with the patient and, with their consent, with the prescribing physician and the primary care physician. Scheduling a review when the prescription ends helps decide the next steps and supports long-term adherence.
Frequently asked questions
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. Eligibility covers long-term conditions, chronic diseases, risk factors and loss of autonomy. Unless the physician indicates otherwise, a physical therapist may renew the initial prescription once or adapt it.
Is the prescription reimbursed?
APA sessions are not covered by French national health insurance as a general rule. After cancer, the global care pathway may include a physical activity assessment, and a pilot covering sessions has been running in three regions since April 2026.
What is the difference between verbal advice and a written prescription?
According to Inserm (2019), a written prescription is on average twice as likely to be acted upon as verbal advice. The written prescription is described as a driver of motivation and engagement in physical activity.
Why is the scheme so rarely used?
Physicians mainly cite a lack of training on adapting activity to the condition, a lack of visibility on services in their area and difficulty translating guidelines into practice. Lack of financial coverage and lack of consultation time add to these barriers.
Where should patients be referred?
To authorized providers: health professionals for severe functional limitations, APA instructors and, under conditions, sports instructors. Sport-Health Centers, of which there are 581 according to the French Ministry of Sports, are there to welcome, inform and refer.
Is a medical clearance certificate required?
Before advising or prescribing physical activity, the HAS asks physicians to carry out a minimal medical assessment: cardiovascular risk, usual activity level, motivation. A dedicated, longer consultation is recommended for higher-risk patients; it may lead to additional tests if needed.
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.