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Adapted Physical Activity Programmes (Programmi di Attività Fisica Adattata)

Adapted Physical Activity programs (APA) are group exercise programs, designed for individuals with chronic conditions, aimed at correcting sedentary life style and hereinafter at the prevention or mitigation of frailty and disability. There is a large body of published evidence indicating that a number of diseases, disabilities and premature deaths can be prevented by the adoption of healthy life styles, where physical activity is recognized to play a primary role. This has been demonstrated not only for healthy individuals, but also for individuals suffering from chronic conditions. The disabling effects of chronic diseases are worsened by the additive effect of sedentary life style, which causes new impairments, new functional limitations and more severe disability. There is sufficient evidence to conclude that this vicious circle can be corrected with an adequate program of exercise. A key question from a policy perspective is how to translate the evidence on the beneficial effects of exercise into an effective large-scale network of services for persons with chronic conditions. The considerable financial pressure caused by the increasing prevalence of chronic diseases associated with an aging population has lead the Tuscany Regional Health System to launch in 2005 the APA programmes and to promote their diffusion throughout the entire Region. Adapted Physical Activity was developed to provide a community-based, progressive, supervised group exercise for elderly, sedentary citizens as an alternative to over-subscribed clinic-based rehabilitation programmes. General practitioners (GPs) were the primary referral source. They were encouraged to refer all elderly patients with chronic musculo-skeletal complaints whom they deemed adequately medically stable to participate in exercise (Low disability classes). The Health Authority then began developing an APA programme for patients with chronic neurological deficits (High disability classes). These patients have significantly impaired function, and thus require a different programme of exercises, and smaller classes then those in the original programme. The Local Health Authority (LHA) staff coordinates patients assignment to local gymnasiums which have joined this initiative. General practitioners refer medically cleared patients for participation. APA participants attend classes two or three times a week in community gyms. LHAs train the gym instructors in protocols for the different chronic conditions and regularly observe APA classes to ensure treatment fidelity. APA programmes are held during the day at “off hours” in the local gyms or pools. In locations where gyms were not available, suitable environments were identified in social clubs or parish premises. This strategy has enabled the LHAs to keep prices low, to get a large number of private operators involved (gyms or pools) and to obtain a wide geographical coverage of the service (thereby reducing travel distance and time). In addition it has facilitated adherence and reduced social isolation by facilitating the interaction among participants. People pay for themselves (2.20/2.50 € for one hour exercise session, i.e. approximately the cost of a cappuccino and a pastry) and must arrange their own transportation. The entire cost of the programme is covered by the participants, except coordination which is provided by LHAs. Since at the end of 2016 the participants were apprroximatively 30,000, we can extimate that the total private expenditure in 1 year is around 7 millions euros (gyms costs, insurance costs, private associations fees), plus about 250,000 euros for coordination activities by LHAs as promotion and monitoring.
Organisation name: 
Regione Toscana
Organisation address: 
Via T. Alderotti 26/n, 50139 Firenze, Italy
Kind of organisation: 
Regional public authorities
Time for deployment: 
Between one year and three years
Preparation of implementation: 
Several actions sustained the implementation of the APA programmes. The Municipalities, through the “Società della Salute” (consortiums of LHAs and Municipalities for the provision of social and health services at community level), assisted in the recruitment of profit and non-profit sport...
Investment per citizen / service user / patient: 
No available calculation.
Cost calculation: 
No data available
Evidence of practice: 
Documented evidence. Evidence is based on systematic qualitative and quantitative studies
Evidence creation: 
There is a large body of published evidence indicating that a number of diseases, disabilities and premature deaths can be prevented by the adoption of healthy life styles, where physical activity is recognized to play a primary role. In addition, Tuscany region promoted research activities to...
Maturity level: 
Proof of concept is available: it works in a test setting and the potential end-users are positive about the concept.
Maturity level detalis: 
The programmes continues to expand rapidly since 2005. Based on the last regional survey (December 2016) the APA programmes were extended to serve about 30,000 (3.3%) citizens aged >65 with chronic conditions in nearly 2062 classes scattered in 876 gums/pools located in 237 (85%) municipalities...
Time of impact: 
Long term and sustainable impact – e.g. a long time after the pilot project ended and routine day-to-day operation began
Kind of impact: 
Better health (societal)
Aspects time of impact: 
Time invested in the initial phase of the initiative should be addressed towards the team making among GPs, LHAs' clinicians and exercise trainers in order to create a strong trust environment among all the actors of the programmes. That might take time and patience, but will be very rewarding...
Transferability level: 
The innovative practice has been transferred in other locations or regions or national scale in the same country
Transferability details: 
In 2011 the Tuscany experience influenced the new Rehabilitation Guidelines of the Italian Ministry of the Health. This led other regions of Italy, to implement APA successfully in their communities.
Type of Practice: 
Good practice
Stakeholders concerned: 
Primary care centres
Specialised physicians
General practioners
Day care centres
Informal caregivers
Private companies
Research centres
National public authorities , WHO
Regional public authorities
Local public authorities
Advocacy organisations patients/users
Advocacy organisations physicians
Advocacy organisations nurses
Advocacy organisations others
Other, please specify
Trade Unions
Reach of initiative: 
10,000 - 99,999
Age group: 
65 - 79
Baseline information: 
Tuscany has 3.744.398 residents (ISTAT 2016) and is one of the most aged regions in Italy with around 25% residents aged 65 and over (about 900.000). The life expectancy is 80,7 years for men and 85,2 for women. The 54% of elderly residents suffers from one ore more chronic conditions (ISTAT 2013...
Source of funding: 
Private funding