Integrating the Chinesiologo AMPA into Italy’s Adapted Physical Activity and Structured Physical Exercise Pathways: A Conceptual Model, Critical Policy Analysis, and Strategic Priorities

Physical activity supports prevention and chronic disease management, but the effective delivery of exercise programmes requires clearly defined responsibilities, access arrange- ments, including professional referral, delivery standards, and financing mechanisms. In Italy, Legislative Decree No. 36/2021 defines attività fisica adattata (AFA; adapted physical activity) and structured physical exercise (EFS) and specifies the functions of the Chinesiol- ogo delle Attività Motorie Preventive e Adattate (Chinesiologo AMPA). Yet no coherent national pathway governs access to and coordinated delivery of these programmes. The reformu- lated amendment 4.47 to A.C. 2700 does not expressly include the Chinesiologo AMPA in its interdisciplinary framework, exposing an implementation gap in coordination among professional groups. This concept paper proposes an intersectoral, competence- and phase- based model linking clinical care with community-based prevention and exercise through AFA, EFS, and the long-term maintenance of physical activity. Six priorities follow: (i) align- ment of emerging legislation with existing law; (ii) implementation of Article 41, especially through verifiable competence criteria under paragraph 8-bis; (iii) national standards for programme access, documented handover, reassessment, and accountability; (iv) explicit specification and financing of AFA and EFS pathways within the Livelli Essenziali di Assis- tenza (LEA; essential levels of care); (v) distinct rules for provider qualification, healthcare accreditation, and public contracting; and (vi) public, interdisciplinary, and intersectoral governance. The model preserves the responsibilities of healthcare professionals for di- agnosis, treatment, and rehabilitation while operationalising, in qualified non-healthcare settings, the functions assigned to the Chinesiologo AMPA in prevention through exercise, adapted exercise programme design and delivery, and functional recovery after completion of rehabilitation. The inclusion of AFA and EFS in the LEA and their functional integration into Servizio Sanitario Nazionale pathways should be prioritised; formal recognition of the Chinesiologo AMPA within Italy’s healthcare-professions framework could be considered only if the necessary political and institutional conditions are in place. Implementation of this model should ensure safe and documented transitions between clinical care and community-based prevention and exercise, equitable access to programmes, and outcomes assessed using shared indicators.