Sport on prescription: prescription, reimbursement, for whom?

The benefits of sport on health no longer need to be proven, whether in preventive mode or in a therapeutic context. Since March 1, 2017all people who suffer from a chronic disease (which is on the list ALD30 below) may be prescribed sports sessions adapted to their state of health and physical abilities. That’s what we call « prescription sports » Where « sport-health ». A decree of December 30, 2016 specifies the conditions for providing physical activity adapted to well-identified patients. To encourage the prescription of sport, in July 2022, the High Authority of Health published a guide detailing the terms of prescription to support doctors, as well as a series of tools. Who can benefit ? Under what conditions ? How is the repayment ? Over there Social Security ? Mutuals ?

What is Prescription Sport?

Sports on prescription is a national measure subject to an official decree (December 30, 2016) allowing patients with a long-term illness (ALD, see list below) to be prescribed by their doctor a physical activity adapted to their pathology, their physical abilities and their medical risk. This adapted practice should be supervised by a professional (paramedical health professionals, APA teachers, qualified sports educators) and is based on the abilities and motivations of people with specific needs that would prevent them from practicing under ordinary conditions.

What are the recognized ALDs?

People who can benefit from prescription sports are patients with Long Term Condition (ALD)a list of 30 diseases which require prolonged therapeutic follow-up and costly care. These 30 diseases (listed in decree no. 2011-77 of January 19, 2011) are:

1. Disabling stroke;
2. Bone marrow failure and other chronic cytopenias;
3. Chronic arteriopathies with ischemic manifestations;
4. Complicated schistosomiasis;
5. Severe heart failure, severe arrhythmias, severe valvular heart disease, severe congenital heart disease;
6. Active chronic liver diseases and cirrhosis;
7. Severe primary immune deficiency requiring prolonged treatment, human immunodeficiency virus (HIV) infection;
8. Type 1 diabetes
9. Type 2 diabetes ;
10. Serious forms of neurological and muscular disorders (including myopathy), severe epilepsy;
11. Haemoglobinopathies, haemolysis, chronic constitutional and severe acquired;
12. Hemophilias and severe constitutional disorders of hemostasis;
13. Coronary disease;
14. Severe chronic respiratory failure;
15. Alzheimer’s disease and other dementias
16. Parkinson disease
17. Hereditary metabolic diseases requiring prolonged specialized treatment;
18. Cystic fibrosis;
19. Severe chronic nephropathy and primary nephrotic syndrome;
20. Paraplegia;
21. Vasculitis, systemic lupus erythematosus, systemic sclerosis;
22. Progressive rheumatoid arthritis;
23. Long-term psychiatric disorders;
24. Progressive ulcerative colitis and Crohn’s disease;
25. Multiple sclerosis
26. Evolutionary structural idiopathic scoliosis (with an angle equal to or greater than 25 degrees) until spinal maturation;
27. severe spondyloarthritis;
28. Organ transplant suites;
29. Active tuberculosis, leprosy;
30. Malignant tumor, malignant disease of lymphatic or hematopoietic tissue.

► Following an amendment of March 13, 2021 by the National Assembly, the Sport on prescription system is extended to people suffering from obesity, high blood pressure and depression (when a diagnosis is made).

Does obesity allow you to benefit from sports on prescription?

Obesity is not one of the pathologies qualified as a long-term illness (ALD). Nevertheless, amendment no. 369 tabled on Saturday March 13, 2021 by the National Assembly endorses the extension of sports on prescription to diseases not appearing on the ALD list such as high blood pressure, depression and obesity. The prescription sports device is therefore accessible to people suffering from obesity.

What are the benefits of prescription exercise?

The practice of physical activity is beneficial for health, both mental than physical. Particularly when sick. Sport, when it is adapted to the patient, makes it possible to improve his health or to limit the aggravation of the disease. But also to reduce the risk of recurrence for people with cancer, for example.

Who can prescribe prescription sports?

Prescription Sport can be prescribed by your attending physician (general practitioner or specialist) since March 1, 2017. The prescription is made after completion of a physical examinationsometimes paraclinical examinations, and a physical assessment by a sports professional, in order to identify possible contraindications and to determine the precautions to be taken.

You must make an appointment at your attending physician who, after a clinical examination and a physical evaluation (with a sports doctor) can, if you are fit, complete a form dedicated to the prescription of an adapted physical activity on which it specifies its duration but also the type of professionals who will have to supervise you during this activity. He can also write down various recommendations (see the form). Your doctor will be able to refer you to suitable professionals (occupational therapists, physiotherapists, qualified coaches in adapted physical activity, etc.) because, as said, the practice of sport must absolutely be framed.

What sports can be prescribed?

Of course, not all sports are suitable for all patients. « Patient care is personalized and progressive in terms of form, intensity and duration of exercise« , specifies the decree. The prescription of the sport on prescription must:

• be adapted to the patient’s illness and physical abilities (it is the doctor who determines this through clinical examinations). Thus, sport on prescription must be supervised by professionals, depending on the case and in agreement with the patient, such as paramedical health professionals (masseurs-physiotherapists, occupational therapists, psychomotor therapists) or some adapted physical activity teachers or some qualified sports educators.
• take into consideration the patient’s medical risk
• be performed on a specific form

For instance : walking (Nordic, fast…), the bike, swimming, gym, water aerobics, yogathe pilates, framed can be prescribed by doctors. Sport on prescription can therefore be done in a rehabilitation center as well as in suitable equipment (swimming pool or sports hall for example) or even in a labeled club if the latter has supervision by a qualified sports educator.

How long is the prescription valid?

The prescription of a physical activity is generally carried out for a period of 6 to 12 months (renewable prescription). However, the duration may vary depending on the patient. With the agreement of the patients, the intervening party (physiotherapist, occupational therapist, specialized educator, etc.) periodically transmits a report on the progress of the physical activity adapted to the prescribing physician and can formulate proposals regarding the continuation of the activity and the risks inherent therein. The patients are recipients of this report.

What reimbursement for prescription sport?

The decree does not mention the question of reimbursement. A priori, sport on prescription is not reimbursed by health insurance (Amelie). Nevertheless, some mutuals (MAIF, Mutuelle des Sportifs? MGEN…) offer refunds with certified APA (Adapted Physical Activity) coaches. Your doctor, via his address book, can also recommend APA coaches. Otherwise, some local authorities as Strasbourg, Paris or Biarritz also offer reimbursement, under certain conditions and for a fixed period. It is right to get closer to your city or his health insurance fund to find out the terms of reimbursement.

► For Strasbourg for example, « people entering the sport-health system on prescription can benefit from it for 3 years. No financial contribution is requested the 1st year to the beneficiary. For the following 2 years, the city of Strasbourg has implemented the principle of solidarity pricing, i.e. an annual financial contribution is requested (20 €, 50 € or 100 €) depending on the family coefficient« .

► In Ile-de-France, the « Prescri’Forme » system give it possibility for the attending physician to prescribe physical activity adapted to his patients. He introduces three particularities of the Ile-de-France region in relation to the legislative framework:

• The possibility of prescription is extended to doctors of any specialty, liberal and hospital
• Beyond the ALDs, the system includes obesity and high blood pressure
• A regional telephone platform for doctors who want to be informed: 09 75 23 71 60

Sources: Prescription Sports Site / Decree No. 2016-1990 of December 30, 2016 relating to the conditions for dispensing adapted physical activity prescribed by the attending physician to patients with a long-term condition