France is set to become one of the first countries to reimburse Adapted Physical Activity (APA) specifically for patients with cardiovascular diseases, as announced by the Ministry of Health on February 5, 2025. This development comes after a decade of research and advocacy led by French athlete Stéphane Diagana and Dr. Alain Fuch, a senior medical advisor at the Caisse nationale de l’Assurance-maladie (Cnam), and currently president of the organization A2S (Azur Sport Santé).

Since 2014, the initiative has been driven by the scientific study "As du cœur," designed to assess the benefits of structured physical activity programs among individuals with cardiovascular conditions.

This project primarily involved a pilot test conducted on a small cohort of patients at the private geriatric hospital Les Sources in Nice, which expanded to a broader group of about 50 patients with heart failure or coronary artery disease across the Alpes-Maritimes region.

The findings of the study indicated that participants adhering to the APA showed significant improvements in health outcomes, including a reduction in cardiovascular risk factors and subsequent medical complications.

Notably, patients following the prescribed APA reported a 30% decrease in healthcare utilization, encompassing medication costs and medical consultations.

A pivotal aspect of this initiative involved addressing financial barriers to accessing physical activity programs.

The introduction of article 51 of the Social Security financing law allowed for the exploration of novel health financing frameworks.

Between late 2021 and early 2023, the A2S program was implemented across eleven departments and five regions in France, providing 466 patients with free access to two weekly APA sessions and educational workshops for five months.

An independent evaluation commissioned by Cnam and the Direction de la recherche, des études, de l’évaluation et des statistiques (Drees) confirmed the program's success, not only clinically but also economically.

The evaluation indicated that 83% of patients enrolled maintained regular activity levels two years post-program, leading to significant health benefits and an estimated annual healthcare savings of approximately €1.5 million for the French health system.

Following these findings, top health authorities have advocated for the integration of APA modalities into standard healthcare practices, reflecting the need for a broader availability of these therapeutic programs for various patient populations, including those with cancer, diabetes, and obesity.

Despite the positive feedback, concerns remain regarding the timeline for full implementation; experts have projected a delay of at least one year before the program becomes widely accessible, potentially hindering immediate healthcare savings.

There is also an expressed urgency to expedite access for the estimated 68,000 patients undergoing cardiac rehabilitation annually, as expanding access could lead to substantial healthcare savings for the system.

This initiative symbolizes a major shift in the approach to healthcare in France, emphasizing non-pharmacological treatment methods and the role of physical activity in enhancing patient outcomes.