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Conference Agenda

Overview and details of the sessions of this conference. Please select a date or location to show only sessions at that day or location. Please select a single session for detailed view (with abstracts and downloads if available).

Daily Overview

Session

GR2_2_3: Symposium: From Policy to Pathways: Embedding Physical Activity as Standard Care Across Portugal’s Health System
Location: Glass room 2

Presentation 1

From Policy to Pathways: Embedding Physical Activity as Standard Care Across Portugal’s Health System

Chair(s): Pedro Morouço (National Program for Physical Activity Promotion, Directorate-General of Health, Lisbon, Portugal)

Physical inactivity remains an under-addressed determinant of health, despite a robust evidence base for the benefits of physical activity and structured exercise in the prevention and management of chronic diseases. The principal barrier is not a lack of awareness, but the absence of scalable frameworks that institutionalize physical activity within healthcare systems. This symposium examines a Portuguese case study, focusing on the design and implementation of a pragmatic care pathway—assessment, counselling, referral, and follow-up—across primary and secondary care, emphasizing feasibility, equity, and sustainability. Perspectives include national pilot data and implementation insights from PNPAF/DGS (Cristina Godinho); a community-based model for chronic disease management (Diabetes em Movimento; Romeu Mendes); hospital-level integration by exercise physiologists (Centro de Medicina Desportiva e do Exercício, Hospital da Luz; Hugo Pereira); and specialized cardiac rehabilitation (CRECUL; Rita Pinto). Collectively, these contributions outline the essential operational components for systematic care delivery: referral criteria, clinical triggers, workflow integration, interprofessional role allocation, monitoring mechanisms, and governance. Equity is addressed through access pathway design, strategies to maximize patient reach, and implementation decisions that reduce burden and prevent health disparities. Attendees will gain a transferable framework—service design logic, implementation mechanisms, and decision points—adaptable to varied healthcare systems seeking to embed physical activity at scale. Rather than revisiting recommendations, we compare real-world operational models within one national health system to extract transferable implementation components.

Presentations of the Symposium

National PA promotion in primary care pilot data and implementation insights

Cristina Godinho
NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Portugal

Background: While physical activity (PA) is recognised as a cornerstone of chronic disease prevention and management, its systematic integration into healthcare remains limited. In Portugal, the National Physical Activity Promotion Programme (PNPAF) developed and implemented a national model for PA promotion within primary care, comprising brief assessment, brief counselling, and a PA consultation supported by digital tools integrated into electronic health records. This presentation focuses on the implementation of the PA consultation.

Methods: The consultation targeted adults with chronic conditions and was piloted in 11 primary care units across Portugal. Twenty-eight semi-structured interviews with physicians, exercise professionals and patients explored implementation barriers and enablers. Data were analysed using the Tailored Implementation for Chronic Diseases and Behaviour Change Wheel frameworks through combined deductive and inductive approaches.

Results: Fifty-three implementation determinants were identified. Key enablers included high intervention acceptability, motivation and strong interpersonal skills among professionals, and the availability of diversified community PA resources. Major barriers were ineffective referral processes, competing clinical demands, and inconsistent local prioritisation of PA promotion.

Conclusions: The model proved feasible and well accepted by both professionals and patients, supporting wider adoption. However, successful scale-up depends on system-level implementation strategies, including clear clinical standards, integrated referral and follow-up pathways, workforce training, governance mechanisms, and stronger links between health services and community PA resources. These findings provide transferable lessons for embedding PA consultations within primary healthcare.

"Diabetes em Movimento" community-based model for chronic disease management

Romeu Mendes
Local Health Unit of Trás-os-Montes e Alto Douro; Directorate-General of Health

Background:

Within the European Region, Portugal ranks among the countries with the highest prevalence of type 2 diabetes (T2D) and levels of physical inactivity, consequently imposing a substantial burden on the National Health Service (NHS).

Methods:

To address this challenge a community-based exercise program for patients with T2D was developed and designated “Diabetes em Movimento” (in English, Diabetes in Motion). Three group exercise sessions per week (on Mondays, Wednesdays and Fridays; 20-30 participants) of 90-min duration are offered to T2D patients of 50-80 years old, aligned with sports seasons – between October and June (9 months cycles). Sessions take place in sports halls and are supervised by exercise professionals and nurses. Participants are referred by their NHS diabetology medical doctors (mainly family medicine and internal medicine doctors). The program also integrates health education sessions to increase participants’ health literacy on topics related to diabetes comorbidities’ management and cardiovascular risk. All activities are provided free of charge to participants.

Results:

The program is managed by the Portuguese Directorate-General of Health since 2018, after a period of scientific validation (ISRCTN09240628; NCT02631902). Although central coordination, the program is implemented at community level within partnerships between Local Health Units, Municipalities; Higher Education Institutions and Sports Clubs and Associations that share their infrastructure and resources. It is currently (2025/2026 season) implemented in 60 municipalities (including Azores and Madeira archipelagos) – a growth of 460% since 2018.

Conclusions:

Notwithstanding the program’s expansion, Portugal comprises 308 municipalities and approximately one million individuals with T2D, highlighting the need for strengthened policy efforts to support its wider scale-up.

Multidisciplinary Integration in Hospital Care: Routine Physical-Activity Assessment and Referral at Hospital da Luz

Hugo Pereira
Universidade Lusofona, Lisboa; Hospital da Luz, Lisboa, Portugal

Background: Although the promotion of physical activity is widely endorsed in health policy, its systematic incorporation into routine clinical practice remains limited. Implementation often depends on individual clinicians rather than on standardized, institutionally supported pathways. This presentation introduces a hospital-wide model that embeds routine assessment of patients’ physical-activity levels and structured referral processes as standard care at Hospital da Luz.

Methods: We describe a policy–practice implementation model organised around four core actions: assess, advise, refer and follow-up. The pathway embeds routine identification of physical-activity needs at specified clinical encounters, applies risk-informed criteria to guide referral, delineates responsibilities across physicians, nurses and exercise physiologists, and standardises documentation to support clinical handover and continuity of care.

Results: The model identifies key operational enablers required to translate policy intent into everyday clinical practice: simple clinical triggers, compatibility with existing workflows, explicit ownership of referral processes, standardised documentation, and feedback from receiving professionals to the originating team. It further delineates how hospital-based referrals can be extended into ambulatory, rehabilitation and community-based services after discharge. Equity considerations are addressed by minimising patient burden, retaining non-digital follow-up options, and tailoring referral pathways to clinical complexity, transport availability, cost, health literacy and patient readiness.

Conclusions: Physical-activity care is more likely to become routine when assessment, referral, documentation and follow-up are configured as a single, governed service pathway rather than relying on discretionary counselling by individual clinicians. The presentation outlines a practical model that can be adapted by other hospitals to their local resources and referral networks.

Phase III public hospital specialized cardiac rehabilitation

Rita Pinto
Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina, Universidade de Lisboa, Portugal

Background
Cardiovascular disease remains a leading cause of mortality, with physical activity and structured exercise training being critical components of long-term secondary prevention. However, integrating Phase III cardiac rehabilitation (CR) into public healthcare remains challenging due to non-standardised pathways. This presentation examines a certified public CR programme addressing continuity, retention, and collaboration.
Methods
Operating within an accredited framework, this Phase III pathway builds on three pillars: education, research, and community. Managed by a multidisciplinary team, the programme complies with strict international standards. Safety, adherence, and effectiveness are verified through specialised evaluations, including cardiopulmonary exercise testing. Delivered via hybrid formats (in-person and online) to overcome barriers, it encompasses individualised exercise prescription, nutritional and physical activity counselling, educational sessions, and risk-factor control. Distinctively, it engages university support, integrating medical students and master’s programme interns into the clinical workflow.
Results
The hybrid approach (in-person and online) mitigates traditional participation barriers. The integration of the education and research pillars drives workforce capacity and high-standard training. Seamless continuity is achieved through a close-knit referral network bridging acute hospital discharge and community-based maintenance. Guided by structured workflows and interprofessional feedback loops, the CR journey delivers highly individualised care, adapting exercise prescription, risk-factor control, and educational components to specific clinical complexities, financial constraints, transport, health literacy, and readiness.
Conclusions
Integrating Phase III CR requires shifting from advocacy to implementation. This certified model provides a transferable blueprint for safe, long-term follow-up in both face-to-face and digital environments, establishing sustainable, equity-driven cardiovascular pathways.