"Exercise more." For decades, this recommendation has been delivered by millions of physicians to millions of patients — without specifics on activity type, intensity, or the supervision needed. 2026 data clearly shows the limits of this approach: after 6 months, only 30% of patients enrolled in a classic gym maintain regular practice. With individual coaching, this figure rises to 70%.[1]
The problem is not sport. It is the absence of structure. A 55-year-old diabetic patient, deconditioned for 10 years, who receives a prescription for "30 minutes of brisk walking 3 times a week" has no way of knowing whether what they are doing is correct, sufficient, or adapted to their limitations. They have no one to answer to. And in an anonymous gym, faced with complex machines and people in visibly better shape, they will statistically abandon before the end of the first month.
| Classic gym | Individual coaching | |
|---|---|---|
| Initial assessment | ❌ None | ✓ Full evaluation |
| Personalised programme | ❌ Generic | ✓ Condition-adapted |
| Supervision during exercise | ❌ Absent | ✓ Constant |
| Comorbidity adaptation | ❌ No | ✓ Integrated |
| Communication with physician | ❌ Not possible | ✓ Possible |
| Injury risk | ⚠ High without follow-up | ✓ Reduced |
| 6-month adherence | ~30% | ~70% |
Cost can be an obstacle. Before referring a patient, it is worth checking whether their supplementary health insurance or health fund contributes to supervised physical activity: conditions vary from one policy to another.
For patients on GLP-1 analogues (semaglutide, tirzepatide), individual coaching is particularly recommended: a 2026 BMJ meta-analysis shows that without structured exercise support, weight returns on average within 1.7 years after stopping treatment. Coaching builds the habits that maintain results long-term.
See also our article on physician burnout in Italy and our other articles for physicians.
How do I direct a patient to a qualified sports coach?
Two main criteria: the professional's qualification (in Italy, for example, a degree in exercise science, Scienze motorie) and experience with the patient's conditions. For patients with cardiovascular comorbidities, diabetes or obesity, private coaching is preferable.
Why is adherence so low in classic gyms?
Four main factors: lack of structure and accountability, insufficient personalisation, intimidating environment for deconditioned or overweight patients, and no progress tracking. Individual coaching resolves all four problems simultaneously — which is why follow-up data shows adherence rates two to three times higher at 6 months.
Can I prescribe individual coaching as a non-pharmacological therapy?
Yes. The physician can write an adapted physical activity (APA) prescription specifying the recommended type of supervision. For patients with long-term conditions or documented cardiovascular risk, this prescription can support a reimbursement request where the patient's insurance provides for one, and helps motivate the patient. A written prescription significantly increases adherence — it gives medical legitimacy to physical activity.
Referral letter, follow-up note, SOAP note — structured from your dictation, for you to review and sign. Hosted in Switzerland.
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