Adapted Exercise and Adapted Sport as Rights of Health Citizenship in Italy: A Legal–Policy Rationale and Framework for Inclusion in the Livelli Essenziali di Assistenza (LEA) and the Role of the Chinesiologo

Background: Adapted exercise and adapted sport are proven, low-cost interventions for chronic disease prevention, management, and social inclusion. However, in Italy, neither is explicitly included in the Livelli Essenziali di Assistenza (LEA; nationally guaranteed essential healthcare services), creating unequal access, fragmented governance, and unstable funding. Provision remains largely dependent on regional schemes such as Palestre della Salute and Attività Fisica Adattata (AFA). Methods: We conducted a narrative review integrating evidence from international guidelines, systematic reviews, and key Italian legislative reforms (Legislative Decrees n. 36/2021, 163/2022, 120/2023). We also examined policy frameworks from Germany, Sweden, and Norway to identify transferable components that could support the development of a nationally guaranteed, rights-based system for adapted exercise and adapted sport. Results: Consistent evidence shows that adapted exercise improves functional capacity, quality of life, and clinical outcomes while reducing hospitalizations and healthcare expenditures. Adapted sport further enhances psychosocial well-being, inclusion, and participation among people with disabilities. Based on this evidence, we outline a legal-policy framework for LEA integration that places the chinesiologo at the center of multidisciplinary health teams, defines national standards for assessment, individualized programming, and monitoring, and introduces accreditation mechanisms for facilities and professionals. A blended financing approach is proposed, combining National Health Service (SSN) coverage with income-adjusted co-payments and targeted public–private partnerships. Conclusions: Explicit LEA inclusion of adapted exercise and adapted sport would translate scientific evidence into enforceable rights of health citizenship and ensure uniform national provision, in line with constitutional principles affirmed by the Italian Court. Such reform would strengthen prevention and chronic-disease management and institutionalize the role of the chinesiologo within the SSN through nationally standardized yet regionally adaptable delivery models.