Machine Learning in Adapted Physical Activity: Clinical Applications, Monitoring, and Implementation Pathways for Personalized Exercise in Chronic Conditions: A Narrative Review

Machine learning (ML) is increasingly influencing the assessment and delivery of movement and exercise, yet its role within adapted physical activity (APA) for individuals with chronic conditions has not been comprehensively synthesized. ML-based approaches have the potential to enhance functional assessment, support individualized exercise prescription, and facilitate scalable monitoring across preventive, community-based, and long-term adapted exercise settings, particularly in populations characterized by functional heterogeneity and variable responses to exercise. The aim of this narrative review is to synthesize and critically discuss current ML applications relevant to the core professional processes of APA practice. A structured narrative review was conducted using searches in PubMed/MEDLINE, Scopus, and Web of Science, complemented by targeted searches in engineering-oriented sources to capture ML methods not consistently indexed in biomedical databases. The search covered the period in which contemporary ML approaches have been increasingly applied to human movement and exercise research and was last updated in January 2026. Evidence was synthesized thematically into application-oriented domains relevant to APA practice. ML applications in APA include markerless motion and gait analysis, wearable-sensor data processing, balance and fall-risk assessment, and functional classification. Predictive and adaptive models support individualized regulation of exercise intensity, progression, and workload, including remote and hybrid delivery models. Applications span oncology, cardiometabolic, respiratory, neuromuscular conditions, and adapted sport contexts. Ethical, legal, and governance issues, such as algorithmic bias, data privacy, and professional accountability, emerge as central considerations for safe and equitable implementation. ML represents a promising decision-support layer for APA, complementing professional expertise through enhanced assessment, personalization, and monitoring. Its effective integration requires robust validation, interpretability, and responsible governance to ensure that ML augments, rather than replaces, professional judgment in APA practice.