2030: Medicine That Walks With Me
26 maggio 2025
A new care paradigm involving physical exercise, community, and local prevention.
In 2030, medicine no longer starts with a prescription but with a walk. This isn't a utopia, but a paradigm shift that has already taken shape in Lombardy. A chronic patient – with a history of diabetes and hypertension – enters her general practitioner's office not to leave with a pharmacological prescription, but with a plan: three walks a week, a meeting with a nutritionist, and two weekly exercise sessions at a "health gym," as is already happening today in Emilia Romagna. This is a personalized prevention network, capable of complementing pharmacological treatment with a genuine behavioral change project.
This vision guides the development of a healthcare system that is slower, more widespread, yet also more transformative. Here, well-being isn't just a clinical objective but a daily journey. And physical exercise stops being generic advice and becomes a real medicine: to be prescribed, dosed, and adapted. This is the full realization of Exercise is Medicine, an initiative promoted by the American College of Sports Medicine and adopted in Italy by EIM Italy, which advocates for the inclusion of structured exercise in therapeutic pathways.
"Exercise is medicine," Anglo-Saxon countries have been repeating for years. A principle that is becoming common practice in Italy thanks to the Health Gyms (Palestre della Salute), as envisioned by Regional Law 36 of February 28, 2021. This doesn't involve building new facilities but rather repurposing existing spaces (public or private), activating them with specific criteria and under the supervision of an AMPA kinesiologist.
«The main requirement will be the presence of an AMPA kinesiologist, specialized in preventive and adapted physical activity, existing gyms can also be used, which, at specific times and under the supervision of qualified professionals, will offer structured exercise prescribed by a doctor.».
Fabio Esposito
Professor at the University of MilanThe therapeutic pathway begins with a real medical prescription. "It's up to the general practitioner or pediatrician in less severe cases, or to a specialist – such as a cardiologist, physiatrist, or sports physician – in the presence of complex pathologies," Esposito continues. These indications are followed by the design of the program by the AMPA kinesiologist, and then its administration, which can also be carried out in authorized gyms or pools.
The Numbers That Explain the Urgency
The need to rethink prevention is supported by data: in Milan, the most common chronic diseases are cardiovascular (46%), followed by cancers (14%), respiratory diseases (10.8%), and diabetes (9.7%). In 2022, over 110,000 hospitalizations (111,804) affected about 7.9% of the resident population.
46%
Cardiovascular diseases
14%
Cancers
11%
Respiratory diseases (~)
10%
Diabetes (~)
Non-communicable chronic diseases – such as diabetes, cardiovascular diseases, and cancers – are currently the leading causes of mortality, disability, and morbidity worldwide. Diabetes affects millions of people: type 2 accounts for about 90% of cases, often linked to family history (present in 40% of cases with first-degree relatives) and risk factors such as physical inactivity, overweight, and belonging to specific ethnicities. In identical twins, the concordance of type 2 diabetes approaches 100%, indicating a strong hereditary component. Cardiovascular diseases, which include heart attacks, strokes, and angina, are responsible for a very high number of deaths and are largely preventable: in addition to non-modifiable factors like age and gender, behaviors such as smoking, alcohol consumption, and unhealthy diets significantly contribute, often also correlated with diabetes, obesity, and and hypertension. World Health Organization maps report the very high incidence of deaths from all three of these pathologies, highlighting the urgency of prevention strategies based on promoting healthy lifestyles and health education.
Yet, current numbers show how much more needs to be done to promote health through movement and prevention. In Milan, nearly 4 out of 10 citizens suffer from one or more chronic diseases, accounting for 70% of healthcare spending, which is constantly increasing. Despite the progress recorded in Lombardy – where the number of people who regularly practice sports increased from 22.6% in 2001 to 29.2% in 2022, a 6.6% increase – inactivity remains a widespread problem. Inactive people in the region decreased from 33.0% to 26.4% during the same period, a figure that places Lombardy fourth among the most virtuous regions and well below the national average (37.2%). However, globally, one in three adults and over 80% of adolescents are not physically active enough. And inactivity comes at a high cost: those who are insufficiently active have a 20-30% higher risk of death compared to those who engage in adequate physical activity.
Exercise as Medicine
The latest scientific evidence unequivocally demonstrates that physical exercise and an active lifestyle contribute to preventing many chronic diseases and are a significant support to traditional therapies in the treatment of cancer, diabetes, and cardiovascular diseases.
For example, the effectiveness of physical exercise in combating cardiometabolic pathologies – such as hypertension, type 2 diabetes, obesity, and dyslipidemia – is extensively demonstrated by numerous international studies, including those published in The Lancet Public Health and JAMA (Journal of the American Medical Association), which highlight how regular physical activity programs can reduce the risk of premature mortality by 20-30%, improve blood glucose and cholesterol levels, slow the progression of chronic diseases, and positively impact mood, sleep, and chronic pain.
However, like any therapy, physical exercise requires awareness, personalization, and control. "Like any drug, exercise must also be prescribed and dosed with competence," warns Fabio Esposito. The risk of improvising or following inadequate plans can, in fact, lead to consequences opposite to those desired:
«Inadequate activity can cause serious harm, aggravating conditions such as sciatica, or exacerbating latent joint, postural, or cardiovascular problems».
Fabio Esposito
Professor at the University of MilanFor this reason, the integrated work between the prescribing physician and the AMPA kinesiologist is fundamental: it allows a generic indication – "do some exercise" – to be transformed into a structured, progressive, and safe pathway, calibrated to the person's clinical, functional, and motivational parameters. In this sense, Health Gyms represent not an alternative to sport, but a clinical outpost of public health, where movement becomes an integral part of care and prevention.