Rehabilitation physical activity service systems for people with disabilities in Korea, the United States, Germany, and Japan: paradigm review and policy directions for Korea

Adults with disabilities engage in substantially less physical activity and experience elevated risks of secondary conditions relative to adults without disabilities. This narrative comparative review examined how rehabilitation physical activity systems are organized across governmental, healthcare, and community service structures in Korea, the United States, Germany, and Japan, and derived policy directions for addressing fragmentation, access limitations, and service sustainability in Korea. A narrative, policy-oriented comparative review integrating peer-reviewed studies, laws, and official documents was conducted between January 2010 and November 2025. Korea is transitioning toward a rehabilitation exercise-and-sport delivery model supported by rehabilitation sports public services and data-driven community platforms, yet governance fragmentation and limited community capacity persist. Across the four countries, a concurrent shift toward biopsychosocial and rights-based paradigms, stronger community anchoring, workforce professionalization, and increasing digitalization was identified, although the institutional forms and implementation gaps differed by country. Korea should strengthen an integrated rehabilitation physical activity system that expands sustained opportunities for physical activity and exercise through coordinated community pathways, stable public financing, disability-competent workforce development, interoperable data systems, and co-production with people with disabilities and their families.