Long-term associations between participation in sport-health gateways, functional capacity and health behaviors: the Limousin Sport Santé cohort study, France

OBJECTIVE: Active lifestyles and adapted physical activity (APA) are promoted for primary, secondary, tertiary chronic disease prevention, but multilevel barriers limit engagement. Sport-health gateways could address this implementation gap by providing APA and referrals to sport-health services. This study examined short- and long-term associations of gateway participation with functional capacity and long-term health behavior changes, in real-world settings. METHODS: We studied the Limousin Sport Santé (LSS) gateways cohort (France, 2015-2025), including participants in primary or secondary/tertiary prevention. The 6-Minute Walk Test (6MWT) and Recent Physical Activity Questionnaire (RPAQ) were administered at baseline(T0). After supervised APA program, 6MWT and attendance were recorded at completion(T1). After referral to sport-health structures, 6MWT, RPAQ, and physical activity practice were assessed at 1-year follow-up(T2). RESULTS: Among 3318 participants, 6MWT distance was higher at T1 (550.0 (125.0) m) and T2 (570.0 (125.0) m) vs baseline (525.0 (130.0) m; p < 0.001). Sedentary time was 48 min/day lower at T2; leisure energy expenditure was over three-fold higher (p < 0.001). Patterns were similar across prevention groups. At T2, 61.6% maintained APA (three sessions/week), with higher maintenance in primary prevention. CONCLUSIONS: LSS gateways were associated with better functional capacity and health behaviors over time, supporting their potential as a sustained model for chronic disease prevention.