{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T16:15:17Z","timestamp":1787588117105,"version":"build-2736575974"},"reference-count":33,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background: Adapted Physical Activity (APA) prescription is a complex decision-making process that integrates clinical guidelines and individual patient characteristics and remains strongly dependent on clinician experience. Generative artificial intelligence (AI) has recently emerged as a potential decision-support tool in exercise prescription; however, its interaction with professional expertise is still unclear. This study compared the perceived quality of APA protocols developed by expert professionals, novice professionals supported by AI, and AI operating autonomously across multiple orthopedic conditions. Methods: In this observational cross-sectional study, five real orthopedic prescriptions (scoliosis, low back pain, osteoporosis, high risk of falls, and osteoarthritis) were used to generate three APA protocols per condition: expert professional (EP), novice professional with AI support (NAI), and AI alone. All protocols were created using an identical standardized prompt and anonymized. A multidisciplinary panel of 135 professionals blindly evaluated the protocols using a structured questionnaire assessing effectiveness, safety, appropriateness, clarity, and progression. Overall quality scores were compared using Friedman tests with post hoc Wilcoxon signed-rank tests. Results: Across all conditions, EP protocols achieved the highest quality scores, followed by NAI, while AI-alone protocols consistently received the lowest ratings (all p &lt; 0.05). NAI protocols showed intermediate performance, partially reducing the expertise gap. Post hoc analyses showed that EP protocols received significantly higher rating than AI protocols in all conditions (p &lt; 0.01). NAI protocols received significantly higher rating than AI protocols in most conditions (p &lt; 0.01) except osteoporosis (p = 0.362). Differences between EP and AI were most pronounced for safety (p &lt; 0.01), appropriateness (tailoring p &lt; 0.01), and progression (p &lt; 0.05), whereas EP\u2013NAI differences were smaller and condition-dependent. AI-alone protocols showed greater variability across pathologies. Conclusions: Professional expertise remains the main determinant of APA protocol quality. AI support can improve protocol structure and perceived quality when used by novice professionals but does not replace expert clinical reasoning. AI-generated protocols without human oversight are not yet suitable for autonomous APA prescription, supporting a complementary, expertise-dependent role of AI in exercise programming.<\/jats:p>","DOI":"10.3390\/jfmk11010113","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T08:58:45Z","timestamp":1773046725000},"page":"113","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Role of Artificial Intelligence and Professional Expertise in Adapted Physical Activity Prescription for Orthopedic Rehabilitation"],"prefix":"10.3390","volume":"11","author":[{"given":"Martina","family":"Sortino","sequence":"first","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via Santa Sofia 89, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7483-8944","authenticated-orcid":false,"given":"Bruno","family":"Trovato","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via Santa Sofia 89, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1256-7605","authenticated-orcid":false,"given":"Rita","family":"Chiaramonte","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Unit, AOU Policlinico G. Rodolico, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Carrera","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via Santa Sofia 89, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8311-9132","authenticated-orcid":false,"given":"Marco","family":"Sapienza","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical Surgical Specialties, Section of Orthopedics and Traumatology, AOU Policlinico-Vittorio Emanuele, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7655-4489","authenticated-orcid":false,"given":"Federico","family":"Roggio","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via Santa Sofia 89, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8260-8890","authenticated-orcid":false,"given":"Giuseppe","family":"Musumeci","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Biotechnological Sciences, Section of Anatomy, Histology and Movement Science, School of Medicine, University of Catania, Via Santa Sofia 89, 95123 Catania, Italy"},{"name":"Research Center on Motor Activities (CRAM), University of Catania, 95123 Catania, Italy"},{"name":"Department of Biology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1249\/MSS.0b013e318213fefb","article-title":"American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise","volume":"43","author":"Garber","year":"2011","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.jvsv.2022.05.004","article-title":"Systematic review of adapted physical activity and therapeutic education of patients with chronic venous disease","volume":"10","author":"Thibert","year":"2022","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100449","DOI":"10.1016\/j.apunsm.2024.100449","article-title":"Personalizing the guidelines of exercise prescription for health: Guiding users from dependency to self-efficacy","volume":"59","author":"Almarcha","year":"2024","journal-title":"Apunt. Sports Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1080\/09638288.2018.1527953","article-title":"Structured clinical reasoning for exercise prescription in patients with comorbidity","volume":"42","author":"Stuiver","year":"2020","journal-title":"Disabil. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1503\/cmaj.150684","article-title":"Prescribing exercise interventions for patients with chronic conditions","volume":"188","author":"Hoffmann","year":"2016","journal-title":"CMAJ Can. Med. Assoc. J. = J. L\u2019association Medicale Can."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"430","DOI":"10.2519\/jospt.2004.34.8.430","article-title":"The interrater reliability among physical therapists newly trained in a classification system for acute low back pain","volume":"34","author":"Heiss","year":"2004","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Hermet, A., Roren, A., Lefevre-Colau, M.-M., Gautier, A., Linieres, J., Poiraudeau, S., and Palazzo, C. (2018). Agreement among physiotherapists in assessing patient performance of exercises for low-back pain. BMC Musculoskelet. Disord., 19.","DOI":"10.1186\/s12891-018-2173-9"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4846","DOI":"10.3402\/meo.v15i0.4846","article-title":"The Dreyfus model of clinical problem-solving skills acquisition: A critical perspective","volume":"15","year":"2010","journal-title":"Med. Educ. Online"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40248-019-0183-6","article-title":"Interobserver variability of ventilatory anaerobic threshold in asymptomatic volunteers","volume":"14","author":"Kaczmarek","year":"2019","journal-title":"Multidiscip. Respir. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1179\/106698110X12640740712770","article-title":"Limited clinical reasoning skills used by novice physiotherapists when involved in the assessment and management of patients with shoulder problems: A qualitative study","volume":"18","author":"May","year":"2010","journal-title":"J. Man. Manip. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-performance medicine: The convergence of human and artificial intelligence","volume":"25","author":"Topol","year":"2019","journal-title":"Nat. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102693","DOI":"10.1016\/j.artmed.2023.102693","article-title":"Artificial intelligence in physical rehabilitation: A systematic review","volume":"146","author":"Sumner","year":"2023","journal-title":"Artif. Intell. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5114\/biolsport.2024.133661","article-title":"Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI\u2019s GPT-4 model","volume":"41","author":"Dergaa","year":"2024","journal-title":"Biol. Sport"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e233341","DOI":"10.1148\/radiol.233341","article-title":"Interobserver Agreement and Performance of Concurrent AI Assistance for Radiographic Evaluation of Knee Osteoarthritis","volume":"312","author":"Lenskjold","year":"2024","journal-title":"Radiology"},{"key":"ref_15","unstructured":"Sharma, M., Tong, M., Korbak, T., Duvenaud, D.K., Askell, A., Bowman, S.R., Cheng, N., Durmus, E., Hatfield-Dodds, Z., and Johnston, S. (2023). Towards Understanding Sycophancy in Language Models. arXiv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.2522\/ptj.20150668","article-title":"Consensus on Exercise Reporting Template (CERT): Modified Delphi Study","volume":"96","author":"Slade","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e59309","DOI":"10.2196\/59309","article-title":"Using Large Language Models to Enhance Exercise Recommendations and Physical Activity in Clinical and Healthy Populations: Scoping Review","volume":"13","author":"Lai","year":"2025","journal-title":"JMIR Med. Inform."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1126\/science.adh2586","article-title":"Experimental evidence on the productivity effects of generative artificial intelligence","volume":"381","author":"Noy","year":"2023","journal-title":"Science"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1186\/s13054-025-05468-7","article-title":"A large language model improves clinicians\u2019 diagnostic performance in complex critical illness cases","volume":"29","author":"Wu","year":"2025","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1111\/j.1365-2923.2007.02915.x","article-title":"How expertise develops in medicine: Knowledge encapsulation and illness script formation","volume":"41","author":"Schmidt","year":"2007","journal-title":"Med. Educ."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1679945","DOI":"10.1080\/10872981.2019.1679945","article-title":"The diagnostic expertise acceleration module (DEAM): Promoting the formation of organized knowledge","volume":"24","author":"Rissmiller","year":"2019","journal-title":"Med. Educ. Online"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Chrismawaty, B.E., Emilia, O., Rahayu, G.R., and Ana, I.D. (2023). Clinical reasoning pattern used in oral health problem solving\u2014A case study in Indonesian undergraduate dental students. BMC Med. Educ., 23.","DOI":"10.1186\/s12909-022-03808-7"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/jep.13541","article-title":"From clinical decision support to clinical reasoning support systems","volume":"27","author":"Boon","year":"2021","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s13013-017-0145-8","article-title":"2016 SOSORT guidelines: Orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth","volume":"13","author":"Negrini","year":"2018","journal-title":"Scoliosis Spinal Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"A1","DOI":"10.2519\/jospt.2012.42.4.A1","article-title":"Low Back Pain","volume":"42","author":"Delitto","year":"2012","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1136\/bjsports-2021-104634","article-title":"Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis","volume":"56","author":"Skelton","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jsams.2016.10.001","article-title":"Exercise and Sports Science Australia (ESSA) position statement on exercise prescription for the prevention and management of osteoporosis","volume":"20","author":"Beck","year":"2017","journal-title":"J. Sci. Med. Sport"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"afac205","DOI":"10.1093\/ageing\/afac205","article-title":"World guidelines for falls prevention and management for older adults: A global initiative","volume":"51","author":"Martin","year":"2022","journal-title":"Age Ageing"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1016\/j.joca.2022.10.009","article-title":"Recommendations for the delivery of therapeutic exercise for people with knee and\/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group","volume":"31","author":"Holden","year":"2023","journal-title":"Osteoarthr. Cartil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e51308","DOI":"10.2196\/51308","article-title":"Comprehensiveness, Accuracy, and Readability of Exercise Recommendations Provided by an AI-Based Chatbot: Mixed Methods Study","volume":"10","author":"Zaleski","year":"2024","journal-title":"JMIR Med. Educ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1038\/s41591-024-03097-1","article-title":"Evaluation and mitigation of the limitations of large language models in clinical decision-making","volume":"30","author":"Hager","year":"2024","journal-title":"Nat. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.2147\/AMEP.S492302","article-title":"Exploring Differences in Clinical Decisions Between Medical Students and Expert Clinicians","volume":"15","author":"Rojas","year":"2024","journal-title":"Adv. Med. Educ. Pract."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s11251-005-3598-8","article-title":"Examining the stability of experts\u2019 clinical case processing: An experimental manipulation","volume":"33","author":"Rikers","year":"2005","journal-title":"Instr. Sci."}],"container-title":["Journal of Functional Morphology and Kinesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/1\/113\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T10:40:32Z","timestamp":1773312032000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5142\/11\/1\/113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jfmk11010113"],"URL":"https:\/\/doi.org\/10.3390\/jfmk11010113","relation":{},"ISSN":["2411-5142"],"issn-type":[{"value":"2411-5142","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]}}}