How France, Spain, and the Netherlands are embedding structured exercise into pulmonary fibrosis treatment—at home and across the healthcare system. Three initiatives make personalized physical activity a core part of care, supporting mobility and quality of life alongside medication.
For people living with pulmonary fibrosis (PF), breathing is only part of the struggle. As the disease progresses and lung function weakens, even simple movements—standing up, climbing stairs, carrying groceries—can become exhausting. Daily life narrows. Social connections fade. Confidence erodes. For decades, PF treatment has focused primarily on medication, while one of the most effective non-pharmacological interventions—exercise— remained inconsistent, difficult to access, or entirely absent from routine care.
Across Europe, that is beginning to change. In France, Spain, and the Netherlands, complementary initiatives are reshaping how the condition is managed by placing structured pulmonary fibrosis exercise where it belongs: at the heart of the care pathway.
Why exercise matters in pulmonary fibrosis
Pulmonary fibrosis is a rare, progressive lung disease marked by irreversible scarring of lung tissue. As the lungs stiffen, breathing becomes increasingly difficult, leading to fatigue, reduced mobility, and declining quality of life. Patients often face delayed diagnoses, fragmented care, and limited treatment options.
The evidence is clear: exercise training improves physical function, reduces fatigue, and supports mental well-being in people living with pulmonary fibrosis. Yet for many years, access to adapted physical activity depended on geography, financial means, or personal advocacy. As a result, these initiatives are grounded in a simple principle: exercise should be discussed, prescribed, and supported—just like medication.
France: Bringing adapted physical activity directly to patients’ homes
In 2020, Boehringer Ingelheim France partnered with Siel Bleu, an association dedicated to making health and well-being accessible to all, to launch PF&Me—an 18-week online adapted physical activity (APA) program for people living with PF.
Delivered entirely through a digital platform, PF&Me removes one of the most persistent barriers PF patients face: physical access. From their homes, participants receive personalized exercise support tailored to their physical condition, abilities, and energy levels—care that is too often out of reach for those living with a rare disease.
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Rare does not mean alone. The digital format offers flexibility and the comfort of home, helping patients stay active and autonomous.
Clémentine Sarda, Project Manager for Siel Bleu at Boehringer Ingelheim France
Developed in collaboration with pulmonology experts and delivered by certified Siel Bleu APA instructors, the program supports patients with idiopathic pulmonary fibrosis (IPF), diffuse interstitial lung disease linked to systemic sclerosis (SSc-ILD), and progressive forms of ILD (PF-ILD).
Each session of the pulmonary rehabilitation program focuses on endurance, strength, flexibility, breathing, and relaxation—supporting patients’ ability to remain independent and better live with PF in daily life. For Jean-Michel, a participant and representative of the French PF patient association, the impact extends beyond physical gains. “It lifts your spirits,” he says. “Thanks to the program, I can still walk with my wife along the ocean—something we’ve cherished for years.”
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To date, 533 patients have benefited from PF&Me, including 143 patients supported in 2025 alone. The ambition is to further expand access to pulmonary fibrosis exercise by 2030—demonstrating how digital delivery can bring equitable support directly to patients, wherever they live.
Spain: Expanding the vision through the Social Innovation Hubs
While PF&Me brings adapted physical activity (APA) directly into French patients’ homes, Siel Bleu Spain is helping push the vision further. The team joined the Social Innovation Hub (SIH) program by Ashoka and Boehringer, which brings together social entrepreneurs and company leaders to co-develop strategies for systemic change.
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True impact happens when innovation moves from pilot to system. We are in that transition—from promising initiative to scalable, long-term transformation.
Guillaume Lefebvre, Vice President Siel Bleu Spain and Executive Director Siel Bleu Europe
The outcome was powerful. France and Spain can now advance faster by developing one shared systems-change model and implementing it locally, side by side. The approach has also been recognized at the European level: Siel Bleu received a SHAPE grant for its post-hospital support project, which detects early weakness, helps patients regain strength, and supports a smoother transition from hospital to home.
This shared model, now rolling out in both countries, aims to make certified APA accessible, visible, and routinely prescribed. Spain is already putting this blueprint into action, having launched a national digital platform that has helped more than 100 patients easily find and enroll in pulmonary fibrosis exercise programs since 2022, while also securing key hospital partnerships with Quirón Hospital in Barcelona as well as Quirón La Luz and HM Montepríncipe in Madrid.
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The momentum is now reinforcing France’s efforts: the strengthened systems-change model feeds directly into its digital APA offering, accelerating the ambition to make adapted exercise a routine part of pulmonary fibrosis care. Together, France and Spain show that when innovation is shared—not siloed—change scales faster, reaches farther, and reshapes healthcare for good.
The Netherlands: Embedding exercise into the PF care pathway
While France expands patient access through digital delivery and Spain accelerates systems change across communities and hospitals, the Netherlands is taking a fundamentally different route: building exercise directly into the clinical fabric of pulmonary fibrosis care. Here, the ambition isn’t just to offer more exercise options—it’s to ensure that every pulmonologist, nurse, physiotherapist, and occupational therapist treats movement as a core therapeutic intervention, embedded into national guidelines and routine practice.
Led by the Pulmonary Fibrosis Patient Association and supported by Boehringer, pulmonologists, nurses, physiotherapists, and occupational therapists, a nationwide effort is underway to embed exercise structurally into PF care. The project is also supported by leading organizations including NVALT (Dutch Society of Pulmonology and Tuberculosis) and ILD expert centers.
“Exercise should be discussed at every consultation—just like medication,” says Dr. Marianne Dortants of the Pulmonary Fibrosis Patient Association, which has held a seat in the core pathway group since 2024.
Launched in 2020, the initiative is progressing toward national rollout and guideline integration by 2026. This wider shift in PF care puts exercise at the center of treatment, supporting everyday movement and mental well-being for patients.
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“Embedding exercise into the care pathway is a game changer,” says Professor Martijn Spruit of CIRO, a national expertise center for chronic lung conditions. Within hospitals, collaboration is strong, but beyond them, challenges remain. PF’s rarity contributes to gaps in primary care knowledge and continuity. Reimbursement structures lag behind clinical evidence. Telemonitoring and wearable technologies offer promise—but meaningful progress depends on a broader shift in mindset. “Exercise is not optional—it’s essential,” says Dr. Aadje Bloem, physiotherapy researcher.
Policymakers also play a critical role. Prioritizing lung health, improving early diagnosis, and ensuring equitable access to non-pharmacological care are essential to making exercise a true standard of care.
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Including exercise in care is not just a new pathway. It’s a cultural shift.
Dr. Marcel Veltkamp, ILD Center of Excellence
Three paths, one shared goal
Together, these initiatives show how progress happens at multiple levels. France demonstrates how innovative delivery models can bring adaptive exercise directly to patients—reducing isolation and restoring confidence. Spain proves how a shared systems-change model can make access broader, more consistent, and built for long-term impact. The Netherlands shows how system-level change can ensure exercise is no longer optional but embedded into routine care.
By 2026, the shared vision is clear: every person living with pulmonary fibrosis should have access to structured exercise as part of their treatment—improving quality of life regardless of geography, income, or disease stage. “We are proud to support this collaborative effort,” says Denise Schuiten, Healthcare Affairs Manager at Boehringer Ingelheim. “It reflects our commitment to creating sustainable impact by improving chronic care and empowering patients to live better.” This initiative demonstrates how collaborative system shaping can advance patient-centered care—showing what is possible when access, partnerships, and healthcare systems move forward together.
Read more on Imagine – Boehringer Ingelheim’s sustainability story hub.
*Image credits: Header picture and static illustrations: Boehringer Ingelheim. Quote pictures: Boehringer Ingelheim, 2026 Guillaume Lefebvre, Dr. Marcel Veltkamp.
