Movement Pills Implementation Handbook

MOVEMENT PILLS IMPLEMENTATION HANDBOOK

Guidelines for Replicating and Scaling the Methodology From Italy to Europe: Transnational Adaptations Evidence-Based Edition

TABLE OF CONTENTS

About this handbook What this handbook is not How it is structured 1.Foundations of the Movement Pills model 1.1 The problem this model addresses 1.2 Core principles 2.The initial methodology and national adaptations 2A. The initial Italian model 2B. National adaptations 2C. Relevant data — comparative table 3. Planning and preparation 3.1 Local context analysis 3.2 Defining realistic objectives 4.Building effective partnerships 4.1 The partnership ecosystem 5.Activity design 6.The distribution system 7.Communication and promotion 8.Top recommendations for new implementing countries 9.Key data from the pilot implementation 9.1 Distribution summary 9.2 Participation summary 9.3 Activity provision

About This Handbook This is an evidence-based handbook, the guidance presented here is grounded in the real implementation experience of five countries and in the measurable outcomes generated during the pilot phase. To fully understand and apply the model correctly, this handbook should be read together with the Movement Pills Toolkit, the Action Plan, and the Capacity Building materials.

These complementary documents provide operational tools, training frameworks and planning instruments that complete the implementation architecture.

Movement Pills promotes physical activity as a form of preventive medicine by distributing free access to sport and exercise through trusted community channels, particularly pharmacies and health professionals.

The initial methodology was first developed in 2010 in Bologna as a local pilot initiative. In 2022, it evolved into a national project implemented across Italy by UISP Aps. In 2024, it was further expanded into an international project and piloted in five countries: Italy, Bulgaria, Estonia, Greece and Poland.

This handbook consolidates the knowledge, operational insights and implementation lessons generated through that five-country experience into a single, structured and transferable reference framework.

The handbook is relevant to: Sport and physical activity organisations, including grassroots associations, sport clubs and national federations, that are looking for a structured, evidence-based approach to engage inactive or under-served populations through the application of the initial methodology.

Public health organisations and healthcare institutions, such as pharmacies, GP networks and hospital foundations, that aim to implement social prescribing initiatives, promote physical activity or strengthen preventive health programmes in alignment with the principles of the initial methodology.

Regional and local authorities responsible for public health, social inclusion or community sport, who require a tested, evidence-based model derived from the initial methodology that can be institutionally supported, integrated into local policy frameworks or co-financed.

NGOs and civil society organisations active in fields such as social inclusion, ageing, workplace well-being or community development, that intend to embed structured physical activity promotion within their existing services by adopting the framework of the initial methodology.

What This Handbook Is Not It is not a rigid script, the Movement Pills model is designed to be adapted, in fact, the pilot demonstrated that rigid application of the initial model in different cultural or institutional contexts produces poor results. What this handbook provides is a principled framework: the core elements that must be preserved in any implementation, alongside the flexibility to shape everything else around your local reality.

This handbook gives you the map. The journey still requires your commitment.

How It Is Structured The handbook follows the logical sequence of a Movement Pills implementation, from conceptual foundations through to sustainability. Each chapter addresses a distinct phase or dimension of the work. You can read it cover to cover or use specific chapters as standalone references depending on your needs.

Throughout the text you will encounter three types of clearly marked boxes:

INITIAL METHODOLOGY Grey background

🇧🇬 🇬🇷 🇪🇪 🇵🇱 COUNTRY EXAMPLES Coloured background per country

RECOMMENDATIONS Red header

The core model as designed by UISP in Italy. These boxes present the standard approach that was tested and validated in the original pilot. They describe what the methodology recommends.

Real stories from the four partner countries. Each bubble is labelled with a flag and a topic so you can find relevant examples quickly.

Some contain direct quotes from partner reports; others describe specific decisions made during implementation.

Cross-cutting lessons that apply regardless of country context, and specific recommendations derived from the consolidated evidence of all five pilots. These are the things worth writing on a wall before you start planning.

1. Foundations of the Movement Pills Model The Movement Pills methodology is built on a deceptively simple premise: physical activity is as essential to health as any prescription medicine, and should be made available with the same institutional weight, accessibility, and trust. This chapter outlines the conceptual foundations, key principles, and quality standards recommended for consistent application across all implementations.

Movement Pills was designed by UISP Bologna (Italy) in response to growing rates of physical inactivity across Italian adult populations. The core concept frames exercise as 'medicine', distributed through trusted health channels (primarily pharmacies) as a INITIAL free, one-month voucher for structured physical activities. The model was designed to METHODOLOGY engage adults who would never choose to go to a gym by addressing both economic and psychological barriers, tackling not only financial constraints but also resistance to change and sedentary routines.

1.1 The Problem This Model Addresses Physical inactivity is the fourth leading risk factor for global mortality (WHO). In Europe, approximately one quarter of adults do not meet the European Commission's and the World Health Organisation’s Regional Office for Europe recommendation on promoting HEPA across sectors.

Traditional sport promotion initiatives fail to reach the most vulnerable groups: lower socioeconomic populations, older adults, people with chronic conditions, and those with long histories of negative sport experiences.

The Leaflet

1.2 Core Principles The following ten principles define the Movement Pills model. They are operational commitments, not abstract values.

1. Accessibility Participation is free or genuinely affordable. Facilities are reachable. Sessions fit around work and family. Psychological barriers, gym intimidation, fear of judgment, are proactively addressed in communication and session design.

2. Inclusiveness and Equity Activities must suit different fitness levels and health conditions. Additional support is provided to those facing greater barriers.

3. Health-Oriented and Preventive Approach Physical activity is promoted as a preventive measure complementing (not replacing) medical treatment. The model reinforces preventive healthcare at community level by connecting sport and health sectors.

4. Partnership-Based Implementation Shared responsibility across health institutions, sport organisations, public authorities and civil society is essential. Clear roles, formal agreements, and regular coordination are required.

5. Quality and Safety Qualified instructors, structured sessions, and risk assessment procedures are non-negotiable.

Participant limitations must be respected and training intensity adapted accordingly.

6. Participant-Centred Approach Participants shape their own activity pathways. Feedback opportunities, individual support, and recognition of achievements build ownership and reduce drop-out.

7. Evidence-Based and Reflective Practice Systematic data collection and honest evaluation inform continuous improvement. Findings are shared across the partnership network.

8. Sustainability and Long-Term Impact The free trial is the entry point, not the destination. Gradual transition to self-managed activity and long-term partnerships are built into the model from day one. 🇧🇬 BULGARIA — Core Principles in Practice The medical-first approach pushed all ten principles to their limit simultaneously. Reaching diabetic and obese patients (Accessibility + Inclusiveness) required deep clinical trust-building. Endocrinologists initially feared liability for exercise injuries, so the team produced a validated low-impact curriculum and conducted on-site safety visits before a single patient was referred (Quality + Safety). The result: a genuinely health-oriented, partnership-based implementation, but one that required 200 hours of project management and 400 hours of coordination before the first session ran.

"Once doctors knew their patients would be safe and not intimidated, they were willing to partner with us."

🇪🇪 ESTONIA — The Credibility Challenge Estonia's experience illustrated what happens when Principle 4 (Partnership-Based Implementation) cannot be established at scale. As a smaller, less well-known organisation, Firmasport found that cold outreach to sport facilities produced almost no results, even when the offer was genuinely attractive.

306 outreach attempts across three cities resulted in just 15 recruited facilities Zero facilities were recruited in Pärnu despite 75 attempts "It is not possible to just leave the pill boxes somewhere without permission. And because it is a pilot project, we cannot give examples of results from our own context, only Italian ones, which do not convince partners here, as the culture is very different."

2. The Initial Methodology and National Adaptations This chapter presents the Movement Pills model as initially designed in Italy, then shows, country by country, how each partner adapted it. Understanding both the initial design and the adaptations is essential for any new implementing organisation: you need to know what is fixed and what is flexible.

2A. The Initial Italian Model (UISP Aps)

INITIAL METHODOLOGY — Distribution

In Italy, Movement Pills boxes are distributed primarily through pharmacies.

Pharmacists are trained to introduce the project to all pharmacy visitors, with a special focus on individuals with chronic health conditions and to proactively hand over the box, not as a leaflet left on a counter, but as an active, personal offer linked to the customer's health situation. This 'active dispensing' method leverages the pharmacist's trusted authority to frame physical activity as a genuine health intervention.

UISP coordinates a large network of grassroots sport associations that pre-exist the Movement Pills project. In the Italian pilot, 370 associations offered 1.200 distinct INITIAL METHODOLOGY activity types across gym-based, outdoor, and water-based settings, from fitness and — Activity yoga to Nordic walking, Venetian rowing, and age-specific aqua gymnastics. This Provision variety ensures that participants can find something that suits their interests, fitness level, and schedule.

Participants access activities through a leaflet included in the box, which lists all

INITIAL affiliated associations along with their schedules and contact information. Registration METHODOLOGY is handled by each association. A baseline questionnaire is completed prior to the first — Registration

session, and a final questionnaire is administered after the one-month period.

INITIAL METHODOLOGY — Scale

The Italian model operated at significant scale: 31 Local UISP committees, 364 Italian Municipalities engaged, 480.000 boxes distributed, 2.457 pharmacies involved. This scale is made possible by the existence of UISP's pre-built national network.

2B. National Adaptations Each of the four pilot partner countries adapted the model significantly. Some adaptations were planned; others emerged in response to unexpected local conditions. All produced valuable learning.

🇧🇬 BULGARIA — The Medical Prescription Model Bulgaria made the most radical adaptation of the original Italian model by embedding Movement Pills inside the clinical referral system. Rather than relying on general pharmacy traffic, the team recruited GPs and endocrinologists as formal 'prescribers', specifically targeting patients with Type 2 Diabetes and clinical obesity.

KEY ADAPTATIONS: Distribution channel: GPs and endocrinologists referred specific patients; pharmacies served as collection points, reinforcing the clinical framing Target group: Adults aged 35–65 with diagnosed or high-risk metabolic conditions, far more defined than Italy's broad community reach Activity design: All classes modified for obesity and diabetes (functional group fitness, yoga, aerobics, strength training). A nutrition coach delivered group health seminars alongside physical sessions Trainer preparation: Extensive, trainers briefed on hypoglycaemia recognition, exercise modification for clinical groups, and escalation procedures Liability management: A validated low-impact curriculum was produced and shared with referring doctors; site safety visits were conducted WHY THIS WORKED: The 'prescription' framing resonated deeply with the medical culture of the region and with patients who needed authoritative encouragement to view exercise as treatment. Gym facilities responded positively when framed as 'community health partners' gaining access to a hidden demographic.

🇧🇬 BULGARIA — Unexpected Pivot: Reaching Teachers During digital monitoring of Facebook campaigns, the team noticed unexpectedly high engagement from educators and school staff. a group not initially targeted.

Cross-referencing with an earlier EU survey showing 80%+ of regional teachers identified critical need for physical activity due to occupational stress, the team dynamically expanded its target to include the education sector.

"We tailored specific messaging to educators, presenting Movement Pills not just as a health tool, but as an intervention for occupational well-being."

This data-driven pivot is now recommended as a best practice for all future implementations: monitor your digital channels weekly and be prepared to adapt.

🇬🇷 GREECE — The Stadium Distribution Model Greece made the most structurally different adaptation: rather than using pharmacies or community centres as distribution points, Olympiacos distributed all 29,586 boxes (99% of allocation, the highest rate of any country) at sport events.

KEY ADAPTATIONS: Distribution channel: Home matches and events of Olympiacos (football, basketball, volleyball) including Euroleague and Champions League games. Collaboration with the Hellenic Athletics Federation enabled distribution at a major Piraeus road running event Target group: Broad, fans of all ages attending events, with additional outreach to universities and students to extend reach beyond stadium audiences Activity provision: All delivered exclusively through Olympiacos SFP Sport Academies (tennis, beach volleyball, boxing, fencing, swimming, sailing, SUP, track and field). Internal coordination between club departments ensured consistency What was not adapted: No healthcare sector involvement (no pharmacies, no GPs). The model relied entirely on the institutional brand and community trust of Olympiacos CHALLENGE: Some older adults perceived the physical activity box as actual medication and required additional explanation. Digital registration via QR codes was also problematic for older adults, the team responded by increasing on-site human support at distribution points.

🇬🇷 GREECE — Scheduling as a Retention Tool Participant drop-off in Greece was primarily driven by scheduling mismatches, training sessions did not align with when participants were actually available.

The team's solution was immediate and practical: new training groups were created and morning weekday sessions were added, making full use of Olympiacos's available facilities.

"Some participants withdrew due to difficulty accessing facilities because of long travel distances. We responded by participating in smaller-scale matches and local activities to bring the project geographically closer to participants."

319 participants engaged in activities; 39 (12%) continued with paid participation after the trial.

🇪🇪 ESTONIA — The Personal Network Model (and its limits) Estonia produced the most candid and instructive account of what happens when the model meets an unsupportive institutional environment. Firmasport's experience is essential reading for any smaller organisation considering implementation.

KEY ADAPTATIONS: Distribution channels: Schools, company offices, a clinic, and member organisations, not pharmacies (cultural and regulatory barriers made pharmacy engagement impractical) Activity provision: Heavy emphasis on free outdoor and community activities (nature trails, disc golf, orienteering, running groups) alongside gym-based Pilates, yoga, jiu-jitsu and Firmasport's own fitness challenges Registration: Rather than directing participants to the main project website, the team created a Linktree enabling them to manage and update their own activity listings independently

🇪🇪 ESTONIA — What Estonia Recommends for Future Implementers Despite the distribution challenges, Estonia's team produced some of the pilot's most honest and transferable lessons: "The project should be led by a well-known or even governmental organisation to gain stakeholder and media attention" "The project website must be in the language of the pilot country, and pilot countries must be able to upload and change information themselves" "The offers for free activities should be listed on paper inside the actual MP box, not only online" 246 participants engaged; 42 (17%) continued with paid participation — a strong relative conversion rate that shows the model works when it reaches the right people.

🇵🇱 POLAND — The Community Hub Model Poland adapted the model by replacing pharmacies entirely with community institutions: cultural centres, libraries, senior centres, kindergartens, restaurants, and local information hubs. The logic was that these are the spaces where different demographic groups already gather, trust the staff, and are receptive to new initiatives.

KEY ADAPTATIONS: Distribution: Boxes placed at reception desks, in activity rooms, and rotated between spaces in facilities with limited room. Facility managers and staff were briefed to actively introduce the boxes to users Activity provision: 3 clubs, 12 activity types including gym fitness, Pilates, yoga, walking, running, cycling, and swimming, well-balanced and accessible Partner engagement: Trainers who co-created the programme acted as its primary ambassadors.

Their existing relationships with target communities were more effective than any formal marketing Promotion: Dedicated website with schedules and online registration, supported by social media from trainers and partner institutions, local press announcements, posters, and neighbourhood council channels CHALLENGE: Formal approval processes for cooperation agreements with public institutions caused delays. Solution: start approval processes 6–8 weeks before planned distribution and maintain proactive follow-up with decision-makers.

🇵🇱 POLAND — Voice from a Participant The Poland report includes a direct testimonial that captures what the model is designed to achieve: "Good morning. I'd also like to say that Ms. Dorota's classes are great (I can compare). I'd love to attend your paid classes."

This participant, who had evidently attended multiple different fitness providers and found Movement Pills better, represents the 19% who went on to continue with paid participation. 80 participants engaged in Poland; 15 (19%) continued after the trial.

2C. Relevant Data Element

🇮🇹 Italy

🇬🇷 Greece

🇪🇪 Estonia

Distribution channel

GPs, endocrinologists, 438 pharmacies pharmacies + 74 GPs (active dispensing)

Sport events (stadium, Euroleague, athletics)

Cultural centres, Offices, schools, libraries, clinic, member senior orgs centres, kindergarten s

Primary target group

General adult community

Diabetic / obese patients (35–65)

Sport fans + students (broad)

Working adults, educators

Mixed community (all ages)

Healthcare integration

Deep (core model)

Deepest of all countries

None (brandbased trust)

Minimal

Minimal

Sport clubs / providers

140 3 clubs, 6 types associations, 39 (clinical focus) activity types

Olympiacos academies only, 9 types

8 clubs, 10 types (outdoor focus)

3 clubs, 12 types (balanced)

Boxes distributed

82,750 (69%)

27,453 (92%)

29,586 (99%)

900 (3%)

20,300 (68%)

Participants

4,243

53

319

246

80

Continued paid (rate)

897 (21%)

13 (25%)

39 (12%)

42 (17%)

15 (19%)

Key innovation

Model origin; pharmacy network

🇧🇬 Bulgaria

Clinical referral Linktree Stadium megastream; educator workaround; distribution pivot outdoor offer

🇵🇱 Poland

Community hub network; trainer as ambassador

3. Planning and Preparation The quality of the planning phase sets the upper limit for implementation success. Investing in structured preparation consistently results in smoother execution.

UISP's planning process is part of an advocacy strategy to promote Health Enhancing Physical Activity following the six phases: (1) Needs Analysis, (2) Partnership INITIAL Development, (3) Programme Preparation, (4) Distribution and Engagement, (5) METHODOLOGY Activity Implementation, (6) Monitoring and Improvement. Each phase informs the next, — Planning creating a continuous learning cycle. Needs analysis in Italy draws on local Framework administrations health data, UISP's existing association network intelligence, and direct community consultation.

3.1 Local Context Analysis Before designing anything, understand where you are working. Map population groups with low physical activity levels, audit cultural attitudes toward exercise and 'free offers', identify existing sport and wellness provision, and assess the institutional landscape. 🇧🇬 BULGARIA — Needs Analysis: Starting from Clinical Data BG Be Active began by identifying the specific health burden of their pilot region: high prevalence of Type 2 Diabetes and clinical obesity in Plovdiv and surrounding areas. This epidemiological framing shaped every subsequent decision, who to target, which healthcare partners to approach, how to design activities, and how to address trainer liability concerns.

"We decided to include GPs and endocrinologists specifically because of the high prevalence of Type 2 Diabetes and obesity in the region. This medical-first approach ensured that Movement Pills were treated by patients as a necessary health intervention rather than a novelty."

🇪🇪 ESTONIA — Needs Analysis: Facing Cultural Barriers Early

Firmasport's pre-pilot assessment identified a critical cultural barrier early: in Estonia, 'there is no free lunch'. The expectation that everything has a price and that giving services away requires special justification is deeply ingrained. This meant that the standard Italian value proposition 'offer free activities in exchange for community visibility' was simply not compelling in the Estonian context.

Recognising this in the planning phase did not eliminate the problem, but it allowed the team to calibrate expectations and focus resources on personal relationship activation rather than broad outreach.

3.2 Defining Realistic Objectives Set objectives according to your actual capacity. The pilot revealed gaps between planned and actual distribution in some countries. Work backward from your desired impact to establish realistic targets: Approximately 50% of distributed boxes are expected to be collected by interested recipients.

About 50% of those who take a box are expected to register for an activity.

Around 20% of participants are expected to continue with paid participation after the trial.

🇬🇷 GREECE — Setting Targets Around Events Olympiacos set a single clear objective: distribute as many boxes as possible through existing home events. By anchoring distribution to stadium attendance figures (Euroleague games regularly draw 10,000+ spectators), the team could predict volume with confidence. 29,586 boxes were distributed from a 30,000 allocation, a 99% rate achieved through pure logistical excellence and the strength of an existing event infrastructure.

The lesson: if you have a reliable high-footfall channel, design your target around it, do not set a target and then search for a channel.

4. Building Effective Partnerships Partnership quality was the single strongest predictor of implementation success across all five pilot countries.

INITIAL METHODOLO GY — The Italian Partnership Ecosystem

In Italy, UISP operates a pre-existing national network of affiliated sport associations.

These associations are accustomed to coordinated national campaigns, familiar with UISP's quality standards, and motivated by a shared social mission. The 'partnership development' phase for UISP is therefore largely an activation exercise, reaching into an existing network, rather than a recruitment exercise.

4.1 The Partnership Ecosystem Effective implementation depends on a well-functioning ecosystem, consider these as the loadbearing pillars.

Partner Type

Role in Movement Pills

What Makes Them Say Yes

Healthcare actors

Distribution, referral, credibility, participant motivation

Patient safety assured; reduced admin burden; alignment with preventive health outcomes

Sport facilities and trainers

Activity delivery, participant onboarding, retention

New demographic access; visibility; social mission; potential for paid membership conversion

Public authorities

Institutional credibility, facility access, communication channels

Community health outcomes; local visibility; alignment with health strategies

Community organisations

Distribution, target group access, trusted communication

Service to existing users; cobranding; low additional workload

🇧🇬 BULGARIA — Winning Over Sport Facilities BG Be Active's most effective engagement strategy was what they called the 'Shared Value Proposition': presenting Movement Pills as a genuine opportunity for gyms to access a demographic they had never previously reached, sedentary adults with metabolic conditions who, once their health improved, had strong motivation to become long-term members.

"The most effective strategy was appealing to clubs' desire for prestige and social contribution. By framing the project as a 'big project' with high social value, we successfully motivated facilities to join. They saw a clear benefit in being publicly associated with a widely recognised initiative that directly supports at-risk patients."

Trainers also reported unexpected professional satisfaction: "Several noted that helping 'patients' improve their health metrics was more motivating than standard fitness training."

🇵🇱 POLAND — The Trainer-as-Ambassador Model Swim for a Dream built their partnership strategy around trusted trainers who already had strong relationships with the communities they served. Rather than approaching facilities as an unknown external organisation, the team asked trainers to introduce the initiative to their existing clients and networks.

This produced faster buy-in, lower administrative friction, and higher participant confidence, because the Movement Pills offer was introduced by someone participants already knew.

Supporting tactics included: co-branding (logos on materials, social media mentions), sharing concrete engagement data from early-adopter facilities, and keeping the cooperation model deliberately simple and low-effort for venues.

5. Activity Design The activity programme is the heart of Movement Pills. Box distribution brings people to the door; compelling, accessible, and safe activities keep them engaged and create lasting behavioural change.

INITIAL METHODOLO GY — Activity Design Principles

Italy's activity offer reflects UISP's founding philosophy of 'sport for all': non-competitive, inclusive, accessible across fitness levels and age groups. The Italian model prioritises breadth to maximise the likelihood that any participant will find something appealing.

Intensity is progressive. Formats are welcoming rather than performance-oriented.

Outdoor and water activities are included alongside gym-based options to remove the psychological barrier of entering a traditional fitness environment.

🇧🇬 BULGARIA — Activity Design for Clinical Populations Bulgaria's activity programme was the most clinically adapted of all pilot countries. Every session was modified for participants with obesity and Type 2 Diabetes: All exercises low-impact and progressively intensified Trainers briefed to recognise and respond to hypoglycaemia Group fitness, yoga, aerobics, kettlebell, and functional classes — no high-intensity formats A nutrition coach delivered a group seminar on healthy eating and metabolic health alongside the physical programme Social atmosphere deliberately cultivated: trainers created non-intimidating environments to ensure retention among participants with long histories of inactivity RECOMMENDATION FROM BULGARIA: Create a formal 'Medical Fitness' certification or quality seal for trainers working with diabetes and obesity. This would significantly accelerate GP trust and referral rates in any future clinical implementation.

🇬🇷 GREECE — Using Existing Academy Infrastructure Greece delivered all activities exclusively through Olympiacos SFP Sport Academies, an existing highquality infrastructure with trained coaches, established safety protocols, and a wide facility network in Piraeus.

9 activity types were offered: boxing, kick boxing, fencing, walking, track and field, tennis, beach volleyball, swimming, sailing and SUP. This 'single provider' model ensured consistency and quality but created a scheduling bottleneck. When participants' availability did not match facility schedules, the team's response was fast and effective: new groups were created, morning weekday slots were added, and smaller local venues were activated to reduce travel barriers.

"All physical activities were delivered exclusively by Olympiacos SFP through its academies, ensuring consistency, high quality standards, and strong participant trust."

🇪🇪 ESTONIA — Outdoor and Free Activities as a Workaround When indoor sport facilities proved difficult to recruit, Estonia expanded its activity offer to include activities that require no facility agreement: nature trails, disc golf parks, orienteering routes, and running groups.

These free, outdoor activities allowed FirmaSport to provide a credible and varied activity offer despite a limited partner base.

8 clubs contributed 10 activity types in total: Pilates, yoga, jiu-jitsu, Firmasport's own fitness challenges, walking, running, orienteering, nature trails, disc golf, and running groups.

LESSON: If indoor facility recruitment is proving slow, launch with outdoor and community-based activities immediately. This maintains momentum, gives participants something to engage with, and creates proof points for approaching reluctant indoor facilities.

🇵🇱 POLAND — Balanced Indoor-Outdoor-Water Offer Poland achieved one of the most balanced activity mix: 12 types across gym (fitness, Pilates, yoga, martial arts, flexibility), outdoor (walking, running, cycling), and water (swimming) settings.

With only 3 sport clubs, this breadth reflects deliberate programming rather than a large provider network.

The team focused on types that were genuinely accessible to their mixed-age, community-centre-based target group.

Senior centres reported particularly strong turnout and engagement, validating the choice of inclusive, low-intensity indoor formats for older participants.

6. The Distribution System The Movement Pills box is simultaneously a physical object, a symbolic gesture, a communications tool, and a psychological trigger. The distribution system is what connects all of them. Getting it right determines who receives the box, what they understand about it, and whether they act on it.

The defining feature of the Italian distribution model is what the project team calls “active dispensing.” Rather than simply leaving boxes on shelves for customers to find, INITIAL METHODOLO pharmacists are trained to present the project to every pharmacy visitor. They also identify GY — Active customers with chronic conditions who are collecting prescriptions and personally hand Dispensing them the box, framing it as a health tool tailored to their specific situation, carrying the same authority as medication.

🇧🇬 BULGARIA — Active Dispensing in Practice In Bulgaria, boxes were actively dispensed: pharmacists and medical staff received specific training to identify patients purchasing medication for chronic conditions (such as diabetes or hypertension) and personally provide them with a Movement Pills box, not as a promotional leaflet, but as a validated health tool.

"Instead of passive placement, we implemented an 'active dispensing' method: pharmacists and medical staff were trained to identify patients purchasing medication for chronic conditions and personally hand them a Movement Pills box. This validated the intervention as a legitimate health tool."

One mid-course adjustment: direct GP referrals were slower than expected due to consultation time limits.

The team shifted a higher volume of stock to pharmacy counters, where staff had more time to explain the project, resulting in faster uptake.

🇬🇷 GREECE — Event-Based Mass Distribution Greece demonstrated that high-volume distribution is achievable without a pharmacy network, if you have a large, trusted event infrastructure. Key elements of the Greek distribution model: Information stands at every home Olympiacos match and major sport event Promotional staff (4 people, part-time during events) dedicated to participant outreach and on-the-spot explanation Collaboration with the Hellenic Athletics Federation for distribution at a Piraeus road running event, extending reach beyond Olympiacos's own fan base CHALLENGE: The box design was occasionally mistaken for actual medication by older participants. The team responded with additional on-site signage and verbal explanation from promotional staff.

🇵🇱 POLAND — Community Hub Distribution Poland's distribution model relied on facility managers to place boxes in visible, high-traffic locations within their institutions, reception desks, activity rooms, notice boards. Where space was limited, boxes were rotated between rooms to ensure visibility.

The key to making this work: facility staff were briefed and personally motivated to champion the initiative to their users. Without this human element, community hub placement risks becoming passive placement, a box on a shelf that nobody notices.

LOGISTICAL CHALLENGE: Several public institutions required formal approval before boxes could be placed on their premises. Starting this approval process 6–8 weeks in advance is now recommended as standard practice.

🇪🇪 ESTONIA — The Linktree Solution Estonia's most practical and transferable innovation was replacing the main project website with a Linktree as the primary activity listing tool.

The original project website required multiple clicks to reach relevant information, could not be updated by local partners, and was in English, all significant barriers for Estonian participants.

The Linktree allowed the Estonia team to add, remove, and update activity offers themselves at any time, without waiting for central project support.

"The offers for free activities should be listed on paper inside the actual MP box, not only online."

7. Communication and Promotion Promotion of Movement Pills serves two distinct purposes: reaching potential participants, and maintaining the commitment of distribution and activity partners. These require different messages and different channels.

INITIAL METHODOLO GY — Italian Communicati on Strategy

UISP's communication model integrates three layers: (1) institutional endorsement from municipalities and health authorities; (2) professional referral via healthcare channels; (3) community-level promotion through local associations' existing networks. The combination of top-down institutional credibility and bottom-up grassroots activation is what makes the Italian model particularly effective at reaching people who would ignore standard advertising.

🇧🇬 BULGARIA — Three-Channel Communication Strategy Bulgaria used a three-channel approach that proved highly effective: OFFLINE (primary): Face-to-face briefings with healthcare professionals. This channel was the most effective for reaching the target clinical group because participants received the recommendation from an authority figure they trusted DIGITAL: Targeted Facebook and Instagram campaigns for the 35–65 age group in the pilot region, sharing participant success stories, and explaining the 'PILLS' concept INSTITUTIONAL: Official endorsement and promotion through the Municipalities of Plovdiv and Markovo, providing institutional validation and reaching citizens through municipal channels UNEXPECTED INSIGHT: Facebook monitoring revealed high engagement from educators, leading to a successful mid-campaign expansion of the target group to include teachers as a distinct segment.

🇬🇷 GREECE — Event Presence as Primary Communication For Greece, sport events were not just distribution channels, they were the primary communication channel. Face-to-face interaction at Olympiacos events allowed promotional staff to explain the concept immediately, answer questions on the spot, and sign participants up in real time.

"Direct engagement during sport events proved to be the most effective communication channel, as it enabled immediate interaction with citizens, on-the-spot information provision and direct registration of interested participants."

When face-to-face was not possible due to geography (many fans live far from Piraeus facilities), the team pivoted to outreach at local universities, reaching a younger, geographically distributed audience through a trusted institutional channel.

🇪🇪 ESTONIA — What Did Not Work — and Why Estonia used social media, a webpage, and newsletters to member companies. The most successful channel was direct email. There was no media interest.

"The only partners we got were through our personal contacts, and it is not sustainable this way."

Three systemic barriers undermined broader communication success: Low organisational name recognition meant press and media did not engage The project website was not user-friendly, not locally editable, and not in Estonian Cultural scepticism toward free offers meant digital promotion generated curiosity but not commitment LESSON FOR FUTURE IMPLEMENTERS: Invest in your own digital infrastructure from the outset. A locally editable, locally translated, simple activity listing page is more valuable than sophisticated marketing if partners and participants cannot navigate to what they need.

🇵🇱 POLAND — Multi-Channel Local Promotion Poland used the most diverse channel mix of all pilot countries: Direct meetings with facility managers and target groups Social media promotion via project trainers and partner institutions (leveraging their existing followers) Local press announcements and articles Posters and leaflets in community centres, libraries, and neighbourhood council boards Promotion in internal brochures of partner institutions The team noted that information spread most effectively within and among the partner facilities' existing communities, confirming that trusted intermediaries outperform direct-to-public advertising for this type of initiative.

8. Top Recommendations for New Implementing Countries

RECOMMENDATION 1

Secure endorsement from a national or regional Public Health authority before approaching distribution or activity partners; if your organisation lacks established recognition, strategically align the initiative with a reputable institution, as organisational credibility cannot be improvised. At the same time, integrate the MP methodology into structured advocacy initiatives targeting local institutions responsible for health promotion, ensuring its effectiveness is formally recognised while further consolidating the credibility of the promoting organisation across diverse contexts.

Over-invest in the simplicity of your distribution process. A pharmacist, gym RECOMMENDATION receptionist, or school librarian should be able to hand over the box and give a 2 coherent one-minute explanation without being an expert. Design, test, and refine this handover until it is foolproof.

Build a digital alternative from day one by offering online video content as a genuine complement, not a secondary option. Ensure your digital activity listing is RECOMMENDATION locally editable, in your own language, and accessible in three clicks or fewer. At 3 the same time, consider including a paper leaflet in the box with activities, facilities, and contact information, especially for older users who may be less comfortable with QR codes or websites.

RECOMMENDATION 4

Plan for real conversion rates, not aspirational ones. Expect approximately: 50% of boxes collected → 50% of those register → 20% continue post-trial. Work backwards from your desired impact to set realistic distribution targets.

Monitor actively and adapt quickly. The most successful country-level adaptations RECOMMENDATION (Bulgaria's teacher pivot, Greece's morning sessions, Estonia's Linktree) all came 5 from teams paying attention to real-time data. Build monitoring responsibilities into

your team structure from week one.

9. Key Data from the Pilot Implementation 9.1 Distribution Summary Country

🇮🇹 Italy

🇬🇷 Greece

🇧🇬 Bulgaria

🇵🇱 Poland

🇪🇪 Estonia

TOTAL

Boxes Allocated

Boxes Distributed

Rate

Partners

120,000

82,750

69%

564

30,000

29,586

99%

2

30,000

27,453

92%

9

30,000

20,300

68%

6

30,000

900

3%

7

240,000

160,989

67%

588

9.2 Participation Summary

Country

🇮🇹 Italy

🇬🇷 Greece

🇪🇪 Estonia

🇵🇱 Poland

🇧🇬 Bulgaria

TOTAL

Participants

Avg. Age

% Female

Continued (paid)

Rate

4,243

58

76%

897

21%

319

52

37%

39

12%

246

48

56%

42

17%

80

60

73%

15

19%

53

38

58%

13

25%

4,941

51.2

72%

1,006

20%

9.3 Activity Provision

Country

🇮🇹 Italy

🇬🇷 Greece

🇧🇬 Bulgaria

🇵🇱 Poland

🇪🇪 Estonia

Sport Clubs

Activity Types

Gym

Outdoor / Water

140

39

Yes (diverse)

Yes (diverse)

2 (Olympiacos)

9

Yes

Yes

3

6

Primary focus

Limited

3

12

Yes

Yes

8

10

Limited

Strong emphasis

Movement Pills Implementation Handbook Disclaimer: Project is funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them. www.movement-pills.eu