The adoption and implementation of physical activity (PA) recommendations vary across countries, largely influenced by their institutional structures. In non-EU, former socialist countries, PA guidelines are often integrated into national health strategies, particularly within Non-Communicable Disease prevention programs. However, these adoptions tend to remain formal, lacking effective implementation due to gaps in knowledge, capacity, and resources. Bulgaria and Romania are still developing their institutional frameworks and intersectoral coordination, while Portugal has established a dedicated committee to address rising inactivity levels and improve stakeholder collaboration.