Background: Community-based exercise programmes are increasingly recognised as an important component of chronic disease management and long-term self-management. As healthcare systems seek to promote prevention, integrated care, and community-based service delivery, there is growing interest in pathways that support sustained physical activity participation beyond traditional clinical settings. In Ireland, the Physical Activity for Health Officer (PAfHO) role has emerged as a novel initiative designed to strengthen links between healthcare services and community-based physical activity opportunities. Objective: To review contemporary evidence relating to community exercise programmes for chronic disease and examine the emerging role and potential contribution of the Physical Activity for Health Officer model within the Irish health system. Methods: A narrative review of peer-reviewed and grey literature published between 2020 and 2025 was conducted. Evidence relating to community exercise programmes, exercise referral and signposting pathways, integrated care models, and the Physical Activity for Health Officer pilot in Ireland was examined and synthesised. Results: Community exercise programmes consistently demonstrate improvements in physical activity participation, functional capacity, and health-related quality of life among people living with chronic disease. Programmes incorporating personalised exercise prescription, behavioural support, and integrated care pathways appear to achieve the strongest outcomes. Emerging evidence from Ireland suggests that the PAfHO role supports the development of referral and signposting pathways, increases access to community-based physical activity opportunities, and enhances collaboration between healthcare, local authority, and community sectors. Conclusions: Community exercise programmes represent an effective and scalable approach to supporting individuals with chronic disease. The PAfHO model aligns with international evidence supporting integrated care and community-based physical activity pathways and may provide an important mechanism for connecting healthcare services with long-term community participation. Further evaluation is required to establish its impact on health outcomes, service utilisation, and health system performance.