Arthritis affects many individuals and can cause pain and limit physical functioning. Exercise is an important treatment option for individuals with arthritis; however, adherence to exercise programs can be challenging. A new initiative in Denmark has introduced nature-based exercises for patients with arthritis. This qualitative study aimed to explore the experiences of the individuals who participated in those exercises. The study used a hermeneutic-phenomenological approach and conducted along-side interviews with 12 women and three men who participated in nature-based exercise programs for arthritis. Analysis of the data revealed two main themes. The first theme highlighted the positive effects of being in nature, such as increased vitality, reduced pain, and a sense of well-being. The second theme emphasized the social benefits of participating in these exercises, including a sense of connection and community with others. Overall, this study suggests that incorporating nature-based exercises in treatment programs for arthritis could have significant benefits for individuals with this condition.
BannuruR. R.OsaniM. C.VaysbrotE. E.ArdenN. K.BennellK.Bierma-ZeinstraS. M. A.KrausV. B.LohmanderL. S.AbbottJ. H.BhandariM.BlancoF. J.EspinosaR.HaugenI. K.LinJ.MandlL. A.MoilanenE.NakamuraN.Snyder-MacklerL.TrojianT.McAlindonT. E. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage/OARS, Osteoarthritis Research Society, 27(11), 1578–1589. https://doi.org/10.1016/j.joca.2019.06.011
2.
BeckM.MartinsenB.MisselM.SimonyC.EngelkeE.van ManenM. A. (2023). Alongside: Exploring the meaningfulness of moments in others’ lives through observation and interview. Pearls, Piths, and Provocations, Qualitative Health Research. (published ahead of Print). https://doi.org/10.1177/10497323231210495
3.
BeyerK. M.SzaboA.HoormannK.StolleyM. (2018). Time spent outdoors, activity levels, and chronic disease among American adults. Journal of Behavioral Medicine, 41(4), 494–503. https://doi.org/10.1007/s10865-018-9911-1
4.
BrambillaA.RebecchiA.CapolongoS. (2019). Evidence Based Hospital Design. A literature review of the recent publications about the EBD impact of built environment on hospital occupants’ and organizational outcomes. Annali di Igiene: Medicina Preventiva e di Comunita, 31(2), 165–180. https://doi.org/10.7416/ai.2019.2269
5.
CarpianoR. M. (2009). Come take a walk with me: The “Go-Along” interview as a novel method for studying the implications of place for health and well-being. Health and Place, 15(1), 263–272. https://doi.org/10.1016/j.healthplace.2008.05.003
CiezaA.CauseyK.KamenovK.HansonS. W.ChatterjiS.VosT. (2021). Global estimates of the need for rehabilitation based on the Global Burden of Disease Study 2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10267), 2006–2017. https://doi.org/10.1016/S0140-6736(20)32340-0
8.
CoventryP. A.BrownJ. E.PervinJ.BrabynS.PatemanR.BreedveltJ.GilbodyS.StancliffeR.McEachanR.WhiteP. L. (2021). Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. SSM - Population Health, 16, 100934. https://doi.org/10.1016/j.ssmph.2021.100934
9.
CrampF.HewlettS.AlmeidaC.KirwanJ. R.ChoyE. H. S.ChalderT.PollockJ.ChristensenR. (2013). Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database of Systematic Reviews, 8(8), CD008322. https://doi.org/10.1002/14651858.CD008322.pub2
10.
DrummenS. J. J.BalogunS.LahhamA.BennellK.HinmanR. S.CallisayaM.CaiG.OtahalP.WinzenbergT.WangZ.AntonyB.MunugodaI. P.Martel-PelletierJ.PelletierJ. P.AbramF.JonesG.AitkenD. (2023). A pilot randomized controlled trial evaluating outdoor community walking for knee osteoarthritis: Walk. Clinical Rheumatology, 42(5), 1409–1421. https://doi.org/10.1007/s10067-022-06477-5
11.
Frederick-RecascinoC. M.Schuster-SmithH. (2003). Competition and intrinsic motivation in physical activity: A comparison of two groups. Journal of Sport Behaviour, 26(3), 240–254. https://doi.org/10.1177/10596011221101247
12.
GBD 2019 Diseases and Injuries Collaborators. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9
13.
GladwellV. F.BrownD. K.WoodC.SandercockG. R.BartonJ. L. (2013). The great outdoors: How a green exercise environment can benefit all. Extreme Physiology and Medicine, 2(1), 3. https://doi.org/10.1186/2046-7648-2-3
14.
HaahrA.MartinsenB. (2018) Van Manen’s thinking and methods. An overview [Van Manen’s tænkning og metode. Et overblik]. In GildbergF. A.HounsgaardL. (Eds.), Qualitative analysis in healthcare science [kvalitative analysemetoder i sundhedsforskning]. Klim.
15.
KatzP.MargarettenM.GregorichS.TrupinL. (2018). Physical activity to reduce fatigue in rheumatoid arthritis: A randomized controlled trial. Arthritis Care and Research, 70(1), 1–10. https://doi.org/10.1002/acr.23230
16.
KrausV. B.SprowK.PowellK. E.BuchnerD.BloodgoodB.PiercyK.GeorgeS. M.KrausW. E. (2018). Effects of physical activity in knee and hip osteoarthritis: A systematic umbrella review. Medicine & Science in Sports and Exercise, 51(6), 1324–1339. https://doi.org/10.1249/MSS.0000000000001944
17.
KvaleS.BrinkmannS. (2015). Interview: The qualitative interview as a research craftmanship [Interview: Det kvalitative forskningsinterview som håndværk] (3rd ed.). Hans Reitzels Forlag.
18.
MahirL.BelhajK.ZahiS.AzanmassoH.LmidmaniF.El FatimiA. (2016). Impact of knee osteoarthritis on the quality of life. Annals of Physical and Rehabilitation Medicine, 59, e159. https://doi.org/10.1016/j.rehab.2016.07.355
19.
MalterudK. (2011). Qualitative methods in medical research: A guidance. Universitetsforlaget. [Kvalitative metoder i medisinsk forskning: en innføring].
20.
MariniS.MauroM.GrigolettoA.ToselliS.Maietta LatessaP. (2022). The effect of physical activity interventions carried out in outdoor natural blue and green spaces on health outcomes: A systematic review. International Journal of Environmental Research and Public Health, 19(19), 12482. https://doi.org/10.3390/ijerph191912482
21.
MatchamF.ScottI. C.RaynerL.HotopfM.KingsleyG. H.NortonS.ScottD. L.SteerS. (2014). The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism, 44(2), 123–130. https://doi.org/10.1016/j.semarthrit.2014.05.001
22.
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1978). The Belmont report: Ethical principles and guidelines for the protection of human Subjects of research. U.S. Department of Health, Education and Welfare.
PolitD. F.BeckC. T. (2014). In PolitD. F.BeckC. T. (Eds.), Essentials of nursing research: Appraising evidence for nursing practice (8th ed.), Wolters Kluwer Health/Lippincott Williams and Wilkins.
25.
Rongen-van DartelS. A. A.Repping-WutsH.FlendrieM.BleijenbergG.MetsiosG. S.van den HoutW. B.van den EndeC. H. M.NeubergerG.ReidA.van RielPLCMFransenJ. (2015). Effect of aerobic exercise training on fatigue in rheumatoid arthritis: A meta-analysis. Arthritis Care amd Research, 67(8), 1054–1062. https://doi.org/10.1002/acr.22561
26.
RyanR. M.DeciE. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Publications.
27.
SafiriS.KolahiA. A.SmithE.HillC.BettampadiD.MansourniaM. A.HoyD.Ashrafi-AsgarabadA.SepidarkishM.Almasi-HashianiA.CollinsG.KaufmanJ.QorbaniM.Moradi-LakehM.WoolfA. D.GuilleminF.MarchL.CrossM. (2020). Global, regional, and national burden of osteoarthritis 1990-2017: A systematic analysis of the Global Burden of Disease Study 2017. Annals of the Rheumatic Diseases, 79(6), 819–828. https://doi.org/10.1136/annrheumdis-2019-216515
28.
SalmonJ. H.RatA. C.SellamJ.MichelM.EschardJ. P.GuilleminF.JollyD.FautrelB. (2016). Economic impact of lower-limb osteoarthritis worldwide: A systematic review of cost-of-illness studies. Osteoarthritis and Cartilage, 24(9), 1500–1508. https://doi.org/10.1016/j.joca.2016.03.012
29.
SandalL. F.ThorlundJ. B.MooreA. J.UlrichR. S.DieppeP. A.RoosE. M. (2019). Room for improvement: A randomised controlled trial with nested qualitative interviews on space, place and treatment delivery. British Journal of Sports Medicine, 53(6), 359–367. https://doi.org/10.1136/bjsports-2016-097448
30.
SkouS. T.RoosE. M. (2019). Physical therapy for patients with knee and hip osteoarthritis: Supervised, active treatment is current best practice. Clinical & Experimental Rheumatology, 37 Suppl 120(5), 112–117.
31.
SkouS. T.RoosE. M. (2020). Physical therapy for patients with knee and hip osteoarthritis: Supervised, active treatment is current best practice study. Clinical & Experimental Rheumatology, 38(5), 1036.
32.
SokkaT.HäkkinenA.KautiainenH.MaillefertJ. F.TolozaS.Mørk HansenT.Calvo-AlenJ.OdingR.LivebornM.HuismanM.AltenR.PohlC.CutoloM.ImmonenK.WoolfA.MurphyE.SheehyC.QuirkeE.CelikS.PincusT. (2008). Physical inactivity in patients with rheumatoid arthritis: Data from twenty-one countries in a cross-sectional international study. Arthritis & Rheumatism, 59(1), 42–50. https://doi.org/10.1002/art.23255
33.
SpradleyJ. P. (1980). Participant observations. Holt, Rinehart and Winston.
34.
TeixeiraP. J.MarquesM. M.SilvaM. N.BrunetJ.DudaJ. L.HaerensL.La GuardiaJ.LindwallM.LonsdaleC.MarklandD.MichieS.MollerA. C.NtoumanisN.PatrickH.ReeveJ.RyanR. M.SebireS. J.StandageM.VansteenkisteM.HaggerM. S. (2020). A classification of motivation and behavior change techniques used in self-determination theory-based interventions in health contexts. Motivation Science, 6(4), 438–455. https://doi.org/10.1037/mot0000172
Thompson CoonJ.BoddyK.SteinK.WhearR.BartonJ.DepledgeM. H. (2011). Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environmental Science and Technology, 45(5), 1761–1772. https://doi.org/10.1021/es102947t
37.
TimmermannC.UhrenfeldtL.BirkelundR. (2015). Room for caring: Patients’ experiences of well-being, relief, and hope during serious illness. Scandinavian Journal of Caring Sciences, 29(3), 426–434. https://doi.org/10.1111/scs.12145
38.
TodresL.GalvinK. (2010). “Dwelling-mobility”: An existential theory of well-being. International Journal of Qualitative Studies on Health and Well-Being, 5(3), 5444. https://doi.org/10.3402/qhw.v5i3.5444
39.
UlrichR. S.BerryL. L.QuanX.ParishJ. T. (2010). A conceptual framework for the domain of evidence-based design. HERD, 4(1), 95–114. https://doi.org/10.1177/193758671000400107
40.
UlrichR. S.SimonsR. F.LositoB. D.FioritoE.MilesM. A.ZelsonM. (1991). Stress recovery during exposure to natural and urban environments. Journal of Environmental Psychology, 11(3), 201–230. https://doi.org/10.1016/s0272-4944(05)80184-7
41.
van ManenM. (2023). Phenomenology of practice: Meaning-giving methods in phenomenological research and writing (2nd ed.). Left Coast Press Inc.
42.
WallisJ. A.WebsterK. E.LevingerP.TaylorN. F. (2013). What proportion of people with hip and knee osteoarthritis meet physical activity guidelines? A systematic review and meta-analysis. Osteoarthritis and Cartilage, 21(11), 1648–1659. https://doi.org/10.1016/j.joca.2013.08.003
43.
WHO (2016). Urban green spaces and health: A review of evidence. World Health Organization.
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, the Journal of the American Medical Association, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053
46.
ZhangG.PoulsenD. V.LygumV. L.CorazonS. S.GramkowM. C.StigsdotterU. K. (2017). Health-promoting nature access for people with mobility impairments: A systematic review. International Journal of Environmental Research and Public Health, 14(7), 703. https://doi.org/10.3390/ijerph14070703
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
