given the heterogenic pathology and symptoms of MS (41, 42).
However, our ﬁndings illuminate qualitative aspects of how to
achieve tailored and meaningful intersubjective interactions in an
exercise intervention.
We consider the instances of the physiotherapist running
together with the participant, which were perceived as important
for participants’ performance, to be an example of“participatory
sense-making” (22). As participants appreciated being guided or
even pushed by the physiotherapists, it appears that the
physiotherapists were trusted in directing this interaction. As
such, we argue that the physiotherapists ’ ability to adapt to
participants’ movements, speech and gestures — tailoring the
interaction to their needs— was important for this ability to be
perceived as purposeful. This is supported by the few negative
incidents described where the participant-physiotherapist
interaction seemed to not be jointly coordinated and appeared to
fail. The reported mutual inﬂuences of sensorimotor capabilities
and interpersonal coordination, with the physiotherapists but
also the group, are in accordance with sensorimotor capacities
and intersubjective interactions being important for sense-
making in the world (35). The beneﬁts of these individualized
participant-physiotherapist interactions are also described in
speciﬁc core-stability exercises in indoor groups (16, 43) and are
in line with the theoretical framework of facilitation of
movement through hands-on interaction previously proposed
(44, 45). Our study informs new knowledge of physiotherapist-
participant interactions to achieve the recommended high-
intensity training and calls for physiotherapy clinical reasoning
through bodily and verbal communication skills adapted to the
participants’ responses in an ongoing and situated way.
Enjoyment has previously been reported to promote PA
in pwMS, and our study brings requested knowledge of what
can constitute enjoyment in an exercise intervention ( 46):
playful group-exercise tasks, a cheerful physiotherapist, and the
outdoor environment.
The appreciation of being active outdoors in the study sample
aligns with that in the general population ( 47). The outdoors
provided a natural environment, which both invited participants to
actively explore abilities thought of as left behind after their
diagnosis with MS, such as running, and provided an appreciated
break from focusing on MS symptoms. We also suggest that the
positive experiences of mastering the challenging weather
conditions and the added meaning of exercising among other
people in the city park can be explained according to such terms.
These positive experiences show how we are enmeshed in our
history, context and social encounters (35) and how these aspects
should also be accounted for when designing exercise interventions.
4.3 Methodological considerations
The design and methods were adequate for deriving
knowledge from individuals’ experiences. The participants self-
referred to the intervention and were recruited based on pre-set
criteria. This approach yielded rich information from people
with mild to moderate disabilities due to MS who were
motivated for physical activity (PA), employed, and residing in
northern Norway. Ethnicity or socio-economic class were not
recorded. However, considering that all these factors can
inﬂuence PA engagement ( 46), it is possible that additional
aspects of the phenomenon could be uncovered in a different
sample ( 48). There was a higher percentage of women
participating than men; however, this corresponds to the gender
distribution in the MS population (1).
The use of enactive theory was innovative within theﬁeld and
allowed for, in particular, new aspects of importance for self-
efﬁcacy to be identiﬁed. Transference of our results to similar
populations can be achieved through theoretical generalization (28).
4.4 Implications for clinical practice
Combining high-intensity walking/running and detailed