It was somewhat distressing during the last interval, as my feet
were not working, and I did not know what to do to increase my
heart rate— when I could not run or walk quickly anymore.
(ID2, EDSS: 2)
The focus on the core or the middle of the body in the detailed
exercises was stated to improve participants ’ PA performance;
participants described being less clumsy or unsteady or walking
without holding on to the walls. Having practiced the detailed
CoreDIST exercises in the indoor group beforehand was
described as a helpful and pertinent preparation by some
participants, as it was regarded as more difﬁcult to accurately
execute the exercise techniques outdoors due to their higher
intensity, the uneven surface, or bad weather. Some participants
commented that the standing exercises (in-between the running/
walking intervals) required too much effort, leaving their legs
tired for running afterward.
3.2 New insights and beliefs
A key feature of the participants’stories was their new insights
into their own physical abilities, which were perceived to inﬂuence
their beliefs about their own possibilities for PA and life in general:
What meant the most for me was the high-pulse training, as I had
thoughts of it being a left behind phase for me. The experience of
being able to master it felt so good. It enhances my focus on future
possibilities rather than limitations.(ID4, EDSS: 0)
Gains in insight were also reported from the detailed exercise
part of the sessions, highlighting how the function of body parts
through movements and sensations was linked to performance in
PA, as illustrated below:
I have simply been taught some tools to improve certain parts of
my body and how that has an effect on, for example, walking:
That my hip has to be with me to maintain balance— and that
makes how I stand on the ground important. Previously I was
not aware of that… ., now everything works better.(ID6, EDSS: 2)
Two participants reported that the intervention motivated
them to commit to new exercise routines, and some stated that
they had more “readiness” for activities such as playing with
their grandchildren, hiking with friends, or engaging in a high-
intensity activity. Some stated that their bodily changes were
perhaps not noticeable for others, but they themselves noticed
that it was easier to climb stairs, balance on one leg and walk
fast or that they now moved in a“better way” or with less pain.
Three participants perceived the duration of the outdoor group
to be too short to feel lasting improvements in their physical
endurance or muscular strength.
3.3 An engaging environment
Most participants reported that their performances were
positively inﬂuenced and motivated by the group setting, for
example, through cooperating in exercises with balls, seeing other
individuals in the group who were “doing well”, cheering each
other and competing when running and walking next to each
other. However, one participant emphasized that observing
people with visible disabilities from MS was distressing, as it
revealed negative thoughts about one ’s own future. It was
emphasized that mastering challenges in the group sessions
added more meaning than doing the same alone:
I think this particular exercise is hard work, and then it becomes
very tiring to do it on my own. However, when I did it in the
group and we could laugh a bit in between and so on, it was
easier because of the social element.(ID12, EDSS: 1.5)
Being active outdoors was preferred by many participants
because of the fresh air and the natural and varied environment:
It was an added positive experience to use our city park and
notice all the other people who were there … it is something
about challenging our comfort-zone. (ID4, EDSS: 0)
The natural environment was also described as taking focus
away from MS symptoms. Cold, rainy or snowy weather
conditions required planning of adequate clothing; in addition,
these conditions led some participants to use cautious behavior