Inside outside: how the outdoor environment affects patients’ physical activity in a rehabilitation center

People in rehabilitation have been found to be motivated to be physically active by accessible and attractive outdoor environments, both vicinity of healthcare facilities and in the larger neighbor-hood. Nevertheless, even when available, outside space is not always optimally used. We aim to gain insight into how the outdoor environment of a rehabilitation center, on and beyond its prem-ises, hampers or supports patients to be physically active. We conducted a qualitative ethnograph-ic study informed by quantitative physical activity data. Semi-structured and walking interviews with 16 patients from one rehabilitation center were supported by output from activity trackers. Two focus-group interviews with four nurses and a physio- and an ergo-therapist provided extra perspectives. All data were inductively analyzed guided by a grounded-theory based approach. An analysis of sensory information, affordances and meaning making showed a wide variety in the roles the outdoor environment plays in patients’ physical activity, both inside and outside the building, ranging from patients travelling to near villages to others staying inside all day but en-joying the view when walking to the end of the hallway. Concrete destinations motivate patients to go outside and be physically active, but also smaller interventions like avoiding even the smallest physical boundaries, facilitating visual control, and providing psychological support have a positive impact. If a rehabilitation center is to encourage physical activity amongst pa-tients, inside and outside, it is important that inside and outside spaces are connected physically, visually, and psychologically.