Balancing Loss of Physical Function in Older Adults’ Everyday Lives with Multimorbidity - a qualitative study

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Despite increasing attention to multimorbidity, little is known about how older adults themselves experience functional decline following hospitalisation, and how person‑centred interventions may support them. This study explores these lived experiences and examines whether a personalised exercise therapy and self‑management programme helped participants live more active lives. Method We conducted individual semi‑structured interviews with 20 older adults with multimorbidity enrolled in a Danish personalised exercise and self‑management intervention. A phenomenological-hermeneutic framework inspired by Ricoeur guided data collection and analysis. Interpretation followed three analytic levels: naïve reading, structural analysis, and critical interpretation. Reporting adhered to COREQ. Results Four themes characterised participants’ experiences: 1) Balancing everyday life - independence and the need for help, reflected tensions between autonomy and increased reliance on relatives, often disrupting relational roles, 2) Adapting to a new everyday life - maintaining autonomy, involved creative workarounds and temporal adjustments that enabled participants to maintain routines and coherence despite functional loss, 3) Uncertainties in everyday life - fear of falling, symptom unpredictability, and reduced social participation, contributing to withdrawal and insecurity, and 4) A sense of community among the (Anonymised for Review) intervention participants - fostered motivation, belonging, and emotional support, reducing isolation and normalising functional limitations. Conclusion Loss of physical function among older adults with multimorbidity seems to constitute an emotionally and existentially challenging process shaped by bodily, relational, and contextual constraints. The personalised exercise and self‑management intervention supported participants by enhancing social connectedness, fostering agency, and helping them reorient everyday practices. Findings underscore the need for holistic, person‑centred care models that integrate physical rehabilitation with emotional, relational, and existential dimensions of ageing with multimorbidity. Health sciences/Health care Humanities/Health humanities Biological sciences/Psychology Social science/Psychology Morbidity Well-Being Intervention Physical Activity Qualitative Methods Figures Figure 1 Figure 2 Background This qualitative study explores how older people with multimorbidity experience loss of physical function in their everyday lives and how the (Anonymised for Review) study supported them in living more active lives. As people age, everyday life often becomes more complex, shaped not only by routines and relationships, but increasingly by the presence of chronic diseases and multimorbidity (European Commission. Statistical Office of the European Union., 2020; Frølich et al., 2017 ). Multimorbidity is defined as two or more coexisting conditions in the same patient and is associated with lower quality of life, physical and cognitive function, and premature death (Anonymised for Review #7). For many older patients, living with multimorbidity means adjusting to physical limitations, navigating care systems, and finding new ways to maintain a sense of self and independence (Holland et al., 2024 ). Still, to our knowledge, little is known about the experienced physical challenges of older patients with multimorbidity following hospitalisation - a critical knowledge gap that calls for further exploration. Multimorbidity management is characterised by being patient-centred without giving priority to one condition (Anonymised for Review #7). Nevertheless, there is a lack of evidence on how to manage multimorbidity effectively (Anonymised for Review #8, #9). Few interventions are tailored to the specific needs, preferences, or participation barriers of people with multimorbidity. Decisions about intervention components are often based on practitioner intuition rather than patient-centred rationale. This underscores a persistent gap in the field: the lack of integration of older patients’ lived experiences and perspectives into intervention design. Carlson and Yarns ( 2023 ) call for more nuanced, person-centred approaches that consider the relational and existential dimensions and recognise the individual lived experience of aging with multimorbidity, dimensions that a Ricoeur-inspired interpretive framework is uniquely positioned to explore. Also calling for a more person-centred approach are Forsyth et al. ( 2024 ) who critically examines exercise modalities in multi-component interventions for older adults with multimorbidity. The review notes that few interventions are tailored to the specific needs, preferences, or participation barriers of this population. Decisions about exercise components were often based on practitioner intuition rather than patient-centred rationale. This underscores a persistent gap in the field: the lack of integration of older patients’ lived experiences and perspectives into intervention design. Smith et al. ( 2021 ) emphasised that individuals with multimorbidity, especially older adults, face substantial challenges, including loss of physical functioning, psychological stress, and treatment burden due to polypharmacy, multiple healthcare appointments, and a fragmented care system. In their systematic review, Smith et al. ( 2021 ) concluded that there is still uncertainty about the effectiveness of interventions for multimorbidity, and the evidence is low due to heterogeneity in populations and interventions. Along this line, we propose that knowledge of the lived life with physical deterioration is imperative for qualifying future interventions (Moore et al., 2015 ; Skivington et al., 2021 ). As part of the Danish (ANONYMISED FOR REVIEW) study (Anonymised for Review #1, #8), we aim to give voice to older patients with multimorbidity (Beck, 2020 ). (ANONYMISED FOR REVIEW) investigated whether a 12-week personalised exercise therapy and self-management support program for people with multimorbidity was superior to usual care alone in improving HRQoL at 12 months (Anonymised for Review #8, #9). Hence, we aim to explore how older patients with multimorbidity experience loss of physical function in their everyday lives, and whether the (ANONYMISED FOR REVIEW) intervention supported the participants in living more active lives. Method The aim of this study was to explore how older patients with multimorbidity experience loss of physical function in their everyday lives, and whether the (ANONYMISED FOR REVIEW) intervention supported the participants in living more active lives. Within a phenomenological hermeneutic approach, we conducted individual interviews inspired by Kvale and Brinkmann ( 2022 ), and data were analysed inspired by Ricoeur (Ricœur, 1976 ; Anonymised for Review #3, #4, #6). The reporting adheres to the 32-item checklist for qualitative research from the consolidated criteria for reporting qualitative research (COREQ) (Tong et al., 2007 ). Participants Participants in both the intervention and control groups were invited through their participation in the (ANONYMISED FOR REVIEW) study (Anonymised for Review #1, #8). Among other eligibility criteria patients had to have at least two specified chronic conditions and a high disease burden to be included in (ANONYMISED FOR REVIEW) (Anonymised for Review #4), As defined by the Bayliss Disease Burden scale (Bayliss et al., 2009 ). Forty-seven patients were assessed for eligibility for this interview study, between August 1 to November 10, 2023. Verbal information about the study was given by phone, followed by an invitation letter to potential participants. Recruitment was ongoing until ten participants randomised to the (ANONYMISED FOR REVIEW) intervention and ten participants randomised to usual care alone were included to ensure that experiences among both groups were considered. No significant differences in gender, age (65 to 89 years old) and number or burden of illnesses in either group. Interviews To ensure a comprehensive exploration of the participants' lived experiences and perspectives, the interviews were conducted using a semi-structured guide. The structure allowed for a pragmatic coverage of key domains while maintaining flexibility for participants to elaborate on issues of personal relevance. Open-ended questions were employed to foster depth and richness in responses, consistent with the phenomenological approach outlined by Kvale & Brinkmann ( 2022 ). The interview guide (appendix 1) was refined and piloted by four (ANONYMISED FOR REVIEW) patient partners and pilot-tested with individuals resembling the group of included participants in two iterations to ensure the appropriateness of questions. The interviews, conducted by phone, lasted between 24 and 56 minutes, were audio-recorded, and transcribed into a total of 195 pages. Analysis Ricoeur’s phenomenological hermeneutic approach is a rich and nuanced method of interpreting human experience, especially in texts, language, and action. It blends phenomenology (the study of lived experience) with hermeneutics (the theory of interpretation), creating a framework that is both descriptive and interpretive (Ricœur, 1976 ). The data was analysed in a three-levelled process as illustrated in Fig. 1 (Anonymised for Review #3, #4, #6). The first author (XXX) conducted a naïve reading to capture an initial understanding of the complete dataset. During this process, significant units of meaning were identified. Next, the first and last authors (XXX and XX) conducted a structural analysis together, in which we identified units of significance, sub-themes and themes. All authors discussed and refined the content, agreeing on the presentation, which is presented in the results section, with the inclusion of selected quotes. Finally, we conducted a critical interpretation and discussion. The first author (XXX) initiated this and then discussed it in the author group. Here the findings were interpreted again with the inclusion of other research and brought from the individual to a universal level. This is what Ricoeur terms a sophisticated understanding (Ricœur, 1976 ). This part is outlined in the discussion section. Results As illustrated in Fig. 2 , four overall themes were identified, highlighting the lived experiences with loss of physical function in older patients with multimorbidity. The overall impression from the naïve reading reflects that participants experienced emotional and existential disruption due to physical deterioration. This had a seemingly deep emotional impact, threatening their sense of identity and integrity; financial disparity in coping, creative adaptation, and social and embodied reorientation with social structures like group exercise therapy and self-management sessions offering vital support. Balancing everyday life – between independence and the need for help Participants strived to maintain a certain level of independence. On the other hand, they experienced an increased need for help. They struggled with balancing their integrity as their close relatives also became their informal caregivers. They experienced economic challenges related to acquiring aid to maintain independence when public healthcare failed to help. Balancing the role as an informal caregiver and relative Participants struggled with experiencing their close relative as both positive and negative ‘support’ regarding the physical decline. Even though the help needed was close by, it overstepped relational borders. When this happened, participants were bothered, feeling deprived of their autonomy. The power structures in the relationship changed and could even be perceived as patronising. One described it with: “…well, my wife really wants to help. She’s so keen to support me, but really, sometimes it’s like, you know, well, she encourages me to go for a ride on the bike or ‘let’s go for a walk’ or something like that. […] it’s more of a nuisance, but what do you do when it’s your nearest and dearest… If they keep suggesting this or that, right? Well, that’s when I become like a 5-year-old, you know…” (pt no. 1, intervention group) This person knew that his wife wanted to support him and appeared to be his personal cheerleader. But at some point, he experienced his wife’s encouragement as (s)mothering. A change in power structure also appeared in the relationship between participants and their children. One described it in this way: “ Even though my daughter is a nurse, I don’t always feel like she sees me as anything but a patient. ” (pt not. 5, control group) The quotes illustrate aggravation and how participants experienced relatives took charge of the actions which felt as a loss of integrity. Balancing economic (in-)equality in health Some participants highlighted how financial limitations impeded their ability to engage in physical exercise and acquire necessary healthcare aids. These constraints not only affected their physical well-being but also contributed to challenges in social participation and autonomy. Due to their loss of physical function, they also experienced limitations regarding transportation to healthcare, physical activities etc.: “…I haven’t asked for any other help than for my arthritis, to get some exercise. And then you are told that ‘you can pay for it yourself’.” (pt no. 9, intervention group) “I would really love to be able to get out of the house. And I wish I could get some help to pay for a motorized wheelchair or what’s it called. […] That way, you’re in the game, you know.” (pt no. 6, intervention group) Economic constraints limited these participants’ access to essential health services and aids. They disclosed that these limitations restrained physical health outcomes and contributed to social isolation and reduced health-related quality of life. In contrast, other participants described their ability to adapt to physical limitations through personal financial investments. They adapted their environment to their physical functions and not the other way around, which allowed them to avoid social isolation and maintain their quality of life. These participants changed the exterior setting to their physical capabilities instead of changing themselves. They managed to keep their independence, though it required resources both economically and mentally. One example was: “ We had to get a new car. We had a car with a low entrance, making it difficult for me to get in and out. And…It’s these kinds of things… […] For example, this year we’re going to Portugal. We’ve chosen a group trip on a cruise ship down the Douro River. This way, my husband can go with the others on those day trips instead of going alone, and then get to do some sightseeing. And I can stay on the boat. It’s these kinds of things we must plan. ” (pt no. 8, control group) In sum, the participants experienced the financial aspects with stark contrast. While some individuals could afford to modify their environment or lifestyle to accommodate their health needs, others were left without basic support. Adapting to a new everyday life – maintaining a sense of coherence Living with pain and loss of daily function led participants to adopt workarounds to cope and maintain a sense of coherence, thereby supporting integrity. Hereby, they strived to maintain a “normal” everyday life. Cleaning was a central task related to physical functions, which somehow represented a sense of “keeping up appearances” or “normal everyday life”. Adapting to constraints in physical functions - Workarounds Participants articulated a process of adaptation that was both pragmatic and emotionally grounded, reflecting a change of routines rather than compromising their integrity. Instead of abandoning previously enjoyed or habitual activities, participants described a shift in how these activities are performed. This reflected a form of resilient continuity, where the essence of the activity remained intact, but its structure was reshaped to accommodate new bodily constraints. Participants disclosed how they did what they liked to do and were used to doing before their physical decline, only differently. Breaking tasks up and taking breaks enabled participants to handle the task themselves, although it required planning and patience. One explained: “… you know, I’ve gradually gotten used to it. That’s just what I have to do, otherwise I can’t cope. And as long as I can plan things, the 'dose' so to speak fits, right? But if I have too much going on, then I get tired and grumpy. But I've kind of factored that into my everyday routine.” (pt no. 2, intervention group) Another participant reflected on the awareness of the dynamics in adapting to a new situation and the physical capacity: “Previously, I went to music festivals and things like that, but that’s not an option anymore, unless I can bring a chair to sit on. I can’t stand up for long periods. So, we’ve chosen this way now. We participate in concerts for an hour, where we can sit down, watch and listen.” (pt no. 8, control group) This covers how participants made strategic modifications that preserved autonomy, identity, and engagement. These adaptations were not only compensatory but reflected a creative reconfiguration of everyday life, enabling them to maintain a sense of normalcy or coherence and purpose despite losing physical functions. Adapting to a new pace Participants also acknowledged the importance of taking their time and doing the things that they liked at a new pace. Accepting that things took longer to accomplish and respecting physical restraints without overdoing them allowed them to continue doing the things they enjoyed. They addressed the practical adjustments, learning to navigate their routines with a greater sense of patience and acceptance of slowness. They came to recognize that time became a resource which allowed them to preserve autonomy and participation in meaningful activities. One stated: “I don’t mow the lawn in one go […] I break it up in two laps, then I can manage it.” (pt no. 1, intervention group) Others described how they for instance began to pay attention to where benches were placed in the public spaces and used health aids when needed, such as magnifying glasses and speech recognition software. It was emotionally demanding for participants to adapt to a new pace; nevertheless, crucial, as one said: “You can’t push yourself. If you can’t do it, then you just can’t. It takes as much time as it takes, and you simply have to learn that. It was a highly difficult thing to learn for me.” (pt no. 9, intervention group) Despite this haze, participants reflected a strategic and meaningful reconfiguration of daily practices. They adjusted to keep up engaging in valued activities, which gave a sense of resilience and agency. Uncertainties in everyday life Participants experienced the decline in physical functioning as distressing. Some experienced that the decline in physical functioning even caused accidents such as falling, heart flutters or alike, which made them insecure – what if it would happen again? The loss of functioning not only reshaped their physical capabilities but also their psychological landscape and social engagement. As the world around them seemingly "became smaller," their sense of agency and safety diminished, leading to a feeling of uncertainty and a cascade of emotional and behavioural adaptations. Participants experienced being afraid to participate in activities or social events because they feared “something would happen” due to the physical dysfunction. They held back from participating “just in case,” which made them feel like they were missing out. This fear was not merely a reaction to isolated incidents but a chronic state of apprehension that influenced decision-making and participation in everyday activities. The anticipation of potential harm leads participants into a pattern of self-restriction and social withdrawal. One said: “ I’m afraid of falling and… I also feel unstable… I really do… ” (pt no. 4, intervention group) Another said: “ Well, I’m very careful about that. You know, if I feel the slightest little thing, then I hold back, you could say […] Basically, I hold back. Also, because I don’t want to risk getting heart flutters again, I would rather hold back. I hold back physically with many things because of that. ” (pt no. 15, control group) Here, the participants describe an increased sensitivity to bodily sensations, which acted as a trigger for avoidance behaviour. This cautiousness, while protective, also contributed to a narrowing of life experiences. The phrase “I hold back” was repeated, underscoring the internal conflict between the desire to act and the fear of doing so. As such, the participants experienced bodily uncertainty to accentuate psychological and social isolation. A sense of community among the (ANONYMISED FOR REVIEW) intervention participants Participants in the intervention group disclosed how taking part in the (ANONYMISED FOR REVIEW) sessions provided them with vital social connectedness. Exercising in teams fostered a sense of community, belonging, and mutual understanding. Participants found community in illness Engaging in physical activity alongside others with similar health challenges fostered a meaningful sense of solidarity among participants. Exercising with peers made it easier to adhere to routines and created a space of mutual understanding. Participants described a sense of relief in being among others who shared the lived experience of illness and functional decline. This shared context reduced the need for explanation and allowed individuals to “be themselves,” fostering acceptance and psychological safety. Participants in the (ANONYMISED FOR REVIEW) intervention reported finding it easier to maintain exercise routines when surrounded by individuals who understood the lived realities of functional decline. This shared context diminished the need for explanation or justification, allowing individuals to “be themselves”. “ But when we are together, you know, there’re other people besides me with COPD, right? That’s kind of nice. ” (pt no. 4, intervention group) The group setting provided a form of emotional and existential relief. Being among others who could relate to the experience of illness, loss of physical function, and symptom burden created a sense of ease. “ Well, I think that participating in (ANONYMISED FOR REVIEW) was good for me. I got better and I was on a team with people who had the same illnesses as me, and so… we all understood each other’s functional limitations. It was really nice. ” (pt no. 2, intervention group) This narrative highlights the dual impact of physical improvement and social cohesion. The participant emphasises the therapeutic value of mutual understanding as a central component of the positive experience. In sum, participants found that engaging in physical activity within a group of peers fostered a profound sense of solidarity, acceptance, and psychological safety. The shared experience of illness and functional decline reduced the need for explanation, allowing individuals to feel understood and “be themselves.” This mutual recognition not only supported sustained exercise participation but also alleviated feelings of isolation and stigma, highlighting the therapeutic value of relational and community-based approaches in chronic disease management. Community in teams The act of leaving one’s home to engage in exercise was made easier by the knowledge that both peers and professionals were expecting one’s presence, functioning as a motivational vehicle. “ We were a small and close team of 3 people and a physiotherapist, and we had some good talks in between about this and that, and I liked that a lot… I wanted to go because the others were there too, and I wanted to keep up… ” (pt no. 18, intervention group) This statement illustrates how informal social interactions within the team contributed to a sense of commitment. The participant’s motivation was anchored in individual health goals but also intertwined with the presence and expectations of others. Another participant emphasised the role of external structure and social accountability: “ It was good for me anyway to join a team because I can’t… Well, you know, pulling yourself together and exercise, yeah… I can do that once or twice, but then… that’s it for me, whereas this… exercising in teams as part of public service, and what’s it called… rehabilitation, and those kinds of things. I’ve attended every time because there were… It meant something that people were waiting for me to be there... I needed to feel like I belonged. ” (pt no. 1, intervention group) This statement reveals the motivational power of being expected and valued within a team, and it covers how participants experienced the (ANONYMISED FOR REVIEW) sessions to support them, also in an emotional way. Discussion The lived experiences of older adults undergoing functional decline revealed an embodied and relational process of navigating everyday life. Even though the bodily functioning was very tangible, the lived experiences with accommodating to the body’s decline were of a processual notion where the person could fall in and out of acceptance according to the contextual or relational setting. Through a phenomenological lens, the lived experiences were not just responses to physical limitations but expressions of how individuals made sense of their changing bodies, relationships, and environments. Our findings emphasised how participants strived to maintain autonomy and a “normal” everyday life, while negotiating increasing dependency, revealing a dynamic interplay between vulnerability and agency. It was this balance between independence and the need for help that challenged the person’s agency and integrity when loss of physical function appeared. Looking through the phenomenological lens, the balancing of independence and the need for help, emphasise the importance of relations, emotional and existential aspects of lived experiences. Incorporating a focus on this complexity may prove beneficial for future research in aging and multimorbidity. Others have found similar results exploring older patients’ lived experiences with multimorbidity. For example, Holland et al. ( 2024 ) support our findings by highlighting the importance of patients’ agency, vulnerability, and existential negotiation. They also emphasise the need for future research to adopt more inclusive and person-centred approaches to multimorbidity, particularly by addressing underrepresented populations and integrating patient and public involvement. Furthermore, they call for conceptual models that incorporate emotional, relational, and existential dimensions of living with multimorbidity, highlighting the importance of holistic care and co-produced knowledge (Holland et al., 2024 ). Our study illustrates how participants experienced a need to reshape their identities, particularly when close relatives assumed caregiving roles. This shift often disrupted familiar relational structures, leading to a sense of disorientation and emotional discomfort, which aligns with the findings of Lei et al. ( 2023 ). In their longitudinal study, Lei et al. ( 2023 ) showed how functional decline increased care needs, especially from family, and highlighted the emotional toll on caregivers. Being cared for by a spouse or child was not neutral; it carried emotional weight, evoking feelings of shame, frustration, and a loss of self. These moments reflected a phenomenological rupture where the familiar became unfamiliar, and the self was experienced as altered through the view and actions of others (Lei et al., 2023 ). In our results, participants narrated on losing their identity when the power structures changed, equivalent to their physical decline which emphasised the importance of considering close relatives in future interventions and treatments. Despite these challenges, we found that participants demonstrated a remarkable capacity for adaptation. They reconfigured their routines, not by abandoning activities but by reshaping them to fit their new bodily realities. This process was not only practical, but also existential. It involved reorientation of time, space, and self, which has also been explored by Ghiglieri et al. (2021) where time itself became a resource, a medium through which autonomy could be preserved. The (ANONYMISED FOR REVIEW) intervention also incorporated reconfiguration of time and resources spent in everyday life. Participants’ adaptations to time and physical functioning are of great importance to consider in future interventions and treatments regarding exercise to older patients with multimorbidity, also highlighted in this study and the (ANONYMISED FOR REVIEW) intervention. The experience of uncertainty was also central. Participants spoke of fear, of falling, of heart flutters, of “something happening.” Participants held back, which was both protective and painful, reflecting a tension between the desire to engage and the need to feel safe (Tsai, 2024 ). The loss of physical functioning and living with multimorbidity, accentuated psychological and social isolation, led to an existential impact on the participants’ everyday life, thus highlighting the paradox in the previous themes regarding independence and help and social aspects and vulnerability. In these situations, Tsai ( 2024 ) call for healthcare professionals to help older people to realise that meaning changes as they age and undergo losses. The (ANONYMISED FOR REVIEW) intervention addresses this need by combining structured exercise with patient education, enabling participants to reframe bodily changes, adapt daily practices, and rediscover meaning in aging despite functional decline. Participants who took part in the (ANONYMISED FOR REVIEW) intervention valued exercising and learning alongside peers. Such settings clearly offer more than physical rehabilitation from exercising sessions; they provide emotional sanctuary as stated by Creighton et al. ( 2022 ) and Royse et al. ( 2023 ) and as provided in the (ANONYMISED FOR REVIEW) study through patient education session. The shared experience of illness when exercising in teams enabled a kind of silent solidarity, where mutual recognition replaced stigma and isolation beyond physical functioning. These lived and shared experiences suggest that interventions like (ANONYMISED FOR REVIEW) do more than support physical function - they respond to the existential needs of older adults. From a phenomenological perspective, such programs honour the complexity of aging, recognizing that the body is not just a biological entity but a lived, relational, and meaning-bearing presence in the world. Securing access to interventions like the (ANONYMISED FOR REVIEW) study could potentially be through new initiatives. As such, our results supported the interview guide used in the ANONYMISED FOR REVIEW (XXX) study, which aimed to improve coordinated care for frail older people with multimorbidity through cross-sectoral video meetings (Anonymised for Review #2, #10). XXX brings together four key parties: the patient and their family, hospital staff, municipal care providers, and the general practitioner. Specifically, the XXX interviews incorporated questions about independence, help from relatives, social relations, and vulnerability - themes that emerged from the (ANONYMISED FOR REVIEW) study. Strengths and limitations A key strength in this study was the application of the phenomenological hermeneutic approach, which enabled a nuanced exploration of emotional, existential, and relational dimensions of multimorbidity. The interpretive process facilitated an understanding of how participants negotiated coherence and autonomy in everyday life. During the interpretive process, data saturation regarding answering the aim, has been an ongoing discussion. The study also has limitations. The findings were context-specific and may not be generalisable to broader populations. Additionally, conducting interviews by phone may have limited the capture of non-verbal cues, potentially affecting the depth of interpretation. The study may be prone to selection and recall bias. Furthermore, participant responses may have been influenced by the interviewer. Conclusion In line with our aim to explore how older patients with multimorbidity experience loss of physical function in their everyday lives, this study suggests that such experiences constitute a complex and challenging journey. The journey of our participants is marked by challenges to identity, autonomy, and relational structures, which underscores that our participants are not only managing physical limitations, but they are also negotiating meaning and integrity within changing life contexts, placing them in an existential crisis. Central to this process is the need for professional support alongside assistance from the personal network. While family caregiving offers practical help, it often disrupts familiar relational dynamics, evoking feelings of shame, frustration, and loss of self. These relational ruptures highlight the necessity of interventions that not only address physical rehabilitation but also attend to emotional and existential dimensions. Our results also indicate that the (ANONYMISED FOR REVIEW) intervention supported participants in living more active lives, not only through physical rehabilitation but by fostering social connectedness. The (ANONYMISED FOR REVIEW) intervention demonstrated the potential of holistic approaches that combined exercise, education, and peer support to meet both physical and psychosocial needs, notions to be considered in future interventions. Co-pilot has been consulted in the development of this conclusion. Declarations Ethics approval and consent to participate The study followed the ethical principles of the Declaration of Helsinki (‘World Medical Association Declaration of Helsinki’, 2013). The Research Ethics Committees of Region Zealand (SJ-857) and the Danish Data Protection Agency (Region Zealand, Denmark, REG-015-2020) approved the (Anonymised for review) study. All authors agree on the translation of quotes from Danish. All participants were informed that their data would be treated confidentially and analysed in anonymised form and that they had the right to withdraw at any given time without consequences. Participants were informed that data would be kept confidential and in accordance with required standards and legislation. Consent for publication Written informed consent for publication was provided by all participants. A confirmatory letter is not applicable. Competing interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Data availability The datasets generated and analyzed during the current study are not publicly available due to Danish legislation but are available from the corresponding author on reasonable request. Funding The MOBILIZE study was funded by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation program (MOBILIZE; grant agreement No 801790), a research program grant from Region Zealand (Exercise First), the Research Fund of Næstved, Slagelse and Ringsted Hospitals, The Danish Regions and The Danish Health Confederation through the Development and Research Fund (project no. 2703), and The Association of Danish Physiotherapists Research Fund. Authors’ contributions Kija Østergaard: Corresponding author, submitting author. Conceptualisation, Methodology, formal analysis, writing: original draft Søren T. Skou: Conceptualisation, Investigation, writing: review and editing, Funding acquisition Alessio Bricca: Conceptualisation, Investigation, writing: review and editing Mette Dideriksen: Conceptualisation, Investigation, writing: review and editing Ditte Høgsgaard: Writing: review and editing Charlotte Simonÿ: Conceptualisation, Investigation, Methodology, writing: review and editing, Funding acquisition, Supervision Acknowledgements Thank you to the MOBILIZE patient partners who helped develop the interview guide for the interviews. And a special thank you to all patients who invited us into their everyday lives. Also thank you to Linda Hvass Støving (MHSc, BN) who originally conducted and transcribed the interviews. We would also like to thank the scientific advisory board, the study funders, the recruitment centres, healthcare providers and everyone involved in conducting the MOBILIZE study. Authors’ information Complete mailing and e-mail addresses: Kija Østergaard The Research and Implementation Unit PROgrez Department of Physiotherapy and Occupational Therapy Central and West Zealand Hospital Fælledvej 6 4200 Slagelse Denmark e-mail address: [email protected] Phone number: +45 2174 8322 Corresponding author ORCID ID 0000-0001-8211-0999 Søren Thougaard Skou The Research and Implementation Unit PROgrez Department of Physiotherapy and Occupational Therapy Central and West Zealand Hospital Fælledvej 6 4200 Slagelse Denmark Center for Muscle and Joint Health Dept. of Sports Science and Clinical Biomechanics The Faculty of Health Sciences University of Southern Denmark Campusvej 55 5230 Odense M Denmark e-mail address: [email protected] ORCID ID 0000-0003-4336-7059 Alessio Bricca Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics University of Southern Denmark Denmark ORCID ID 0000-0001-9717-918X e-mail address: [email protected] Mette Dideriksen The Research and Implementation Unit PROgrez Department of Physiotherapy and Occupational Therapy Central and West Zealand Hospital Fælledvej 6 4200 Slagelse Denmark e-mail address: [email protected] Ditte Høgsgaard The Research and Implementation Unit PROgrez Department of Physiotherapy and Occupational Therapy Central and West Zealand Hospital Fælledvej 6 4200 Slagelse Denmark Institute of Regional Health Research Faculty of Health University of Southern Denmark Campusvej 55 5230 Odense M Denmark Primary and e-health Care Region Zealand Sorø Denmark e-mail address: [email protected] https://orcid.org/0000-0003-2752-881X Charlotte Simonÿ The Research and Implementation Unit PROgrez Department of Physiotherapy and Occupational Therapy Central and West Zealand Hospital Fælledvej 6 4200 Slagelse Denmark Institute of Regional Health Research Faculty of Health University of Southern Denmark Campusvej 55 5230 Odense M Denmark e-mail address: [email protected] ORCID: https://orcid.org/0000-0003-1189-2967 References Anonymised for Review #1. Anonymised for Review #2. Anonymised for Review #3. Anonymised for Review #4. Anonymised for Review #5. Anonymised for Review #6. Anonymised for Review #7. Anonymised for Review #8. Anonymised for Review #9. Anonymised for Review #10. Bayliss, E. A., Ellis, J. L. & Steiner, J. F. Seniors’ self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. J. Clin. Epidemiol. 62 (5), 550–557e1. https://doi.org/10.1016/j.jclinepi.2008.05.002 (2009). Beck, M. The Patient’s Voice in the Development of Complex Interventions. Iris J. Nursing Care . 3 (3). https://doi.org/10.33552/IJNC.2020.03.000564 (2020). Carlson, D. M. & Yarns, B. C. Managing medical and psychiatric multimorbidity in older patients. Therapeutic Adv. Psychopharmacol. 13 , 20451253231195274. https://doi.org/10.1177/20451253231195274 (2023). Creighton, R. M., Paradis, K. F., Blackburn, N. E. & Tully, M. A. Group-Based Physical Activity Interventions Targeting Enjoyment in Older Adults: A Systematic Review. J. Ageing Longev. 2 (2), 113–129. https://doi.org/10.3390/jal2020011 (2022). European Commission. Statistical Office of the European Union. Ageing Europe: Looking at the lives of older people in the EU : 2020 edition. Publications Office. https://data.europa.eu/doi/ (2020). 10.2785/628105 Forsyth, F. et al. Exercise Modalities in Multi-Component Interventions for Older adults with Multi-Morbidity: A Systematic Review and Narrative Synthesis. The J. Frailty Aging . 13 (4), 341–348. https://doi.org/10.14283/jfa.2024.28 (2024). Frølich, A., Olesen, F. & Kristensen, I. Hvidbog om MULTISYGDOM: Dokumentation af multisygdom i det danske samfund—Fra silotænkning til sammenhæng (1. udgave). Fjerritslev Tryk A/S. (2017). https://www.cachet.dk/-/media/sites/cachet/about/reports-papers-and-other-resources/hvidbog-om-multisygdom/multisygdom_hvidbog_2017.pdf Holland, E. et al. The impact of living with multiple long-term conditions (multimorbidity) on everyday life – a qualitative evidence synthesis. BMC Public. Health . 24 (1), 3446. https://doi.org/10.1186/s12889-024-20763-8 (2024). Kvale, S. & Brinkmann, S. Interview: Det kvalitative forskningsinterview som håndværk (Bjørn Nake, Trans.; 3. udgave). Hans Reitzel. (2022). Lei, L., Maust, D. T. & Leggett, A. N. Functional Decline Over Time and Change in Family and Other Unpaid Care Provided to Community-Dwelling Older Adults Living With and Without Dementia. Journals Gerontology: Ser. B . 78 (10), 1727–1734. https://doi.org/10.1093/geronb/gbad107 (2023). Moore, G. F. et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ 350 (mar19 6), h1258–h1258. https://doi.org/10.1136/bmj.h1258 (2015). Ricœur, P. Interpretation theory: Discourse and the surplus of meaning (5. print). Texas Christian Univ. Pr. (1976). https://books.google.dk/books?hl=da&lr=&id=TS98mJVaxqIC&a mp;oi=fnd&pg=PR11&dq=Ricoeur,+P.+1976.+Interpretation+Theory:+Discourse+and+ the+Surplus+of+Meaning.+5th+ed.+T exas+Christian+University+Press.& ;ots=hRn4ZAO5hR&sig=ka9AFdtEe9J RwFA_fAsOjHEWXAY&redir_esc=y#v= onepage&q&f=false Royse, L. A. et al. It’s not time for us to sit down yet: How group exercise programs can motivate physical activity and overcome barriers in inactive older adults. Int. J. Qualitative Stud. Health Well-Being . 18 (1), 2216034. https://doi.org/10.1080/17482631.2023.2216034 (2023). Skivington, K. et al. A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. BMJ , n2061. (2021). https://doi.org/10.1136/bmj.n2061 Smith, S. M., Wallace, E., Clyne, B., Boland, F. & Fortin, M. Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: A systematic review. Syst. Reviews . 10 (1), 271. https://doi.org/10.1186/s13643-021-01817-z (2021). Tong, A., Sainsbury, P. & Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care . 19 (6), 349–357. https://doi.org/10.1093/intqhc/mzm042 (2007). Tsai, G. Aging Meaningfully: The Ethics of Existential Suffering for Older Adults in Healthcare. Can. J. Bioeth. 7 (2–3), 138–149. https://doi.org/10.7202/1112285ar (2024). Additional Declarations No competing interests reported. Supplementary Files Appendix1anonymisedforreview.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 05 Apr, 2026 Reviewers invited by journal 05 Apr, 2026 Editor assigned by journal 05 Apr, 2026 Editor invited by journal 13 Feb, 2026 Submission checks completed at journal 12 Feb, 2026 First submitted to journal 12 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8783794","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":619510775,"identity":"70c8c779-f967-4e8b-a998-29b1f7178a9f","order_by":0,"name":"Kija Østergaard","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYBACCXYGxgdAmgfEMWBgsJAB0zwH8GhhZmA2QNIiwUOMFjYJZD5hLZLNzMeqKypqZfil2x8U/KiQ4OGf3byB4c0Z3FqkmdnSbp45c5xHcs4ZA8OeMxI8EneOFTDOuYFbixwzj9nNxrZjPAY3chgMeNuADruRY8DM8wG/lsLGfyAt6Q8M//6T4JEnpEUaqIWxsaEGqCXBwJi3QQJkHVALHodJNrMlSzYcO8AjOSPHwFjmmASP4Y20goNz8Hhf4njzwY8NNXX2/BLpzwzf1NjIyd1I3vjgzTHcWqDgMIhgM4BxDxDUwMBQByKYHxChchSMglEwCkYgAAD+9E3AX010zQAAAABJRU5ErkJggg==","orcid":"","institution":"Research and Implementation Unit PROgrez, Central and West Zealand Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kija","middleName":"","lastName":"Østergaard","suffix":""},{"id":619510777,"identity":"7ee0c393-dd63-48cf-823f-ba43eb3f4f68","order_by":1,"name":"Søren Thorgaard Skou","email":"","orcid":"","institution":"Research and Implementation Unit PROgrez, Central and West Zealand Hospital","correspondingAuthor":false,"prefix":"","firstName":"Søren","middleName":"Thorgaard","lastName":"Skou","suffix":""},{"id":619510779,"identity":"3d57c634-8960-42a0-a577-d452ce78b4fa","order_by":2,"name":"Alessio Bricca","email":"","orcid":"","institution":"University of Southern Denmark","correspondingAuthor":false,"prefix":"","firstName":"Alessio","middleName":"","lastName":"Bricca","suffix":""},{"id":619510781,"identity":"cfb2c16f-766c-422f-a4ea-e2644cb52cd9","order_by":3,"name":"Mette Dideriksen","email":"","orcid":"","institution":"Research and Implementation Unit PROgrez, Central and West Zealand Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mette","middleName":"","lastName":"Dideriksen","suffix":""},{"id":619510783,"identity":"49e3d3c1-ecec-4495-82c4-68e89bb4d6f5","order_by":4,"name":"Ditte Høgsgaard","email":"","orcid":"","institution":"Research and Implementation Unit PROgrez, Central and West Zealand Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ditte","middleName":"","lastName":"Høgsgaard","suffix":""},{"id":619510784,"identity":"558a970f-04c1-470c-82dc-21b362888d28","order_by":5,"name":"Charlotte Simonÿ","email":"","orcid":"","institution":"Research and Implementation Unit PROgrez, Central and West Zealand Hospital","correspondingAuthor":false,"prefix":"","firstName":"Charlotte","middleName":"","lastName":"Simonÿ","suffix":""}],"badges":[],"createdAt":"2026-02-04 08:38:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8783794/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8783794/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106726034,"identity":"8172e390-57fe-4ac3-885d-a306253411df","added_by":"auto","created_at":"2026-04-12 18:35:01","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30138,"visible":true,"origin":"","legend":"\u003cp\u003eThe analysis moved between understanding and explanation in a dialectical movement back and forth between the three phases (XXX)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8783794/v1/c03db92f24775fead52a55a9.png"},{"id":106596566,"identity":"26ebf9da-cfb3-4b7a-8227-36dc03503bc9","added_by":"auto","created_at":"2026-04-10 09:37:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":92100,"visible":true,"origin":"","legend":"\u003cp\u003eBalancing loss of physical function in elderly patients - sub-themes\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8783794/v1/370969454b8dcc5400dba01c.png"},{"id":106727568,"identity":"6d9153e2-f46e-42b0-b8f8-08d3a741eb93","added_by":"auto","created_at":"2026-04-12 18:39:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":781601,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8783794/v1/6870b661-d0b1-49a4-8d1c-f052ccd338b8.pdf"},{"id":106596564,"identity":"22b76569-7bcf-414f-adbb-700da1a57a64","added_by":"auto","created_at":"2026-04-10 09:37:38","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":89279,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1anonymisedforreview.docx","url":"https://assets-eu.researchsquare.com/files/rs-8783794/v1/7ff6590e6173d5dc90c245bf.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Balancing Loss of Physical Function in Older Adults’ Everyday Lives with Multimorbidity - a qualitative study","fulltext":[{"header":"Background","content":"\u003cp\u003eThis qualitative study explores how older people with multimorbidity experience loss of physical function in their everyday lives and how the (Anonymised for Review) study supported them in living more active lives.\u003c/p\u003e \u003cp\u003eAs people age, everyday life often becomes more complex, shaped not only by routines and relationships, but increasingly by the presence of chronic diseases and multimorbidity (European Commission. Statistical Office of the European Union., 2020; Frølich et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Multimorbidity is defined as two or more coexisting conditions in the same patient and is associated with lower quality of life, physical and cognitive function, and premature death (Anonymised for Review #7). For many older patients, living with multimorbidity means adjusting to physical limitations, navigating care systems, and finding new ways to maintain a sense of self and independence (Holland et al., \u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e). Still, to our knowledge, little is known about the experienced physical challenges of older patients with multimorbidity following hospitalisation - a critical knowledge gap that calls for further exploration.\u003c/p\u003e \u003cp\u003eMultimorbidity management is characterised by being patient-centred without giving priority to one condition (Anonymised for Review #7). Nevertheless, there is a lack of evidence on how to manage multimorbidity effectively (Anonymised for Review #8, #9). Few interventions are tailored to the specific needs, preferences, or participation barriers of people with multimorbidity. Decisions about intervention components are often based on practitioner intuition rather than patient-centred rationale. This underscores a persistent gap in the field: the lack of integration of older patients’ lived experiences and perspectives into intervention design. Carlson and Yarns (\u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e) call for more nuanced, person-centred approaches that consider the relational and existential dimensions and recognise the individual lived experience of aging with multimorbidity, dimensions that a Ricoeur-inspired interpretive framework is uniquely positioned to explore. Also calling for a more person-centred approach are Forsyth et al. (\u003cspan class=\"CitationRef\"\u003e2024\u003c/span\u003e) who critically examines exercise modalities in multi-component interventions for older adults with multimorbidity. The review notes that few interventions are tailored to the specific needs, preferences, or participation barriers of this population. Decisions about exercise components were often based on practitioner intuition rather than patient-centred rationale. This underscores a persistent gap in the field: the lack of integration of older patients’ lived experiences and perspectives into intervention design. Smith et al. (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) emphasised that individuals with multimorbidity, especially older adults, face substantial challenges, including loss of physical functioning, psychological stress, and treatment burden due to polypharmacy, multiple healthcare appointments, and a fragmented care system. In their systematic review, Smith et al. (\u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e) concluded that there is still uncertainty about the effectiveness of interventions for multimorbidity, and the evidence is low due to heterogeneity in populations and interventions. Along this line, we propose that knowledge of the lived life with physical deterioration is imperative for qualifying future interventions (Moore et al., \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e; Skivington et al., \u003cspan class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs part of the Danish (ANONYMISED FOR REVIEW) study (Anonymised for Review #1, #8), we aim to give voice to older patients with multimorbidity (Beck, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). (ANONYMISED FOR REVIEW) investigated whether a 12-week personalised exercise therapy and self-management support program for people with multimorbidity was superior to usual care alone in improving HRQoL at 12 months (Anonymised for Review #8, #9).\u003c/p\u003e \u003cp\u003eHence, we aim to explore how older patients with multimorbidity experience loss of physical function in their everyday lives, and whether the (ANONYMISED FOR REVIEW) intervention supported the participants in living more active lives.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe aim of this study was to explore how older patients with multimorbidity experience loss of physical function in their everyday lives, and whether the (ANONYMISED FOR REVIEW) intervention supported the participants in living more active lives.\u003c/p\u003e\u003cp\u003eWithin a phenomenological hermeneutic approach, we conducted individual interviews inspired by Kvale and Brinkmann (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e), and data were analysed inspired by Ricoeur (Ricœur, \u003cspan class=\"CitationRef\"\u003e1976\u003c/span\u003e; Anonymised for Review #3, #4, #6). The reporting adheres to the 32-item checklist for qualitative research from the consolidated criteria for reporting qualitative research (COREQ) (Tong et al., \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eParticipants\u003c/p\u003e\u003cp\u003eParticipants in both the intervention and control groups were invited through their participation in the (ANONYMISED FOR REVIEW) study (Anonymised for Review #1, #8). Among other eligibility criteria patients had to have at least two specified chronic conditions and a high disease burden to be included in (ANONYMISED FOR REVIEW) (Anonymised for Review #4), As defined by the Bayliss Disease Burden scale (Bayliss et al., \u003cspan class=\"CitationRef\"\u003e2009\u003c/span\u003e). Forty-seven patients were assessed for eligibility for this interview study, between August 1 to November 10, 2023. Verbal information about the study was given by phone, followed by an invitation letter to potential participants. Recruitment was ongoing until ten participants randomised to the (ANONYMISED FOR REVIEW) intervention and ten participants randomised to usual care alone were included to ensure that experiences among both groups were considered. No significant differences in gender, age (65 to 89 years old) and number or burden of illnesses in either group.\u003c/p\u003e\u003cp\u003eInterviews\u003c/p\u003e\u003cp\u003eTo ensure a comprehensive exploration of the participants' lived experiences and perspectives, the interviews were conducted using a semi-structured guide. The structure allowed for a pragmatic coverage of key domains while maintaining flexibility for participants to elaborate on issues of personal relevance. Open-ended questions were employed to foster depth and richness in responses, consistent with the phenomenological approach outlined by Kvale \u0026amp; Brinkmann (\u003cspan class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe interview guide (appendix 1) was refined and piloted by four (ANONYMISED FOR REVIEW) patient partners and pilot-tested with individuals resembling the group of included participants in two iterations to ensure the appropriateness of questions. The interviews, conducted by phone, lasted between 24 and 56 minutes, were audio-recorded, and transcribed into a total of 195 pages.\u003c/p\u003e\u003cp\u003eAnalysis\u003c/p\u003e\u003cp\u003eRicoeur’s phenomenological hermeneutic approach is a rich and nuanced method of interpreting human experience, especially in texts, language, and action. It blends phenomenology (the study of lived experience) with hermeneutics (the theory of interpretation), creating a framework that is both descriptive and interpretive (Ricœur, \u003cspan class=\"CitationRef\"\u003e1976\u003c/span\u003e). The data was analysed in a three-levelled process as illustrated in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e(Anonymised for Review #3, #4, #6).\u003c/p\u003e\u003cp\u003eThe first author (XXX) conducted a naïve reading to capture an initial understanding of the complete dataset. During this process, significant units of meaning were identified. Next, the first and last authors (XXX and XX) conducted a structural analysis together, in which we identified units of significance, sub-themes and themes. All authors discussed and refined the content, agreeing on the presentation, which is presented in the results section, with the inclusion of selected quotes.\u003c/p\u003e\u003cp\u003eFinally, we conducted a critical interpretation and discussion. The first author (XXX) initiated this and then discussed it in the author group. Here the findings were interpreted again with the inclusion of other research and brought from the individual to a universal level. This is what Ricoeur terms a sophisticated understanding (Ricœur, \u003cspan class=\"CitationRef\"\u003e1976\u003c/span\u003e). This part is outlined in the discussion section.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, four overall themes were identified, highlighting the lived experiences with loss of physical function in older patients with multimorbidity.\u003c/p\u003e \u003cp\u003eThe overall impression from the na\u0026iuml;ve reading reflects that participants experienced emotional and existential disruption due to physical deterioration. This had a seemingly deep emotional impact, threatening their sense of identity and integrity; financial disparity in coping, creative adaptation, and social and embodied reorientation with social structures like group exercise therapy and self-management sessions offering vital support.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eBalancing everyday life \u0026ndash; between independence and the need for help\u003c/h2\u003e \u003cp\u003eParticipants strived to maintain a certain level of independence. On the other hand, they experienced an increased need for help. They struggled with balancing their integrity as their close relatives also became their informal caregivers. They experienced economic challenges related to acquiring aid to maintain independence when public healthcare failed to help.\u003c/p\u003e \u003cp\u003eBalancing the role as an informal caregiver and relative\u003c/p\u003e \u003cp\u003eParticipants struggled with experiencing their close relative as both positive and negative \u0026lsquo;support\u0026rsquo; regarding the physical decline. Even though the help needed was close by, it overstepped relational borders. When this happened, participants were bothered, feeling deprived of their autonomy. The power structures in the relationship changed and could even be perceived as patronising. One described it with:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;well, my wife really wants to help. She\u0026rsquo;s so keen to support me, but really, sometimes it\u0026rsquo;s like, you know, well, she encourages me to go for a ride on the bike or \u0026lsquo;let\u0026rsquo;s go for a walk\u0026rsquo; or something like that. [\u0026hellip;] it\u0026rsquo;s more of a nuisance, but what do you do when it\u0026rsquo;s your nearest and dearest\u0026hellip; If they keep suggesting this or that, right? Well, that\u0026rsquo;s when I become like a 5-year-old, you know\u0026hellip;\u0026rdquo;\u003c/em\u003e (pt no. 1, intervention group)\u003c/p\u003e \u003cp\u003eThis person knew that his wife wanted to support him and appeared to be his personal cheerleader. But at some point, he experienced his wife\u0026rsquo;s encouragement as (s)mothering.\u003c/p\u003e \u003cp\u003eA change in power structure also appeared in the relationship between participants and their children. One described it in this way:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eEven though my daughter is a nurse, I don\u0026rsquo;t always feel like she sees me as anything but a patient.\u003c/em\u003e\u0026rdquo; (pt not. 5, control group)\u003c/p\u003e \u003cp\u003eThe quotes illustrate aggravation and how participants experienced relatives took charge of the actions which felt as a loss of integrity.\u003c/p\u003e \u003cp\u003eBalancing economic (in-)equality in health\u003c/p\u003e \u003cp\u003eSome participants highlighted how financial limitations impeded their ability to engage in physical exercise and acquire necessary healthcare aids. These constraints not only affected their physical well-being but also contributed to challenges in social participation and autonomy. Due to their loss of physical function, they also experienced limitations regarding transportation to healthcare, physical activities etc.:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;I haven\u0026rsquo;t asked for any other help than for my arthritis, to get some exercise. And then you are told that \u0026lsquo;you can pay for it yourself\u0026rsquo;.\u0026rdquo;\u003c/em\u003e (pt no. 9, intervention group)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I would really love to be able to get out of the house. And I wish I could get some help to pay for a motorized wheelchair or what\u0026rsquo;s it called. [\u0026hellip;] That way, you\u0026rsquo;re in the game, you know.\u0026rdquo;\u003c/em\u003e (pt no. 6, intervention group)\u003c/p\u003e \u003cp\u003eEconomic constraints limited these participants\u0026rsquo; access to essential health services and aids. They disclosed that these limitations restrained physical health outcomes and contributed to social isolation and reduced health-related quality of life.\u003c/p\u003e \u003cp\u003eIn contrast, other participants described their ability to adapt to physical limitations through personal financial investments. They adapted their environment to their physical functions and not the other way around, which allowed them to avoid social isolation and maintain their quality of life.\u003c/p\u003e \u003cp\u003eThese participants changed the exterior setting to their physical capabilities instead of changing themselves. They managed to keep their independence, though it required resources both economically and mentally. One example was:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWe had to get a new car. We had a car with a low entrance, making it difficult for me to get in and out. And\u0026hellip;It\u0026rsquo;s these kinds of things\u0026hellip;\u003c/em\u003e [\u0026hellip;] \u003cem\u003eFor example, this year we\u0026rsquo;re going to Portugal. We\u0026rsquo;ve chosen a group trip on a cruise ship down the Douro River. This way, my husband can go with the others on those day trips instead of going alone, and then get to do some sightseeing. And I can stay on the boat. It\u0026rsquo;s these kinds of things we must plan.\u003c/em\u003e\u0026rdquo; (pt no. 8, control group)\u003c/p\u003e \u003cp\u003eIn sum, the participants experienced the financial aspects with stark contrast. While some individuals could afford to modify their environment or lifestyle to accommodate their health needs, others were left without basic support.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAdapting to a new everyday life – maintaining a sense of coherence\u003c/h3\u003e\n\u003cp\u003eLiving with pain and loss of daily function led participants to adopt workarounds to cope and maintain a sense of coherence, thereby supporting integrity. Hereby, they strived to maintain a \u0026ldquo;normal\u0026rdquo; everyday life. Cleaning was a central task related to physical functions, which somehow represented a sense of \u0026ldquo;keeping up appearances\u0026rdquo; or \u0026ldquo;normal everyday life\u0026rdquo;.\u003c/p\u003e \u003cp\u003eAdapting to constraints in physical functions - Workarounds\u003c/p\u003e \u003cp\u003e Participants articulated a process of adaptation that was both pragmatic and emotionally grounded, reflecting a change of routines rather than compromising their integrity. Instead of abandoning previously enjoyed or habitual activities, participants described a shift in \u003cem\u003ehow\u003c/em\u003e these activities are performed. This reflected a form of resilient continuity, where the essence of the activity remained intact, but its structure was reshaped to accommodate new bodily constraints.\u003c/p\u003e \u003cp\u003eParticipants disclosed how they did what they liked to do and were used to doing before their physical decline, only differently. Breaking tasks up and taking breaks enabled participants to handle the task themselves, although it required planning and patience. One explained:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip; you know, I\u0026rsquo;ve gradually gotten used to it. That\u0026rsquo;s just what I have to do, otherwise I can\u0026rsquo;t cope. And as long as I can plan things, the 'dose' so to speak fits, right? But if I have too much going on, then I get tired and grumpy. But I've kind of factored that into my everyday routine.\u0026rdquo;\u003c/em\u003e (pt no. 2, intervention group)\u003c/p\u003e \u003cp\u003eAnother participant reflected on the awareness of the dynamics in adapting to a new situation and the physical capacity:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Previously, I went to music festivals and things like that, but that\u0026rsquo;s not an option anymore, unless I can bring a chair to sit on. I can\u0026rsquo;t stand up for long periods. So, we\u0026rsquo;ve chosen this way now. We participate in concerts for an hour, where we can sit down, watch and listen.\u0026rdquo;\u003c/em\u003e (pt no. 8, control group)\u003c/p\u003e \u003cp\u003eThis covers how participants made strategic modifications that preserved autonomy, identity, and engagement. These adaptations were not only compensatory but reflected a creative reconfiguration of everyday life, enabling them to maintain a sense of normalcy or coherence and purpose despite losing physical functions.\u003c/p\u003e \u003cp\u003eAdapting to a new pace\u003c/p\u003e \u003cp\u003e Participants also acknowledged the importance of taking their time and doing the things that they liked at a new pace. Accepting that things took longer to accomplish and respecting physical restraints without overdoing them allowed them to continue doing the things they enjoyed. They addressed the practical adjustments, learning to navigate their routines with a greater sense of patience and acceptance of slowness. They came to recognize that time became a resource which allowed them to preserve autonomy and participation in meaningful activities. One stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t mow the lawn in one go [\u0026hellip;] I break it up in two laps, then I can manage it.\u0026rdquo;\u003c/em\u003e (pt no. 1, intervention group)\u003c/p\u003e \u003cp\u003eOthers described how they for instance began to pay attention to where benches were placed in the public spaces and used health aids when needed, such as magnifying glasses and speech recognition software.\u003c/p\u003e \u003cp\u003eIt was emotionally demanding for participants to adapt to a new pace; nevertheless, crucial, as one said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You can\u0026rsquo;t push yourself. If you can\u0026rsquo;t do it, then you just can\u0026rsquo;t. It takes as much time as it takes, and you simply have to learn that. It was a highly difficult thing to learn for me.\u0026rdquo;\u003c/em\u003e (pt no. 9, intervention group)\u003c/p\u003e \u003cp\u003e Despite this haze, participants reflected a strategic and meaningful reconfiguration of daily practices. They adjusted to keep up engaging in valued activities, which gave a sense of resilience and agency.\u003c/p\u003e\n\u003ch3\u003eUncertainties in everyday life\u003c/h3\u003e\n\u003cp\u003eParticipants experienced the decline in physical functioning as distressing. Some experienced that the decline in physical functioning even caused accidents such as falling, heart flutters or alike, which made them insecure \u0026ndash; what if it would happen again? The loss of functioning not only reshaped their physical capabilities but also their psychological landscape and social engagement. As the world around them seemingly \"became smaller,\" their sense of agency and safety diminished, leading to a feeling of uncertainty and a cascade of emotional and behavioural adaptations.\u003c/p\u003e \u003cp\u003eParticipants experienced being afraid to participate in activities or social events because they feared \u0026ldquo;something would happen\u0026rdquo; due to the physical dysfunction. They held back from participating \u0026ldquo;just in case,\u0026rdquo; which made them feel like they were missing out. This fear was not merely a reaction to isolated incidents but a chronic state of apprehension that influenced decision-making and participation in everyday activities. The anticipation of potential harm leads participants into a pattern of self-restriction and social withdrawal. One said:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI\u0026rsquo;m afraid of falling and\u0026hellip; I also feel unstable\u0026hellip; I really do\u0026hellip;\u003c/em\u003e\u0026rdquo; (pt no. 4, intervention group)\u003c/p\u003e \u003cp\u003eAnother said:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWell, I\u0026rsquo;m very careful about that. You know, if I feel the slightest little thing, then I hold back, you could say [\u0026hellip;] Basically, I hold back. Also, because I don\u0026rsquo;t want to risk getting heart flutters again, I would rather hold back. I hold back physically with many things because of that.\u003c/em\u003e\u0026rdquo; (pt no. 15, control group)\u003c/p\u003e \u003cp\u003e Here, the participants describe an increased sensitivity to bodily sensations, which acted as a trigger for avoidance behaviour. This cautiousness, while protective, also contributed to a narrowing of life experiences. The phrase \u0026ldquo;I hold back\u0026rdquo; was repeated, underscoring the internal conflict between the desire to act and the fear of doing so. As such, the participants experienced bodily uncertainty to accentuate psychological and social isolation.\u003c/p\u003e\n\u003ch3\u003eA sense of community among the (ANONYMISED FOR REVIEW) intervention participants\u003c/h3\u003e\n\u003cp\u003e Participants in the intervention group disclosed how taking part in the (ANONYMISED FOR REVIEW) sessions provided them with vital social connectedness. Exercising in teams fostered a sense of community, belonging, and mutual understanding.\u003c/p\u003e \u003cp\u003eParticipants found community in illness\u003c/p\u003e \u003cp\u003e Engaging in physical activity alongside others with similar health challenges fostered a meaningful sense of solidarity among participants. Exercising with peers made it easier to adhere to routines and created a space of mutual understanding. Participants described a sense of relief in being among others who shared the lived experience of illness and functional decline. This shared context reduced the need for explanation and allowed individuals to \u0026ldquo;be themselves,\u0026rdquo; fostering acceptance and psychological safety.\u003c/p\u003e \u003cp\u003eParticipants in the (ANONYMISED FOR REVIEW) intervention reported finding it easier to maintain exercise routines when surrounded by individuals who understood the lived realities of functional decline. This shared context diminished the need for explanation or justification, allowing individuals to \u0026ldquo;be themselves\u0026rdquo;.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eBut when we are together, you know, there\u0026rsquo;re other people besides me with COPD, right? That\u0026rsquo;s kind of nice.\u003c/em\u003e\u0026rdquo; (pt no. 4, intervention group)\u003c/p\u003e \u003cp\u003e The group setting provided a form of emotional and existential relief. Being among others who could relate to the experience of illness, loss of physical function, and symptom burden created a sense of ease.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWell, I think that participating in (ANONYMISED FOR REVIEW) was good for me. I got better and I was on a team with people who had the same illnesses as me, and so\u0026hellip; we all understood each other\u0026rsquo;s functional limitations. It was really nice.\u003c/em\u003e\u0026rdquo; (pt no. 2, intervention group)\u003c/p\u003e \u003cp\u003eThis narrative highlights the dual impact of physical improvement and social cohesion. The participant emphasises the therapeutic value of mutual understanding as a central component of the positive experience.\u003c/p\u003e \u003cp\u003e In sum, participants found that engaging in physical activity within a group of peers fostered a profound sense of solidarity, acceptance, and psychological safety. The shared experience of illness and functional decline reduced the need for explanation, allowing individuals to feel understood and \u0026ldquo;be themselves.\u0026rdquo; This mutual recognition not only supported sustained exercise participation but also alleviated feelings of isolation and stigma, highlighting the therapeutic value of relational and community-based approaches in chronic disease management.\u003c/p\u003e \u003cp\u003eCommunity in teams\u003c/p\u003e \u003cp\u003eThe act of leaving one\u0026rsquo;s home to engage in exercise was made easier by the knowledge that both peers and professionals were expecting one\u0026rsquo;s presence, functioning as a motivational vehicle.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWe were a small and close team of 3 people and a physiotherapist, and we had some good talks in between about this and that, and I liked that a lot\u0026hellip; I wanted to go because the others were there too, and I wanted to keep up\u0026hellip;\u003c/em\u003e\u0026rdquo; (pt no. 18, intervention group)\u003c/p\u003e \u003cp\u003eThis statement illustrates how informal social interactions within the team contributed to a sense of commitment. The participant\u0026rsquo;s motivation was anchored in individual health goals but also intertwined with the presence and expectations of others.\u003c/p\u003e \u003cp\u003eAnother participant emphasised the role of external structure and social accountability:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eIt was good for me anyway to join a team because I can\u0026rsquo;t\u0026hellip; Well, you know, pulling yourself together and exercise, yeah\u0026hellip; I can do that once or twice, but then\u0026hellip; that\u0026rsquo;s it for me, whereas this\u0026hellip; exercising in teams as part of public service, and what\u0026rsquo;s it called\u0026hellip; rehabilitation, and those kinds of things. I\u0026rsquo;ve attended every time because there were\u0026hellip; It meant something that people were waiting for me to be there... I needed to feel like I belonged.\u003c/em\u003e\u0026rdquo; (pt no. 1, intervention group)\u003c/p\u003e \u003cp\u003e This statement reveals the motivational power of being expected and valued within a team, and it covers how participants experienced the (ANONYMISED FOR REVIEW) sessions to support them, also in an emotional way.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe lived experiences of older adults undergoing functional decline revealed an embodied and relational process of navigating everyday life. Even though the bodily functioning was very tangible, the lived experiences with accommodating to the body\u0026rsquo;s decline were of a processual notion where the person could fall in and out of acceptance according to the contextual or relational setting. Through a phenomenological lens, the lived experiences were not just responses to physical limitations but expressions of how individuals made sense of their changing bodies, relationships, and environments.\u003c/p\u003e \u003cp\u003eOur findings emphasised how participants strived to maintain autonomy and a \u0026ldquo;normal\u0026rdquo; everyday life, while negotiating increasing dependency, revealing a dynamic interplay between vulnerability and agency. It was this balance between independence and the need for help that challenged the person\u0026rsquo;s agency and integrity when loss of physical function appeared. Looking through the phenomenological lens, the balancing of independence and the need for help, emphasise the importance of relations, emotional and existential aspects of lived experiences. Incorporating a focus on this complexity may prove beneficial for future research in aging and multimorbidity. Others have found similar results exploring older patients\u0026rsquo; lived experiences with multimorbidity. For example, Holland et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) support our findings by highlighting the importance of patients\u0026rsquo; agency, vulnerability, and existential negotiation. They also emphasise the need for future research to adopt more inclusive and person-centred approaches to multimorbidity, particularly by addressing underrepresented populations and integrating patient and public involvement. Furthermore, they call for conceptual models that incorporate emotional, relational, and existential dimensions of living with multimorbidity, highlighting the importance of holistic care and co-produced knowledge (Holland et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study illustrates how participants experienced a need to reshape their identities, particularly when close relatives assumed caregiving roles. This shift often disrupted familiar relational structures, leading to a sense of disorientation and emotional discomfort, which aligns with the findings of Lei et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In their longitudinal study, Lei et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) showed how functional decline increased care needs, especially from family, and highlighted the emotional toll on caregivers. Being cared for by a spouse or child was not neutral; it carried emotional weight, evoking feelings of shame, frustration, and a loss of self. These moments reflected a phenomenological rupture where the familiar became unfamiliar, and the self was experienced as altered through the view and actions of others (Lei et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). In our results, participants narrated on losing their identity when the power structures changed, equivalent to their physical decline which emphasised the importance of considering close relatives in future interventions and treatments.\u003c/p\u003e \u003cp\u003eDespite these challenges, we found that participants demonstrated a remarkable capacity for adaptation. They reconfigured their routines, not by abandoning activities but by reshaping them to fit their new bodily realities. This process was not only practical, but also existential. It involved reorientation of time, space, and self, which has also been explored by Ghiglieri et al. (2021) where time itself became a resource, a medium through which autonomy could be preserved. The (ANONYMISED FOR REVIEW) intervention also incorporated reconfiguration of time and resources spent in everyday life. Participants\u0026rsquo; adaptations to time and physical functioning are of great importance to consider in future interventions and treatments regarding exercise to older patients with multimorbidity, also highlighted in this study and the (ANONYMISED FOR REVIEW) intervention.\u003c/p\u003e \u003cp\u003eThe experience of uncertainty was also central. Participants spoke of fear, of falling, of heart flutters, of \u0026ldquo;something happening.\u0026rdquo; Participants held back, which was both protective and painful, reflecting a tension between the desire to engage and the need to feel safe (Tsai, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The loss of physical functioning and living with multimorbidity, accentuated psychological and social isolation, led to an existential impact on the participants\u0026rsquo; everyday life, thus highlighting the paradox in the previous themes regarding independence and help and social aspects and vulnerability. In these situations, Tsai (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) call for healthcare professionals to help older people to realise that meaning changes as they age and undergo losses. The (ANONYMISED FOR REVIEW) intervention addresses this need by combining structured exercise with patient education, enabling participants to reframe bodily changes, adapt daily practices, and rediscover meaning in aging despite functional decline.\u003c/p\u003e \u003cp\u003eParticipants who took part in the (ANONYMISED FOR REVIEW) intervention valued exercising and learning alongside peers. Such settings clearly offer more than physical rehabilitation from exercising sessions; they provide emotional sanctuary as stated by Creighton et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and Royse et al. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and as provided in the (ANONYMISED FOR REVIEW) study through patient education session. The shared experience of illness when exercising in teams enabled a kind of silent solidarity, where mutual recognition replaced stigma and isolation beyond physical functioning. These lived and shared experiences suggest that interventions like (ANONYMISED FOR REVIEW) do more than support physical function - they respond to the existential needs of older adults. From a phenomenological perspective, such programs honour the complexity of aging, recognizing that the body is not just a biological entity but a lived, relational, and meaning-bearing presence in the world.\u003c/p\u003e \u003cp\u003eSecuring access to interventions like the (ANONYMISED FOR REVIEW) study could potentially be through new initiatives. As such, our results supported the interview guide used in the ANONYMISED FOR REVIEW (XXX) study, which aimed to improve coordinated care for frail older people with multimorbidity through cross-sectoral video meetings (Anonymised for Review #2, #10). XXX brings together four key parties: the patient and their family, hospital staff, municipal care providers, and the general practitioner. Specifically, the XXX interviews incorporated questions about independence, help from relatives, social relations, and vulnerability - themes that emerged from the (ANONYMISED FOR REVIEW) study.\u003c/p\u003e \u003cp\u003eStrengths and limitations\u003c/p\u003e \u003cp\u003eA key strength in this study was the application of the phenomenological hermeneutic approach, which enabled a nuanced exploration of emotional, existential, and relational dimensions of multimorbidity. The interpretive process facilitated an understanding of how participants negotiated coherence and autonomy in everyday life. During the interpretive process, data saturation regarding answering the aim, has been an ongoing discussion.\u003c/p\u003e \u003cp\u003eThe study also has limitations. The findings were context-specific and may not be generalisable to broader populations. Additionally, conducting interviews by phone may have limited the capture of non-verbal cues, potentially affecting the depth of interpretation. The study may be prone to selection and recall bias. Furthermore, participant responses may have been influenced by the interviewer.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn line with our aim to explore how older patients with multimorbidity experience loss of physical function in their everyday lives, this study suggests that such experiences constitute a complex and challenging journey. The journey of our participants is marked by challenges to identity, autonomy, and relational structures, which underscores that our participants are not only managing physical limitations, but they are also negotiating meaning and integrity within changing life contexts, placing them in an existential crisis.\u003c/p\u003e \u003cp\u003eCentral to this process is the need for professional support alongside assistance from the personal network. While family caregiving offers practical help, it often disrupts familiar relational dynamics, evoking feelings of shame, frustration, and loss of self. These relational ruptures highlight the necessity of interventions that not only address physical rehabilitation but also attend to emotional and existential dimensions.\u003c/p\u003e \u003cp\u003eOur results also indicate that the (ANONYMISED FOR REVIEW) intervention supported participants in living more active lives, not only through physical rehabilitation but by fostering social connectedness. The (ANONYMISED FOR REVIEW) intervention demonstrated the potential of holistic approaches that combined exercise, education, and peer support to meet both physical and psychosocial needs, notions to be considered in future interventions.\u003c/p\u003e \u003cp\u003e \u003cem\u003eCo-pilot has been consulted in the development of this conclusion.\u003c/em\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe study followed the ethical principles of the Declaration of Helsinki (\u0026lsquo;World Medical Association Declaration of Helsinki\u0026rsquo;, 2013). The Research Ethics Committees of Region Zealand (SJ-857) and the Danish Data Protection Agency (Region Zealand, Denmark, REG-015-2020) approved the (Anonymised for review) study.\u003c/p\u003e\n\u003cp\u003eAll authors agree on the translation of quotes from Danish. \u003c/p\u003e\n\u003cp\u003eAll participants were informed that their data would be treated confidentially and analysed in anonymised form and that they had the right to withdraw at any given time without consequences. Participants were informed that data would be kept confidential and in accordance with required standards and legislation.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eWritten informed consent for publication was provided by all participants. A confirmatory letter is not applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. \u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available due to Danish legislation but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe MOBILIZE study was funded by the European Research Council (ERC) under the European Union\u0026rsquo;s Horizon 2020 research and innovation program (MOBILIZE; grant agreement No 801790), a research program grant from Region Zealand (Exercise First), the Research Fund of N\u0026aelig;stved, Slagelse and Ringsted Hospitals, The Danish Regions and The Danish Health Confederation through the Development and Research Fund (project no. 2703), and The Association of Danish Physiotherapists Research Fund. \u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003col\u003e\n\u003cli\u003eKija \u0026Oslash;stergaard: Corresponding author, submitting author. Conceptualisation, Methodology, formal analysis, writing: original draft\u003c/li\u003e\n\u003cli\u003eS\u0026oslash;ren T. Skou: Conceptualisation, Investigation, writing: review and editing, Funding acquisition\u003c/li\u003e\n\u003cli\u003eAlessio Bricca: Conceptualisation, Investigation, writing: review and editing\u003c/li\u003e\n\u003cli\u003eMette Dideriksen: Conceptualisation, Investigation, writing: review and editing\u003c/li\u003e\n\u003cli\u003eDitte H\u0026oslash;gsgaard: Writing: review and editing\u003c/li\u003e\n\u003cli\u003eCharlotte Simon\u0026yuml;: Conceptualisation, Investigation, Methodology, writing: review and editing, Funding acquisition, Supervision\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThank you to the MOBILIZE patient partners who helped develop the interview guide for the interviews. And a special thank you to all patients who invited us into their everyday lives. Also thank you to Linda Hvass St\u0026oslash;ving (MHSc, BN) who originally conducted and transcribed the interviews. We would also like to thank the scientific advisory board, the study funders, the recruitment centres, healthcare providers and everyone involved in conducting the MOBILIZE study. \u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; information\u003c/h2\u003e\n\u003cp\u003eComplete mailing and e-mail addresses:\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKija \u0026Oslash;stergaard\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe Research and Implementation Unit PROgrez\u003c/p\u003e\n \u003cp\u003eDepartment of Physiotherapy and Occupational Therapy\u003c/p\u003e\n \u003cp\u003eCentral and West Zealand Hospital\u003c/p\u003e\n \u003cp\u003eF\u0026aelig;lledvej 6\u003c/p\u003e\n \u003cp\u003e4200 Slagelse\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003ee-mail address: [email protected]\u003c/p\u003e\n \u003cp\u003ePhone number: +45 2174 8322\u003c/p\u003e\n \n \u003cp\u003eCorresponding author\u003c/p\u003e\n \n \u003cp\u003eORCID ID 0000-0001-8211-0999 \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS\u0026oslash;ren Thougaard Skou\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe Research and Implementation Unit PROgrez\u003c/p\u003e\n \u003cp\u003eDepartment of Physiotherapy and Occupational Therapy\u003c/p\u003e\n \u003cp\u003eCentral and West Zealand Hospital\u003c/p\u003e\n \u003cp\u003eF\u0026aelig;lledvej 6\u003c/p\u003e\n \u003cp\u003e4200 Slagelse\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003eCenter for Muscle and Joint Health\u003c/p\u003e\n \u003cp\u003eDept. of Sports Science and Clinical Biomechanics \u003c/p\u003e\n \u003cp\u003eThe Faculty of Health Sciences\u003c/p\u003e\n \u003cp\u003eUniversity of Southern \u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \u003cp\u003eCampusvej 55\u003c/p\u003e\n \u003cp\u003e5230 Odense M\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003ee-mail address: [email protected]\u003c/p\u003e\n \n \u003cp\u003eORCID ID 0000-0003-4336-7059\u003c/p\u003e\n \n \n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlessio Bricca\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCenter for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics \u003c/p\u003e\n \u003cp\u003eUniversity of Southern Denmark \u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003eORCID ID 0000-0001-9717-918X\u003c/p\u003e\n \n \u003cp\u003ee-mail address: [email protected] \u003c/p\u003e\n \n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMette Dideriksen\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe Research and Implementation Unit PROgrez\u003c/p\u003e\n \u003cp\u003eDepartment of Physiotherapy and Occupational Therapy\u003c/p\u003e\n \u003cp\u003eCentral and West Zealand Hospital\u003c/p\u003e\n \u003cp\u003eF\u0026aelig;lledvej 6\u003c/p\u003e\n \u003cp\u003e4200 Slagelse\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003ee-mail address: [email protected] \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDitte H\u0026oslash;gsgaard\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe Research and Implementation Unit PROgrez\u003c/p\u003e\n \u003cp\u003eDepartment of Physiotherapy and Occupational Therapy\u003c/p\u003e\n \u003cp\u003eCentral and West Zealand Hospital\u003c/p\u003e\n \u003cp\u003eF\u0026aelig;lledvej 6\u003c/p\u003e\n \u003cp\u003e4200 Slagelse\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003eInstitute of Regional Health Research\u003c/p\u003e\n \u003cp\u003eFaculty of Health\u003c/p\u003e\n \u003cp\u003eUniversity of Southern Denmark\u003c/p\u003e\n \u003cp\u003eCampusvej 55\u003c/p\u003e\n \u003cp\u003e5230 Odense M\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003ePrimary and e-health Care\u003c/p\u003e\n \u003cp\u003eRegion Zealand Sor\u0026oslash;\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003ee-mail address: [email protected] \u003c/p\u003e\n \n \u003cp\u003ehttps://orcid.org/0000-0003-2752-881X \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharlotte Simon\u0026yuml;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe Research and Implementation Unit PROgrez\u003c/p\u003e\n \u003cp\u003eDepartment of Physiotherapy and Occupational Therapy\u003c/p\u003e\n \u003cp\u003eCentral and West Zealand Hospital\u003c/p\u003e\n \u003cp\u003eF\u0026aelig;lledvej 6\u003c/p\u003e\n \u003cp\u003e4200 Slagelse\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003eInstitute of Regional Health Research\u003c/p\u003e\n \u003cp\u003eFaculty of Health\u003c/p\u003e\n \u003cp\u003eUniversity of Southern Denmark\u003c/p\u003e\n \u003cp\u003eCampusvej 55\u003c/p\u003e\n \u003cp\u003e5230 Odense M\u003c/p\u003e\n \u003cp\u003eDenmark\u003c/p\u003e\n \n \u003cp\u003ee-mail address: [email protected] \u003c/p\u003e\n \n \u003cp\u003eORCID: https://orcid.org/0000-0003-1189-2967\u003c/p\u003e\n \n \n \n \n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnonymised for Review #1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnonymised for Review #2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnonymised for Review #3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnonymised for Review #4.\u003c/span\u003e\u003c/li\u003e 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A., Ellis, J. L. \u0026amp; Steiner, J. F. Seniors\u0026rsquo; self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. \u003cem\u003eJ. Clin. Epidemiol.\u003c/em\u003e \u003cb\u003e62\u003c/b\u003e (5), 550\u0026ndash;557e1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jclinepi.2008.05.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jclinepi.2008.05.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2009).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck, M. The Patient\u0026rsquo;s Voice in the Development of Complex Interventions. \u003cem\u003eIris J. Nursing Care\u003c/em\u003e. \u003cb\u003e3\u003c/b\u003e (3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.33552/IJNC.2020.03.000564\u003c/span\u003e\u003cspan address=\"10.33552/IJNC.2020.03.000564\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlson, D. M. \u0026amp; Yarns, B. C. Managing medical and psychiatric multimorbidity in older patients. \u003cem\u003eTherapeutic Adv. Psychopharmacol.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e, 20451253231195274. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/20451253231195274\u003c/span\u003e\u003cspan address=\"10.1177/20451253231195274\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCreighton, R. M., Paradis, K. F., Blackburn, N. E. \u0026amp; Tully, M. A. Group-Based Physical Activity Interventions Targeting Enjoyment in Older Adults: A Systematic Review. \u003cem\u003eJ. Ageing Longev.\u003c/em\u003e \u003cb\u003e2\u003c/b\u003e (2), 113\u0026ndash;129. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/jal2020011\u003c/span\u003e\u003cspan address=\"10.3390/jal2020011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEuropean Commission. Statistical Office of the European Union. \u003cem\u003eAgeing Europe: Looking at the lives of older people in the EU : 2020 edition.\u003c/em\u003e Publications Office. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://data.europa.eu/doi/\u003c/span\u003e\u003cspan address=\"https://data.europa.eu/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2785/628105\u003c/span\u003e\u003cspan address=\"10.2785/628105\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForsyth, F. et al. Exercise Modalities in Multi-Component Interventions for Older adults with Multi-Morbidity: A Systematic Review and Narrative Synthesis. \u003cem\u003eThe J. 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(2017). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cachet.dk/-/media/sites/cachet/about/reports-papers-and-other-resources/hvidbog-om-multisygdom/multisygdom_hvidbog_2017.pdf\u003c/span\u003e\u003cspan address=\"https://www.cachet.dk/-/media/sites/cachet/about/reports-papers-and-other-resources/hvidbog-om-multisygdom/multisygdom_hvidbog_2017.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolland, E. et al. The impact of living with multiple long-term conditions (multimorbidity) on everyday life \u0026ndash; a qualitative evidence synthesis. \u003cem\u003eBMC Public. Health\u003c/em\u003e. \u003cb\u003e24\u003c/b\u003e (1), 3446. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12889-024-20763-8\u003c/span\u003e\u003cspan address=\"10.1186/s12889-024-20763-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKvale, S. \u0026amp; Brinkmann, S. \u003cem\u003eInterview: Det kvalitative forskningsinterview som h\u0026aring;ndv\u0026aelig;rk\u003c/em\u003e (Bj\u0026oslash;rn Nake, Trans.; 3. udgave). Hans Reitzel. (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLei, L., Maust, D. T. \u0026amp; Leggett, A. N. Functional Decline Over Time and Change in Family and Other Unpaid Care Provided to Community-Dwelling Older Adults Living With and Without Dementia. \u003cem\u003eJournals Gerontology: Ser. B\u003c/em\u003e. \u003cb\u003e78\u003c/b\u003e (10), 1727\u0026ndash;1734. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/geronb/gbad107\u003c/span\u003e\u003cspan address=\"10.1093/geronb/gbad107\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoore, G. F. et al. 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(1976). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://books.google.dk/books?hl=da\u0026amp;lr=\u0026amp;id=TS98mJVaxqIC\u0026a\nmp;oi=fnd\u0026amp;pg=PR11\u0026amp;dq=Ricoeur,+P.+1976.+Interpretation+Theory:+Discourse+and+\nthe+Surplus+of+Meaning.+5th+ed.+T\nexas+Christian+University+Press.\u0026amp\n;ots=hRn4ZAO5hR\u0026amp;sig=ka9AFdtEe9J\nRwFA_fAsOjHEWXAY\u0026amp;redir_esc=y#v=\nonepage\u0026amp;q\u0026amp;f=false\u003c/span\u003e\u003cspan address=\"https://books.google.dk/books?hl=da\u0026amp;lr=\u0026amp;id=TS98mJVaxqIC\u0026amp;oi=fnd\u0026amp;pg=PR11\u0026amp;dq=Ricoeur,+P.+1976.+Interpretation+Theory:+Discourse+and+the+Surplus+of+Meaning.+5th+ed.+Texas+Christian+University+Press.\u0026amp;ots=hRn4ZAO5hR\u0026amp;sig=ka9AFdtEe9JRwFA_fAsOjHEWXAY\u0026amp;redir_esc=y#v=onepage\u0026amp;q\u0026amp;f=false\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoyse, L. A. et al. It\u0026rsquo;s not time for us to sit down yet: How group exercise programs can motivate physical activity and overcome barriers in inactive older adults. \u003cem\u003eInt. J. Qualitative Stud. Health Well-Being\u003c/em\u003e. \u003cb\u003e18\u003c/b\u003e (1), 2216034. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/17482631.2023.2216034\u003c/span\u003e\u003cspan address=\"10.1080/17482631.2023.2216034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSkivington, K. et al. A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. \u003cem\u003eBMJ\u003c/em\u003e, n2061. (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmj.n2061\u003c/span\u003e\u003cspan address=\"10.1136/bmj.n2061\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith, S. M., Wallace, E., Clyne, B., Boland, F. \u0026amp; Fortin, M. Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: A systematic review. \u003cem\u003eSyst. Reviews\u003c/em\u003e. \u003cb\u003e10\u003c/b\u003e (1), 271. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13643-021-01817-z\u003c/span\u003e\u003cspan address=\"10.1186/s13643-021-01817-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTong, A., Sainsbury, P. \u0026amp; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. \u003cem\u003eInt. J. Qual. Health Care\u003c/em\u003e. \u003cb\u003e19\u003c/b\u003e (6), 349\u0026ndash;357. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/intqhc/mzm042\u003c/span\u003e\u003cspan address=\"10.1093/intqhc/mzm042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2007).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsai, G. Aging Meaningfully: The Ethics of Existential Suffering for Older Adults in Healthcare. \u003cem\u003eCan. J. Bioeth.\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e (2\u0026ndash;3), 138\u0026ndash;149. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7202/1112285ar\u003c/span\u003e\u003cspan address=\"10.7202/1112285ar\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Morbidity, Well-Being, Intervention, Physical Activity, Qualitative Methods","lastPublishedDoi":"10.21203/rs.3.rs-8783794/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8783794/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eOlder adults living with multimorbidity often experience progressive loss of physical function, which affects autonomy, identity, and everyday participation. Despite increasing attention to multimorbidity, little is known about how older adults themselves experience functional decline following hospitalisation, and how person‑centred interventions may support them. This study explores these lived experiences and examines whether a personalised exercise therapy and self‑management programme helped participants live more active lives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod \u003c/strong\u003eWe conducted individual semi‑structured interviews with 20 older adults with multimorbidity enrolled in a Danish personalised exercise and self‑management intervention. A phenomenological-hermeneutic framework inspired by Ricoeur guided data collection and analysis. Interpretation followed three analytic levels: naïve reading, structural analysis, and critical interpretation. Reporting adhered to COREQ.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eFour themes characterised participants’ experiences: 1) Balancing everyday life - independence and the need for help, reflected tensions between autonomy and increased reliance on relatives, often disrupting relational roles, 2) Adapting to a new everyday life - maintaining autonomy, involved creative workarounds and temporal adjustments that enabled participants to maintain routines and coherence despite functional loss, 3) Uncertainties in everyday life - fear of falling, symptom unpredictability, and reduced social participation, contributing to withdrawal and insecurity, and 4) A sense of community among the (Anonymised for Review) intervention participants - fostered motivation, belonging, and emotional support, reducing isolation and normalising functional limitations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eLoss of physical function among older adults with multimorbidity seems to constitute an emotionally and existentially challenging process shaped by bodily, relational, and contextual constraints. The personalised exercise and self‑management intervention supported participants by enhancing social connectedness, fostering agency, and helping them reorient everyday practices. Findings underscore the need for holistic, person‑centred care models that integrate physical rehabilitation with emotional, relational, and existential dimensions of ageing with multimorbidity.\u003c/p\u003e","manuscriptTitle":"Balancing Loss of Physical Function in Older Adults’ Everyday Lives with Multimorbidity - a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-10 09:37:22","doi":"10.21203/rs.3.rs-8783794/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-27T23:41:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123478972657905151638992641001965966402","date":"2026-04-05T23:21:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-05T19:56:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-05T19:55:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-13T12:22:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T12:36:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-12T12:20:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"db66402e-35ee-4977-b2cd-45d37f9dfc09","owner":[],"postedDate":"April 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":65921071,"name":"Health sciences/Health care"},{"id":65921072,"name":"Humanities/Health humanities"},{"id":65921073,"name":"Biological sciences/Psychology"},{"id":65921074,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-04-10T09:37:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-10 09:37:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8783794","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8783794","identity":"rs-8783794","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}