Abstract
Physical activity (PA) is an established and evidence-based intervention for managing long-term conditions (LTCs). People living in rural communities experience inequitable health outcomes arising from limited service access, geographic isolation, and structural constraints. Physiotherapists are well-placed to promote PA for people with LTCs, yet rural physiotherapists face distinct challenges that shape how PA is promoted in practice. This study aimed to explore how rural physiotherapists in Aotearoa New Zealand (NZ) promote and prescribe PA for people with LTCs.
An interpretive descriptive methodology was used. Registered NZ rural physiotherapists were invited to participate in individual semi-structured interviews via Zoom. Interviews were transcribed verbatim and analysed inductively for themes using reflexive thematic analysis. Eight rural physiotherapists participated in this study.
Three themes were constructed in the data: rural physiotherapists 1) personalised the PA journey in collaboration with the patient, 2) responded to limited resourcing by drawing upon their kiwi ingenuity to promote creative and sustainable PA solutions, and 3) embedded PA into the rural social and cultural life within the community. Individual, interpersonal, organisational, and policy factors influenced how rural physiotherapists promoted PA. Physiotherapists adopted the ‘number 8 wire’ mindset to find successful solutions within the constraints of their environment. Furthermore, the absence of rural-specific policy frameworks for PA promotion and broader health support reveals a significant governance gap.
The interconnectedness between physiotherapists, patients, their whānau, and the wider community emerged as central to fostering person-centred, sustainable, and community-embedded PA. Future research should explore culturally grounded approaches to PA promotion, such as incorporating the perspectives of Māori and Pasifika physiotherapists, to enhance equity and relevance in rural health services. Policies should address foundational determinants such as transport, infrastructure, and service accessibility for PA, otherwise rural inequities will continue.