“There’s no better medicine than my outdoors”: understanding the importance of physical activity in rural and remote First Nations communities in Northern British Columbia, Canada

Abstract Background While Canadian First Nations communities actively participate in sport, cultural, and land-based activities, they face various barriers to physical activity. Despite calls for increased support at all government levels, access to suitable programs for those with chronic conditions in particular remains limited. As part of an ongoing partnership between the University of British Columbia and Carrier Sekani Family Services (CSFS), this qualitative study aimed to explore current values, perceived barriers, and potential facilitators of physical activity among people living with chronic health conditions in rural and remote First Nations communities in northern British Columbia. Methods This qualitative study is part of a larger mixed-methods, community-based participatory action project with CSFS titled Niwh Yizt’iyh Hilht’iz Nets’eelh’iyh – “Strengthening our Bodies”. Semi-structured interviews, with optional Photovoice, were conducted with participants aged 12 years and older who had at least one chronic condition and belonged to First Nations communities served by CSFS. Participants were recruited from a prior community-based physical activity survey study that captured brief information on current physical activity experiences in their community. Data were analyzed using reflexive thematic analysis, guided by Indigenous Wholistic Theory (a framework emphasizing the interconnected and cyclical physical, mental, emotional, and spiritual dimensions of health and wellness) to ensure cultural relevance. Coding progressed from semantic to latent themes, supported by NVivo and reflexive journaling. Results Interviews were conducted with 29 participants from three communities (69% female, mean age: 55 years old), all managing various chronic conditions such as diabetes, arthritis, and cardiovascular disease. The identified themes were: 1) Integrating cultural values with physical activity to manage chronic disease, 2) Cultural disconnection: A barrier to health and physical activity, and 3) Community approaches to facilitate physical activity in chronic disease. Together, these themes highlight the role of culture, supportive community structures, and tailored approaches in physical activity engagement. Conclusion To strengthen physical activity programming, service providers should ensure initiatives are aligned with community values, address identified barriers, and encourage locally recognized facilitators. These insights will empower health care organizations and communities to develop targeted, inclusive strategies for physical activity programming tailored to individuals with chronic conditions.