Effects of group aerobic exercise on health and social adaptation in earthquake survivors: A qualitative study

Abstract

Exercise is known to support physical and psychological health following traumatic events; however, qualitative evidence on its role in post-disaster recovery remains limited. This study aimed to explore the effects of a group aerobic exercise program on health and social adaptation among earthquake survivors and to understand participants’ lived experiences. This qualitative study employed a descriptive phenomenological design. Participants were survivors of the 2023 Kahramanmaraş earthquakes recruited using purposive sampling among individuals who had participated in a group aerobic exercise program for at least 6 weeks. Data were collected through semi-structured interviews and analyzed using thematic analysis following the Braun and Clarke approach. A total of 17 participants (15 women and 2 men), aged between 21 and 31 years (mean ± standard deviation = 23.88 ± 2.34), were included in the study. The findings indicated that participation in the exercise program was associated with perceived improvements in biological/physiological, physical, and psychological well-being, as well as enhanced social adaptation and intellectual development. Participants reported reduced stress, improved sleep quality, increased emotional regulation, and strengthened interpersonal relationships. Group aerobic exercise may contribute to perceived improvements in physical, psychological, and social well-being among earthquake survivors. These findings suggest that structured exercise programs could be considered as supportive components of post-disaster rehabilitation strategies.

1. Introduction

Two powerful earthquakes with moment magnitudes of 7.7 and 7.6 struck Kahramanmaraş, Türkiye, on February 6, 2023, impacting millions.^[1] In addition to physical damage and casualties, earthquakes can lead to profound mental and physical health issues.^[2–4] Earthquake survivors face a range of traumas – including life-threatening experiences, bereavement, injury, and displacement – that severely impact their mental and physical well-being. Forced displacement and grief can disrupt both personal and communal relationships among disaster survivors.^[5] The stress experienced by survivors of natural disasters is strongly associated not only with psychological well-being but also with physical health.^[6] After such traumatic events, increasing physical activity levels of individuals improves their physical and biological/physiological health. This also increases cardiovascular endurance and physical performance, and reduces cardiometabolic risk factors.^[3,7]

Exercise contributes to biological/physiological, physical, and psychological recovery after traumatic events.^[8–10] Exercise increases life and sleep quality, subjective well-being, self-esteem, and self-efficacy, and reduces distress in trauma survivors.^[4,8–10] Pre-disaster exercise habits serve as a key protective factor for post-disaster mental health.^[6] Both individual and group exercises help promote sustainable lifestyle changes.^[3,11,12] However, the health benefits of group exercise involve not only the physiological mechanisms of physical activity but also the social network and social support mechanisms of participating in a group activity.^[13,14] Group exercises have been shown to improve psychosocial health outcomes more than individual exercises by improving adaptation to social relationships.^[14] Effective post-disaster support requires assessing survivors’ health across biological/physiological, physical, and psychological domains and identifying appropriate strategies for their situation.^[6]

Previous research on earthquake-related health has largely focused on quantitative outcomes, with relatively limited attention to individuals’ subjective experiences.^[15] To the best of our knowledge, qualitative research exploring the role of group aerobic exercise in post-disaster recovery remains limited. Understanding survivors’ lived experiences may provide valuable insights for developing effective rehabilitation and support strategies in disaster settings. The aim of this study was to explore earthquake survivors’ perceived physical, psychological, and social experiences related to participation in a group aerobic exercise program.

2. Materials and methods

2.1. Design

This study employed a descriptive phenomenological qualitative design, which seeks to capture and describe participants’ lived experiences regarding a specific phenomenon.^[16] It was informed by Giorgi’s descriptive phenomenological approach, which focuses on describing the essential structure of participants’ lived experiences while minimizing interpretative bias.^[17] A qualitative approach was deemed appropriate to explore in depth how survivors perceive and experience the effects of group exercise on their health and adaptation processes. This design enables researchers to identify the essence of participants’ shared experiences and to generate a comprehensive understanding of the phenomenon under study.^[18] Although grounded in a phenomenological perspective, the study utilized thematic analysis as a flexible analytic method to systematically identify patterns across participants’ accounts.

2.2. Ethics approval

The study was conducted in accordance with the Helsinki Declaration Guideline. This study involves human participants and was approved by Mardin Artuklu University Non-Interventional Clinical Research Ethics Committee (application number: 2024/3-38). Written informed consent was obtained from all participants, who were informed of voluntary participation and their right to withdraw without penalty.

2.3. Participants

Participants were recruited through purposive sampling, a non-probability sampling method used to select individuals with specific characteristics relevant to the purpose of the research. In this study, purposive sampling was chosen to include participants who both attended a group exercise program and had direct experience of the Kahramanmaraş earthquakes. This approach ensured that participants could provide in-depth insights into the psychosocial and physical effects of the program following the disaster. Inclusion criteria required participants to be at least 18 years of age, to have volunteered to participate in the study, to have attended the exercise sessions for a minimum of 6 weeks (with at least 2 sessions per week), to have participated in these exercise programs within the 3 months preceding data collection, and to have experienced the Kahramanmaraş earthquakes firsthand. The participants were selected from individuals who had voluntarily joined group exercise sessions organized in Mardin after the earthquakes. At the time of the interviews, all participants were continuing to live in Mardin following relocation after the earthquake. In total, 42 individuals were initially reached. Of these, 11 had attended the exercise sessions for fewer than 6 weeks, 8 did not volunteer to participate in the study, and 6 did not attend the sessions regularly; therefore, they did not meet the inclusion criteria. Ultimately, 17 participants who met all criteria volunteered to take part in the interviews. All 17 participants completed the exercise program and participated in the interviews. Data saturation guided the determination of sample size.^[19] Saturation was achieved when no new themes or meaningful insights emerged from the interviews. This point was reached after approximately 10 to 12 interviews. However, to enhance data richness and ensure theoretical saturation, all 17 eligible participants were included in the study. The final interviews further confirmed that saturation had been reached, as no additional meaningful themes emerged.

2.4. Exercise program

The program was supervised by a licensed physiotherapist and included structured aerobic exercises in groups of 5 to 10 participants. Aerobic exercise shows greater improvement in biological/physiological, physical, and mental health parameters compared to other types of exercise.^[20] Participants completed an exercise program covering the conditions in Table 1. Exercise intensity was monitored and adjusted using the Borg Scale,^[21] which is based on the subjective feeling of exertion and fatigue during exercise. This 6 to 20 point scale, ranging from “no exertion (6)” to “maximal effort (20),” allows for the regulation of intensity based on the participants’ subjective feelings of fatigue. Following this protocol, the exercise workload was progressively increased every 2 weeks, as shown in Table 1.

Table 1.

Aerobic exercise program.

	Warm-up phase	Progressive overload phase	Cool-down phase
Exercise components	Stretching and warm-up exercises	15 min treadmill	Stretching, relaxation, and breathing exercises
		15 min cycling
Duration (50–60 min)	10 min	30 min	10–20 min
Exercise intensity (Borg Scale)	–	11–12 (wk 1–2)	–
		12–14 (wk 3–4)
		14–16 (wk 5–6)

min = minute, wk = week.

Although the exercise program was primarily physical, each session was conducted in a collective and synchronized manner under the supervision of the physiotherapist, beginning and ending with group-based warm-up, cool-down, breathing, and relaxation exercises. While the program did not include any formal psychoeducational components, this structured group setting and synchronized execution of routines were integral parts of the intervention design.

2.5. Data collection

The data for this study were collected between March 5 and April 20, 2024, in Mardin, Türkiye. Following the February 6, 2023, Kahramanmaraş earthquakes, many affected individuals temporarily relocated to Mardin. Among them, some voluntarily participated in group aerobic exercise sessions initiated by volunteer physiotherapists as part of post-disaster support activities.

These exercise sessions were newly initiated after the earthquake and were not a continuation of any preexisting exercise program. Individuals who had participated in these exercise sessions for 6 to 8 weeks within the 3 months preceding data collection were included in the study.

The exercise program was implemented independently of the present research. The current study did not involve the design or delivery of an exercise intervention; rather, it was conducted subsequently to qualitatively explore the experiences of individuals who had participated in these community-based exercise sessions. Importantly, the researchers involved in data collection and analysis had no role in the planning, supervision, or delivery of the exercise sessions. The exercise sessions were conducted exclusively by licensed physiotherapists, ensuring a clear separation between the intervention context and the research process and minimizing potential bias.

The interviews were conducted in Turkish, the native language of the participants. The audio recordings were transcribed verbatim in Turkish and subsequently translated into English for reporting purposes. The translations were reviewed by 2 researchers with advanced proficiency in both Turkish and English to ensure accuracy and consistency. In addition, a back-translation procedure was applied to further verify the accuracy of the translated data.

2.5.1. Participant information form

The participant information form was used to collect basic sociodemographic data, including age, gender, height, weight, marital status, education level, earthquake-related losses, and exercise duration. These characteristics are summarized in Table 2.

Table 2.

Sociodemographic characteristics of participants.

Sociodemographic characteristics	Participants
Gender, n (%)
Female	15 (88.2)
Male	2 (11.8)
Age (yr)
Mean ± SD	23.88 ± 2.342
M (min–max)	24 (21–31)
Height (cm)
Mean ± SD	163.94 ± 7.72
M (min–max)	163 (150–183)
Weight (kg)
Mean ± SD	61.94 ± 13.45
M (min–max)	58 (40–90)
Marital status, n (%)
Married	1 (5.9)
Single	16 (94.1)
Education status, n (%)
High school	7 (41.2)
Graduate	9 (52.9)
Postgraduate	1 (5.9)
Loss of a loved one in the earthquake
Yes	6 (35.3)
No	11 (64.7)
Exercise duration (wk)
Mean ± SD	7.18 ± 0.88
M (min–max)	7 (6–8)

% = percentage, cm = centimeter, kg = kilogram, M = median, max = maximum, min = minimum, n = number, SD = standard deviation.

2.5.2. Semi-structured interview form

The semi-structured interview form was developed with input from experts in physiotherapy, mental health, and qualitative research, and piloted with 2 participants prior to the data collection. This interview format enabled the exploration of participants’ lived experiences in depth while maintaining consistency across interviews. It included 4 core open-ended questions:

1. “Can you tell us about your earthquake experience?”

2. “What are the effects of the exercise program you participated in on your general health?”

3. “What were the effects of the exercise program you participated in on your mental health?”

4. “What would you say when evaluating the exercise and its aftermath in general?”

Follow-up prompts such as “Could you elaborate on that experience?,” “How did that make you feel?,” or “Can you describe a specific moment that was particularly significant for you?” were used to obtain more detailed explanations. In addition, the question “Which aspects of the exercise program contributed most to your well-being?” was included to encourage participants to reflect freely.

All interviews were conducted by a researcher (H.A.), a professor of social work with clinical expertise in qualitative research methods, who had no prior relationship with the participants and was not involved in the exercise program. The interviews were conducted in a private, quiet room to ensure participant comfort and confidentiality. Each interview lasted approximately 35 minutes. With participants’ consent, interviews were audio-recorded and data were stored in password-protected files.

2.6. Data analysis

The data were analyzed using reflexive thematic analysis as outlined by Braun and Clarke^[22] adopting an inductive and semantic approach. This method was selected for its flexibility and compatibility with a phenomenological orientation, enabling the identification of patterns across participants’ lived experiences without imposing preexisting theoretical frameworks.

The 6-step thematic analysis developed by Braun and Clarke^[22] was followed: familiarizing with the data, creating initial codes, searching for themes, reviewing themes, identifying and naming themes, and creating the report. NVivo Qualitative Data Analysis Software (NVivo) was used to manage the data analysis process. The analysis of responses to open-ended questions was conducted using NVivo to code and categorize patterns, frequencies, and relationships.^[23] A hierarchical coding structure (tree coding) was used to organize and refine codes into broader categories. The relationship between the codes was then examined to form the final themes.^[24] The analysis process involved systematically deriving themes from the data, with a focus on capturing explicit meanings (semantic level) rather than latent interpretations.

The researchers held regular meetings to discuss themes generated from their independent analysis of the first 3 interviews. A consensus was reached through discussions among the research team. This ensured greater transparency. The final themes were formed based on the research team’s consensus. In addition, a member check was conducted with 5 participants to ensure that the generated themes were compatible with the participants’ views on the topic and process, thus minimizing researcher bias. Participants reported a high level of agreement (approximately 95%) between the identified themes and their lived experiences, supporting the credibility of the findings. The analysis was conducted independently by 2 researchers (M.S.K. and H.A.) with expertise in clinical psychology and qualitative research methods, followed by consensus discussions to enhance analytic rigor.

3. Results

A total of 17 participants (15 women and 2 men), aged between 21 and 31 years (mean ± standard deviation = 23.88 ± 2.34), were included in the study. Participants had attended the aerobic exercise sessions for 6 to 8 weeks (mean ± standard deviation = 7.18 ± 0.88 weeks). The sociodemographic characteristics of the participants are summarized in Table 2. All had experienced significant disruption due to the disaster, such as displacement, loss of property, or bereavement.

3.1. Psychological symptoms caused by the earthquake

The qualitative interviews revealed several psychological themes reflecting participants’ experiences following the earthquake. The themes reflected a range of psychological experiences, including depressive symptoms, anxiety-related experiences, purposelessness, and anger following the earthquake. Figure 1 details the main psychological symptoms obtained from the qualitative interview and present them in the visualization. One of the participants expressed the disaster and the impact it had on them as follows:

Figure 1.

Psychological symptoms caused by the earthquake.

We lost nearly 200 of our relatives. When I heard the news of the deaths, at first, I did not believe it; I was so upset that I lost my mind. That day, I said I would never leave the house again and did not want to attend school anymore… After the earthquake, I realized that my memory was not as good as it used to be. I was forgetting everything very quickly. (Participant 11)

The perception that life is “over” signifies a profound existential crisis. The statement of another participant is as follows:

Earthquakes were a natural disaster I feared even before the Kahramanmaraş earthquakes. After February 6, I constantly felt psychologically helpless and fear. I did not want to separate from my family. In every place I went, I planned how to escape in case of an earthquake and was terrified of entering high-rise buildings. Even in another city, I felt like I could be caught in an earthquake at any moment. I kept the earthquake kit by my bedside. (Participant 3)

These symptoms reported by the participants are consistent with trauma-related psychological responses following the earthquake. Another participant summarized the psychological damage caused by the natural disaster, including dissociation, in 1 paragraph as follows:

When I remember the moment when I felt so helpless and unable to do anything but calm my family down, when I completely pushed my emotions aside, I wanted to disappear. In those moments when I was desperately waiting for hours to see if something would happen, it felt like the world had stopped, and I realized that nothing mattered in my life even months later, and I could not connect to anything because I was afraid of losing my life. (Participant 8)

Another participant who drew attention to the psychological effects of the disaster, particularly “purposelessness and loss of meaning” said:

The earthquake had a very negative impact on my mental health, as it does for everyone. I can say it changed my perspective on life. I also had periods when I thought we were living unnecessary and purposeless lives. The thought of losing someone close to me in such a horrible way was devastating. I think they are complicated processes. (Participant 6)

Finally, one of the participants summarized almost all of the psychological symptoms expressed in this theme with the following statements:

The losses have taken a toll on me psychologically, hurting my mood, reducing my quality of sleep and life. I became more connected to my loved ones and more concerned about them. Although months have passed, I still feel like I am reliving the same moments at the slightest triggering event. My fear has increased, I have become a very anxious person, and I am constantly worried about my loved ones; I miss my cousins, friends, and relatives that I have lost and our memories are constantly on my mind. I am anticipating the possibility of experiencing the same thing again. (Participant 4)

3.2. The effect of the exercise program conducted

Following the interviews with the participants, it was found that the exercise programs supported their intellectual development, social adaptation in daily life, and biological/physiological, physical, and mental health (Fig. 2). One participant expressed the contribution of these exercise programs to intellectual development as follows:

Figure 2.

The effect of the exercise program conducted.

It increased my focus time while carrying out my daily activities. While reading books, studying, and chatting with people, I adapted to the subject more quickly and started to experience less distraction. (Participant 4)

In the context of post-traumatic recovery, the experience of another participant is particularly illuminating. They talked about the initial psychological fog and uncertainty they experienced after the earthquake and how the exercise program helped them build resilience:

After the earthquake, there seemed to be a complete fog in the minds of most earthquake survivors. We were all living uncertain lives, unaware of what tomorrow would bring. We had no idea how to react to the events. When I completed this exercise program, my psychological resilience was better than my family’s. I cannot describe it in detail, but there is a big difference between the way I reacted to the events immediately after the earthquake, between me, who first looked at the bad side of every event and the me who now lives with the thought that everything will pass even if it is difficult. (Participant 8)

Another participant expressed how “mental health and exercises are directly related to each other” in the following sentences:

Just as a rolling stone gathers no moss, I believe that a person who doesn’t move stagnates everything, including basic brain and other body functions. We can think of the soul and body as a whole and this whole as a wheel. The well-being of one person depends greatly on the well-being of another person. So exercise certainly plays a big role in a calmer mood. It is crucial to be able to control one’s body and one’s will. Anger, which often cannot be controlled, can be overcome by using a variety of exercise techniques, including breathing exercises. (Participant 7)

The psychological advantages of exercise are further supported by the following remark, which emphasizes how it can reduce stress and foster optimism:

I think exercise is effective in reducing the psychological impact of an earthquake. It supports a more positive, energetic, and vigorous life. This is a sign of excellent psychological support. For example, I find that exercises help me control my stress, strengthen my positive thoughts, and eliminate negative energy. (Participant 6)

Finally, another participant highlights how exercise is beneficial in reducing physical and mental fatigue by improving sleep quality (biological/physiological contribution):

It has affected my sleep quality in a very positive way because, after the earthquake and floods, I was having a hard time sleeping and waking up with heart palpitations. It was exhausting and frightening for me, both physically and mentally. When I went to bed with relaxed muscles after the exercise, I slept easily and woke up very well.

The same participant followed:

Exercise has been highly influential on physical health in terms of posture disorder, problems with the digestive, respiratory and circulatory systems. My social relations have been strengthened by the group exercises we do. My time spent on my body and myself has increased. Taking time for myself increased my sense of value as an individual. It was a great relief to do something for myself and see that the exercises were beneficial. Seeing that I was doing well mentally also led me to turn to exercise when I was feeling distressed, and exercise became a regular part of my life. (Participant 3)

4. Discussion

This study was conducted to examine the effects of a group aerobic exercise program on the health and social adaptation of survivors of the Kahramanmaraş earthquakes in Türkiye and to gain insight into their experiences.

Qualitative interviews identified psychological themes in earthquake survivors, reflecting depressive symptoms, anxiety-related experiences, dissociative experiences, and trauma-related symptoms.^[25] These findings reflect participants’ self-reported experiences and should not be interpreted as clinical diagnoses. Studies investigating the effects of natural disasters such as earthquakes on people have revealed that earthquakes cause psychological disorders such as post-traumatic stress disorder,^[26] depression,^[27] and generalized anxiety disorder.^[28] Similarly, in studies conducted in Türkiye, high levels of earthquake-related psychological distress were found in university students who were survivors of the Kahramanmaraş earthquakes.^[29] The severity of these symptoms often necessitates integrative interventions; for instance, evidence from clinical case reports suggests that multidimensional approaches can significantly reduce high levels of depression and interpersonal sensitivity, which are common barriers to social reintegration after traumatic life events.^[30]

In addition to these symptoms, participants in this study also reported difficulties and psychological conditions, such as sleep problems, hypervigilance, fear of death, purposelessness and meaninglessness, anger, and panic after the earthquake. In the acute phase of natural disasters, sleep disturbance mainly occurs as a stress response.^[31] Furthermore, depending on the magnitude of the disaster, individuals who are exposed to earthquakes may be injured and may face helplessness, anxiety, and an intense fear of death. People who witness injured people and dead bodies in earthquake zones may experience more psychological trauma.^[32] Tuna et al^[33] conducted a study in 379 households in Van, Türkiye, and found that earthquakes have a negative psychological impact on disaster survivors. Similar to this study’s findings, the researchers’ findings indicated that the participants reported experiences, such as cognitive problems (sleep disorders, flashbacks, and intrusive thoughts about the earthquake), emotional problems (anhedonia), and physical and behavioral problems (anorexia, agoraphobia, and aggression).

In this study, participants reported that the group aerobic exercise program was associated with improvements in their mental health. Research, including survivors of the Great East Japan Earthquake, indicates that participants in the exercise intervention experienced significant improvements in mental health, subjective well-being, and perceived health status.^[9,10] Another study conducted after the same earthquake showed that participation in regular exercise activities was associated with a higher frequency of laughter.^[34] Exercise was reported to improve well-being and frequency of going out in earthquake survivors.^[9,35]

While both group and individual exercise programs may influence mental health,^[12] exercising socially active with others can increase mental health benefits compared to exercising alone.^[36,37] A study on 21,684 adults reported that individuals who exercised with others had better subjective health than those who exercised alone.^[14] Tsuji et al^[38] support the idea that participation in group exercises may help prevent mental health problems and reduce symptom severity in earthquake survivors. The combination of physical activity and civil society engagement can alleviate the stress or depressive feelings experienced by earthquake survivors.^[37]

The findings of this study suggest that exercise may contribute to improved mental health in post-disaster settings. Kukihara et al^[6] showed that some earthquake survivors had relatively good psychological resilience to traumatic events and that resilience is a critical factor in coping with such events. Psychological resilience has been associated with healthy lifestyles such as exercise habits, good nutrition, and employment.^[6] A systematic review has shown that regular physical activity, both prior to and after traumatic events, can reduce the impact of traumatic events on mental health.^[3] These findings highlight the potential importance of encouraging participation in exercise and healthy lifestyle behaviors following disasters.

Exercise is an important strategy for maintaining and preventing deterioration of physical function. Moreover, maintaining and improving physical functioning is linked to improved quality of life.^[39]

While exercise is associated with improvements in biological/physiological and physical health outcomes, such as immunity, sleep, and pain, post-earthquake studies addressing these outcomes are limited.^[4,40,41] In this study, participants reported that the exercise programs contributed to their biological/physiological and physical health. Participation in an exercise intervention for earthquake survivors has been shown to enhance physical functioning, balance, muscle strength, and quality of life and positively impact sleep patterns.^[15]

Studies suggest that exercise interventions after earthquakes may be beneficial, particularly when implemented early.^[8,15] The higher incidence of physical dysfunctions in the first year after the earthquake highlights the significance of early intervention measures.^[8] According to Kuroda et al,^[8] in emergencies such as earthquakes, early identification of those with impaired activities of daily living and implementation of interventions such as exercise may help reduce the risk of physical dysfunction among the affected population. This study’s findings align with the literature emphasizing the value of post-disaster exercise interventions. These findings suggest that exercise may play a supportive role in maintaining physical health following natural disasters.

Individuals who participated in this study reported that exercise programs positively affected their intellectual development and social adaptation in daily life. Although many studies^[42,43] have shown the positive effects of exercise on intellectual development and cognitive performance, there is limited research on this topic after the earthquake. Narita-Ohtaki et al^[44] discussed that exercise can help alleviate cognitive dysfunctions in traumatized women. Exercise may also help distract attention from adverse events.^[45] These findings suggest that exercise may contribute to improvements in intellectual development.

The exercise program may encourage participation in community activities and support health activities. The lack of social support is significantly associated with a lack of exercise habits in earthquake survivors.^[46] Sato et al^[47] reported that social adaptation contributed to reducing depression in a study conducted after the Kumamoto earthquake. In the study by Greiner et al,^[15] gains in mental health were observed with a regular exercise program. Participants described the group as a major source of morale and enjoyment. The implementation of an exercise group has been shown to contribute to the formation of exercise habits in earthquake survivors.^[15] These findings suggest that creating opportunities for social interaction may support social adaptation and the psychological state of earthquake survivors. The protective role of social support is not limited to physical activities; literature reports that social interactions established through digital platforms during periods of isolation serve a similar function in reducing feelings of loneliness and maintaining psychological well-being.^[48]

Taken together, these findings may be interpreted within a biopsychosocial framework, which emphasizes the interaction between physical, psychological, and social factors in health and recovery.^[49] In the present study, participants described not only perceived physical and psychological benefits of exercise, but also enhanced social interaction, sense of belonging, and engagement in daily life. These interconnected experiences suggest that group aerobic exercise may support post-disaster recovery through multiple and mutually reinforcing pathways following traumatic events such as earthquakes.

In disaster psychology, the disillusionment phase emerges months after the event and is characterized by increasing disappointment as external aid diminishes, heightened psychosomatic symptoms, and ongoing stressors such as financial strain, disrupted routines, and unmet recovery expectations.^[50,51] Therefore, this study may address an important gap in long-term rehabilitation needs, particularly during a period when external support has substantially decreased. Evaluating participants’ experiences 1 year after the earthquake represents a notable strength of the study. Collecting data during this specific period may be considered a delay, but rather as a strategically selected timeframe aimed at preventing chronicity and supporting long-term recovery.

To the best of our knowledge, qualitative studies examining the effects of exercise on health, cognition, and social adaptation among earthquake survivors are limited. Furthermore, exercise studies are generally conducted quantitatively. Qualitative studies on this subject can provide more comprehensive and descriptive information about individuals’ perspectives on exercise. This study, rather than quantitatively expressing a disaster such as an earthquake, aimed to go beyond the numbers by focusing on each individual’s unique experiences.

4.1. Limitations

The relatively small number of participants was due to the voluntary nature of the program and the challenges of reaching earthquake survivors during the post-disaster period. The sample consisted predominantly of female participants (15 women and 2 men), which may reflect gender-related differences in participation in community-based exercise programs following disasters. The focus on Kahramanmaraş earthquake survivors may restrict generalizability to other disasters. As a qualitative study, the results reflect participants’ subjective experiences and should be interpreted within this context. In addition, detailed information regarding participants’ relocation timeline, living conditions, and displacement status following the earthquake was not systematically collected, and these contextual factors may have influenced participants’ psychological and social experiences. The voluntary nature of participation and inclusion of individuals who regularly attended the exercise sessions may have contributed to selection bias and a predominance of positive experiences in the findings. Furthermore, the interviews were conducted after completion of the exercise program and relied on retrospective participant accounts, which may have introduced recall bias. Moreover, no objective physical or physiological health parameters were assessed, and the qualitative design of the study does not allow for establishing a definitive causal relationship between exercise participation and perceived improvements in mood or well-being.

4.2. Future directions

This study suggests that exercise may have positive biological/physiological, physical, and psychological effects among earthquake survivors; however, several gaps remain. Future studies may include larger and more gender-balanced samples to increase generalizability, as the current study mainly involved women. Moreover, the use of mixed-method research designs combining quantitative and qualitative approaches could provide a more comprehensive understanding of how exercise contributes to post-disaster recovery.

Based on the present findings, future interventions may consider integrating structured group exercise programs into post-disaster rehabilitation and psychosocial support efforts, and collaboration between physiotherapists, mental health professionals, and community organizations may enhance program sustainability. Further qualitative research may also explore cultural, environmental, and motivational factors influencing participation in exercise after disasters, which may provide deeper insights to inform public health policy and practice.

5. Conclusions

Earthquakes are significant factors that negatively affect the mental health of individuals. Exercise intervention may enhance the biological/physiological, physical, and mental health of earthquake survivors. Social adaptation and intellectual development can be supported. These findings highlight the potential role of exercise in post-disaster recovery.

Acknowledgments

We would like to acknowledge the participants for their openness to sharing their experiences with us.

Author contributions

Conceptualization: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, Bahar Anaforoglu.

Data curation: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, M. Siyabend Kaya.

Formal analysis: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, M. Siyabend Kaya, Bahar Anaforoglu.

Investigation: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, M. Siyabend Kaya.

Methodology: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, M. Siyabend Kaya, Bahar Anaforoglu.

Project administration: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, M. Siyabend Kaya, Bahar Anaforoglu.

Resources: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, M. Siyabend Kaya.

Software: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, M. Siyabend Kaya.

Supervision: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak.

Validation: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak.

Visualization: Fatma Betul Yardimci, Hafize Altay Ili, M. Siyabend Kaya.

Writing – original draft: Fatma Betul Yardimci.

Writing – review & editing: Fatma Betul Yardimci, Hafize Altay Ili, Hidir Apak, M. Siyabend Kaya, Bahar Anaforoglu.