## 4 Discussion  
This study explored patients' and health professionals' perceptions on therapeutic green exercise. Participants had a generally positive attitude towards green exercise, encompassed by certain concerns referring to the barriers a patient might encounter. A notable convergence has been identified concerning views on facilitating and impeditive factors within the above focus groups (Figure 1). The results showed that green exercise is a form of physical activity that might be well tolerated by people with chronic conditions. Other studies confirm that physical activity in natural settings is a feasible intervention that could be used in the rehabilitation of chronic diseases with encouraging effects, especially on mental health [57; 58]. Safety was a major concern for performing green exercise. Patients and HPs were apprehensive about potential risks of therapeutic green exercise. Participants indicated that road conditions might be unfriendly, with cars, bicycles, and pedestrians being plausible causes of accidents, noting that dangers might also occur via assailants or animals. Health professionals noted that air pollution and insect bites are further risks. These results are in accordance with [PERSON] who indicated that physical safety was a major concern for women exercising outdoors [59]. A qualitative study on chronic pain also showed that safety is a perceived barrier to engage with green exercise [48]. Inadequate infrastructures were also a limiting factor for participating in therapeutic green exercise. The poor city planning and the very few and/or inaccessible green spaces are reasons for not performing green exercise. In other studies, pedestrian infrastructures in built environments were principal for outdoor walking, and proper green urban spaces enhanced physical activity [60; 61]. Bad and rainy weather or too warm weather were inhibitory factors for green exercise. Heat has been confirmed as a barrier to use urban parks in Japan [62]. In a study in six European countries, warmer temperatures were associated with outdoor physical activity in older people [63]. Respectively, mild temperatures seem to be more adequate for therapeutic green exercise. There are also subjective factors that prohibit green exercise. According to HPs, patients abstain from exercise due to their illness and the lack of motivation. Health professionals recognized that they do not provide sufficient support to their patients in relation to their involvement in therapeutic green exercise. However, these findings seem to be relevant to exercise engagement overall, and not particularly with green exercise [64]. Green exercise positively affects chronic patients' mental health and averts them from negative feelings and thoughts. In a study with in-patients with mild to moderate depression, outdoor physical activity was more advantageous than indoor physical activity [65]. The engagement in therapeutic green exercise is entertaining and improves their mood. Figure 1: Health professionals’ and chronic patients’ beliefs. The feeling of nature connectedness helps immerse themselves in the natural surroundings and promotes wellbeing. Nature provides high air quality and has a wide variety of images, odors, and sounds. As has been proven by a meta-analysis, people who feel connected to nature seem to have greater levels of self-reported personal growth [66]. Patients agreed that natural environments are unfavorable places for the spread of diseases. However, HPs indicated that there might be a risk of diseases transmitted by mosquitoes. In effect, it is proven that airborne transmitted diseases are dispersed much more indoors than outdoors, even compared with crowded outdoor areas [67]. It is a good opportunity for patients with chronic diseases to socialize with peers during therapeutic green exercise. It is a form of exercise that facilitates group interaction, and participants can set a good example for their co-patients.