Constructing the picture of COVID-19 disease in the minds of patients was of a social nature [14]. For most of the respondents, the very existence of the disease was unmistakable. In group I, only 2% of it was asymptomatic, 25% considered the symptoms mild, and 71% of COVID-19 was severe. In group II, no one passed the disease asymptomatically, 25% of respondents passed with mild symptoms, and 73% with severe symptoms. Despite the fact that in 2020 and 2021 there were differences in the scope of official information reported in the media on COVID-19, information of significant importance did not reach a large group of respondents. Patients from both studied groups were mostly unaware of the seriousness of the situation and the scale of the epidemic threat in Poland, and they did not relate the threat to themselves. After the first symptoms of the disease appeared, 11% of the respondents in the 1st group thought it was a cold, and 12.6% - the flu. 33.1% of respondents, even after the appearance of more serious symptoms of the disease, did not think that it could be COVID-19. They only began to worry as their symptoms worsened. 38.6% of respondents, even after experiencing severe symptoms that started to develop rapidly, still did not think that they got COVID-19. In the second group of respondents, despite the fact that the epidemic had already lasted in Poland for two years, as many as 26.47% of respondents were very surprised by the disease ("because no one was ill in my environment"), a further 25% were surprised ("because before I was never ill with anything serious”), and 10.29% of the disease surprised them, because they had not been interested in it before and did not know anything about it. This result can be considered shocking on the background of the high level of education of the respondents which should help them comprehend the world and receive the information with understanding. Only 35.29% of the respondents from group II were aware of the real possibility of infection and they were not surprised. 25% because they got infected from a person who was known to be sick, and 10.29% because they realized that at the age of 60 + and suffering from various chronic diseases they were particularly at risk of contracting the disease. It can be concluded that the information disseminated by the Ministry of Health reached only this group (less than 10% of respondents) and was internalized by them.
The reactions to the diagnosis of COVID-19 in the first group of respondents were characterized by fear. In the surveyed group, 41 people (32.28%) chose the statement "I felt a lot of fear, I was afraid of what would happen next", 30 people (23.62%) "I was afraid that the disease would cause some complications", 21 people (16.53% ) "I worried that my relatives would not cope without me", 10 people (7.87%) "I was afraid that the disease would last a long time and I would suffer", 12 people (9.44%) "I thought that I would die ", 6 people (4.72%)" I was afraid that my children would become orphans ", 6 people (4.72%)" I was paralyzed, for several days I did not believe that I would survive" and 5 (3.93% ) "I worried that I would be left without a respirator and help". Only a few, after obtaining the diagnosis, were able to control negative emotions (the statements "I decided to stay calm" − 21 people (16.53%) and "I was not afraid, I trusted the doctors" − 10 people (7.87%). Among the group II respondents suffering from COVID-19, symptomatic reactions expressing the fear of the disease were also the most common, but it seems to be a bit more channelized. 36.76% of respondents chose the answer "I was afraid, based on information from the media, that it could be COVID-19", and 17.65% answered "I was very afraid because the disease started to develop so quickly that I knew it was COVID-19 ”. However, there were not as many statements with a dramatic personal overtone as in group I. After a year of the COVID-19 epidemic, it turned out that most of the patients were recovering, which the patients in group II seemed to relate to themselves as well. As many as 22.06% of respondents declared that after noticing the first symptoms of COVID-19 they considered them to be a common cold, and 14.71% to be flu. The percentages were higher than in group I, which proves that the information about the epidemic had not reached the respondents or they treated it as irrelevant to themselves. For some of the respondents from group II, the COVID-19 diagnosis was a surprise because they were undergoing the disease asymptomatically. They (5.88% of respondents) found out from health care workers that they were sick with COVID-19 after people who fell ill gave their name as contact persons (2.94%) and in other ways (14, 71%). For respondents in this group, the information about the serious course and effects of COVID-19 was inconsistent with their personal experience.
The feelings and fears of patients from both study groups related to contracting COVID-19 were private and personal. Their dominant feature was the fear of the unknown. The patients from group I feared death, suffering, complications, and the consequences of their illness and death for their relatives. In those who survived the disease in the hospital (36.22%), the most painful experiences were the fear of death, suffering caused by the disease, fear of its consequences and the death or disability of relatives. Some also mentioned the feeling of isolation and the dry disinteresting attitude of the staff to the patients in some hospitals. For those who survived COVID-19 at home, fear, a sense of abandonment, and even hunger were the dominant experiences. Only 50% of the respondents from this group could count on the help of adult children during the disease. The statements of patients from group II were similar. For those who stayed in the hospital, the worst experience was the illness itself ("I had little strength to think about anything else" − 33.82%), strict sanitary regime (10.29%), no close personal contact with the doctor (2, 94%). For those who stayed at home, the most common feeling was fear of deterioration of health ("I was afraid that the disease would start to worsen, and I would not be able to call a doctor and die without help" − 20.59%), feeling of loneliness and isolation (19.12%), experiencing the nuisance of quarantine (10.29%), fear of death ("fear that even if they take me to the hospital, they will not cure me there anyway" − 8.82%). For 4.41% of respondents, the perceived problem was the lack of information about the disease ("I did not know what could really happen to me" − 4.41%). Objectively, however, most of the respondents from both groups did not sufficiently understand the information about COVID-19 provided by public institutions in the years 2020–2022.
The statements of the respondents from both groups significantly differ from the interpretations of the psychological effects of the epidemic published in the press and disseminated in the media in 2020–2022. In the first group of respondents, where 98% had full-blown COVID-19, only slightly more than half of them considered that the disease would have an impact on their further life. This was declared by 40% of the respondents, and further 14.2% considered it to be a serious impact. Respondents who declared such a position derived this influence from measurable clinical and social facts (severe level of dysfunction that occurred in them after COVID-19, death or serious health complications in the spouse). The remaining respondents in this group did not recognize the incidence of COVID-19 as an issue that would have a serious impact on their future. The explanation of this position is the sense of material security, obtaining satisfactory medical help during the disease and the possibility of undergoing stationary rehabilitation. As many as 33.9% of respondents from this group did not return to work since they had been diagnosed with COVID-19 undergoing long-term treatment and rehabilitation, which they obtained free of charge while on a paid sick leave. Further 29% of respondents expressing this view were retirees and pensioners, also receiving treatment and rehabilitation free of charge and maintaining their pre-disease income level. Contrary to the opinions published in the years 2020–2021 in the Polish press and expressed on the Internet, patients from group I did not recognize COVID-19 as a "milestone" in their existence. Experiencing the serious symptoms of the disease and its effects, most of them, however, expressed the conviction that they could recover. At the same time, they were aware that they may not return to their previous physical condition or that it would be a long process. This created the basis for the involvement of patients in the implementation of the proposed exercise program and faith in its potential effectiveness.
Answers regarding the current health condition of the respondents starting rehabilitation were important. Among the most common symptoms (multiple answers possible), the most frequent were breathing difficulties (66.18%), followed by physical weakness (60.29%), symptoms of brain fog (lack of concentration, memory and cognitive impairment − 50%), muscle aches (39.71%), headaches and other physical symptoms (22.06%). 8.82% of the respondents had no complaints. Among the symptoms that accompanied the respondents before starting rehabilitation, the most frequently mentioned were: trouble sleeping and waking up several times a night (58.82%), difficulty falling asleep and waking up in the early morning without being able to fall asleep again (30.88%), insomnia (19 12%). Other problems were related to: drowsiness (17.65%), apathy (11.76%), lack of joy (anhedonia − 11.76%), symptoms related to the mental state (11.76%), increased nervousness (8.82% ) and nightmares (5.88%).
The respondents were also asked about the evaluation of the rehabilitation methods used in the facility in Głuchołazy. In this section, they could choose multiple answers. The highest were evalated activities such as training on a stationary bike (69.12%), group improvement exercises (61.76%), breathing exercises (58.82%), group walks (51.47%), inhalations (47.06%), exercises to develop cognitive functions, short-term memory, hand-eye coordination (25%), exercises using virtual reality (VR) (20.59%). Less popular were the classes with Nordic walking poles (11.76%), learning how to cough effectively (10.29%) and training on a treadmill (8.82%). 11.76% of the responses concerned the interest in other forms of rehabilitation, such as training with the use of stochastic resonance, high-intensity magnetic field, relaxation classes with the use of VR. The subjects responded positively to the possibility of using other rehabilitation methods related to motor organ dysfunctions during their stay in the hospital in Głuchołazy. This fact was accepted by 47.06% of the respondents, and 35% were of a different opinion. Among the methods of psychological rehabilitation, the respondents would most likely use individual psychotherapy during rehabilitation (35.29%), art therapy (23.53%), group psychotherapy (17.65%). 5.88% expected other forms, such as access to a library, workshops with a psychologist, classes with the use of therapeutic coloring books with mandalas. The respondents positively assessed the fact of providing them with help / pastoral care appropriate to their needs during the rehabilitation period after COVID-19 (64.71%). 11.76% of the respondents were of the opposite opinion. 80.88% were satisfied with medical care during their stay in the hospital in Głuchołazy, while 10.29% expressed a different opinion. At the same time, the respondents saw the need for changes in this area. 42.65% would like more frequent medical visits and tests of family members with a pulse oximeter, blood pressure and temperature tests, 20.59% pointed to the need for thorough examinations during admission and to establishing additional procedures. 17.65% did not have an opinion on this subject. The results regarding satisfaction with physiotherapy care were even better. 89.7% positively assessed the care of physiotherapists, and 2.94% disagreed. The results concerning the level of satisfaction of the respondents with the conditions of stay during rehabilitation in the hospital in Głuchołazy seem interesting. The standard of offered physical exercises was rated the best by 82.35%, with 14.71% negative. Food order: 80.88% positive and 16.18% negative. Standard and availability of additional rehabilitation treatments: 66.18% and 32.35%, respectively. Pastoral assistance / care: 51.47% and 45.59%. Accommodation standard: 50% and 47.06%. Psychological help was assessed positively by 35.29% and negatively by 61.76%. In general, the respondents assessed the rehabilitation program offered by the hospital in Głuchołazy as satisfactory (54.41%) or effective (30.88%). 7.35% found it very effective, and no one assessed it as ineffective or not meeting their needs. At the same time, the respondents saw the need to enrich the current post-covid rehabilitation program with new, additional elements, which would make it more effective. This fact was confirmed by 80.88% and the opposite was confirmed by 2.94%. Among the new elements in the rehabilitation program after COVID-19 they would see: organized transport of patient groups for swimming in the pool (61.76%), organized bus trips around the area (44.12%), thematic talks on the management of COVID-19 (30, 88%), organized discussion groups working under the supervision of a psychologist (25%), art therapy classes (17.65%). The smallest number of respondents recognized the need to organize meetings for patients with pension and disability pension advisors from the Social Insurance Institution, advisors from employment offices, etc., while 25% mentioned other elements. Most often these were additional physical exercises after 4 p.m. (26.47%), talks on respiratory methods of combating post-covid ailments (25%), ENT and phoniatric (22.06%) classes (rehabilitation) and more physical exercises and going out to the fresh air (8.82%). When asked how the respondents imagine their return to work after the end of rehabilitation after COVID-19 and whether they would like to return to work at all, they most often answered that they want to return to work and pursue their passions in it (26.47%), and also, that they want to go back to work and start earning as before the epidemic or more (22.06%). 8.82% of the respondents decided that they wanted to return to work in order to work out the years of employment needed for retirement and that they had to return to work to earn a living for themselves and their families. 25% were not interested in returning to work because of the age or as disable pensioners. When it comes to the question of whether and to what extent rehabilitation after COVID-19 at the hospital in Głuchołazy created better opportunities for the respondents to return to work, 60.3% of respondents assessed the rehabilitation program positively, and 14.6% had a different opinion. The remaining respondents had no opinion on this subject as they had not planned to return to work.
In the second group, 29.41% of respondents considered that having COVID-19 would have a large impact on their further life, 8.82% of respondents said that it would have little impact and nothing special would change, and 51.47% had no opinion. Again, their opinion was influenced by their family and social situation, on the basis of the same parameters as in group I (serious complications, loss of a spouse). However, the majority of the respondents were not afraid of losing their jobs and livelihoods. Comparing the responses obtained from members of both groups, we can conclude that the impact of COVID-19 on further life was due to biological and clinical factors (post-sickness complications, death of a loved one), and not related to the socio-occupational situation of the respondents. Before, during and after the disease, it was equally stable. This attitude distinguished the way the COVID-19 epidemic was experienced by members of both study groups from that part of the Polish population which saw the effects of this epidemic primarily in socioeconomic terms (loss of income, work, orders, supplies, outlets, recipients' interest in their activity that was previously a source of earnings, etc.) and whose feelings were extensively reported in the media and on the Internet in 2020–2021.
In both groups of respondents (apart from people who lost their loved ones as a result of an epidemic), the intensification of symptoms of depression, a sense of a collapse in life prospects, etc., was not observed, which was often reported in the Polish media. There were, however, feelings that can be characterized in terms similar to post-traumatic growth. In all respondents from group I, a sense of joy and gratitude towards their fate was noted that resulted from the fact that they managed to survive such a serious illness. Confronting the possibility of one's own death and observing the disease and death of other patients became an impulse for most of the respondents from group I to increase the affirmation of life and to have plans for the future. Their common feature can be distinguished as restoring the sense of agency and control over their own biography. For the employed, this was to be achieved by returning to work, for retirees and pensioners due to the possibility of implementing the existing lifestyle elements (gardening, social contacts, renovation of the apartment, travel, etc.). The resumption of the current activity and the return to the lifestyle from before the disease were considered as restoring the normal trajectory of the biography by all the respondents. The most important thing for the subjects was the ability to independently plan their own activity and carry it out in accordance with this plan. The sense of agency was associated in the respondents from the first group with the intention to resume the social roles they had performed before the illness and which were a source of satisfaction for them. After their recovery, the respondents intended to occupy the same (or a similar) place in the social structure as in the pre-illness period. They strove to do so even when, due to emerging dysfunctions, they could no longer work so intensively or in the same position. Similar trends also occurred in the second group of respondents, the more so as the financial situation of the respondents was even better there and almost 20% did not have a severe form of COVID-19 (therefore no serious dysfunctions were revealed).
Among the respondents, 10.2% from group I thought that their life after COVID-19 would be better than before, because they would appreciate life more, take more care of their health, express a more positive attitude towards the future, re-evaluate their life priorities, change jobs. This is possible because they have gained more faith in the effectiveness of treatment and rehabilitation. As many as 63.8% of respondents from group I believed that COVID-19 would not change anything in their lives or it is difficult to say what it would change. 74% of respondents in this group said that having COVID-19 would not affect their future prospects. This way of experiencing the disease has a very favorable prognosis. It can be a good basis for patient involvement in the process of long-term clinical rehabilitation, when it is needed, or for a successful return to work interrupted by an illness. The patients’ attitude towards their own disease is based on their internalization of the clinical standard. They perceive the risks associated with the disease in a realistic manner, which directs them towards constructive resolution of health and social problems [15]. In the second group of respondents, a similar attitude was also represented by a majority of the respondents. Among the respondents, 5.88% believed that life would be better, 20.59% believed that after the epidemic their life would be worse, 8.82% that nothing would change, and 54.41% of the respondents did not have any opinion.
In the first group of respondents, 18.1% believed that their life after COVID-19 would be worse than before. The respondents expressed concerns about the destruction of their body by the disease, the occurrence of complications, lack of strength to work and mental disorders caused by isolation. They were also concerned about the factors related to a wider social context, such as permanent loss of interpersonal contacts, economic crisis, financial problems for many people, and the fact that the COVID-19 epidemic would remain with us forever. These fears reflect the fundamental threads present in 2020 in the Polish press and media discourse, which the respondents internalized and they became a source of fears and suffering for them [1]. In the second group of respondents, as many as 75% considered the presence of persistent symptoms of reduced physical fitness after suffering from the disease, 25% the constant fear for their own health and life, 23.53% death of close friends, 22.06% depression, 14.71% death of other relatives, 5.88% death of a spouse and loss of the job and permanent earnings, 2.94% emergence of permanent changes in professional work - loss of previous employment, lower earnings in the new job.
In the respondents’ experiences, the course of COVID-19 focusses on the level of satisfaction with the help provided to them during the disease. 52.8% of the respondents from group I considered that the medical assistance provided to them during their illness was appropriate and that they were properly cared for. 20.5% stated that they had problems with obtaining it (it was difficult to reach the doctor or the Sanitary Inspectorate), but nevertheless made further attempts and finally received the expected help. 36.2% of respondents waited at home for the disease to develop or subside, and only when symptoms worsened did they start seeking medical attention. None of the respondents in this group tried to deny the occurrence of serious disease symptoms or to self-medicate. Nobody had used para-scientific methods or those characteristic of the so-called alternative medicine. The respondents correctly addressed the people and institutions in which they intended to obtain help, they also expected that it would be provided to them in accordance with the current medical standard. Even when, due to the organizational inefficiency of the Polish anti-epidemic protection system, they faced problems with meeting these expectations (impeded contact with a doctor and the health officer), they made systematic and sometimes even persistent efforts to obtain medical help. Most of the subjects in this group were eventually admitted to a hospital that had a rise in COVID-19 patients under professional care. In the assessment of hospital experiences, there were only sporadic instances of bad, "cold" and harsh treatment of the patients. The respondents also indicated examples of behavior full of care and warmth (Kluczbork, Kędzierzyn-Koźle). They appreciated the efforts of the medical and nursing staff and the general atmosphere in these hospitals, which gave them confidence and faith in survival. In the second group of respondents, when asked what the most difficult during their stay in hospital was, 10.29% considered the strict sanitary regime, including personnel in special costumes and isolation, 2.94% no close and warm contact with a doctor. 33.82% of respondents indicated the disease itself and the lack of strength to think about anything else, while 7.35% mentioned other factors, such as, for example, no contact with the family, no visits from relatives, awareness of what was happening around that such a large number of patients died after contracting the virus, a sense of danger in the ICU, black bags in the corridor and others.
Patients' experiences related to COVID-19 were significantly influenced by the manner of reporting the epidemic in the Polish media, which is discussed in more detail in the monograph devoted to it [1]. Overall, it can be said that the way of informing was not correct. Until the announcement of the state of the epidemic alert, and then the state of the COVID-19 epidemic in Poland (March 2020), information about it was sparse and biased, and the possibility of spreading the epidemic to Poland was minimized, even when in February 2020 it was already spreading in Europe. An appropriate standard of information about the epidemic was not developed, nor presented to Poles in an unambiguous and understandable way. As a result, the respondents from both surveyed groups were not aware that the epidemic could threaten them, and when they fell ill with COVID-19 they did not have an effective management strategy. The official information obtained until October 2020 from the public television minimized the threat, after which the epidemic got out of control. When the introduction of anti-epidemic restrictions turned out to be necessary during the successive waves of the epidemic, they were not understood and accepted by the majority of the society. The respondents from both groups, due to the high level of education, expressed a higher than average level of acceptance for presenting the epidemics in clinical terms. They were independently seeking information about COVID-19 from various sources, including 15% from foreign television. In January 2020, the Internet was the main source of the news for only 3.1% of them. When the epidemic broke out in China, only 65.4% of respondents considered the information about COVID-19 to be alarming. When the epidemic moved to Europe in February 2020, 88.9% were worried about this fact, and at the end of February, already 92.1% of respondents. The official information strategy on COVID-19, which was present in the Polish media from January to March, was assessed negatively by the respondents. They stated that they had not been adequately prepared by the country's authorities for the outbreak of the epidemic in Poland. As many as 24.4% were completely surprised by the outbreak of the epidemic in Poland, and 9.4% by its dynamic development in our country. The government media dominated by the "official optimism" was blamed for the Poles' unpreparedness for the epidemic. Therefore, the respondents still searched for information from various sources, including 48.0% from the Internet. However, only 9.44% of respondents drew information about COVID-19 only from this source. This explains the maintenance of a high level of trust in the standard of clinical medicine among the respondents from group I and the lack of popularity of alternative treatment and prophylaxis methods among them.
The respondents from group I expressed specific expectations towards the information on COVID-19 stating that it should be professional, regular and useful. Despite the fact that they considered the information available in the Polish media insufficient, they still found it useful. 48.8% of respondents said that they felt better informed about what was going on, 30.7% found it useful in practice and allowing them to better organize their lives during the epidemic. 28.3% of respondents said that the information about COVID-19 should be provided regularly by doctors, not politicians. 20.5% felt that more information in the media would allow people to prepare well for the epidemic, 18.1% that the information should be more consistent. Only 14.9% of respondents said that it would have been better if Poles had received less information about COVID-19, because then people would have been calmer and taken care of their own matters. In the second group, there were no longer extended expectations of the respondents regarding the information on COVID-19. They were being widely reported in the official media. Their social credibility turned out to be a problem, because those communicated in the clinical standard were opposed by the alternative "internet" standard. Parascientific and overtly anti-scientific views on COVID-19 became popular in the Polish society. Against this background, the confidence in the clinical standard among the respondents from the second group seems to be higher than the average in the Polish population. However, this was not tantamount to sufficient awareness of the threats related to COVID-19 and relating the epidemic's dangers to oneself. This is clearly visible in the responses to the question: Will the COVID-19 epidemic affect Poland? In the first group of respondents, the individual course of the disease did not affect the construction of the projections by the respondents regarding the impact of the epidemic on the situation in Poland. Over 50% of the respondents were not able to clearly assess ("hard to say" − 56.56%) or did not give an answer at all (7.87%). The situation that would change for the worse was chosen by 17.32%, 10.23% said that it would change for the better, and 7.87% that nothing would change. In the second group, the assessment was completely different. As many as 61.76% of respondents considered that the epidemic would be of great importance for Poland, 1.47% that it would be of little importance, and 26.47% could not make an unambiguous assessment ("hard to say"). It can be hypothesized that the cause of this change was the prolonged duration of the epidemic and the information reaching respondents from the media every day. That information was not in line with their personal experience.
In the experience related to COVID-19 in both groups of the respondents, the possibility of undertaking inpatient post-covid rehabilitation in a hospital ward played an important and positive role. Patients who experienced COVID-19 symptomatically expected that rehabilitation would eliminate the related dysfunctions, such as reduced respiratory efficiency of the lungs, disorders of the nervous system and cognitive disorders (the so-called post-covid fog). The subjects also expected an overall improvement in well-being, an improvement in physical condition, a return to full physical condition and obtaining instructions on how to do so. They expected an improvement in the parameters related to mental and social functioning, that is reducing or eliminating the so-called post-covid fog, stress and anxiety. They also wanted to learn more about recovering from the COVID-19 disease and preserving health. Patients' expectations regarding inpatient rehabilitation should be considered realistic and adjusted to their knowledge of the nature of COVID-19 and the complications associated with this disease. Patients were aware of the biological causes of the disease, as well as its effects, which they also defined in clinical terms. They expressed their readiness to actively participate in the proposed exercise program and believed that their individual rehabilitation would prove effective. A similar attitude was found in the second group of respondents.
The presented opinions of the respondents based on the results of the survey may be supplemented with statements obtained in the form of an unstructured interview. The respondents (group III) expressed a high level of approval for the model of stationary rehabilitation proposed by the Specialist Hospital of the Ministry of Interior and Administration in Głuchołazy. The approval grew as the course progressed, along with the gradual improvement of the patient's physical capacity and the observation of the progress of rehabilitation in other patients. Patients highly rated the personalized rehabilitation model, based on assigning each patient to a group with specific performance parameters. By doing exercises together with patients with a similar degree of physical capacity, the respondents did not develop a sense of disability and physical incompetence. They did not assume the role of an outsider during the exercises, supported both by physiotherapists and people doing the exercises together. Patients downplayed (as insignificant) the restriction of personal freedom associated with undergoing rehabilitation under the hospital regime. In their opinion, the serious physical dysfunctions that motivated them to come to rehabilitation balanced the need to comply with the hospital regime, as well as a fairly average standard of accommodation. The respondents expressed a positive opinion of the possibility of using the religious service in the hospital and attending the Holy Mass. They also assessed very well the communication skills of nurses and physiotherapists who would find time for individual talks with patients and provide them with support.
Some of the patients undergoing rehabilitation in the hospital regime perceived the proposed model negatively. They considered the expectations related to the possibility of free walks, establishing contacts with other patients and getting closer to them on a social basis as insufficiently satisfied. There were no special spaces for this purpose in the hospital. The expectations of this group came close to the spa treatment model, in which the above-mentioned needs are successfully met in specially designated facilities and places. Some patients who underwent COVID-19 asymptomatically and did not develop serious physical dysfunctions critically referred to the rehabilitation model proposed in Głuchołazy for other reasons. They did not feel any decline in physical condition or any measurable ailments. These patients were not interested in doing many exercises each day as part of the individual rehabilitation program that was offered to them. This applied to both exercises with the use of modern equipment and typical gymnastic activities. Patients treated them with reluctance because they did not feel any limitation in their physical fitness, so they did not see the need for physical improvement.