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A narrative review of research on the effects of physical activity on people living with HIV and opportunities for health promotion in disadvantaged settings
Abstract
The article explores different types and effects of physical activity for people living with HIV. Considering the lack of studies done in African contexts and the disparity between research settings and natural settings, a narrative review of the literature was conducted and contextualised to South Africa. Various physical, psychological and social-cultural constraints impair the wellbeing of people living with HIV, in part by restricting their participation in physical activities. Apart from the well-studied immediate physiological benefits on health, we argue that physical-sportive group activities, such as sport or recreational games, can improve psychosocial factors and generate holistic health effects for people living with HIV. Group-activity effects could improve individuals’ motivation and adherence to participating in physical activities, provided that positive interaction and non-stigmatisation are guaranteed. However, most studies in this field have been limited to the benefits of aerobic exercise and resistance training. There has been little research on the types and different effects of physical activity and adherence to physical activity of people living with HIV in African contexts. Based on an analysis of the different types and effects, we suggest opportunities for and challenges to implementing physical activities for people living with HIV, especially in disadvantaged settings, and also identify gaps in the research to date.
... See Figure 1 Table 1 describes the characteristics of the included articles. Among the 41 included articles, 35 (85%) were research studies involving primary data collection [21, one (2%) was a secondary analysis [68], three (7%) were systematic reviews [69][70][71], and two (5%) were narrative reviews [22,72] (Figure 1). Table 1 describes the characteristics of the included articles. ...
... Table 1 describes the characteristics of the included articles. Among the 41 included articles, 35 (85%) were research studies involving primary data collection [21, one (2%) was a secondary analysis [68], three (7%) were systematic reviews [69][70][71], and two (5%) were narrative reviews [22,72] (Figure 1). The encouragement participants received from their families and community members helped them adhere to the exercises, and, they encouraged their children, partners, and neighbors to start exercising. ...
... Figure 2 displays the timing of publications, which represents the trend for consideration of SDOH in the context of HIV and PA or exercise over the years. Primary Purpose of Included Articles: Thirty-one (76%) of the 41 included articles included a primary purpose to explore the association or relationship of SDOH with PA or exercise in PLWH [21,22,36,[38][39][40][41][42][43][44][45]47,[51][52][53][54][55][56][57][58][59][60]62,64,[66][67][68][69][70][71][72], whereas 10 (24%) articles examined SDOH in the context of other aims [34,35,37,46,[48][49][50]61,63,65]. Among these 10 articles, four (40%) evaluated the association of SDOH with PA or exercise as a secondary aim of the study [46,49,61,63]. ...
Physical activity (PA) and exercise are an effective rehabilitation strategy to improve health outcomes among people living with HIV (PLWH). However, engagement in exercise among PLWH can vary. Our aim was to characterize the literature on the role of social determinants of health (SDOH) on engagement in PA or exercise among adults living with HIV. We conducted a scoping review using the Arksey and O’Malley Framework. We searched databases between 1996 and 2021. We included articles that examined PA or exercise among adults with HIV and addressed at least one SDOH from the Public Health Agency of Canada Framework. We extracted data from included articles onto a data extraction charting form, and collated results using content analytical techniques. Of the 11,060 citations, we included 41 articles, with 35 studies involving primary data collection 23 (66%) quantitative, 8 (23%) qualitative, and four (11%) mixed methods. Of the 14,835 participants, 6398 (43%) were women. Gender (n = 24 articles), social support (n = 15), and income and social status (n = 14) were the most commonly reported SDOH in the literature with the majority of studies addressing only one SDOH. Future research should consider the intersection between multiple SDOH to better understand their combined impact on engagement in PA or exercise among PLWH.
... However, studies conducted in high-income countries cannot be extrapolated in SSA due to differences in societies, cultures, and health systems. Studies on HIV, social cultural issues, and physical activity in SSA are scarce [20], and this has been stipulated as a gap in a recent systematic review on physical activity and HIV in SSA [21]. ...
Background
People living with HIV (PLWH) have low levels of physical activity. Using the social ecological model to understand perceptions, facilitators and barriers of physical activity in this population is of importance for developing contextualised interventions to improve physical activity in PLWH.
Method
This was a qualitative sub-study conducted between august and November 2019 as part of a cohort study on diabetes and associated complications in HIV infected in Mwanza, Tanzania. Sixteen in-depth interviews and three focus groups with nine participants in each were conducted. The interviews and focus groups were audio recorded, transcribed and translated into English. The social ecological model was considered during the coding and interpretation of the results. Transcripts were discussed, coded and analyzed using deductive content analysis.
Results
Forty-three PLWH aged 23–61 years participated in this study. The findings showed that most PLWH perceived physical activity as beneficial to their health. However, their perceptions of physical activity were rooted within existing gender stereotypes and roles in the community. Running and playing football were perceived as activities for men while household chores activities were for women. Further, men were perceived to do more physical activity than women. For women, household chores and income-generating activities were perceived as sufficient physical activity. Social support and engagement of family members and friends in physical activity were reported as facilitators of physical activity. Reported barriers of physical activity were lack of time, money, availability of physical activity facilities and social support groups, and poor information on physical activity from health care providers in HIV clinics. Human-immunodeficiency virus (HIV) HIV infection was not perceived by PLWH as a barrier for doing physical activity but most family members did not support them to do physical activity, fearing that it might worsen their condition.
Conclusion
The findings demonstrated differing perceptions, facilitators and barriers of physical activity among PLWH. Interventions addressing awareness, gender stereotypes and roles related to physical activity from individual to community level are needed. Supportive environment and infrastructures are needed to improve physical activity levels in PLWH in Tanzania.
... Secondly, the findings add support to existing, and hopefully will inspire to new, health promotion activities, that include a focus on increasing SOC, and activities that strengthen social support as an available resistance resource. In the literature there appear to be more examples of mental health promoting interventions including specific at risk or treatment groups [79,80], but the principles of empowerment and findings on influence on social capital and social cohesion should still be relevant for the general population. Health promoting activities with a salutogenic perspective may benefit from careful attention to including elements of both empowerment and reflection [38], and an exploration of strengthening SOC at different system levels [81]. ...
Background
The aim of the present study was to examine to what extent observed gender differences in mental health are associated with the protective factors social support, sense of coherence and participation in regular physical activity and more generally, engagement in organized or unorganized activity with other people.
Methods
This study was based upon a cross-sectional regional health survey in Norway, conducted during the winter of 2015–2016, in three southern counties; Aust-Agder, Vest-Agder and Vestfold. The study focused on young adults, comparing three age groups; 18–24 years old ( n = 624), 25–31 ( n = 582), and 32–38 years old ( n = 795).
Results
Sense of coherence was strongly associated with low mental distress in all age groups and for both genders, while the association between low social support and mental distress was significant for young women only. Regular physical activity was not positively associated with low mental distress when sense of coherence and social support were included in the analysis.
Conclusion
Social support appears to have a stronger role as a protective factor for mental distress among young women, compared to young men and older persons. This has implications for health promoting activities that target young women. Sense of coherence showed a strong association with low mental distress scores for all ages studied.
... However, in Sub-Saharan Africa (SSA), studies on HIV and physical activity are scarce [13]. ...
Background
People Living with HIV (PLWH) have low levels of physical activity. Understanding of perceptions, facilitators and barriers of physical activity in this population is of importance for future perspectives in developing contextual based intervention to improve physical activity in PLWH.
Method
This study explored perceptions, facilitators and barriers of physical activity in PLWH using sixteen in-depth interviews and three focus group discussions conducted in Mwanza, Tanzania. The interviews and discussions were audio recorded, transcribed and translated into English. Transcripts were coded and analysed deductively using thematic content analysis. The themes were interpreted and presented using the social ecological model.
Results
Forty-three PLWH age 23-61 years old participated in this study. The findings showed that, PLWH perceived physical activity was beneficial to their health and that their perceptions and practices were rooted within the existing gender stereotypes and roles in the community. In addition to that, house-chores and income generating activities were perceived as sufficient physical activity to achieve adequate levels of physical activity. As facilitators, social support and interactions from family and friends were appraised positively as motivating factors of physical activity in this population. Indeed, at individual to community/environmental levels, PLWH reported barriers of physical activity were lack of time, money, and availability of facilities, as well as lack of social groups participating in physical activity in the communities and inadequate information on physical activity from health care providers at ART clinics. HIV disease was not reported as a main barrier of physical activity but rather stipulated from family members as a reason not to support physical activity in PLWH.
Conclusion
The findings demonstrated differing perceptions, facilitators and barriers of physical activity among PLWH. Interventions addressing physical activity awareness, gender stereotypes and roles relating to physical activity performances from individual to community level, building supportive environment and infrastructures are needed to elevate physical activity levels in PLWH particularly in low and -middle income countries.
... Secondly, the ndings add support to existing, and hopefully will inspire to new, health promotion activities that have a focus on increasing SOC, including activities that strengthens social support as an available resistance resource. In the literature there appear to be more examples of mental health promoting interventions including speci c at risk or treatment groups [77,78], but the principles of empowerment and ndings on in uence on social capital and social cohesion are relevant. Health promoting activities with such a salutogenic perspective may bene t from careful attention to including elements of both empowerment and re ection [79]. ...
Background: The aim of the present study was to examine to what extent observed gender differences in mental health are associated with the protective factors social support, sense of coherence and participation in regular physical activity and more generally, engagement in organized or unorganized activity with other people.
Methods: This study was based upon a cross-sectional regional health survey in Norway, conducted during the winter 2015-2016, in three southern counties; Aust-Agder, Vest-Agder and Vestfold. The study focused on young adults, comparing three age groups; 18-24 years old (n=624), 25-31 (n=582), and 32-38 years old (n=795).
Results: Sense of coherence was strongly associated with low mental distress in all age groups and for both genders, while the association with social support was highly significant for young women only. Regular physical activity was not positively associated with low mental distress when sense of coherence and social support were included in the analysis.
Conclusion: Social support appears to have a stronger role as a protective factor for mental distress among young women, compared to young men and older persons. This has implications for health promoting activities that target young women. Sense of coherence showed a strong association with low mental distress scores for all ages studied.
... For instance, sport is used as part of psychosocial aid programmes in refugee camps and in postdisaster intervention (ICSSPe 2008; Ley and Rato Barrio 2012a). It can contribute to conflict resolution and prevention (Sugden 2008;Munro 2012;Ley and Rato Barrio 2013) and is also a useful tool for the prevention of diseases such as HIv/AIDS (Tackle Africa 2010; Mwanga 2012; Ley and Rato Barrio 2012b;Hershow et al. 2015). In divided societies, a sports playground is often the only place where children can interact with their peers from different communities (Gasser and Levinsen 2004;Giulianotti 2011). ...
... Resultados de algunos estudios han mostrado como el entrenamiento en atención plena amortigua los descensos en linfocitos T CD4+ en adultos infectados con VIH 82 . Y también parece ser que las actividades grupales físicas, como los juegos deportivos o recreativos, pueden mejorar los factores psicosociales y generar efectos beneficiosos sobre la salud inmunológica para las personas que viven con esta enfermedad 83 . Sin embargo, la literatura consultada no parece aclarar si dichas mejoras en pacientes con VIH provienen de la estimulación de una única vía de intervención (adherencia a antirretrovirales) o del efecto protector de varias vías (adherencia a antirretrovirales más incremento de salud psicosocial). ...
The purpose of this study was to analyse behavioural biomarkers within the health sciences. Recent and classic contributions of psychoneuroimmunology have been reviewed, illustrating the importance of psychosocial factors that modulate certain functions and biological
systems offering an epigenetic perspective on health and disease. The obtained results confirm the modulation of the immune and inflammatory systems by psychosocial factors, proposing summative ways of intervention to health problems with high prevalence and mortality
rate. The results of the reviewed research are discussed, offering important clues to legislators, professionals and students of health sciences. It also reflects on the challenges and opportunities
for researchers and teachers in the health area interested in the aetiopathogenesis of the mind-body binomial, and the opening of new future perspectives of work.
Orang yang menderita HIV/AIDS seringkali mendapat stigma negatif dan perubahan nilai sosial. Penelitian ini bertujuan untuk mengetahui penurunan stigma dan perubahan nilai sosial ODHA (orang dengan HIV/AIDS) melalui aktivitas olahraga futsal Rumah Cemara Bandung. Penelitian ini menggunakan metode causal comparative (ex-post facto). Desain dalam penelitian ini adalah criterion group design. Pengambilan sampel dalam penelitian ini menggunakan teknik convience sampling. Sampel dalam penelitian ini berjumlah 20 orang dengan dibagi dalam dua karakteristik 10 ODHA yang beraktif olahraga dan 10 ODHA yang tidak aktif olahraga. Instrumen yang digunakan berupa angket tertutup dan wawancara dengan menggunakan Skala Likert. Berdasarkan uji alat ukur validitas dan reliabilitas peneliti menggunakan angket yang di adopsi dan di diskusikan dengan expert judgment. Analisis data diolah menggunakan SPSS software versi 23. Hasil penelitian ini menunjukan ada penurunan stigma dan perubahan nilai sosial dilihat dari uji independent sampel T dengan T hitung T dengan menarik kesimpulan Nilai t- Hitung tabel Stigma sebesar 3.439 2.10092 dan Nilai Sosial sebesar 3.730 2.10092. Artinya, aktivitas olahraga berpengaruh terhadap penuruna stigma dan perubahan Nilai Sosial ODHA.
Sports activities are activities that can be carried out by all groups with the aim of improving the quality of life in terms of physical fitness and psycho-social well-being. People who suffer from HIV/AIDS often get negative stigma and changes in social values. This study was aimed at determining the decrease in stigma and changes in the social value of PLWHA (people with HIV / AIDS) through futsal Rumah Cemara Bandung sports activities. The method used in this study was a comparative causal method (ex-post facto). Design of the study used criteria group. The technique of sampling in this study used convience sampling technique. The sample of this study consisted of 20 people divided into two groups: 10 PLWHA who were active in sports and 10 PLWHA who were not active in sports. Data collection process was conducted through face-to-face interview and structured questionnaire. Based on validity and reliability tests, researchers used an adopted questionnaire and discussed the questionnaire with the expert. Data analysis was conducted by using SPSS version 23 employing independent sample T-test. The results of this study indicate a decrease in stigma and changes in social values seen from T test with tcount ttable. The conclusions from the Stigma calculation was 3.439 2.10092 and Social Value was 3.730 2.10092. The result concludes that sports activities have an effect on reducing the stigma and changes in the Social Value of PLWHA.
Aims
To develop an understanding of what a storytelling intervention entails, its main effects and how this causes the promotion of physical activity in chronically ill patients.
Methods
An integrative review was undertaken in three stages; a) search b) appraisal c) synthesis. Studies were included if they represented participants with a chronic illness and used a storytelling approach for the intervention as well as including physical activity as a component of the intervention.
Findings:
Fourteen articles were identified that included a total of 818 participants (191 male, 348 female, 279 unknown). No articles were identified as flawed and all were included in the synthesis. Four themes were identified: (1) ideal processes within interventions, (2) psychosocial factors which influenced storytelling, (3) perceived outcomes relating to storytelling. And (4) the perceived benefits of physical activity.
Conclusions:
This review develops a deeper understanding of the required processes, associated factors and outcomes of storytelling interventions for people with chronic illness. It provides evidence of how storytelling can be used to promote physical activity. Further research into storytelling interventions is required.
The scientific literature about AIDS and physical exercise has been traditionally dominated by biomedical approaches. The first studies which were published in the beginning of the nineties focused mainly on the transmission risks of the virus during sports. Later studies were concerned with the physiological logics of the exercise on HIV-positive persons. Since the end of the nineties the therapeutic progress contributed to envisage sport as a way to mediate the side effects of medical treatments. However the present review highlights a serious gap in the literature on Sport and HIV using a sociological point of view. The authors of this article argue that the time has come to consider sociological data linked to the experiences of HIV/AIDS in order to understand the difficulties and barriers that seropositive persons have to face when participating in sport.
BACKGROUND: Elderly people present alterations in body composition and physical fitness, compromising their quality of life. Chronic diseases, including HIV/AIDS, worsen this situation. Resistance exercises are prescribed to improve fitness and promote healthier and independent aging. Recovery of strength and physical fitness is the goal of exercise in AIDS wasting syndrome. OBJECTIVE: This study describes a case series of HIV-positive elderly patients who participated in a progressive resistance training program and evaluates their body composition, muscular strength, physical fitness and the evolution of CD4+ and CD8+ cell counts. METHODS: Subjects were prospectively recruited for nine months. The training program consisted of three sets of 8-12 repetitions of leg press, seated row, lumbar extension and chest press, performed with free weight machines hts, twice/week for one year. Infectious disease physicians followed patients and reported all relevant clinical data. Body composition was assessed by anthropometric measures and dual-energy x-ray absorptiometry before and after the training program. RESULTS: Fourteen patients, aged 62-71 years old, of both genders, without regular physical activity who had an average of nine years of HIV/AIDS history were enrolled. The strengths of major muscle groups increased (74%-122%, p=0.003-0.021) with a corresponding improvement in sit-standing and walking 2.4 m tests (p=0.003). There were no changes in clinical conditions and body composition measures, but triceps and thigh skinfolds were significantly reduced (p=0.037). In addition, there were significant increases in the CD4+ counts (N=151 cells; p=0.008) and the CD4+/CD8+ ratio (0.63 to 0.81, p=0.009). CONCLUSION: Resistance training increased strength, improved physical fitness, reduced upper and lower limb skinfolds, and were associated with an improvement in the CD4+ and CD4+/CD8+ counts in HIV positive elderly patients without significant side effects.
Objective: we investigated the association between measures and determinants of obesity in African women.
Methods: for a cross-sectional study of adult black women in the North West Province, South Africa, we used a stratified sample of 1040 volunteers from 37 randomly selected sites in the province according to the level of urbanization. We analyzed the association between measures of obesity, namely body mass index (BMI), waist circumference, waist-to-hip ratio, triceps and subscapular skinfolds, and socioeconomic factors, dietary intakes, and physical activity.
Results: the rate of obesity (BMI > 30) in the sample was 28.6%. We found a significant positive association between household income and measures of obesity. After exclusion of underreporters and adjustments for age, smoking, and household income, we found significant positive correlations between total energy intake, fat intake, and BMI. Physical activity index (derived from a subset of 530 subjects) correlated negatively with BMI and waist circumference. Subjects in the highest third of physical activity were less likely to be obese (odds ratio-0.38, 95% confidence interval-0.22–0.66).
Conclusions: women with higher incomes and lower physical activity were at the greatest risk of increased BMI. Physical inactivity showed the strongest association with measures of obesity in this study.
HTV infection and its treatment is associated with unfavourable metabolic and morphological abnormalities. These metabolic abnormalities, particularly alterations in body composition and fat distribution, may increase the risk for cardiovascular and metabolic complications, as well as reduce functional independence and lower self-esteem. Thus there is an urgent need to develop interventions intended to manage secondary side effects of HIV or antiretroviral therapy-related complications. In poly-treated patients, nonpharmacological interventions are a logical first step. Exercise training in particular may help alleviate some of the metabolic adverse effects associated with antiretroviral therapy by favourably altering body composition and patterns of body fat distribution. Studies have shown that exercise training, particularly aerobic training, can help reduce total body and visceral fat, as well as normalizing lipid profiles in HIV-infected patients. The results for resistance training, however, are less conclusive. Knowledge of the use of resistance and aerobic training and its attendant effects on insulin resistance and adipocytokines may represent an effective nonpharmacologic means for treating metabolic complications of HIV-infected persons who are receiving appropriate antiretroviral therapy. In this brief review we examine the effects of aerobic and resistance training on body composition, body fat distribution, and selected metabolic outcomes.
The present study was designed to examine the effects of a 16-week exercise intervention on several aspects of psychological and physical well-being in a sample of HIV-1 positive individuals. An exercise group (n = 19) was compared with a control group (n - 14) prior to and following the intervention on several outcome variables, including health related quality of life, psychological well-being (depression, anxiety, global symptoms), immune parameters, and cardiopulmonary parameters. The exercise group experienced a significant improvement in cardiopulmonary fitness, and health related quality of life improved significantly in that group relative to the control group. Psychological well-being improved similarly in both groups, however, while immune indices did not change in either group. Consistent with earlier studies, it is suggested that a moderate exercise intervention enhanced the health related quality of life in HIV-1 positive individuals.