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African Journal of AIDS Research
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Effects of an exercise programme with people living
with HIV: research in a disadvantaged setting
Clemens Leya, Lloyd Leachb, María Rato Barrioc & Susan Bassettb
a Universität Wien, Institut für Sportwissenschaft, Auf der Schmelz 6a, 1150 Wien,
Austria
b University of the Western Cape, Department of Sport, Recreation and Exercise Science,
Private Bag X 17, Bellville, 7535, South Africa
c Palacky University Olomouc, Department of Development Studies, tr. 17. listopadu 12,
77146 Olomouc, Czech Republic
Published online: 02 Jan 2015.
To cite this article: Clemens Ley, Lloyd Leach, María Rato Barrio & Susan Bassett (2014) Effects of an exercise programme
with people living with HIV: research in a disadvantaged setting, African Journal of AIDS Research, 13:4, 313-319, DOI:
10.2989/16085906.2014.961937
To link to this article: http://dx.doi.org/10.2989/16085906.2014.961937
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African Journal of AIDS Research 2014, 13(4): 313–319
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http://dx.doi.org/10.2989/16085906.2014.961937
Introduction
Over the past decades evidence has emerged regarding
the benefits of exercise on physical functioning, cardio-
pulmonary fitness, metabolism and muscle endurance
of people living with HIV (Smith et al. 2001, Driscoll et al.
2004, O’Brien et al. 2004, Farinatti et al. 2010, O’Brien
et al. 2010). These effects are important in the light of
HIV-associated diseases, including lipodystrophy, body
changes, the side effects of antiretroviral medication and
comorbidities. In addition, improvements in cardiopulmo-
nary fitness and functional capacities have an important role
in the management of daily life, wellbeing and quality of life
of people living with HIV (Mutimura et al. 2008, Myburgh
and De Bruto 2008, Gomes et al. 2010, Gomes et al.
2013a).
Mos reviewed studies used individualised exercise
training over a period of 10 to 12 weeks. Aerobic training
was used, mainly on a treadmill or cycle ergometer, with
a moderate intensity workload of 40% to 60% of VO2max,
although some studies used a moderate to high intensity
of 60% to 85% of VO2max (Stringer 2004, O’Brien et al.
2010). Results of a Cochrane review indicated that regular
progressive resistance training is safe, and improves the
physical factors of strength, weight and body composition,
and may also contribute to an improvement in cardiopulmo-
nary fitness and psychological status of adults living with
HIV (O’Brien et al., 2004). Thus a combination of aerobic
and progressive resistance training is widely recommended
(Robinson et al. 2011, Yahiaoui et al. 2011). However,
many questions remain unanswered, such as how to
achieve these physical and physiological effects in the
specific context of people living with HIV in disadvantaged
communities. There is a paucity of research that explores
different types of physical activities including, for example,
sport and games that are popular and accessible in many
communities around the world (Ley and Rato Barrio 2012,
Gomes et al. 2013b). Besides the physiological effects of
aerobic and progressive resistance training, the popularity
and group dynamics of sport and games could facili-
tate better access to physical activity and adherence to a
physically active lifestyle. Few authors have discussed the
opportunities that these activities provide for people living
with HIV (Florijn 1996, Rojas Salcedo 2001, Ferez and
Luauté 2008, Ley and Rato Barrio 2012).
Effects of an exercise programme with people living with HIV: research in
a disadvantaged setting
Clemens Ley1*, Lloyd Leach2, María Rato Barrio3 and Susan Bassett2
1 Universität Wien, Institut für Sportwissenschaft, Auf der Schmelz 6a, 1150 Wien, Austria
2 University of the Western Cape, Department of Sport, Recreation and Exercise Science, Private Bag X 17, Bellville, 7535,
South Africa
3 Palacky University Olomouc, Department of Development Studies, tr. 17. listopadu 12, 77146 Olomouc, Czech Republic
* Corresponding author, email: clemensley@gmail.com
This study aimed to analyse the physical health effects of a community based 10-week physical activity programme
with people living with HIV. It was developed, implemented and evaluated in a disadvantaged community in South
Africa. A pre-post research design was chosen. Major recruitment and adherence challenges resulted in a small
sample. Among the 23 participants who took part in both baseline and final testing, compliant participants (n = 12)
were compared to non-compliant participants (n = 11). Immunological (CD4, viral load), anthropometric (height,
weight, skinfolds and waist to hip ratio), muscular strength (h1RM) and cardiopulmonary fitness (time on treadmill)
parameters were measured. The compliant and non-compliant groups were not different at baseline. Muscular
strength was the parameter most influenced by compliance with the physical activity programme (F = 4.516,
p = 0.047). Weight loss and improvement in cardiopulmonary fitness were restricted by the duration of the
programme, compliance and influencing factors (e.g. nutrition, medication). The increase in strength is significant
and meaningful in the context, as the participants’ goals were to look healthy and strong to avoid HIV related
stigma. The improvements in appearance were a motivational factor, especially since the changes were made
visible in a short time. Practical implications for health promotion are described. More research contextualised in
disadvantaged settings is needed.
Keywords: exercise, health, health promotion, intervention study, movement, South Africa, sport
Downloaded by [University of Western Cape] at 02:24 20 January 2015
Ley, Leach, Barrio and Bassett314
In addition, few studies have been done in Africa (Ley
and Rato Barrio 2012), where the main burden of HIV is
found. HIV infection is one of the four major burdens of
disease in South Africa, with an estimated prevalence
at 17.8% among 15–49-year-olds (UNAIDS 2010).
“Conclusions drawn from women [with HIV] living in a
Western society will not necessarily reflect those found in
sub-Saharan Africa where socio-economic factors and
ethnicity could influence body composition changes”
(Myburgh and De Bruto 2008: 340, cf. Chopra and Ford
2005). In addition, some authors argue that “obesity is
valued in many African cultures because it is associ-
ated with dignity, wealth and being treated well by one’s
husband, and weight loss is regarded as a source of stigma
and a sign of disease, in particular HIV/AIDS” (Stern et al.
2010: 2, cf. Ezekiel et al. 2009, Matoti-Mvalo and Puoane
2011). Limited space and impoverished living conditions
in disadvantaged communities do not offer a favourable
environment for practising physical activity (McVeigh et al.
2004) and physical activity levels of people living with HIV
are low in South Africa (Kinsey et al. 2007, 2008). At the
same time, “exercise training is an inexpensive and effica-
cious strategy for improving QoL in HIV+ African subjects,
which may improve HAART [Highly Active Anti-Retroviral
Treatment] adherence and treatment initiatives in resource-
limited areas of sub-Saharan Africa” (Mutimura et al. 2008:
377). There is a vast gap in the research contextualised in
Africa, especially in disadvantaged communities (Ley and
Rato Barrio 2012).
Therefore the purpose of this study was to determine
the health effects of a community based physical activity
programme on people living with HIV contextualised in a
disadvantaged context, as opposed to a laboratory setting.
In addition, it aimed to analyse challenges encountered in
undertaking the research and intervention programme.
Methods
Design
A pre-post test design was chosen to evaluate the effects
of the 10-weeks exercise programme. A disadvantaged
urban setting on the outskirts of Cape Town, South Africa,
was selected to conduct the research at community level
with people living with HIV. Because of the social stigma
related to HIV in this community, the research project
could not be publicised as a project for people living with
HIV. Instead, recruitment was done through advertising for
a health promotion programme through institutions working
in the field, such as community clinics, non-governmental
organisations (NGOs) and HIV programmes. All partici-
pants recruited for the programme were asked to take part
in the research. The recruited sample size was too small to
establish a control group, as had been planned.
Participants
Study inclusion criteria were participants had to be
HIV-positive and willing to participate in the exercise
programme. Exclusion criteria were acute infection (e.g.
active tuberculosis), pregnancy, uncontrolled hypertension,
and any other disease or infection that was contra-indicated
for sport and exercise participation. No selection to the
project was based on HIV stage, disease progression,
medication use or associated illnesses or physiological
changes (e.g. lipodystrophy).
Although regular reminders were sent to the 50 persons
who were initially interested, only 36 arrived for baseline
testing. Of these, three were without HIV infection but
were allowed to participate in all activities together with the
other participants (to avoid stigmatisation and to secure
the support of friends), but these participants were omitted
from the data analysis. Another five of the participants
were excluded from the project because of acute tubercu-
losis (n = 1), a recent operation (n = 1), pregnancy (n = 1)
and uncontrolled high blood pressure (n = 2). Of the 28
HIV-positive participants remaining, all were asked to partic-
ipate in the final measurement independent of their compli-
ance. Five participants were not available for the final
testing, because of relocating to another suburb (n = 3) and
not being contactable (n = 2). The remaining 23 participants
varied in age between 20 and 44 years (M ± SD = 30.00 ±
7.44 years). Of these, 3 were male and 20 were female.
Intervention
Special efforts were made to make the intervention
suitable and meaningful for the participants and pertinent
to the specific setting in which it occurred. In a participa-
tory process, the participants discussed their preferences
and needs. Two different programme settings were identi-
fied. Participants in Group A (n = 11) preferred to train
individually. Reasons for this were mainly time availa-
bility, but doubts about the group dynamics and confiden-
tiality in group settings were issues identified as potentially
conflicting. A gym with qualified trainers was used. The
trainers were blinded to the research goals and HIV status
of the participants.
The participants in Group B (n = 12) preferred to train in
a group setting. The programme setting for this group was
a school within the disadvantaged community that was
made available in the afternoons. The activities in both
groups were based on the same training principles, and
included aerobic exercises (running/walking, stepper, etc.),
progressive resistance training and stretching. In Group B,
in addition, a sport or a game was played in each session.
The workload in Group B was measured during some
sessions with a Polar Team2® heart rate monitor, and a
record of the exercises, intensity, repetitions, duration and
exertion of each session were kept by using a session
sheet in both groups.
Although the time of a training session in Group B
(approximately 90 minutes) was longer than in Group A
(60–70 minutes), the workload was similar for both groups.
This was mainly because group dynamics were slower
than individual training (e.g. more time was spent changing
from one exercise to another, waiting for everyone to
finish the exercise or allowing discussions among partici-
pants between activities) and the type of physical activity
chosen. The games and sports played were less strenuous
per time unit than the more focused individual training. The
intensity of both programmes was moderate (ranging from
40% to 70% of estimated maximal heart rate) and followed
a progressive overload. All participants were asked to
participate 3 times a week for a period of at least 10 weeks.
Follow-up interventions and research are ongoing.
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African Journal of AIDS Research 2014, 13(4): 313–319 315
Research procedures
After ethical clearance had been obtained from the
University Research Committee (Reg. Nº 11/4/17 and
11/4/18) and the Municipality Health Committee (Reg. Nº:
10258), participants were recruited through the collabo-
rating community clinic, health forum, NGOs and HIV
programmes. They were informed about the research and
exercise intervention by oral presentation and an informa-
tion sheet. They were given the opportunity to participate in
the exercise intervention without participating in the research
study or to participate only partially in the research project
(e.g. not giving blood) without the other participants knowing
of their decision. All information and research instruments
were made available in isiXhosa and English. Reverse-
translation was used to check the accuracy of the question-
naires. Bilingual facilitators and translators were present at
all times for the participants. All recruited persons gave their
informed consent. No payments were made to the partici-
pants. Each participant was given a code, and the identi-
fiers were safeguarded. None of the participants were asked
to reveal their HIV status except to the medical doctor and
main researcher. The research assistants were likewise
blinded to the HIV status of the participants. All testing was
done at a tertiary institution. At the end of the programme,
feedback was given individually to the participants.
A medical doctor examined the participants, checked for
signs and symptoms, assessed their health and medication
backgrounds, and recommended full, partial or no participa-
tion in the project. The following measurements were taken
at baseline and after the 10-week intervention, independent
of compliance.
Measures
A blood sample was drawn by a nurse and sent to a
national health laboratory for analysis. The tetrachrome
T-Cell subsets test (Immunophenotyping per marker) was
used to analyse CD4 count (cells/μl) and percentage (%);
the EasyQ HIV viral load test (Abbott m2000 RealTime
HIV-1 assay) was used to measure HIV viral load (RNA
cps/ml).
Anthropometric measurements were taken by trained
research assistants. Weight and height were measured
with a beam balance scale and stadiometer, and body
mass index (BMI) was calculated. Waist circumference at
the narrowest point and maximum hip circumference were
measured with an anthropometric tape measure, and waist-
to-hip ratio (WHR) was calculated. Thickness of three
central (subscapula, suprariliac, vertical abdomen) and four
peripheral skinfolds (triceps, biceps, thigh and medial calf)
were measured with a Harpenden skinfold caliper, to the
nearest 1.0 mm.
A submaximal graded exercise test using the modified
Bruce protocol was conducted on a treadmill, where the
participants were stopped at 85% of estimated maximal
heart rate. Time on treadmill (fatigue) was measured
and VO2max was estimated. Heart rate was recorded
every minute, while blood pressure and the Borg rating
of perceived exertion were taken every three minutes.
Participants were continuously monitored during testing, by
an electrocardiogram (ECG).
Strength test was measured on a leg-press machine.
Hypothetic-one-repetition-maximum testing (h1RM) was
used to avoid maximal static pressure and forced respira-
tion (Baumann 2008). Instructions from Giessing (2003)
were followed to calculate maximal strength performance
according to a validated table.
During the period of the intervention, exercise compliance
was monitored in both groups by taking a register of attend-
ance. Non-compliance was attributed to a participant when
she/he took part in the programme on average for less than
once a week, that means, less than one-third of the total
number of sessions.
In addition, qualitative data were captured during
the programme planning, implementation and evalua-
tion period, using participatory observation (field diaries),
semi-structured interviews with all participants (recorded
and transcribed) and group discussions (extensive notes).
The data were analysed according to the quantitative
results.
Data management and analysis
Data on the treadmill, ECG, and Polar Team2® measure-
ments were recorded using a computer, and through an
exercise log sheet. A secure database was created and
the data were analysed with the Statistical Package for the
Social Sciences version 18.
Descriptive analysis was used to describe the sample.
Categorical baseline measures were compared, using
the chi-square test. Continuous baseline measures were
compared between the compliant and non-compliant
groups, and between the two different intervention groups,
using t-tests. When the data were not normally distributed,
the Mann–Whitney U-test was used. The t-test for paired
samples was used to compare initial and final measure-
ments in the compliant and in the non-compliant group
separately.
Analysis of covariance (ANCOVA), with change from
baseline as the dependent variable and compliance as the
independent variable (and baseline values as the covari-
ates), was used to determine the influence of compliance.
Results
The marital status of the participants ranged from single
(n = 13), married (n = 5), separated (n = 2) to widowed
(n = 1). A total of 19 indicated isiXhosa as their home
language, 1 indicated English and 2 indicated other
languages. Sixteen were unemployed, three were working
(paid) part-time and four were working (paid) full time.
CD4+ cell count ranged from 155 to 1 315 cells/μl (M ±
SD = 535.32 ± 256.06 cells/μl) and CD4+ percentage from
9–41% (M ± SD = 25.77 ± 9.40%). At baseline, 13 (56.5%)
of the 23 participants were taking antiretroviral medica-
tion and their viral load was undetectable. The viral load
of the other participants was between 1 751 and 152 063
RNA cps/ml (M ± SD = 16676.5 ± 36729.41 cps/ml). The
participants were medically classified into World Health
Organization (WHO) stage I (n = 10); WHO stage II (n = 6);
WHO stage III (n = 5); and WHO stage IV (n = 2).
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Ley, Leach, Barrio and Bassett316
Differences between the two intervention groups at
baseline
No significant differences at baseline were found between
the two intervention groups with regard to the WHO
stage, based on the examination of the medical doctor
(chi-square = 2.561; p = 0.464), the CD4 cell count
(U = 44.5; p = 0.307) and CD4 percentage (U = 56;
p = 0.792). In the groups A and B, respectively 36% and
75% of the participants were taking ARV medication
(chi-square = 3.486; p = 0.062). Group A was on average
slightly younger than Group B (t = −2.431; p = 0.024). There
were no significant differences between the groups for any
of the physical parameters measured.
Differences between compliers and non-compliers at
baseline
Group A was significantly less compliant
(chi-square = 9.763; p = 0.002), having only two partici-
pants who participated in at least one-third of all the training
sessions over the 10-week period. Reasons given for
non-compliance were mainly challenges in time manage-
ment, illness, HIV-related stigma, and competing priorities,
like caring of children, getting financial support from various
sources, work and/or studies.
No significant differences were found regarding WHO
stage (chi-square = 4.432; p = 0.218), CD4 count (U = 52;
p = 0.598) and CD4 percentage (U = 45.5; p = 0.338).
Ten of the 12 participants in the compliant group were
on ARV medication compared to only 3 of the 11 in the
non-compliant group (chi-square = 6.418; p = 0.011).
Compliers were slightly older (t = −2.039; p = 0.054).
Physical parameters at baseline were not significantly
different in the compliant and non-compliant groups (see
Table 1).
Differences between pre- and post-test according to
compliance
Since only two participants complied with the programme
in Group A, it was not possible to compare changes from
initial to final measurement according to the two intervention
groups.
Compliance with the physical activity programme had no
significant influence on changes in CD4 count (F = 2.846;
p = 0.109) and percentage (F = 0.161; p = 0.693), using
ANCOVA. In addition, the heterogeneity in initial CD4 count,
influencing factors, such as disease progression, antiretro-
viral medication, and the small sample size limited the data
analysis and results.
Compliance had a significant influence on the changes in
strength. In the compliant group, strength improved signif-
icantly more than in the non-compliant group (see Table
1). The time on the treadmill and the estimated VO2max
increased from baseline. However, compliance had no
significant influence in the ANCOVA.
Compliance with the exercise programme had no signif-
icant influence on changes in anthropometric measures,
except in the case of the peripheral skinfolds sum, showing
more decrease in the non-compliant group. Generally,
(p = 0.087) BMI decreased in the compliant group and
increased in the non-compliant group (Table 1).
Differences between pre- and post-test in the compliant
group
Analysing for change in each group separately, using paired
t-test, a significant decrease in the peripheral skinfold sum
(t = −3.283; p = 0.008) was observed as the only differ-
ence between baseline and final measurements in the
non-compliance group, whereas in the compliant group
endurance (time on treadmill and estimated VO2max:
t = 2.845; p = 0.017) and muscle strength (h1RM: t = 2.272;
p = 0.044 and strength/body ratio: t = 2.755; p = 0.019)
improved significantly.
Discussion
This study hypothesised that there would be an improve-
ment in physical health parameters through a 10-week
physical activity programme with people living with HIV in a
disadvantaged community.
A significantly greater improvement in muscular strength
was observed in the compliant group. This result is particu-
larly meaningful for the participants in the described
context. The improvements in muscular strength were
Table 1: Analysis of covariance (ANCOVA) of changes on physical parameters according to compliance
Information
Compliers Non-compliers
Fp
Pre-test Post-test Pre-test Post-test
n Mean (SD) Mean (SD) n Mean (SD) Mean (SD)
Weight (kg) 12 75.3 (13.94) 74.2 (15.24) 11 68.3 (15.36) 69.1 (15.43) 2.473 0.131
Body mass index (kg/m2) 12 29.6 (5.45) 29.2 (6.13) 11 26.5 (5.69) 26.8 (5.91) 3.242 0.087
Σ Central skinfolds (mm) 12 67.7 (30.69) 67.9 (34.80) 11 83.8 (38.18) 75.8 (34.15) 1.078 0.312
Σ Peripheral skinfolds (mm) 11 104.0 (46.03) 99.6 (41.32) 11 107.7 (41.38) 88.5 (30.75) 6.767 0.018*
Waist girth (cm) 11 81.8 (9.23) 81.5 (10.76) 11 79.6 (13.6) 80.9 (14.53) 1.041 0.320
Hip girth (cm) 11 106.3 (14.32) 104.6 (11.43) 11 103.4 (10.94) 103.0 (10.39) 0.241 0.629
Waist to hip ratio 11 0.77 (0.06) 0.78 (0.08) 11 0.77 (0.08) 0.78 (0.10) 0.137 0.716
Time on treadmill (min) 11 11.5 (3.31) 12.8 (2.65) 10 11.4 (2.96) 12.0 (2.18) 2.065 0.168
Est. VO2max (ml/kg per min) 11 22.3 (7.71) 25.4 (6.16) 10 22.1 (6.89) 23.4 (5.07) 2.065 0.168
Strength (kg) 12 134.0 (43.88) 169.5 (46.75) 10 110.7 (34.95) 120.3 (39.06) 4.516 0.047*
Strength/body ratio 12 1.81 (0.59) 2.33 (0.67) 10 1.69 (0.47) 1.86 (0.57) 3.384 0.081
Downloaded by [University of Western Cape] at 02:24 20 January 2015
African Journal of AIDS Research 2014, 13(4): 313–319 317
visible much faster than other improvements and therefore
were a motivating factor for the participants. The improve-
ment in strength had a role to play not only in improving
physical function and wellbeing, but also had psychoso-
cial importance, namely in avoiding being stigmatised.
Appearing physically thin is often associated with being
unhealthy and infected with HIV (Stern et al. 2010, Matoti-
Mvalo and Puoane 2011). Social-cultural beliefs and fear
of disclosure were often named as profoundly influencing
factors, and must be considered in the context of HIV
(Mahajan et al. 2008). Besides aiming to reduce body
weight, particularly central fat weight, the main goal of the
participants was to improve appearance, and to look good,
healthy and strong. In that sense, their goals were in line
with the recommendations of the state-of-the-art, which
are to combine aerobic and progressive resistance training
(O’Brien et al. 2004, Robinson et al. 2007, Hand et al. 2009,
Lazzarotto et al. 2010, O’Brien et al. 2010, Souza et al.
2011, Yahiaoui et al. 2011).
Fatigue (time on the treadmill and estimated VO2max)
increased slightly from baseline to post-test in the compliant
group, although it was not significant in the ANCOVA.
Participation in the intervention programme was probably too
short and too irregular. In addition, compliance was defined
in this study as an average participation of at least one
session per week in the intervention programme. Only two
participants attained the recommended level of exercising at
least three times a week. Correspondingly, changes in body
weight and BMI did not reach significance level.
Another major influencing factor with regard to weight
management was nutrition, which was a shortcoming of
the programme. Numerous discussions arose amongst the
participants concerning the access to healthy food in the
community and recommendations on nutrition were given
informally by the facilitators. However, this did not consti-
tute a formal intervention strategy of the programme.
Some participants said that they knew what to eat and
that nutrition is important when taking ARV medication,
but that healthy food was too expensive to buy and was
often inaccessible in their community. They could not even
afford to buy foods such as fruits and vegetables, which
was particularly disconcerting. Other studies in the same
environment confirm these challenges (Temple et al. 2011,
Stupar et al. 2012). Various authors recommend combining
physical activity with nutrition programmes, and call for
more holistic, community-based and multi-level interven-
tions (Whitelaw et al. 2001, Biddle and Mutrie 2008, Weiss
et al. 2011, Ley and Rato Barrio 2012).
Although a randomised controlled trial was planned at
the outset of the study, this was not possible during the
implementation phase of the study because of challenges
in recruitment and compliance. These challenges
included fear of disclosure and stigmatisation, mistrust
towards the research endeavour, poor time management,
people regularly changing telephones, altering living and
workplaces, and the fact that the research and physical
exercise programme competed with the participants’
immediate priorities in social security in their struggle for
daily living.
Participant-orientated sampling was used that identi-
fied two groups with different needs and priorities. A
comparison between the two groups was limited by the
disproportional lack of compliance in Group A. Quite a
heterogeneous group of people participated in the physical
activity programme, representing an extensive diversity
with regard to CD4 count, disease progression, medica-
tion use, and signs and symptoms (e.g. lipodystrophy).
These factors have a complex influence on body changes,
weight loss or gain, and body composition (Caron-Debarle
et al. 2010). Therefore determining precisely the effects
of the 10-week physical activity programme and control-
ling for the influencing factors were particular challenges in
this research setting. A heterogeneous group is probably
daunting when implementing a physical activity programme
in a disadvantaged community (and outside of a structured
research setting). Studying an exclusive homogeneous
population of people living with HIV might give us a distor-
tion of the reality and might have limited practical implica-
tions. However, more intervention research is needed that
allows adequate differentiation among the participants living
with HIV, their motivations, needs, preferences, health
conditions and so on, in their specific social-ecological
framework.
In conclusion, muscular strength training may be an
important element of physical activity programmes with
people living with HIV in disadvantaged communities, to
promote health, in addition to being motivational (fast,
visible positive outcome) and being coherent with partici-
pants’ goals. Long-term adherence to physical activity is
crucial to achieving further health benefits in a very unstable
context. In addition, multi-dimensional intervention research
is needed to control and have an impact on a high variety of
influencing factors (including nutrition, medication, stress,
social and physical barriers). Participatory processes
in assessment, planning, implementation and evalua-
tion are crucial to understanding and differentiating needs
and preferences of participants in the specific context and
to promote physical activity in a pertinent and meaningful
manner. Sociocultural beliefs, fears of disclosure and
HIV-related stigma played a major role in participants’
goal-setting, motivation and compliance.
Acknowledgements — We thank all the participants for their partic-
ipation, and the community clinic, laboratory, HIV unit, health
promoters, nurse, facilitators and research assistants for their
support. We are very grateful for the continuous support granted
by the Universidad Politécnica de Madrid (UPM). We thank the
University of the Western Cape, Programme Dynamic of Building
a Better Society (DBBS-VLIR), and the Ministerio de Asuntos
Exteriores y de Cooperación-Agencia Española de Cooperación
International para el Desarrollo (MAEC-AECID) for supporting the
respective post-doctoral fellowships of Clemens Ley and María
Rato Barrio.
The authors — Clemens Ley, PhD, works at the University
of Vienna. He teaches and researches in the fields of sport and
exercise psychology, exercise and movement therapy and health
psychology. His research interests are in sport, development, HIV,
trauma, mental illness and psychosocial aspects of rehabilitation.
Lloyd Leach, PhD, is senior lecturer and deputy departmental
chairperson at the University of the Western Cape, South Africa.
His research interests are in sport and HIV/AIDS, biokinetics,
exercise therapy and rehabilitation, as well as health risk
behaviours of firefighters.
Downloaded by [University of Western Cape] at 02:24 20 January 2015
Ley, Leach, Barrio and Bassett318
María Rato Barrio, PhD, is a Sport Scientist and Anthropologist.
She lectures on sport and development, research methods and
evaluation. Her research interests are in sport for development,
monitoring and evaluation, intercultural processes, and impacts of
violence on otherness and urban transformation.
Susan Bassett, PhD, works at the University of the Western
Cape, South Africa. Her research interests include exercise for
health and wellness, whole body vibration and fitness.
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