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Social-Ecological, Motivational and Volitional Factors for Initiating and Maintaining Physical Activity in the Context of HIV



Sport and exercise can have several health benefits for people living with HIV. These benefits can be achieved through different types of physical activity, adapting to disease progression, motivation and social-ecological options. However, physical activity levels and adherence to exercise are generally low in people living with HIV. At the same time, high drop-out rates in intervention studies are prevalent; even though they often entail more favourable conditions than interventions in the natural settings. Thus, in the framework of an intervention study, the present study aims to explore social-ecological, motivational and volitional correlates of South African women living with HIV with regard to physical activity and participation in a sport and exercise health promotion programme. The qualitative data was produced in the framework of a non-randomised pre-post intervention study that evaluated structure, processes and outcomes of a 10-week sport and exercise programme. All 25 participants of the programme were included in this analysis, independent of compliance. Data was produced through questionnaires, participatory group discussions, body image pictures, research diaries and individual semi-structured interviews. All participants lived in a low socioeconomic, disadvantaged setting. Hence, the psychological correlates are contextualised and social-ecological influences on perception and behaviour are discussed. The results show the importance of considering social-cultural and environmental influences on individual motives, perceptions and expectancies, the fear of disclosure and stigmatisation, sport and exercise-specific group dynamics and self-supporting processes. Opportunities and strategies to augment physical activity and participation in sport and exercise programmes in the context of HIV are discussed.
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96 The Open AIDS Journal, 2015, 9, (Suppl 1: M6) 96-103
1874-6136/15 2015 Bentham Open
Open Access
Social-Ecological, Motivational and Volitional Factors for Initiating and
Maintaining Physical Activity in the Context of HIV
Clemens Ley*,1, María Rato Barrio2 and Lloyd Leach3
1Universität Wien, Institut für Sportwissenschaft, Austria
2Palacky University Olomouc, Department of Development Studies, Czech Republic
3Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, 7535, South Africa
Abstract: Sport and exercise can have several health benefits for people living with HIV. These benefits can be achieved
through different types of physical activity, adapting to disease progression, motivation and social-ecological options.
However, physical activity levels and adherence to exercise are generally low in people living with HIV. At the same
time, high drop-out rates in intervention studies are prevalent; even though they often entail more favourable conditions
than interventions in the natural settings. Thus, in the framework of an intervention study, the present study aims to
explore social-ecological, motivational and volitional correlates of South African women living with HIV with regard to
physical activity and participation in a sport and exercise health promotion programme. The qualitative data was produced
in the framework of a non-randomised pre-post intervention study that evaluated structure, processes and outcomes of a
10-week sport and exercise programme. All 25 participants of the programme were included in this analysis, independent
of compliance. Data was produced through questionnaires, participatory group discussions, body image pictures, research
diaries and individual semi-structured interviews. All participants lived in a low socioeconomic, disadvantaged setting.
Hence, the psychological correlates are contextualised and social-ecological influences on perception and behaviour are
discussed. The results show the importance of considering social-cultural and environmental influences on individual
motives, perceptions and expectancies, the fear of disclosure and stigmatisation, sport and exercise-specific group
dynamics and self-supporting processes. Opportunities and strategies to augment physical activity and participation in
sport and exercise programmes in the context of HIV are discussed.
Keywords: Culture, disadvantaged, disclosure, exercise therapy, HIV, motivation, sport, stigmatisation.
Sport and exercise can have several health benefits for
people living with HIV. For instance, aerobic and resistance
training can have a positive impact on cardiovascular fitness,
fatigue, body composition, psychological well-being and
quality of life [1-5], in addition to reducing the health risks
and diseases associated to a sedentary lifestyle. These
benefits can be pursued through a wide range of different
types and levels of physical activity, adapting to disease
progression, individual motivation and social-ecological
options [6].
Despite many of these benefits [7, 8], the physical
activity level and adherence to sport and exercise are
generally low in people living with HIV [9]. At the same
time, high drop-out rates in intervention research are
prevalent even though they often have more favourable
conditions than interventions in the natural setting of people
living with HIV [6, 9-12].
Studies about the underlying reasons for the low physical
activity level in people living with HIV are scarce [6].
*Address correspondence to this author at the University of Vienna, Auf der
Schmelz 6a, 1150 Wien, Austria; Tel: 0043 699 1720 8761;
Research in other population groups has identified several
correlates, both psychological and social-ecological ones, for
initiating and maintaining physical activity. Psychological
determinants include, for instance, evaluation of previous
experiences; outcome expectancies; awareness of risks,
vulnerability and need to change; control beliefs, i.e. self-
efficacy; intention strength and self-concordance; and
perceived barriers and resources [10, 13-16]. Several models
describe motivational and volitional processes covering the
building of intentions, action and coping planning, initiation
and maintaining action [17-22]. However, various authors
[23, 24] criticise adopting a mere psychological-behavioural
approach, and focusing only on individuals’ lifestyles as a
primary cause for disease, especially as individuals take
choices in the social-ecological context. “While most
observers acknowledge that social forces influence these
choices, most interventions focus on changing individuals”
[23]. Social-ecological correlates include, for instance,
family and friends; social-cultural beliefs, norms and
practises; perceived environment, such as safety; living and
work conditions; policies; and the use of the space and
infrastructure [24-28].
This article aims to explore the correlates of motivational
and volitional processes of women living with HIV with
regard to physical activity and the participation in a sport and
exercise health promotion programme. This was done in the
Motivation for Physical Activity The Open AIDS Journal, 2015, Volume 9 97
framework of an intervention study in a low-socioeconomic,
disadvantaged setting in South Africa. Hence, individual
psychological correlates are contextualised, and the role of
social-cultural, environmental and gender-specific influences
on perception and behaviour are investigated.
Two qualitative case studies were performed in a
disadvantaged urban setting in South Africa, in order to
conduct the research at community level with people living
with HIV. One was placed in a university setting and the
other in a nearby disadvantaged community. The data was
produced in the framework of a 10-week sport and exercise
health promotion programme that was evaluated in a non-
randomised pre-post study design [29]. Study inclusion
criteria were for participants 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. 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 (in order to avoid
stigmatisation and to secure the support of friends), but these
participants were precluded from the data analysis. Another
five of the participants were excluded from the project
because of acute tuberculosis (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 participate in the final measurement independent of
their compliance. Five participants were not available for the
final testing, because of relocating to another suburb (n=3)
and not being contactable (n=2). All 25 female participants
of the programme were included in this analysis,
independent of compliance to the programme.
All participants lived in a disadvantaged setting
characterised by limited choices in daily life, limited options
for individual and social-economic development, and high
stigmatisation of people living with HIV. Group A was less
disadvantaged than group B in the sense of having access to
institutional knowledge and academic support. The subjects’
ages ranged between 20 and 44 years. CD4+ cell count and
percentage ranged from 155 to 1315 cells/µl (M = 535.32;
SD = 256.064) and 9 to 41% (M = 25.77; SD = 9.402),
respectively. At baseline, 13 participants were taking
antiretroviral medication and their viral load was not
detectable. The viral load of the other participants was
between 1751 and 152063 RNA cps/ml (M = 16676.5; SD =
36729.41). Ten participants were classified by the medical
doctor in WHO stage I; six in WHO stage II; five in WHO
stage III and two in WHO stage IV.
Research Procedures and Measures
After ethical clearance was obtained from the
university’s research committee (Reg. Nº: 11/4/17+18) and
the municipal health committee (Reg. Nº: 10258),
participants were recruited either through a collaborating
community clinic, health forum or non-governmental
organisation (NGO). They were informed about the research
by oral presentation and a written information sheet,
available in Xhosa and English. Bilingual researcher
assistants and translators were present at all times and used
when the participants wished. All participants gave their
informed consent.
Before starting the programme, a short questionnaire was
attached to the registration form that included questions
regarding motivation and goals to participate in the physical
activity programme, as well as preferences regarding time,
type of physical activity and organisation.
This was followed by a participatory group discussion in
which participants discussed needs, perceptions,
expectancies and preferences with regard to intervention
setting, conditions and contents of the programme. Extensive
notes were taken by the principal researcher and checked and
completed by the bilingual research assistance.
Furthermore, eight body image pictures were used in the
study to deepen the participants understanding on related
goals and perceptions. This research tool was validated in the
South African context and used in a very similar context [30,
A survey was developed containing questions (a)
assessing psychological-behavioural determinants, such as
outcome expectancies, self-efficacy, implementation
intentions and planning, predominantly adopted from studies
on the Health Action Process (HAPA) Model [22, 32] and
the Motivation-Volition (MoVo) model [20, 33], and (b)
assessing social-ecological influences on cognitions and
behaviours [24, 34].
A questionnaire was administrated at the end of the
programme to evaluate the outcome experiences and
perceived changes in the participants. It also allowed for
detecting further barriers and challenges that were not
mentioned at the beginning of the intervention.
The principal researcher and facilitator recorded research
diaries based on their participatory observation during the
period of the intervention. The researchers´ participation in
the intervention allowed them to establish a trustworthy
relationship with the participants in order to produce rich and
comprehensive data and to obtain a deeper understanding of
the emotions, cognitions and behaviours of the participants.
Furthermore, the two participatory observers contrasted their
observations among each other continuously and with the
research team as well.
Individual semi-structured interviews were conducted.
The questions dealt with participation, motivation for
participation, anticipated future participation in physical
activity, the challenges and barriers to participation and any
recommendations for future projects.
During the period of the intervention, compliance was
monitored in both groups by keeping a register of
98 The Open AIDS Journal, 2015, Volume 9 Ley et al.
attendance. Non-compliance was assigned when a participant
took part in the programme on average less than once a
week, that means, less than one third of the total sessions.
Data Management and Analysis
All interviews were recorded and later transcribed into
written records. Group discussions were captured by means
of extensive notes. Participatory observation was recorded in
research diaries, while open-ended questions were answered
in the questionnaires. All qualitative data was analysed
according to the themes that emerged from the data
(inductive coding) and the theory (deductive coding). If
differences among the two intervention groups were
detected, data referring to group A (University setting) and B
(Community setting) was marked accordingly in the text.
Research Challenges
The research is based on a limited number of participants
and a high drop-out rate in the intervention. Getting people
living with HIV to participate in the intervention study was
very challenging. However, recruitment problems are also
mentioned by other researchers in the field:In an attempt to
recruit enough participants, the discovery was made that
HIV is still a highly stigmatised disease in both Mpumalanga
and Gauteng. After eighteen months of negotiations with
AIDS clinics, mine groups and a newspaper advertisement,
only three participants were enrolled [35]. In our case, we
consider the following reasons as predominant: mistrust
about participating in intervention studies; fear of HIV
disclosure; competing immediate priorities and daily-living
The high drop-out is also discussed in the literature [10].
Regarding a 40% loss of exercise participants with HIV in an
individualised 12-week exercise programme, Neidig et al.
[12] stated that “individuals who were lost from the study
were often among the working poor and reported abrupt
changes in employment, unreliable transportation, and
increased family responsibilities.” Apart from
socioeconomic and socio-cultural constraints, non-adherence
to treatment or health programmes are often related to
individual factors, such as self-efficacy, depression and
psychosomatic diseases. Petroczi et al. [9] mentioned that
“actual physical fitness level or other physical
characteristics” seem to be less influential on adherence to
physical activity. Conversely, Stringer [36] suggested that
“patients with chronic diseases such as HIV sometimes have
decreased motivation to perform regular aerobic exercise....
This lack of activity results in a vicious cycle of decreased
exercise, pain, slow recovery from activity, loss of lean body
mass, anxiety of exercise, de-conditioning, and reduced gain
from aerobic exercise sessions.”
Another research challenge was the heterogeneous
composition of the group, representing a broad diversity with
regard to disease progression, medication, signs and
symptoms and living situation.
Perceptions and Expectancies Regarding the Social
Environment and Programme Structure
The initial participatory group discussion captured the
perceptions and cognitions regarding the intervention setting
and conditions with reference to the environment and social-
cultural beliefs.
The discussion was strongly dominated by worries about
serostatus disclosure and HIV-related stigma. Most of the
participants were not living openly with their HIV status.
Serostatus was hardly disclosed in the most intimate circles,
such as partners, family members or close friends: “only my
partner knows”; “I don’t speak with anybody about it”; “only
my best friend, she knows”. As a reason they discussed that
stigmatisation of people living with HIV is very high in the
community: “In my community, they call you with bad
names if they know that you have HIV”; “they change their
behaviours towards you” [cf. 37-39]. Hence, there was
consent among the participants in the present study that
disclosure of serostatus must be avoided by all means:
“nobody must know it”; “not to speak about it”.
In dealing with the risk of serostatus disclosure, two
different “voices” were identified amongst the participants.
One “voice” was concerned about who should participate in
the physical activity group. Some participants argued that
everybody should take part “independent of HIV” or
“without questioning HIV status”, hence “to take part as
anybody else”. Therefore, the programme should be open for
both HIV-positive and HIV-negative participants. Some
expressed that they would not take part in a programme only
for people living with HIV. These arguments were related to
the perceived risk of disclosure. However, there was also the
second “voice” that argued for not wanting to get labelled or
to be treated as “ill” or “different”. It was argued that they
should be able to play and exercise the same as anybody
else. Consequently, these fears and concerns were an appeal
for mainstream physical activity opportunities, such as
recreational sport teams, to be available for all and that do
not isolate and deal specifically with HIV.
Conversely, some participants also voiced the wish to
speak about their problems and concerns, which would only
be possible for them in a group of people, all living with
HIV. This was more prevalent in the group B (Community
group) where the need for mutual support was more voiced
by the participants. This wish calls for specific physical
activity opportunities, such as supportive sport and exercise
groups, that deal with challenges related to HIV and where
members can share experiences and support each other.
In the group discussion, the participants stressed, in a
common voice, the need to preserve confidentiality at all
times. “HIV-status must neither be revealed in the group nor
outside the group”. If a participant wanted to disclose his/her
status, he/she could do so personally in the group or to a
member, but “it must be your own choice to speak about it”,
Motivation for Physical Activity The Open AIDS Journal, 2015, Volume 9 99
thus “nobody must speak about it” and, for example, “the
trainer should not know why I am coming to exercise”. In
that regard, the only participant who was living and talking
openly about her status had the following to say in an
interview: “I don’t greet the others [participants], unless they
first greet me. People know my status. I tell them [the other
participants] that it is up to them to come to me. It is their
decision”. She first gives the choice to the participants, who
can then act in that situation to avoid the possible stigma of
being associated with HIV. Also one researcher argued that:
“I always stress to everyone that I do research on health
promotion, and that I have several projects, inclusive of HIV.
If people know that I am working only with people living
with HIV, they might question the status of those I am
walking and/or talking with during work time”. Bearing this
in mind, the research programme was not presented as an
HIV programme, but rather as a general sport and exercise
health promotion programme for all who were interested in
participating. The participants agreed that, for research
purposes and for giving individual feedback and advice, the
principal researcher and the participating doctor should know
their HIV-status. Those who wanted an HIV-specific group
especially articulated the importance that all members of the
group must take personal responsibility and commit to
treating all information as confidential, and not to talk to
people outside of the programme about happenings in the
programme: “it must stay in the group”; “not to speak about
it outside”. These disclosure-related concerns were also to be
observed in other contexts, such as in relation to who should
participate in the HIV-related support groups, and what
setting and conditions were needed in the HIV-specific
support groups.
Thus, two different programme settings were identified
in the discussion. The participants of Group B preferred to
train in a group setting. The programme setting was a school
within the community, who kindly made their premises
available for the sport and exercise health promotion
programme in the afternoons. Conversely, participants of
Group A preferred to train individually in a fully-equipped
training centre in a university setting. The reasons mentioned
by these participants were that they had predominantly
diverse times of availability, and also expressed doubts about
the maintenance of confidentiality in the group setting.
Although the physical activity intervention consisted of
individualised exercise training, it was proposed that they go
for training in small groups in order to boost exercise
adherence. In fact, some expressed being “motivated by
training together in pairs”. However, training in small groups
was also challenged by the diverse times of availability.
Thus, several participants asked if they could bring along a
friend (even if they were HIV-negative) as that would
improve their participation, and two of the participants did
so. This indicated the need for social support or peer-
support, but essentially trustful and confidential support,
from a good friend.
Fear of disclosure was repeatedly an issue also
throughout the duration of the programme (see below
discussion about barriers for participation and drop-out).
Motives, Intentions to Initiate Physical Activity and
Outcome Expectancies
At the registration of the programme, a questionnaire was
used to capture the initial motives and interest for
participating in the physical activity programme. These were
further discussed in the initial participatory group discussion,
especially their expectations, as well as the programme
content and types of physical activities to include.
The participants’ main motives were health-orientated: “I
want to improve my healthiness”; “I want to live a healthy
lifestyle”; “To build up my immune system more”; “To stay
healthy”; “To improve my health, immune system + and to
be happy”; however, frequently they included a special
reference to the body and appearance: “I want to keep my
body healthy”; “To [be] physically fit”; “I want to get
strong“; “to lose weight”; “lose some weight, as I have
gained a lot since last year”; “I want to look and feel healthy,
physically and mentally”. Participatory observation
throughout the programme confirmed the paramount
importance that appearance was given. Appearance was
important in the participants’ strategies of avoiding HIV-
related stigma. “In our community, people who are very thin
are thought to have HIV”; “if you are thin, people will think
that there is something wrong, that you are ill” [30, 40, 41].
A researcher remarked in his diary: “One participant told me
concerned that she already perceives the effects of the
‘gyming’, that she is losing weight. I was surprised, as the
training only just started a few weeks ago and I suspected
other reasons for the weight loss; and as I saw her concern, I
asked her if that would not be a good result to lose weight.
She replied that she is afraid of losing too much weight”. In
conclusion, most of the participants,Want to reduce weight
in the stomach area, but not to be thin”.
Perceptions of appearance was also analysed by means of
a questionnaire showing a normed sequence of eight pictures
of a female body with gradually increasing body dimension
[30, 31]. The questionnaire served two purposes. Firstly, it
was used to analyse appearance and weight-related goals by
asking them, individually, which picture represented them
best at the moment and, secondly, it was used to identify
which picture they aimed to be. Their perception on which
picture represented them best was compared with the
anthropometric measurements actually taken, i.e., height and
weight that were used to calculate Body Mass Index (BMI).
In addition, they were asked which picture represented a
healthy person. The results showed a concurrence between
subjective perceptions and objective anthropometric
measurements. The goal body picture identified by the
participants ranged mainly between a healthy perceived
person (with a normal BMI following WHO classification)
and a slightly overweight person (BMI between 25 and 30
kilograms per square metre). These results confirm the
above-stated goal for a number of participants which was not
to lose too much weight, but rather to stay a little bit more
overweight. These results are also in agreement with other
studies that conclude that fear of HIV-related stigma,
encourage black African women to be rather “slightly
100 The Open AIDS Journal, 2015, Volume 9 Ley et al.
overweight, but not obese, than thin and having people think
they were infected with HIV or they had AIDS” [30]. In
South Africa, where 29% of men and 56% of women are
classified as either overweight or obese [42], the stigma
related to HIV “may be responsible for fuelling the obesity
epidemic among black African women” [30]. It definitely
influences behaviour and goal setting with regard to physical
Finally, the potential to gain knowledge was another
motive for participation; “I want to know how exercise
impacts upon my health status”. While most participants
were expecting positive outcomes, some participants, were
less convinced (“I really would like to see the outcomes”).
Therefore, feedback on their progress was given
continuously and, most importantly, after the medical and
fitness assessments at the beginning and end of the 10-week
research period. The participants showed much appreciation
for the feedback. Most of them asked many questions, which
demonstrated a keen interest in gaining knowledge.
According to these motives for participation, the physical
activity programme included moderate aerobic exercise and
progressive resistance training. In addition, in group B,
modified sports and games were played. Members of group
A trained individually. In both groups, the intention was to
train regularly, ideally three times or more, but at least twice
a week, and to learn and build up skills and habits that
facilitated the inclusion of physical activity in daily life.
Self-Concordance and Strengths of Intentions
The intention to participate in the programme and to
exercise regularly was mainly determined by their
motivation to look and to live healthy. Firstly, exercise in
order to look healthy, was constructed mainly on their
motivation to protect themselves from external HIV-related
stigma and to avoid discrimination. This motivation was
particularly strong. Thus, the physical activity training,
specifically the resistance training or “body-building
exercises” seemed for them to fit in well with this
motivation. Their motivation was especially high for these
kinds of exercises. Then, secondly, exercising in order to live
healthy, seemed mostly intrinsically motivated, such as “I
always have been interested in exercise, but I just do not
have the time”. However, others showed more extrinsically
motivated intentions to exercise, for example, a woman
referred to her intention to participate, “when I heard that the
programme was going to be helpful for our health”. Some
also expressed doubts, for example, “I really would like to
see the outcomes” and asked many questions in the initial
group discussion about how physical activity would help
It is noteworthy to mention briefly, in this context, that
the women were not motivated through the environment or
through the community to exercise and to be physical active.
In the disadvantaged community, for example, women
generally are not seen running in the street for exercise and
health reasons. This situation might be due to a lack of safety
and security in such areas, but also due to social-cultural
norms and attitudes about women in the black African
community [41, 43-45]. On the one hand, women are not
supposed to play, since only young girls play, but once they
reach adulthood they have to fulfil their family duties and
responsibilities. Sport is mainly engaged and dominated by
young men and children. As a consequence, the group B
(Community group) was conducted in the afternoons in the
inner yard of a school in order to be less visible from the
community and, in that way, reduce possible inhibitions in
the participants to play or to train. On the other hand, with
the transitional changes (urbanization, socio-economic
growth, etc.), being sedentary has become a luxury. So far,
walking was used as a coping strategy in daily life, for
example, to walk long distances in order to get water. In the
black African community, being sedentary might be
perceived as a symbol for social-economic wellbeing.
Therefore, we consider that the social-cultural and
environmental situation were not directly motivational for
women to exercise. Although, indirectly, the HIV-related
stigma, might have stimulated the motivation to exercise in
order to look healthier.
The motivation and intention to fulfil the set goals were
perceived as very high in the beginning: “participants were
quite happy to join, laughed and seemed very motivated”;
they expressed positive emotions about the programme; “it is
refreshing”, “feeling good exercising”; “it really reminded
me of the good old days when I used to be an athlete,
handball player, netball player, so it was fun”. Most
participants felt that physical activity was high on their
priority list. However, throughout the duration of the
programme, it seemed that the reality of daily life was
overwhelming, and gradually the participants mentioned
steadily increasingly competing priorities, such as studies (in
group A, especially during exam time) and the need for
getting financial income (work or getting bursaries,
especially in group B); or “something urgent that I need to
attend to”. For example, a participant wrote an email to the
principal researcher: “Good morning, I’m sorry for not
having been available at gym this week but I was struggling
in terms of school work; it was a hectic week for me, but I
promise next week I will be there during my time slots; I’m
sure I will at least be above the water then, because as of
now am slightly sinking. Thank you for your concern”.
Further barriers and time management challenges are
discussed later on; here, we conclude that the intention to
achieve the goals were generally perceived as very high but,
nevertheless, standing in direct opposition to the emerging
priorities and challenges of daily life.
Barriers for Participation and Drop-Out During the
Intervention Process
During the sport and exercise intervention programme,
expressions of fear and continuous avoidance of HIV
disclosure by participants were dominant and were
considered as obstacles for participation: “Before going to
the gym, if I was with friends, they would ask me where I
was going. So, sometimes, it was difficult to go to the gym”;
“My friends asked about why I go to gym”; “Others asked
me, what was the programme for”; “My neighbour was
asking where I go, and then also if she can join me, and I
didn’t know how to say no”. In fact, twice a neighbour was
brought along in group B, which created an uncomfortable
situation among the participants. They discussed it and
decided that we have to declare the group full, in order to
Motivation for Physical Activity The Open AIDS Journal, 2015, Volume 9 101
avoid any disturbance by new and unknown members, as
well as to avoid disclosure and stigmatisation of the group.
Other challenges experienced were concerns with time
management or competing priorities (“Not enough time”;
“Sometimes I had something urgent to attend to. If it
happened that I finished on time where I am was going, I can
even come by later, before the gym closed, because I would
really feel bad if tomorrow's session would go to waste”; “I
had to get the bursary”), family responsibilities (“I have a
child that I have to take care of”; “I got pregnant”; “The last
two weeks I was not feeling well, I was not even able to
come to the gym, I was vomiting, having severe pains. I
decided to go and see the doctor only to find out that I'm
pregnant. So, me and the father of the baby decided together
to abort the baby, that will be on the 5 September, so please I
would like you to give me a week or 2 weeks so that I could
recover this, as I'm not gonna be able to start with gym
immediately after I have done this”) and illness (“Sickness”;
“flu”, “vomiting”, “pain”, “too tired” (fatigue); “I was
stressed”; “Participants suffer from different illnesses and
were getting sick during the period of the programme”). One
participant explained that the reason for dropping-out was
because of the change in her work situation, and another one
stated that she had to miss out due to traveling (“I am sorry I
could not come to the training last week, because I went
home and its far for me to travel”). Transport problems were
mentioned in group A, because it was a challenge to come to
campus in holidays due to lack of funding (“The school is
closed and my aunt is not giving me money for transport,
and in that way I can´t be present at the gym”).
Discomfort from exercising (“pain after training”, “pain
the next day”) was mentioned, but was seldom. The
discomfort due to the exercising setting in the gym (“noisy”,
“people watching”) was reported more frequently. Others,
however, in converse, stated that it was comfortable in the
gym where they were “exercising just as anybody else”.
Participation was also influenced by the changing
situation during the month; “having to stand in lengthy cues
for getting bursaries at the beginning of the month” and
“having more money available at the end of the month, after
being paid” were mentioned.
Approximately 50 % of the participants were non-
compliant, attending on average less than once a week.
Drop-out was higher in the individual exercise group A (80
% drop-out) than in the group intervention B.
Control Expectancies
Compliant participants showed a higher task self-efficacy
(“I am confident that I can be physically active 5 times a
week”) (t = 2.191; p = 0.04) than the non-compliant
participants. They also expressed more often having a coping
plan (“I have a plan about what to do in difficult situations in
order to stick to my exercise intentions”) (t = 2.435; p =
Most of the participants were confident that the
challenges and barriers of participation would decrease in
future, and that “next year it will be easier”. Some of them
expressed that even though they could not attend regularly
“it was the first time they had joined a gym” and that this
first step was important in order to join a gym in future and
to maintain an active lifestyle.
Outcome Experiences and Perceived Results (After the
Once the programme ended, most participants in group A
(individual training) expressed the wish to participate in a
group intervention in future: “I don’t want to exercise
alone”; “Next time, we would like to do it in a group”. In
this group, there was hardly any interaction observed among
the participants, even though some of them trained at the
same time.
In the group intervention (group B), mutual support was
observed. They often exchanged experiences and opinions
about ARV medication, avoidance of side-effects, coping
strategies and nutrition. They also discussed concrete plans
of together building a gardening project to plant vegetables,
as this produce was too expensive for them to buy (“Even if
we know what to eat, we cannot afford it. Healthy food is too
expensive”). Participants in this group made friends and
supported each other even outside the programme. They
often collected each other in order to come together to the
programme. They also left together and walked together to
their homes. When one of the participant died one year later,
the other participants went together to visit the deceased’s
family and assisted with the funeral. These self-supporting
processes were possible, as this group was only for members
living with HIV and, thus, they could disclose status to each
other, if they wanted to, and be able to speak about HIV-
specific challenges without fear of repercussions.
In general, the programme was perceived as “refreshing”,
they were “feeling good exercising”, and “enjoying every
moment”. One participant stated that “it really reminded me
of the good old days when I was an athlete, handball player,
netball player, so it was fun”. Enjoyment was an important
motivational factor for the participants as a way of opposing
the daily hassles and challenges of living with HIV.
Statements regarding the perceived changes from
participating in the programme were quite diverse: “I
disliked food before, but now I eat a lot, I like that”; “weight
loss”; “I feel more energetic”; “small increase in muscle
mass”; “feel more power”; “my appearance improved”; “I
feel so strong about myself”; “to be able to face life
challenges, having a positive attitude towards life, and the
most important thing is that I accept myself”; “the way in
which I feel about myself”; “before the programme, I was
always exhausted, but while I was on the programme I did
not get exhausted at all”; “the programme made me more
interested in exercising”; and “eager to make friends”. These
aspects indicate a trend towards several psychosocial
One recurrent perceived change concerned the subjective
improvement of strength. This was in agreement with the
observed high motivation for the resistance training
exercises. Bearing in mind the relatively short duration of the
programme (10 weeks) and the irregular pattern of
participation, strength improvements were more likely to be
visible than other physical changes. In fact, the results of
further physical measurements were also reported in another
publication [29], which showed that in the compliant group,
102 The Open AIDS Journal, 2015, Volume 9 Ley et al.
strength improved significantly more than in the non-
compliant group (ANCOVA F=4.516 p=0.047); meanwhile
no significant changes were observed with regard to any
other physical measurements, such as fatigue (time on
treadmill). The improvement in perceived strength has
psychosocial importance, because appearing physically
strong is perceived as beneficial in protecting oneself from
forced HIV-disclosure. Thus, the improvements are aligned
with the participants’ goals. Therefore, muscular strength
training may be an important element of physical activity
programmes with people living with HIV, not only in order
to achieve health outcomes, but also to motivate
participation and adherence.
Nevertheless, some of the participants also expressed the
concern that they had not achieved what they wanted or
expected: “Because I was not attending the gym regularly, I
am not completely fit as I want to be.”; “I have [changed],
but if the programme had started earlier, I would have lost
more weight.”; “the days when I was absent, played a big
role in my levels.”; “physical strength, it didn't change much,
because I stopped attending”.
In order to plan and implement the sport and exercise
programme in accordance with the motives, intentions and
expectancies of the participants, the intervention study took
on an evolving and participatory approach, continuously
dialoguing and adapting according to the progressively
emerging results. Such an approach is convenient, as it
facilitates a more appropriate and subjectively meaningful
intervention, as well as more active involvement by the
The motives to exercise were strongly influenced by
HIV-related and social-ecological perceptions and
cognitions. The participants mostly wanted to lose weight,
but not too much, rather to be a little bit overweight rather
than too thin, because it might mistakenly be associated with
HIV. Thus, the main motive to exercise was to be strong and
obtain a healthy appearance. Accordingly, the sport and
exercise setting and participants’ behaviour were strongly
dictated by self-protection from HIV stigma and the fear of
disclosure of HIV serostatus. Two different intervention
groups were implemented: one was a main-stream
intervention where participants exercised, just as any other
person, in a gym-setting at the university, while the other
was a group intervention in the community, where the self-
supporting processes were facilitated through an ‘only
people living with HIV’ group. The latter one seemed to be
more successful, as compliance was higher, mutual support
was evident and the group dynamic was highly valued.
Strength training was important in both groups. Objective
and subjective strength improvements were perceived and
may have affected the motivation to exercise, as it is
concordant with the goals of looking stronger and healthier
and avoiding HIV disclosure.
Nevertheless, the high motivation to initiate a sport and
exercise intervention was opposed by strong challenges of
daily living and compounded by several barriers to
maintaining participation. During the sport and exercise
intervention expressions of fear and continuous avoidance of
HIV disclosure were dominant, and were considered as
obstacles to participation. Further reasons for non-
participation were competing personal priorities: family,
studies and work duties, challenges with time management
and coping with daily hassles and problems, changing
circumstances throughout the month and sickness (ranging
from fatigue to disease progression and comorbidities).
Feelings of discomfort from exercising were seldom
mentioned; but some discomfort was mentioned by the
participants due to the exercise setting. Compliant
participants showed a higher task self-efficacy and expressed
a higher degree of planning than the non-compliant
participants. Therefore, it would be crucial to increase the
knowledge, action planning and coping skills that are in
concordance with the personal and social-ecological
situation. At the same time, the sport and exercise
programme should put more emphasis on facilitating
experiences that promote self-efficacy.
Furthermore, the results show that both psychological
and socio-ecological perspectives should be combined, and
that multi-level interventions are needed. Such interventions
should also respond to the individual situation and living
condition, as well as to the social perceptions and cognitions
regarding people living with HIV and regarding exercising.
Participatory approaches offer valuable opportunities in this
complex field of research and intervention.
The authors confirm that this article content has no
conflict of interest.
We thank all the participants for their participation, 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 Technical University of Madrid (UPM). We thank the
University of the Western Cape, Programme Dynamic of
Building a Better Society (DBBS - VLIR) for supporting the
respective postdoctoral fellowships of Clemens Ley.
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Received: July 31, 2015 Revised: August 8, 2015 Accepted: August 16, 2015
© Ley et al.; Licensee Bentham Open.
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... The theoretical social ecological model (SEM) shows the interplay of all levels including; interpersonal, intrapersonal, organizational and policy, illustrating how factors at one level influence factors at another level in behaviour [27]. The strength of the SEM model is that it provides a comprehensive understanding of the determinants of health behaviours and mechanism of change for each level [27,28]. ...
... Previous studies have shown that cultural-sensitive behavioural theories such as the SEM model are useful in attempting to understand the factors which influence physical activity behaviour in vulnerable populations [15,29]. In addition, other studies have used SEM to create and maintain interventions which facilitate communities to actively engage in physical activity [27][28][29]. Using qualitative study, we aimed to explore the perceptions, facilitators and barriers of physical activity among PLWH to better understand multifactorial influences of physical activity at individual, social and family, community and environmental levels. ...
... The topic guides for the interviews and focus groups were developed in English and consisted of open-ended questions on perceptions, facilitators and barriers influencing physical activity [19,28,29,32]. The topic guides were translated into Kiswahili and included questions about participants' perceptions of the terms used to express "physical activity" and "exercise" ("Shughuli za Mwili" and "Mazoezi" respectively). ...
Full-text available
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.
... These findings indicate that women living with HIV may have access to more exercise resources than men or that they are more likely to take advantage of resources, resulting in higher intensity, more balanced exercise patterns. [34,35,37,38,40,42,44,45,[48][49][50][51][52][53][54]57,59,[61][62][63][64][65][66], eight (23%) qualitative [21,36,39,41,47,55,56,58], and four (11%) mixed method studies [43,46,60,67]. Among the 23 quantitative studies, 18 (78%) studies were cross-sectional [34,37,38,40,42,44,45,[48][49][50][52][53][54]59,[62][63][64]66], two (9%) cohort studies [35,61], two (9%) intervention studies [51,57], and one (4%) was a randomized controlled trial (RCT) [65]. ...
... [34,35,37,38,40,42,44,45,[48][49][50][51][52][53][54]57,59,[61][62][63][64][65][66], eight (23%) qualitative [21,36,39,41,47,55,56,58], and four (11%) mixed method studies [43,46,60,67]. Among the 23 quantitative studies, 18 (78%) studies were cross-sectional [34,37,38,40,42,44,45,[48][49][50][52][53][54]59,[62][63][64]66], two (9%) cohort studies [35,61], two (9%) intervention studies [51,57], and one (4%) was a randomized controlled trial (RCT) [65]. ...
... Study Location: Among the 35 studies involving primary data collection, study locations included the United States (n = 10; 28%) [35,36,39,40,49,55,56,59,64,65], South Africa (n = 5; 14%) [41,[50][51][52]60], Uganda (n = 3; 8%) [38,63,67], Malawi (n = 2; 6%) [34,53], Canada (n = 2; 6%) [21,58], and the UK [57], Vietnam [42], Rwanda [45], China [48], France [47], Brazil [62], Thailand [54], Switzerland [61], Columbia [46], and Nigeria [44] one study each (3%). Three studies (8%) involved more than one study location [37,43,66]. ...
Full-text available
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.
... Critics on these health-behavioural models have argued that, changes focusing on individual's lifestyle or behaviour including physical activity needs more than psychological-behaviour approach, since individuals make decisions or choices within a social-ecological context [17] and that includes the social ecological model (SEM) approach with intrapersonal, interpersonal, community/environment and policy in uences [18]. These critics have called for qualitative studies to provide in-depth understanding of contextual in uences of behaviour, including physical activity [19] and studies have used SEM to create and maintain interventions or programs which facilitates communities to actively engage in physical activity [18,20,21]. Thus, we aimed to explore the perceptions, facilitators and barriers of physical activity among PLWH by utilizing the socio-ecological model (SEM). ...
... Furthermore, PLWH reported bene ts resulting from doing physical activity such as increased physical strength, selfe cacy and improved health motivated them to initiate and maintain physical activity [12,37]. However, it has also been argued that the concerns of PLWH for health improvements and improved physical appearance is among the fundamental coping strategies to reduce HIV related stigma [21]. Overall, our ndings provide evidence for the value of social support to PLWH in physical activity. ...
Full-text available
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.
... This line of research identified exercise risks with the fear of sustaining an injury as a main barrier , while improved physical function appeared as a major benefit and facilitator to PA in PLHIV (e.g., . Social support was also a recurring facilitator to PA engagement (Ley, Barrio, & Leach, 2015;. These studies were generally based on perceptions of an exercise intervention program (i.e., Ley, Barrio, & Leach, 2015; or were focused on readiness to exercise . ...
... Social support was also a recurring facilitator to PA engagement (Ley, Barrio, & Leach, 2015;. These studies were generally based on perceptions of an exercise intervention program (i.e., Ley, Barrio, & Leach, 2015; or were focused on readiness to exercise . They were not designed to describe barriers to and facilitators of PA in daily-life. ...
Physical activity (PA) has been reported to have many beneficial effects among people living with HIV (PLHIV), especially on fatigue, which is one of the main prevalent symptom and possible side effects of treatments in this population. Nevertheless, PLHIV remain insufficiently active according to PA recommendations. Based on contemporary theories of stereotypes applied to health behaviours (e.g., Stereotype Embodiment Theory, Levy, 2009; Stereotype Threat Theory, Steele & Aronson, 1995) and an integrative approach of fatigue (Kluger et al., 2013), this doctoral work postulated that exercise stereotypes endorsement or activation would play a role in the PA level of PLHIV and in their performance in fatiguing tasks. The first part of this dissertation identified the content of stereotypes related to PA and HIV through a qualitative approach (Study 1) and conducted the development and validation of a specific scale (Study 2). The second part aimed at identifying the mechanisms at play in the relationship between exercise stereotypes, fatigue and PA. Results showed that exercise stereotypes might influence PA through ego depletion mechanisms, as indexed by perceived fatigue and, be tempered by exercise self-efficacy (Study 3). Perceived fatigue and performance fatigability might also depend on the PA level of PLHIV, the more physically active PLHIV being characterised by lower perceived fatigue and performance fatigability (Study 4). Finally, based on stereotype threat theory, the last part of this doctoral work indicated that the nonexerciser stereotype threat could affect performance fatigability in less active PLHIV (Study 5) but not in healthy adults (Study 6). Furthermore, self-efficacy tempered the effect of the nonexerciser stereotype in less active PLHIV (Study 5). These results enrich the literature on stereotypes in the PA domain while raising interesting questions for contemporary models of fatigue in chronic diseases.
... Barriers to engaging in exercise for people living with HIV are multifactorial. Environmental (location, physical accessibility, cost), personal (multimorbidity, physical health, lack of knowledge or self-efficacy, anxiety), and social factors (competing priorities, caregiver responsibilities, and fear of social stigma) can prevent engagement in exercise for adults living with HIV [16][17][18][19][20][21][22]. Most systematic reviews did not consider these factors, and focused primarily on highly supervised therapeutic interventions by physiotherapists and exercise physiologists that may be unsustainable in community settings [12][13][14]23]. ...
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Purpose Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. Methods We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O 2 peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. Results Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O 2 peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). Conclusion Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O 2 peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. Identifier NCT02794415 . .
... Recommended Supervised PA has the potential to encourage ALWH to participate in PA regularly. Studies of adults with other chronic conditions (e.g., arthritis, obesity, kidney failure patients on dialysis, heart failure, diabetes, and cancer) were shown to have increased PA participation after involvement in a PA intervention supervised by a clinician or allied health professional ( A few qualitative research studies conducted in South-African persons living with HIV (PLWH) indicated that barriers to physical activity include physical complaints, e.g., low-energy levels, psychological complaints such as increased stress levels, family responsibility such as being primary caregivers, and the fear of disclosure and stigmatization, the physical environment including adverse weather conditions, the social environment including domestic abuse and crime, and the workplace situation, e.g., being in a sedentary job (Roos et al.,2013, Ley, Barrio & Leach, 2015. Facilitators of physical activity included support and encouragement from friends and family, religious practices during worship and community environment, e.g., having access to parks and sport fields (Roos et al.,2013). ...
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The objective of this review was to investigate the role of physical activity (PA) on outcomes of adults living with HIV (ALWH) with the intention to try and establish gaps in literature for further research. The results of this review contribute to the HIV/AIDS body of literature. The review also synthesizes the evidence from the existing literature to show how PA interventions increase functional capacity in ALWH. The review revealed a new role for health providers as facilitators of PA interventions. More robust designs of studies are needed by health professionals to further investigate the impact of types and intensities of PA on health outcomes across the lifespan of ALWH. This review provides evidence to encourage and support PA in ALWH, offers directions for future research that will advance the extant HIV literature, and suggests policy interventions that could serve all populations with chronic conditions, including ALWH. In addition, it guides advance practice nurses in the care of ALWH by focusing on PA assessment and prescriptions as adjunct therapy. Finally, this review addresses critical gaps in the current HIV literature and the needs of a growing underrepresented population. The findings of this review may have implications for health practitioners in primary care regarding the assessment of PA in patients with HIV and the prescription of PA as an adjunct therapeutic strategy in the management of the disease. Combined, these studies offer insight into PA patterns in ALWH and the interdependencies of PA and environmental factors. The findings from this dissertation will illuminate effective strategies to support and measure PA in ALWH as part of long-term health promotion.
... help them to be with physical fitness and mental health. [14,15] In our previous study we have highlighted the importance of Deva Chooranam and showing the importance of three major plants and its various properties [16] and in continuation to this in this study an attempt has been made to study the major compounds present in Deva Chooranam using TLC and HPTLC assay. ...
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HIV a well known virus since 1980s, and the main etiological agent of acquired immune deficiency syndrome (AIDS) is considered to be the most important diseases among the sexually transmitted infection in the recent decade, and is believed to be evolved in 1980s. Globally 40 million people are living with the AIDS and pandemic in nearly 150 countries. The traditional form of medicine is widely accepted in the community especially in South India. This study was aimed to find the chemical composition of the herbal formulation of the siddha drug Deva Chooranam that has been reported to have the combinations of herbs Cedrus deodara, Alpinia galangal, Cinnamomum tamala which have significant immunomodulatory property. The TLC and HPTLC were performed for the Deva Chooranam. The HPTLC fingerprint revealed the presence of seven prominent peaks showing the presence of versatile components. The peak four occupied the major area of 29.43% with an Rf value of 0.60 and it denoted the abundant existence of this compound followed by peak 3 and peak 5 occupying the area of 19.32 and 15.33%. This study had provided a detailed analysis of the phytocompounds present in the Deva Chooranam with a fingerprint analysis of HPTLC depicting respective peaks. KEYWORDS: HIV, AIDS, Deva Chooranam, HPTLC analysis.
... [24][25][26][27] Similarly, a number of qualitative studies have explored attitudes towards exercise or physical activity among diverse populations of PLWH and have identified factors influencing exercise or routine physical activity, such as physical health and self-efficacy (personal), social support and competing priorities such as caregiver responsibilities (social), and accessibility of safe environments for exercise (community). [28][29][30][31][32][33] However, these studies did not distinguish the viewpoints of participants with and without established exercise habits. Thus, the focus of this qualitative study was to explore whether the facilitators, barriers and the ideal environment for exercise or physical activity differ between older PLWH who self-identify as exercisers and non-exercisers, with the hypothesis that many factors directly influencing exercise behaviour would span the SEM levels. ...
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Objectives Although exercise interventions have been shown to improve health outcomes among older people with HIV (PLWH), this population remains highly sedentary. The purpose of this study was to examine the differences in perceived barriers and benefits of exercise among older PLWH by self-identified exercise status. Design Five focus groups were formed among PLWH: two groups of exercising men, two groups of non-exercising men and one group of women (mixed exercisers and non-exercisers). Themes were analysed in relation to the social-ecological model, utilising the constant comparative approach. Setting Patients were recruited from an academic medical centre, HIV clinic and community locations. Participants PLWH aged 50 or older, diagnosed with HIV for at least 2 years, with no other health conditions that would preclude exercise. Primary and secondary outcome measures Determine facilitators, barriers and the ideal environment for exercise or physical activity and determine whether these differ between older PLWH who self-identify as exercisers or non-exercisers. Results Among 25 men (11 exercisers and 14 non-exercisers) and four women (three non-exercisers and one exerciser), non-exercisers mentioned fewer benefits of exercise (n=46) than exercisers (n=75). Exercisers emphasised positive reinforcement, positive mood change and increased energy as benefits of exercise; interpersonal benefits of exercise were also discussed twice as often by exercisers than by non-exercisers. Non-exercisers emphasised barriers to exercise including lack of motivation, lack of self-efficacy and a negative perception of gym culture. Non-exercisers identified the need for age-appropriate activities as a feature of an ideal exercise environment. Both groups identified time, cost and health-related challenges as barriers to exercise. Conclusions Unique exercise barriers and benefits by self-identified exercise status provide important insights into the design of future interventions to initiate and maintain exercise. Trial registration number NCT02404792 ; Results.
... Although scientific literature has revealed a near zero probability of contamination in sports, fear seems to dominate these debates with the same questions reappearing. 46 This fear could be reflective of HIV stigma 47 and more specifically of mandatory HIV testing implemented in team sports years ago. [48][49][50] In their negative form, physical self- perceptions concerning lack of perceived capacity to be physically active and nega- tive perceived physical appearance con- sisted of barriers to PA. ...
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Objectives: The benefits of physical activity in people living with HIV (PLHIV) are numerous and are largely reported in the literature. Understanding why PLHIV engage or not in physical activity is key to better accompanying health behaviors. Through a qualitative approach, our study sought to identify barriers to and facilitators of physical activity participation in PLHIV. Methods: PLHIV were recruited by purposive sampling. Semi-structured interviews were carried-out in Center and Southern France. The data were analyzed following the principals of thematic analysis. Physical activity level was assessed through questions related to physical activity recommendations and a physical activity questionnaire. Results: Fifteen semi-structured interviews (seven men and eight women; Mage = 46.6; SD = 10.3) were analyzed. Only a third of our sample was considered physically active with almost half being considered inactive according to recommendations. A multidimensional perspective of physical activity barriers and facilitators emerged. Barriers to and facilitators of physical activity were related to the physical, psychological and socio-environmental domains. Discussion: Our research sought to better understand the beliefs and attitudes of PLHIV towards physical activity. Physical activity was overall viewed as beneficial by both active and less active PLHIV; however, PLHIV remain insufficiently active. This is discussed through our multidimensional approach of the barriers to and facilitators of physical activity.
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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.
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has always been a central consideration of urban planning. The premise of municipal (upheld by the US Supreme Court under Village of
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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.
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Several studies have reported the benefits of exercise training for adults with HIV, although there is no consensus regarding the most efficient modalities. The aim of this study was to determine the effects of different types of exercise on physiologic and functional measurements in patients with HIV using a systematic strategy for searching randomized controlled trials. The sources used in this review were the Cochrane Library, EMBASE, MEDLINE, and PEDro from 1950 to August 2012. We selected randomized controlled trials examining the effects of exercise on body composition, muscle strength, aerobic capacity, and/or quality of life in adults with HIV. Two independent reviewers screened the abstracts using the Cochrane Collaboration's protocol. The PEDro score was used to evaluate methodological quality. In total, 29 studies fulfilled the inclusion criteria. Individual studies suggested that exercise training contributed to improvement of physiologic and functional parameters, but that the gains were specific to the type of exercise performed. Resistance exercise training improved outcomes related to body composition and muscle strength, with little impact on quality of life. Aerobic exercise training improved body composition and aerobic capacity. Concurrent training produced significant gains in all outcomes evaluated, although moderate intensity and a long duration were necessary. We concluded that exercise training was shown to be a safe and beneficial intervention in the treatment of patients with HIV.
Objective: To explore the perception among black South African women that people who are thin are infected with HIV or have AIDS. Setting: Khayelitsha, an urban township in Cape Town. Subjects: 513 women aged 18-65 years. Methods: This was an exploratory study employing both quantitative and qualitative research methodology. Data were collected in two phases. The first phase involved collecting quantitative data among 513 participants. During the second phase, qualitative data were collected in a purposely selected sub-sample of 20 women. For the qualitative data collection, participants were shown eight body figures, ranging from thin to obese, and asked to choose a figure representing the ideal figure, a preferred figure and a figure thought to symbolise health. They were also invited to choose a figure that they thought represented a person infected with HIV or who had AIDS. They had the option of saying that they did not associate any of the figures with people infected with HIV or who had AIDS. Weight and height measurements were also taken. After the quantitative analysis was completed, focus group discussions explored perceptions about body image and the relation to HIV among purposely selected participants. Data were summarised by content based on questions discussed. Results: Sixty-nine per cent of the participants associated a thin figure with a person infected with HIV, or who had AIDS. Only 10.2% thought the thin figure symbolised health. Fifty per cent preferred a normal-weight figure, while 34.2% thought that normal weight symbolised health. Only 2% thought that people in the normal-weight category were infected with HIV or had AIDS. Thirty-four per cent preferred to be overweight and 31% thought that being overweight symbolised health. None of the participants thought the overweight figure represented people infected with HIV or who had AIDS. Only 8% preferred the obese figure. The results of the qualitative data analysis suggested that participants preferred to be overweight and at risk of acquiring cardiovascular diseases, rather than being thin and stigmatised as a person infected with HIV or who had AIDS. Conclusion: This study revealed that the stigma associated with HIV and AIDS may undermine strategies for prevention of chronic noncommunicable diseases among urban black South African women.
new findings on how to increase physical activity levels among targeted sectors of the population. The aim of this essay is to provide an overview of The research agenda for the future includes initiatives designed to increase physical activity development of both basic and applied research among different populations and in different on physical activity, and the integration of thesettings, and to set the context for the major ory across social, behavioral and biomedical challenges that lie ahead. The decline in habitual disciplines. physical activity with modernization, and the causal link between physical activity and health