Effects of an exercise programme with people living with HIV: research in a disadvantaged setting.

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.

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.

A narrative review of research on the effects of physical activity on people living with HIV and opportunities for health promotion in disadvantaged settings.

The article explores different types and effects of physical activity for people living with HIV. Considering the lack of studies done in African contexts and the disparity between research settings and natural settings, a narrative review of the literature was conducted and contextualised to South Africa. Various physical, psychological and social-cultural constraints impair the wellbeing of people living with HIV, in part by restricting their participation in physical activities. Apart from the well-studied immediate physiological benefits on health, we argue that physical-sportive group activities, such as sport or recreational games, can improve psychosocial factors and generate holistic health effects for people living with HIV. Group-activity effects could improve individuals' motivation and adherence to participating in physical activities, provided that positive interaction and non-stigmatisation are guaranteed. However, most studies in this field have been limited to the benefits of aerobic exercise and resistance training. There has been little research on the types and different effects of physical activity and adherence to physical activity of people living with HIV in African contexts. Based on an analysis of the different types and effects, we suggest opportunities for and challenges to implementing physical activities for people living with HIV, especially in disadvantaged settings, and also identify gaps in the research to date.