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

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.

A qualitative focus group study of perceived barriers and benefits to exercise by self-described exercise status among older adults living with HIV

“…Social isolation and a desire to connect with other social groups were discussed by all participants, though not directly in the context of exercise. The importance of social support for exercise among PLWH has been described, whether as a ‘workout buddy’, general community activities or more social support in general 28 29 32 33. Older PLWH have high rates of social isolation and may have challenges related to loss of friends due to illness or estrangement from family due to HIV or other stigma 6 43.…”

“…Indeed, the SEM model has been used extensively in the exercise health- behaviour literature to investigate the many competing factors that influence physical activity 24–27. 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) 28–33. However, these studies did not distinguish the viewpoints of participants with and without established exercise habits.…”

Physical activity correlates in people living with HIV/AIDS: a systematic review of 45 studies

“…Also uncertainty about the future [28], avoiding stigma [29], adverse weather conditions and domestic abuse and crime [27] are reported in this population. People living with HIV/AIDS participating in physical activity programs recognized as well that engaging in regular physical activity could provide energy, improve the self-concept and sleeping quality, and increase physical fitness and mental health [27,29]. In order to elaborate and confirm such qualitative findings, quantitative research 5 which is able to identify potential correlates of actual physical activity levels in people living with HIV/AIDS is also needed.…”

“…Qualitative research in people living with HIV/AIDS exploring the perceived barriers for physical activity participation indicated that physical exertion, lack of social support, time and financial constraints and the distance to facilities are considered the most important and reported barriers [26,27,28]. Also uncertainty about the future [28], avoiding stigma [29], adverse weather conditions and domestic abuse and crime [27] are reported in this population. People living with HIV/AIDS participating in physical activity programs recognized as well that engaging in regular physical activity could provide energy, improve the self-concept and sleeping quality, and increase physical fitness and mental health [27,29].…”

Sustained Obesity and Depressive Symptoms over 6 Years: Race by Gender Differences in the Health and Retirement Study

“…Bandura's Social Cognitive Theory suggests that we are not what we are, or what we think we are, but what we think other people think about us (Bandura, 1986). The Social Ecological Framework also suggests that individuals' behaviors and emotions are shaped by their social interactions and environment (Ley et al, 2015). Although, high BMI influences body image perception and body dissatisfaction (Altintas et al, 2014; Coy et al, 2014; Das and Evans, 2014; Stephen and Perera, 2014; Webb et al, 2014a,b; Laus et al, 2015), there is a wealth of literature suggesting that these associations depend on gender (Altintas et al, 2014; Coy et al, 2014; Laus et al, 2015), race and ethnicity (Mikolajczyk et al, 2012; Richmond et al, 2012; Chithambo and Huey, 2013; Thomas et al, 2013; Fletcher, 2014; Gitau et al, 2014; Pope et al, 2014; Sabik, 2015; Blostein et al, 2016), and age (Altintas et al, 2014; Pope et al, 2014).…”