Perspectives of adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital in Zimbabwe towards Physical activity: -A Cross- sectional study

Perspectives of adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital in Zimbabwe towards Physical activity: -A Cross- sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perspectives of adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital in Zimbabwe towards Physical activity: -A Cross- sectional study Farayi Kaseke, Precious R Pamire, Tecla Mlambo, Clement Nhunzvi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2377762/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 May, 2023 Read the published version in BMC Sports Science, Medicine and Rehabilitation → Version 1 posted 10 You are reading this latest preprint version Abstract Background Regular physical activity and exercise have been shown to be of benefit in managing the HIV disease, its complications and the side effects of HAART. The perceptions of those living with HIV toward physical activity and exercises is a key factor in advocating for participation of rehabilitation personnel in the management of this disease. However, this domain remains underexplored in Zimbabwe Methods A descriptive cross-sectional quantitative study was conducted with 327 people living with HIV. participants. Participants were consecutively sampled from Chitungwiza Central Hospital Opportunistic Clinic. The International Physical Activity Questionnaire (IPAQ) and the Exercise Benefits/Barriers Scale (EBBS) were respectively used to measure the physical activity level and perceived benefits/barriers of physical exercise among adults living with HIV. The tools were self-administered. The analyses were done for 323 participants using the Statistical Package for the Social Sciences (SPSS) version 21. Results The mean age was 41.1 ± 11.0. Females constituted n = 225; (69.7%) of the sample. The majority of participants (n = 184; 57%) described themselves as being highly physically active (3204(IQR = 2139–4441 MET-minutes/week). Most of the participants agreed that physical activity prevented heart attacks with a mean value of 3.34 ± 0.65. The majority perceived psychological outlook as the greatest benefit from physical activity among the benefit sub-scales. Furthermore, most of the participants agreed that it cost too much for them to exercise which had a mean of 3.00 ± 0.88. Family discouragement was the most agreed perceived barrier to physical activity with a mean of 2.91 ± 0.67. Those who perceived physical activity as being beneficial reported less barriers. A statistically significant association was found between level of physical activity and CD4 ( p = 0.035) cell count as well as with employment status ( p = 0.000). No statistically significant association was reported between the perceived benefits and the level of physical activity (p = 0.214). A statistically significant association was reported between the perceived barriers and age ( p = 0.000) as well as with employment status ( p = 0.006). Conclusion Adults living with HIV receiving HAART at Chitungwiza Central Hospital are highly active when compared to other studies done in Sub-Saharan Africa. It is also important to create interventions that promote physical activity considering what this population considers as perceived benefits and barriers to physical activity. Physical activity Exercise Physical exercise HIV/AIDS Perceived benefits Perceived barriers Figures Figure 1 Background According to The Global HIV and AIDS statistics Fact Sheet, 38.4 million [33.9–43.8] people were living with HIV worldwide at the end of 2021 [ 1 , 2 ]. The majority of people in infected by HIV are women and girls (54%). Among those infected, 25.6 million (66%) are in Africa with 20.6 million (53%) in Sub-Saharan Africa which accounts for nearly 71% of the total population of people living with HIV (PLWH) worldwide ) [ 1 ]. In 2021, 28.7 million of all people living with HIV were on HAART and there was a 35% decrease in HIV related deaths worldwide since 2005 to 2013 [ 3 ]. In Sub-Saharan Africa, the incidence rate decreased by 33% from 2005 to 2013. Zimbabwe has an adult prevalence of 12.9% (1.23 million adults) in 2020 [ 4 , 5 , 6 ]. There has been a decrease of HIV prevalence from 26.5% in 1997 to 14.3% to date [ 7 ] and a 0.31% in incidence rate from 2011 to 2013 [ 8 ]. Although the incidence rate is declining, PLWH are living longer and annual HIV related deaths are decreasing due to the advent of antiretroviral therapy making HIV a chronic manageable disease [ 9 ]. With this increase in chronicity also comes an increase in prevalence and impact of HIV associated complications in this population, many of which can be successfully treated with rehabilitation [ 9 ]. Complications of HIV infection include lipodystrophy [ 10 ], chronic pain, neurological deficits and musculoskeletal impairments [ 9 ]. There is also an increased prevalence of cardiovascular diseases among PLWH. Complications involving the pulmonary system include pulmonary hypertension and lung cancer [ 11 ]. Physical activity is a treatment technique employed by rehabilitation personnel in managing complications associated with HIV [ 12 ]. Physical activity in HIV positive people has been shown to be beneficial as it improves muscle strength and endurance as well as an increase in the expiratory flow rate [ 12 ]. When done regularly, physical activity contributes to an improvement of the quality of life among PLWH. Physical activity has also been shown to improve body fat composition and metabolic profiles as well as cardiovascular fitness in this population [ 9 ]. Despite the strong evidence for the benefits of physical activity in particular regular exercise in people living with HIV, it is not known how well this advice is being taken into action and whether the levels of uptake are sufficient enough to achieve health benefits [ 13 ]. Many individuals do not take part in sufficient physical activity due to a (negative perception) low perception of the benefits and high perception of barriers to exercise [ 14 ]. Research has mainly focused on the effectiveness of physical activity in particular physical exercise among PLWH and there is limited information on the perception thereof and levels of physical activity among patients living with HIV in Sub-Saharan Africa [ 15 ]. Given the strong evidence base for the (positive outcomes) beneficial effects of regular physical exercise for all and particularly for those living with HIV, this research aimed to determine the physical activity levels and the perceptions towards physical activity among adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital, Zimbabwe. This study aimed to determine the physical activity levels and the perceptions towards physical activity among adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital (CCH). Specifically, the study aimed to determine the levels of physical activity and perceived benefits of physical activity perceived barriers to physical activity among adults living with HIV, attending the opportunistic infections clinic at Chitungwiza Central Hospital; Methods Study design and setting A descriptive quantitative cross-sectional study was conducted. The study was carried out at CCH in a Harare Dormitory Town. This is one of the largest referral hospitals and is among the first to offer opportunistic infections (OI) services for people living with HIV in Zimbabwe. In this setting patients receive medical, rehabilitation, maternity and pharmaceutical services. The OI clinic runs daily, 5 days/week for adults living with HIV. Participants The study targeted male and female out-patients adults aged 18 years and above, who were accessing antiretroviral therapy at CCH OI clinic at the time of the study and had been on HAART for at least one year. Those too ill to participate and those with other evident comorbid physical conditions/disabilities were excluded. Sample Size The calculated sample size was 322 based on sample size calculation for cross-sectional studies. The proportion of PLWH who were estimated to be involved in physical activity30%. Instrument The data collection tool had three sections. Section A collected socio-demographic (age, gender, marital status, and employment status) and clinical data (duration on HAART and CD4 + cell counts). Section B evaluated the participants’ level of physical activity using the International Physical Activity Questionnaire (IPAQ). Section C was the Exercise Benefits/Barriers Scale (EBBS) which assessed the perceived benefits and barriers to physical exercise. The IPAQ consisted of 27 questions grouped into five sections which assessed the different categories of physical activity including job related physical activity, transportation physical activity, housework, house maintenance and caring for family, recreation, sports and leisure-time physical activity as well as the time spent sitting. Levels of physical activity were determined in relation to IPAQ scoring protocol. Frequencies and duration of participating in physical activity were also included. The EBBS comprised of the benefits component and the barriers component. The benefits component was divided into five sub-scales (physical performance, life enhancement, psychological outlook, social interaction and preventive health) and the barriers component was divided into four sub-scales (exercise milieu, time-expenditure, physical exertion and family discouragement) [ 14 ]. There are 29 items for the benefits and 14 items for the barriers. The EBBS has four-responses, Likert type format and the responses ranged from 4 (strongly agree) to 1 (strongly disagree). The higher the benefit scores, the more positively the participant perceived benefit of physical activity. For the barrier scale, the higher the score the more negatively the participant perceived physical exercise. The tools were translated to Shona a local vernacular language used in Chitungwiza using the forward-backward translation method. A pilot study was then conducted to validate as well as to test for reliability of the translated version. For validity the physical activity questionnaire was computed on SPSS and calculation of Cronbach’s alpha yielded a standardized alpha of 0.734. Calculation of Cronbach’s alpha for the Exercise Benefits and Barrier Scale yielded a standardized alpha of 0.912. Therefore, these translated versions of the questionnaires were valid enough to be used for data collection in the main study. Data Collection Ethical review and approval of the study protocol was done by the Joint Research Ethics Committee for the University of Zimbabwe and Parirenyatwa Group of Hospitals after the Ethics Committee at CCH had given permission to carry out study (JREC 258/15) and the Medical Research Council of Zimbabwe (MRCZ/B/951). Participants willing to participate gave informed written consent. Consecutive sampling was used to recruit participants who met the inclusion criteria until the required number was reached. The data collection tool was self-administered in both Shona and English languages for easy communication with participants. Data was collected whilst patients were waiting to be attended to by the doctor. Data was collected from Monday to Friday over a period of three weeks. The completed questionnaires were collected on the same day. Participants also received advice on the benefits of physical activity after completing the questionnaire. Data analysis Microsoft Excel was used to capture the data. Data was analysed using the Statistical Package for the Social Sciences (SPSS) (Version 21). Continuous data was summarised using means and standard deviations. Categorical data was reported as frequencies and percentages. Single paired t-tests were used to find whether these adults perceived more benefits or barriers to physical exercise. Multiple paired t-tests were used for analysis of sub-scale significant differences. For the benefits scale, ten comparisons were analyzed whereas six comparisons were done for the barrier scale. For the correction of critical p values Bonferroni method using an alpha of 5% was used. Results Sample characteristics of adults living with HIV A total of 322 answered the questionnaires. Four were not included for analysis because they did not meet the requirements of the IPAQ scoring protocol for completeness where participants gave “I don’t know” as an answer, walking was more than 16 hours and where minimum duration of activity was less than 10 minutes, leaving 323 questionnaires for analysis. Clinical Information The minimum time spent on HAART was one year and the maximum time was 20 years with the mean time on HAART being 4.3 ± 3.2 years. In addition, 202(62.8%) of the participants had spent 5 and more years on HAART. Current CD4 cell counts of the sample ranged from 6 cells per mm 2 to 1572 cells per mm 2 with a mean of 406.6 ± 279.9 cells per mm 2 . Most (n = 157; 48.9%) of the participants had CD4 cell counts ≥ 350 cells per mm 2 . Physical Activity Levels Of The Study Sample Out of the 322 participants 184 (57.1%) were found to be highly active (3204(IQR = 2139–4441 MET-minutes/week) (Fig. 1 ). The mean sitting time was 192 ± 93 minutes per day. The most frequent activity with the most energy expenditure was moderate physical activity which include household, yard work, moderate activities at work, during leisure time and cycling for transportation with a median value of 1770(IQR = 1060-2620MET-minutes/week). The study participants spent most of their time in sitting with a median value of 1260(IQR = 840–1800 minutes/week) when compared to other activities. A statistically significant association between levels of physical activity and CD4 cell counts ( p = 0.035) was found. Participants who had CD4 cell counts that were ≥ 350mm 2 were found to be highly active. In addition, there was also a statistically significant association between employment status and levels of physical activity (p = 0.000). Perceived Benefits/barriers To Physical Exercise The minimum total score was 32 and the maximum was 116, with a mean of 92.1 ± 13.8. Computed means of each benefit item showed that the participants agreed the most with the item: ‘I will prevent heart attacks by exercising’ (M ± SD = 3.34 ± 0.65), followed by ‘I enjoy exercise (M ± SD = 3.33 ± 0.75) and ‘exercise improves my mental health (feeling happy and emotionally well’ (M ± SD = 3.33 ± 0.69). ‘My disposition is improved with exercise (mood or general attitude about life)’ (M ± SD = 2.75 ± 0.95), was the least agreed by the study sample. For all the benefit items, the mean was 3.18 ± 0.48 (Table 1 ). Table 1 Mean and standard deviation of each exercise benefits scale questionnaire item PERCEIVED BENEFITS ITEMS M ± SD LIFE ENHANCEMENT SUB-SCALE 25. My disposition is improved with exercise (mood or general attitude about life). 26. Exercising helps me sleep better at night. 29. Exercise helps me decrease fatigue. 32. Exercising improves my self-concept (the way in which I think about myself and the image I have of myself). 34. Exercising increases my mental alertness (speed of thought or power of concentration). 35. Exercise allows me to carry out normal activities without becoming tired. 36. Exercise improves the quality of my work 41. Exercise improves overall body functioning for me. 2.75 ± 0.95 3.26 ± 0.72 3.10 ± 0.81 3.06 ± 0.78 2.98 ± 0.84 3.28 ± 0.63 3.10 ± 0.76 3.23 ± 0.68 PHYSICAL PERFOMANCE SUB-SCALE 7. Exercise increases my muscle strength (the ability of a muscle to employ an effort against some resistance e.g. digging) 15. Exercising increases my level of physical fitness (the ability to carry out activities without undue tiring). 17. My muscle tone (the state of tension inside the muscle that is maintained continuously even at rest or when relaxed and which increases in resistance to stretch) is improved with exercise 18. Exercising improves functioning of my heart and circulation of blood in my body. 22. Exercise increases my stamina (the ability to maintain prolonged physical or mental effort). 23. Exercise improves my flexibility (the ability of joints and muscles to move freely e.g. lifting the arm, bending the body). 31. My physical endurance is improved by exercising (the strength to keep going e.g. being able to walk for 30 minutes or more). 43. Exercise improves the way my body looks. 3.32 ± 0.66 3.31 ± 0.71 3.18 ± 0.70 3.26 ± 0.74 3.23 ± 0.76 3.16 ± 0.77 3.03 ± 0.83 3.24 ± 0.72 PSYCHOLOGICAL OUTLOOK SUB-SCALE 1. I enjoy exercise 2. Exercise decreases feelings of stress and tension for me. 3. Exercise improves my mental health (feeling happy and emotionally well). 8. Exercise gives me a sense of personal accomplishment (the successful completion of something). 10. Exercising makes me feel relaxed. 20. I have improved feelings of wellbeing from exercise (to be healthy, comfortable and happy). 3.33 ± 0.75 3.25 ± 0.72 3.33 ± 0.69 3.24 ± 0.70 3.31 ± 0.69 3.15 ± 0.74 SOCIAL INTERACTION SUB-SCALE 11. Exercising lets me have contact with friends and persons I enjoy 30. Exercising is a good way for me to meet new people 38. Exercise is good entertainment for me. 39. Exercising increases my acceptance by others. 3.06 ± 0.87 3.07 ± 0.82 3.06 ± 0.78 2.99 ± 0.84 PREVENTIVE HEALTH SUB-SCALE 5. I will prevent heart attacks by exercising. 13. Exercising will keep me from having high blood pressure 27. I will live longer if I exercise. 3.34 ± 0.65 3.20 ± 0.75 3.23 ± 0.75 ALL BENEFITS ITEMS 3.18 ± 0.48 The greatest perceived benefit from exercise was psychological outlook (M ± SD = 3.27 ± 0.52), closely followed by preventive health (M ± SD = 3.26 ± 0.56). Multiple paired t-tests for identification of any statistically significant difference between sub-scales showed that psychological outlook was significantly higher (M = 3.27) than all other benefits sub-scales. It was closely followed by preventive health (Table 2 ). Table 2 Standardized perceived benefit means and standard deviations and differences between sub-scales mean values for multiple comparisons BENEFIT SUB-SCALE^ BENEFIT SUB-SCALE MEAN(SD) 1 2 3 4 5 1. Life enhancement 3.09(0.53) -- 0.12 0.17* -0.05 0.16* 2. Physical performance 3.21(0.51) -- 0.05 -0.17* 0.04 3. Psychological outlook 3.27(0.52) -- -0.22* -0.01 4. Social interaction 3.05(0.62) -- 0.21* 5. Preventive health 3.26(0.56) -- Possible scores range from 1 to 4 for all sub-scales. Four represents the highest perception of benefits to physical exercise; ^Values in the cells of these columns are actual differences between sub-scale mean values; * Indicates that the means of the benefits sub-scales that are compared are significantly different, using Bonferroni corrected critical p values for benefits (p < 0.05). The minimum total score for the barrier items was 14 and the maximum was 56, with a mean of 32.2 ± 6.5. Computed mean for each barrier item showed that the participants agreed the most with the item: ‘it costs too much to exercise’ (M ± SD = 3.00 ± 0.88), followed by, ‘I’m too embarrassed to exercise’, (M ± SD = 2.96 ± 0.88), and ‘my family members do not encourage me to exercise’ (M ± SD = 2.95 ± 0.84). The most disagreed items were: ‘places for me to exercise are too far away’ (M ± SD = 2.42 ± 0.91), and ‘exercise tires me’ (M ± SD = 2.42 ± 0.95). For all the barrier items, the mean was 2.72 ± 0.47 (Table 3 ). Table 3 Mean and standard deviation of each exercise barrier scale questionnaire items PERCEIVED BARIERS ITEMS M ± SD EXERCISE MILIEU SUB-SCALE 9. Places for me to exercise are too far away 12. I am too embarrassed to exercise. 14. It costs too much to exercise. 16. Exercise facilities do not have convenient schedules for me. 28. I think people in exercise clothes look funny. 42. There are too few places for me to exercise. 2.42 ± 0.91 2.96 ± 0.88 3.00 ± 0.88 2.55 ± 0.88 2.81 ± 0.90 2.46 ± 0.91 TIME EXPENDITURE SUB-SCALE 4. Exercising takes too much of my time. 24. Exercise takes too much time from family relationships 37. Exercise takes too much time from my family responsibilities. 2.60 ± 0.83 2.61 ± 0.94 2.59 ± 0.93 PHYSICAL EXERTION SUB-SCALE 6. Exercise tires me. 19. I am fatigued (state of being very tired) by exercise. 40. Exercise is hard work for me. 2.42 ± 0.95 2.65 ± 0.90 2.90 ± 0.81 FAMILY DISCOURAGEMENT SUB-SCALE 21. My spouse (wife or husband) does not encourage exercising. 33. My family members do not encourage me to exercise. 2.89 ± 0.83 2.95 ± 0.84 ALL BARRIER ITEMS 2.72 ± 0.47 Family discouragement (M ± SD = 2.91 ± 0.67) was the most perceived barrier to exercise followed by exercise milieu (M ± SD = 2.70 ± 0.52). Multiple paired t-tests for identification of any statistically significant difference between sub-scales showed that family discouragement was rated significantly higher as compared to the others (Table 4 ). Table 4 Standardized perceived barrier means and standard deviations and differences between sub-scales mean values for multiple comparisons BARRIER SUB-SCALE^ BARRIER SUB-SCALE MEAN(SD) 1 2 3 4 1. Exercise Milieu 2.70(0.52) -- -0.10 -0.04 0.22* 2. Time Expenditure 2.60(0.67) -- 0.06 0.31* 3. Physical Exertion 2.66(0.62) -- -0.26* 4. Family Discouragement 2.91(0.67) -- Possible scores ranged from 1 to 4 for all sub-scales. Four represents the highest perception of barriers to physical exercise; ^Values in the cells of these columns are actual differences between sub-scale mean values; * Indicates that the means of the barriers sub-scales that are compared are significantly different, using Bonferroni corrected critical p values for barriers (p < 0.001). No further differences were noted between exercise milieu, time expenditure and physical exertion. Possible scores ranged from 1 to 4 for all sub-scales. No statistically significant association was reported between the perceived barriers and the level of physical activity. A statistically significant association was reported between the perceived barriers and age (p = 0.000) as well as with employment status (p = 0.006). No other statistically significant association was noted among the other personal characteristics and perceived barriers to physical exercise. Discussion A large number of adults living with HIV accessing HAART at Chitungwiza Central Hospital OI clinic, were highly active (57.0%). This may be because the majority are women who are expected to maintain their roles in the home. Most of the people affected are within the working age group hence may still be involved at work. This could also be explained by the fact that people living with HIV are encouraged to be physically active hence are more likely to change their physical activity behaviour in a positive way to live longer [ 13 ]. In addition, Littlewood et al., [ 16 ] also suggested that HIV diagnosis can result in a positive health behaviour change, in this case, regular physical exercise participation. The finding that the most frequent activity with the most energy expenditure was moderate physical activity (yardwork, inside chores etc.) suggests that the participants might not be aware of the need to vigorously exercise for the benefit of their health, moderate physical activity is being done to run house and other day to day activities necessary at home. Participants spent most of their time sitting which is a cause for concern as it is a risk factor for cardiovascular disease among people living with HIV [ 17 ]. On the other hand, considering that the majority were highly active suggests that the time spent sitting was for resting and energy conservation. Furthermore, the current economic challenges in Zimbabwe results in people being highly active doing menial jobs to aid their financial needs. The standard practice in ART programme is that PLWH are encouraged to engage in healthy habits including regular exercise by counsellors. The sample’s general levels of perceived benefits to physical exercise showed that adults living with HIV ‘strongly agreed ‘or ‘agreed’ with most of the benefits items. All the five sub-scales of the benefits demonstrated standardized means of > 3 thus representing ‘true’ agreement that all these benefit items had factors that the participants viewed as benefits from regular physical exercise participation. The study revealed that psychological outlook was the most perceived benefit to physical exercise among the sub-scales of the benefit components, which indicated that participants perceived physical exercise as a way of reducing depression as well as improving their wellbeing in general. Furthermore, getting an HIV positive diagnosis is stressful in nature hence the need for exercises which is deemed beneficial in this psychological domain of benefits. It is encouraging that these adults living with HIV perceived psychological components as benefits to physical exercise as this supports the evidence that psychological wellbeing is improved by increasing the levels of physical activity [ 17 ]. Furthermore, this finding was also in agreement with the evidence that physical activity participation results in better mental health [ 18 ]. Participants perceived relatively fewer benefits from physical exercise in relation to life enhancement and social interaction. The reason might be that after being diagnosed of HIV, the participants might have lost a sense of belonging, hence physical training for them became a source of interaction with like people whom they could openly interact with without shying anyone. Participants fairly agreed with many of the barrier items indicating that most of these items were an actual presentation of the barriers to physical exercise participation among the participants. Participants agreed the most with, ‘it costs too much to exercise’ with a mean of 3.00 ± 0.88. Therefore, these participants are less likely to exercise due to the perception that they have to go somewhere and pay for the services to be physically active. PLWH felt that family discouragement was the most perceived barrier to physical exercise among all the barrier sub-scales. This is of concern as the results of this present study indicates that these participants were more likely not to engage in physical exercise due to the lack of support from their family members. Another possible explanation could be social cultural beliefs or systems of sick-role, care giving, interdependence and over-protective care givers which promote less activity in PLWH as highlighted among stroke patients [ 19 ]. Participants had a limited perception of time expenditure as a barrier to exercise. This limited perception of time expenditure as a barrier to physical exercise is positive as this indicates potential time to engage in physical exercise among the study participants [ 14 ]. The study results showed that a statistically significant association existed between the perceived barriers and age (p = 0.000) which suggest that those who are older were less likely to engage in physical exercise. Furthermore, the finding that a statistically significant association existed between the perceived benefits and employment (p = 0.006), suggests that employed individuals are more likely to exercise as they perceive less barriers than unemployed individuals. In addition, it is socially accepted in the Zimbabwean context that vigorous activity is associated with the young age, moreover employment opportunities favor young adults than those who would have grown up and working towards retirement. A statistically significant association existed between levels of physical activity and CD4 cell counts ( p = 0.035), which suggests that participants who have high CD4 cell counts were more likely to have physical endurance to exercise than those with lower CD4 cell counts in this present study. Evidence also exists that support that regular physical activity participation results in an increase in CD4 + cell counts [ 20 ]. A statistically significant association existed between employment status and levels of physical activity (p = 0.000). The possible explanation could be that employed people are more likely to be physically active than unemployed because the physical activity involved with them is mostly work related, where as physical activity related with structured programs like training or aerobics is less likely practiced. Moreover, the employment opportunities are very low, considering the economic challenges, thus most of the available jobs are labour related not office related, or they maybe self-employed as working directors molding bricks or farming. This present study had several limitations. Comparisons with other studies was difficult as different questionnaires were used to measure the levels of physical activity. The study participants were from one hospital in Chitungwiza thus limiting the generalisation of these results to other settings like rural areas. The questionnaire used to measure physical activity levels was also a limitation as it subjectively measures physical activity and there is a tendency of participants to over-estimate or under-estimate the time, they spend doing a particular activity. In addition, the cross-sectional design could not establish cause and effect. Conclusion It is clearly evident that the majority of the participants in this study were highly active, it is of importance to promote and encourage an active life among PLWH as they are burdened by the disease and the side effects of HAART and the effects the virus poses on their health. It is also important to create interventions that promote physical activity considering what this population considers as perceived benefits and barriers to exercise. It is therefore essential for rehabilitation personnel in conjunction with health education and promotion personnel to design health education and promotion programmes on the importance of physical exercise to increase physical activity levels among adults living with HIV. Rehabilitation personnel should also design and implement structured exercise programmes in hospitals for HIV infected people. It would also be useful to investigate the physical activity levels and anthropometric measurements like height, weight and BMI in relation to physical activity and find any associations between these measurements and level of physical activity in our setting. The actual facilitators and barriers to physical exercise must also be investigated in our setting so that development of exercise programs tailored specifically for this population will be put in place considering these factors. It would also be useful for health personnel including rehabilitation personnel to train and specialise in HIV. Abbreviations HIV: Human Immunodeficiency Virus. AIDS: Acquired Immunodeficiency Syndrome UNSAIDS: Joints United Nations Programme on HIV/AIDS OI: Opportunistic Infections PLWH-People Living With HIV WHO; World Health Organisation HAART: Highly Active Antiretroviral Therapy ART: Antiretroviral Therapy CCH: Chitungwiza Central Hospital EBBS: Exercise Benefits/Barrier Scale IPAQ: International Physical Activity Questionnaire JREC -Joint University of Zimbabwe, College of Health Sciences and Parirenyatwa Group of Hospitals Ethics Committee MRCZ - Medical Research Council of Zimbabwe Declarations Ethics approval and consent to participate: The authors hereby declare that a ll methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was obtained from the Joint University of Zimbabwe, Faculty of Medicine and Health Sciences and Parirenyatwa Group of Hospitals Ethics Committee (JREC 258/15) and Medical Research Council of Zimbabwe (MRCZ/B/1001). Informed consent was provided by the participants Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: No funding was sought for this study. Authors' contributions: F Kaseke and P Pamire – conceptualization of research and data collection. T Mlambo and C Nhunzvi- data analysis. All authors – write up. F Kaseke contributed to the editing of the final manuscript. All authors read and approved the final manuscript. Acknowledgements: Would like to thank all the people who contributed to the success of this project; hospital staff and the patients attending the OI clinic at Chitungwiza Central Hospital. Authors details: 1 University of Zimbabwe, Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, Rehabilitation Sciences Unit. P.O Box A178 Avondale, Harare, Zimbabwe. Corresponding author: Farayi Kaseke +263 772 890 865 / +250 792400642. farayi.kaseke @gmail.com References Global. HIV &AIDS statistics. 2022. https://www.unaids.org/en/resources/fact-sheet . Accessed 24 September 2022. World Health Statistics. 2021. https://www.who.int/data/gho/publications/world-health-statistics . Accessed 03 March 2022. UNAIDS. 2014. Regional statistics. https://unaids-. test.unaids.org/sites/default/files/unaids/contentassets/documents/unaidspublication/2014/UNAIDS_Gap_report_en.pdf . Accessed 17 April 2019. Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA). 2020. https://phia.icap.columbia.edu/wp-content/uploads/2020/11/ZIMPHIA-2020-Summary-Sheet_Web.pdf . Accessed 14 August 2021. UNAIDS Data 2021. 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The physical activity levels among people living with human immunodeficiency virus/acquired immunodeficiency syndrome receiving high active antiretroviral therapy in Rwanda. J Social Aspects HIV/AIDS. 2013;10(3–4):113–8. http://www.tandfonline.com/doi/abs/ 10.1080/17290376.2014.886081 . Littlewood R, Vanable P, Michael P. The Association of Benefit Finding to Psychosocial and Health Behavior Adaptation Among HIV + Men and Women. J Behav Med. 2011;18(11):1492–501. Fillipas S, Cicuttini FM, Holland AE, Cherry CL. Physical Activity Participation and Cardiovascular Fitness in People Living with Human Immunodeficiency Virus: A One- Year Longitudinal Study. Journal of AIDS & Clinical Research . 2013;04(04):2–6. http://www.omicsonline.org/physical-activity-participation-and-cardiovascular-fitness-in-people-living-with-human-immunodeficiency-virus-a-one-year-longitudinal-study-2155-6113.S 9-002.php?aid=13298. Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress. Clin Psychol Rev. 2001;21(1):33–61. Mudzi W. Impact of caregiver education on stroke survivors and their caregivers, PhD Thesis, University of Witwatersrand. 2010. Luz E, Sampaio E, Souza R. A Randomized Clinical Trial to Evaluate the Impact of Regular Physical Activity on the Quality of Life, Body Morphology and Metabolic Parameters of Patients With AIDS in Salvador, Brazil. J Acquir Immunedeficiency Syndrome. 2011;57(Supplement 3):179–85. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 May, 2023 Read the published version in BMC Sports Science, Medicine and Rehabilitation → Version 1 posted Editorial decision: Major revision 15 Mar, 2023 Reviews received at journal 09 Mar, 2023 Reviewers agreed at journal 28 Feb, 2023 Reviewers agreed at journal 16 Jan, 2023 Reviewers agreed at journal 14 Jan, 2023 Reviewers invited by journal 11 Jan, 2023 Editor assigned by journal 11 Jan, 2023 Editor invited by journal 23 Dec, 2022 Submission checks completed at journal 23 Dec, 2022 First submitted to journal 14 Dec, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2377762","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":162438405,"identity":"a11facba-3c0e-4c36-a94c-e98512ffec9d","order_by":0,"name":"Farayi Kaseke","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBAC9gYQaQCEDAzMDAwVIIq5Aa8WngMoWs6AKEZitDBAtTC2gdiEtLCfffiZp4DBmL//8GGDj/Nqo/nbgVp+VGzDrYUn3Viax4DBTOJGWnLizG3Hc2ccZmxg7DlzG6cWe4Y0BpAWG4YbPMaHebcdy20AamFmbMOthYf/GfNvkBb58+c/H/4751jufIJaJNLYwA4zOJDDnMzYUJO7gbCWZ2yWcwwkjA1vpBkb9hw7kLsRqOUgPr/w8Kcx33jzx8Zw3vnDjyV+1NTlAhkHH/yowK0FBJh4GCRg7MNg8gBe9UDA+APBriOkeBSMglEwCkYgAAAFF1WZJYLzpwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Zimbabwe","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Farayi","middleName":"","lastName":"Kaseke","suffix":""},{"id":162438407,"identity":"a8b983bd-efb8-4122-92fe-8d68183b0c98","order_by":1,"name":"Precious R Pamire","email":"","orcid":"","institution":"University of Zimbabwe","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Precious","middleName":"R","lastName":"Pamire","suffix":""},{"id":162438409,"identity":"6da74a12-5b4b-4feb-9a70-8a10da160970","order_by":2,"name":"Tecla Mlambo","email":"","orcid":"","institution":"University of Zimbabwe","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tecla","middleName":"","lastName":"Mlambo","suffix":""},{"id":162438410,"identity":"632df92d-4f81-4ee7-a42d-249f1fc60a59","order_by":3,"name":"Clement Nhunzvi","email":"","orcid":"","institution":"University of Zimbabwe","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Clement","middleName":"","lastName":"Nhunzvi","suffix":""}],"badges":[],"createdAt":"2022-12-14 12:14:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2377762/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2377762/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13102-023-00676-6","type":"published","date":"2023-05-01T20:40:30+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":31024182,"identity":"f5e43551-65c8-46bf-bcfc-d4b6b9f9dc4e","added_by":"auto","created_at":"2023-01-03 14:27:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":4899,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eLevels of physical activity\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-2377762/v1/11d2d4216bbb347dded0736b.png"},{"id":44727830,"identity":"52383981-cf5a-4ec3-8223-b94341ac3c11","added_by":"auto","created_at":"2023-10-16 20:56:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":426677,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2377762/v1/5bb1f2bc-dd82-454b-965e-7a6f9c97efdc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perspectives of adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital in Zimbabwe towards Physical activity: -A Cross- sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to The Global HIV and AIDS statistics Fact Sheet, 38.4\u0026nbsp;million [33.9\u0026ndash;43.8] people were living with HIV worldwide at the end of 2021 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The majority of people in infected by HIV are women and girls (54%). Among those infected, 25.6\u0026nbsp;million (66%) are in Africa with 20.6\u0026nbsp;million (53%) in Sub-Saharan Africa which accounts for nearly 71% of the total population of people living with HIV (PLWH) worldwide ) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 2021, 28.7\u0026nbsp;million of all people living with HIV were on HAART and there was a 35% decrease in HIV related deaths worldwide since 2005 to 2013 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In Sub-Saharan Africa, the incidence rate decreased by 33% from 2005 to 2013.\u003c/p\u003e \u003cp\u003eZimbabwe has an adult prevalence of 12.9% (1.23\u0026nbsp;million adults) in 2020 [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. There has been a decrease of HIV prevalence from 26.5% in 1997 to 14.3% to date [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and a 0.31% in incidence rate from 2011 to 2013 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although the incidence rate is declining, PLWH are living longer and annual HIV related deaths are decreasing due to the advent of antiretroviral therapy making HIV a chronic manageable disease [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith this increase in chronicity also comes an increase in prevalence and impact of HIV associated complications in this population, many of which can be successfully treated with rehabilitation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Complications of HIV infection include lipodystrophy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], chronic pain, neurological deficits and musculoskeletal impairments [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. There is also an increased prevalence of cardiovascular diseases among PLWH. Complications involving the pulmonary system include pulmonary hypertension and lung cancer [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePhysical activity is a treatment technique employed by rehabilitation personnel in managing complications associated with HIV [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Physical activity in HIV positive people has been shown to be beneficial as it improves muscle strength and endurance as well as an increase in the expiratory flow rate [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. When done regularly, physical activity contributes to an improvement of the quality of life among PLWH. Physical activity has also been shown to improve body fat composition and metabolic profiles as well as cardiovascular fitness in this population [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the strong evidence for the benefits of physical activity in particular regular exercise in people living with HIV, it is not known how well this advice is being taken into action and whether the levels of uptake are sufficient enough to achieve health benefits [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Many individuals do not take part in sufficient physical activity due to a (negative perception) low perception of the benefits and high perception of barriers to exercise [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Research has mainly focused on the effectiveness of physical activity in particular physical exercise among PLWH and there is limited information on the perception thereof and levels of physical activity among patients living with HIV in Sub-Saharan Africa [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Given the strong evidence base for the (positive outcomes) beneficial effects of regular physical exercise for all and particularly for those living with HIV, this research aimed to determine the physical activity levels and the perceptions towards physical activity among adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital, Zimbabwe.\u003c/p\u003e \u003cp\u003eThis study aimed to determine the physical activity levels and the perceptions towards physical activity among adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital (CCH). Specifically, the study aimed to determine the levels of physical activity and perceived benefits of physical activity perceived barriers to physical activity among adults living with HIV, attending the opportunistic infections clinic at Chitungwiza Central Hospital;\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eA descriptive quantitative cross-sectional study was conducted. The study was carried out at CCH in a Harare Dormitory Town. This is one of the largest referral hospitals and is among the first to offer opportunistic infections (OI) services for people living with HIV in Zimbabwe. In this setting patients receive medical, rehabilitation, maternity and pharmaceutical services. The OI clinic runs daily, 5 days/week for adults living with HIV.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe study targeted male and female out-patients adults aged 18 years and above, who were accessing antiretroviral therapy at CCH OI clinic at the time of the study and had been on HAART for at least one year. Those too ill to participate and those with other evident comorbid physical conditions/disabilities were excluded.\u003c/p\u003e\n\u003ch3\u003eSample Size\u003c/h3\u003e\n\u003cp\u003eThe calculated sample size was 322 based on sample size calculation for cross-sectional studies. The proportion of PLWH who were estimated to be involved in physical activity30%.\u003c/p\u003e\n\u003ch3\u003eInstrument\u003c/h3\u003e\n\u003cp\u003eThe data collection tool had three sections. Section A collected socio-demographic (age, gender, marital status, and employment status) and clinical data (duration on HAART and CD4\u0026thinsp;+\u0026thinsp;cell counts). Section B evaluated the participants\u0026rsquo; level of physical activity using the International Physical Activity Questionnaire (IPAQ). Section C was the Exercise Benefits/Barriers Scale (EBBS) which assessed the perceived benefits and barriers to physical exercise.\u003c/p\u003e \u003cp\u003eThe IPAQ consisted of 27 questions grouped into five sections which assessed the different categories of physical activity including job related physical activity, transportation physical activity, housework, house maintenance and caring for family, recreation, sports and leisure-time physical activity as well as the time spent sitting. Levels of physical activity were determined in relation to IPAQ scoring protocol. Frequencies and duration of participating in physical activity were also included.\u003c/p\u003e \u003cp\u003eThe EBBS comprised of the benefits component and the barriers component. The benefits component was divided into five sub-scales (physical performance, life enhancement, psychological outlook, social interaction and preventive health) and the barriers component was divided into four sub-scales (exercise milieu, time-expenditure, physical exertion and family discouragement) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. There are 29 items for the benefits and 14 items for the barriers. The EBBS has four-responses, Likert type format and the responses ranged from 4 (strongly agree) to 1 (strongly disagree). The higher the benefit scores, the more positively the participant perceived benefit of physical activity. For the barrier scale, the higher the score the more negatively the participant perceived physical exercise.\u003c/p\u003e \u003cp\u003eThe tools were translated to Shona a local vernacular language used in Chitungwiza using the forward-backward translation method. A pilot study was then conducted to validate as well as to test for reliability of the translated version. For validity the physical activity questionnaire was computed on SPSS and calculation of Cronbach\u0026rsquo;s alpha yielded a standardized alpha of 0.734. Calculation of Cronbach\u0026rsquo;s alpha for the Exercise Benefits and Barrier Scale yielded a standardized alpha of 0.912. Therefore, these translated versions of the questionnaires were valid enough to be used for data collection in the main study.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003e Ethical review and approval of the study protocol was done by the Joint Research Ethics Committee for the University of Zimbabwe and Parirenyatwa Group of Hospitals after the Ethics Committee at CCH had given permission to carry out study (JREC 258/15) and the Medical Research Council of Zimbabwe (MRCZ/B/951). Participants willing to participate gave informed written consent. Consecutive sampling was used to recruit participants who met the inclusion criteria until the required number was reached. The data collection tool was self-administered in both Shona and English languages for easy communication with participants. Data was collected whilst patients were waiting to be attended to by the doctor. Data was collected from Monday to Friday over a period of three weeks. The completed questionnaires were collected on the same day. Participants also received advice on the benefits of physical activity after completing the questionnaire.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eMicrosoft Excel was used to capture the data. Data was analysed using the Statistical Package for the Social Sciences (SPSS) (Version 21). Continuous data was summarised using means and standard deviations. Categorical data was reported as frequencies and percentages. Single paired t-tests were used to find whether these adults perceived more benefits or barriers to physical exercise. Multiple paired t-tests were used for analysis of sub-scale significant differences. For the benefits scale, ten comparisons were analyzed whereas six comparisons were done for the barrier scale. For the correction of critical p values Bonferroni method using an alpha of 5% was used.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSample characteristics of adults living with HIV\u003c/h2\u003e \u003cp\u003eA total of 322 answered the questionnaires. Four were not included for analysis because they did not meet the requirements of the IPAQ scoring protocol for completeness where participants gave \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo; as an answer, walking was more than 16 hours and where minimum duration of activity was less than 10 minutes, leaving 323 questionnaires for analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Information\u003c/h3\u003e\n\u003cp\u003eThe minimum time spent on HAART was one year and the maximum time was 20 years with the mean time on HAART being 4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2 years. In addition, 202(62.8%) of the participants had spent 5 and more years on HAART. Current CD4 cell counts of the sample ranged from 6 cells per mm\u003csup\u003e2\u003c/sup\u003e to 1572 cells per mm\u003csup\u003e2\u003c/sup\u003e with a mean of 406.6\u0026thinsp;\u0026plusmn;\u0026thinsp;279.9 cells per mm\u003csup\u003e2\u003c/sup\u003e. Most (n\u0026thinsp;=\u0026thinsp;157; 48.9%) of the participants had CD4 cell counts\u0026thinsp;\u0026ge;\u0026thinsp;350 cells per mm\u003csup\u003e2\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003ePhysical Activity Levels Of The Study Sample\u003c/h3\u003e\n\u003cp\u003eOut of the 322 participants 184 (57.1%) were found to be highly active (3204(IQR\u0026thinsp;=\u0026thinsp;2139\u0026ndash;4441 MET-minutes/week) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean sitting time was 192\u0026thinsp;\u0026plusmn;\u0026thinsp;93 minutes per day. The most frequent activity with the most energy expenditure was moderate physical activity which include household, yard work, moderate activities at work, during leisure time and cycling for transportation with a median value of 1770(IQR\u0026thinsp;=\u0026thinsp;1060-2620MET-minutes/week). The study participants spent most of their time in sitting with a median value of 1260(IQR\u0026thinsp;=\u0026thinsp;840\u0026ndash;1800 minutes/week) when compared to other activities. A statistically significant association between levels of physical activity and CD4 cell counts (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035) was found. Participants who had CD4 cell counts that were \u0026ge;\u0026thinsp;350mm\u003csup\u003e2\u003c/sup\u003e were found to be highly active. In addition, there was also a statistically significant association between employment status and levels of physical activity (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003ePerceived Benefits/barriers To Physical Exercise\u003c/h3\u003e\n\u003cp\u003eThe minimum total score was 32 and the maximum was 116, with a mean of 92.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8. Computed means of each benefit item showed that the participants agreed the most with the item: \u0026lsquo;I will prevent heart attacks by exercising\u0026rsquo; (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;3.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65), followed by \u0026lsquo;I enjoy exercise (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75) and \u0026lsquo;exercise improves my mental health (feeling happy and emotionally well\u0026rsquo; (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69). \u0026lsquo;My disposition is improved with exercise (mood or general attitude about life)\u0026rsquo; (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95), was the least agreed by the study sample. For all the benefit items, the mean was 3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean and standard deviation of each exercise benefits scale questionnaire item\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePERCEIVED BENEFITS ITEMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLIFE ENHANCEMENT SUB-SCALE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25. My disposition is improved with exercise (mood or general attitude about life).\u003c/p\u003e \u003cp\u003e26. Exercising helps me sleep better at night.\u003c/p\u003e \u003cp\u003e29. Exercise helps me decrease fatigue.\u003c/p\u003e \u003cp\u003e32. Exercising improves my self-concept (the way in which I think about myself and the image I have of myself).\u003c/p\u003e \u003cp\u003e34. Exercising increases my mental alertness (speed of thought or power of concentration).\u003c/p\u003e \u003cp\u003e35. Exercise allows me to carry out normal activities without becoming tired.\u003c/p\u003e \u003cp\u003e36. Exercise improves the quality of my work\u003c/p\u003e \u003cp\u003e41. Exercise improves overall body functioning for me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003cp\u003e2.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003cp\u003e3.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePHYSICAL PERFOMANCE SUB-SCALE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Exercise increases my muscle strength (the ability of a muscle to employ an effort against some resistance e.g. digging)\u003c/p\u003e \u003cp\u003e15. Exercising increases my level of physical fitness (the ability to carry out activities without undue tiring).\u003c/p\u003e \u003cp\u003e17. My muscle tone (the state of tension inside the muscle that is maintained continuously even at rest or when relaxed and which increases in resistance to stretch) is improved with exercise\u003c/p\u003e \u003cp\u003e18. Exercising improves functioning of my heart and circulation of blood in my body.\u003c/p\u003e \u003cp\u003e22. Exercise increases my stamina (the ability to maintain prolonged physical or mental effort).\u003c/p\u003e \u003cp\u003e23. Exercise improves my flexibility (the ability of joints and muscles to move freely e.g. lifting the arm, bending the body).\u003c/p\u003e \u003cp\u003e31. My physical endurance is improved by exercising (the strength to keep going e.g. being able to walk for 30 minutes or more).\u003c/p\u003e \u003cp\u003e43. Exercise improves the way my body looks.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003cp\u003e3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003cp\u003e3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003cp\u003e3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePSYCHOLOGICAL OUTLOOK SUB-SCALE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. I enjoy exercise\u003c/p\u003e \u003cp\u003e2. Exercise decreases feelings of stress and tension for me.\u003c/p\u003e \u003cp\u003e3. Exercise improves my mental health (feeling happy and emotionally well).\u003c/p\u003e \u003cp\u003e8. Exercise gives me a sense of personal accomplishment (the successful completion of something).\u003c/p\u003e \u003cp\u003e10. Exercising makes me feel relaxed.\u003c/p\u003e \u003cp\u003e20. I have improved feelings of wellbeing from exercise (to be healthy, comfortable and happy).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003cp\u003e3.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003cp\u003e3.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003cp\u003e3.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003cp\u003e3.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003cp\u003e3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSOCIAL INTERACTION SUB-SCALE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11. Exercising lets me have contact with friends and persons I enjoy\u003c/p\u003e \u003cp\u003e30. Exercising is a good way for me to meet new people\u003c/p\u003e \u003cp\u003e38. Exercise is good entertainment for me.\u003c/p\u003e \u003cp\u003e39. Exercising increases my acceptance by others.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003cp\u003e3.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003cp\u003e3.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePREVENTIVE HEALTH SUB-SCALE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. I will prevent heart attacks by exercising.\u003c/p\u003e \u003cp\u003e13. Exercising will keep me from having high blood pressure\u003c/p\u003e \u003cp\u003e27. I will live longer if I exercise.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003cp\u003e3.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALL BENEFITS ITEMS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe greatest perceived benefit from exercise was psychological outlook (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52), closely followed by preventive health (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56). Multiple paired t-tests for identification of any statistically significant difference between sub-scales showed that psychological outlook was significantly higher (M\u0026thinsp;=\u0026thinsp;3.27) than all other benefits sub-scales. It was closely followed by preventive health (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStandardized perceived benefit means and standard deviations and differences between sub-scales mean values for multiple comparisons\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eBENEFIT SUB-SCALE^\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBENEFIT SUB-SCALE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMEAN(SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Life enhancement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.09(0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.17*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.16*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Physical performance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.21(0.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.17*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Psychological outlook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.27(0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.22*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Social interaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.05(0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.21*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Preventive health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.26(0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003ePossible scores range from 1 to 4 for all sub-scales. Four represents the highest perception of benefits to physical exercise; ^Values in the cells of these columns are actual differences between sub-scale mean values; * Indicates that the means of the benefits sub-scales that are compared are significantly different, using Bonferroni corrected critical p values for benefits (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe minimum total score for the barrier items was 14 and the maximum was 56, with a mean of 32.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5. Computed mean for each barrier item showed that the participants agreed the most with the item: \u0026lsquo;it costs too much to exercise\u0026rsquo; (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88), followed by, \u0026lsquo;I\u0026rsquo;m too embarrassed to exercise\u0026rsquo;, (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88), and \u0026lsquo;my family members do not encourage me to exercise\u0026rsquo; (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;2.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84). The most disagreed items were: \u0026lsquo;places for me to exercise are too far away\u0026rsquo; (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91), and \u0026lsquo;exercise tires me\u0026rsquo; (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95). For all the barrier items, the mean was 2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean and standard deviation of each exercise barrier scale questionnaire items\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePERCEIVED BARIERS ITEMS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEXERCISE MILIEU SUB-SCALE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Places for me to exercise are too far away\u003c/p\u003e \u003cp\u003e12. I am too embarrassed to exercise.\u003c/p\u003e \u003cp\u003e14. It costs too much to exercise.\u003c/p\u003e \u003cp\u003e16. Exercise facilities do not have convenient schedules for me.\u003c/p\u003e \u003cp\u003e28. I think people in exercise clothes look funny.\u003c/p\u003e \u003cp\u003e42. There are too few places for me to exercise.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003cp\u003e3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003cp\u003e2.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003cp\u003e2.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003cp\u003e2.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTIME EXPENDITURE SUB-SCALE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Exercising takes too much of my time.\u003c/p\u003e \u003cp\u003e24. Exercise takes too much time from family relationships\u003c/p\u003e \u003cp\u003e37. Exercise takes too much time from my family responsibilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003cp\u003e2.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePHYSICAL EXERTION SUB-SCALE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Exercise tires me.\u003c/p\u003e \u003cp\u003e19. I am fatigued (state of being very tired) by exercise.\u003c/p\u003e \u003cp\u003e40. Exercise is hard work for me.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003cp\u003e2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFAMILY DISCOURAGEMENT SUB-SCALE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21. My spouse (wife or husband) does not encourage exercising.\u003c/p\u003e \u003cp\u003e33. My family members do not encourage me to exercise.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003cp\u003e2.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eALL BARRIER ITEMS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFamily discouragement (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67) was the most perceived barrier to exercise followed by exercise milieu (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u0026thinsp;=\u0026thinsp;2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52). Multiple paired t-tests for identification of any statistically significant difference between sub-scales showed that family discouragement was rated significantly higher as compared to the others (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStandardized perceived barrier means and standard deviations and differences between sub-scales mean values for multiple comparisons\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eBARRIER SUB-SCALE^\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBARRIER SUB-SCALE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMEAN(SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Exercise Milieu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.70(0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.22*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Time Expenditure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.60(0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Physical Exertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.66(0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.26*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Family Discouragement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.91(0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003ePossible scores ranged from 1 to 4 for all sub-scales. Four represents the highest perception of barriers to physical exercise; ^Values in the cells of these columns are actual differences between sub-scale mean values; * Indicates that the means of the barriers sub-scales that are compared are significantly different, using Bonferroni corrected critical p values for barriers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo further differences were noted between exercise milieu, time expenditure and physical exertion. Possible scores ranged from 1 to 4 for all sub-scales. No statistically significant association was reported between the perceived barriers and the level of physical activity. A statistically significant association was reported between the perceived barriers and age (p\u0026thinsp;=\u0026thinsp;0.000) as well as with employment status (p\u0026thinsp;=\u0026thinsp;0.006). No other statistically significant association was noted among the other personal characteristics and perceived barriers to physical exercise.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eA large number of adults living with HIV accessing HAART at Chitungwiza Central Hospital OI clinic, were highly active (57.0%). This may be because the majority are women who are expected to maintain their roles in the home. Most of the people affected are within the working age group hence may still be involved at work. This could also be explained by the fact that people living with HIV are encouraged to be physically active hence are more likely to change their physical activity behaviour in a positive way to live longer [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In addition, Littlewood et al., [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] also suggested that HIV diagnosis can result in a positive health behaviour change, in this case, regular physical exercise participation. The finding that the most frequent activity with the most energy expenditure was moderate physical activity (yardwork, inside chores etc.) suggests that the participants might not be aware of the need to vigorously exercise for the benefit of their health, moderate physical activity is being done to run house and other day to day activities necessary at home. Participants spent most of their time sitting which is a cause for concern as it is a risk factor for cardiovascular disease among people living with HIV [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. On the other hand, considering that the majority were highly active suggests that the time spent sitting was for resting and energy conservation. Furthermore, the current economic challenges in Zimbabwe results in people being highly active doing menial jobs to aid their financial needs. The standard practice in ART programme is that PLWH are encouraged to engage in healthy habits including regular exercise by counsellors.\u003c/p\u003e \u003cp\u003eThe sample\u0026rsquo;s general levels of perceived benefits to physical exercise showed that adults living with HIV \u0026lsquo;strongly agreed \u0026lsquo;or \u0026lsquo;agreed\u0026rsquo; with most of the benefits items. All the five sub-scales of the benefits demonstrated standardized means of \u0026gt;\u0026thinsp;3 thus representing \u0026lsquo;true\u0026rsquo; agreement that all these benefit items had factors that the participants viewed as benefits from regular physical exercise participation. The study revealed that psychological outlook was the most perceived benefit to physical exercise among the sub-scales of the benefit components, which indicated that participants perceived physical exercise as a way of reducing depression as well as improving their wellbeing in general. Furthermore, getting an HIV positive diagnosis is stressful in nature hence the need for exercises which is deemed beneficial in this psychological domain of benefits.\u003c/p\u003e \u003cp\u003eIt is encouraging that these adults living with HIV perceived psychological components as benefits to physical exercise as this supports the evidence that psychological wellbeing is improved by increasing the levels of physical activity [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Furthermore, this finding was also in agreement with the evidence that physical activity participation results in better mental health [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Participants perceived relatively fewer benefits from physical exercise in relation to life enhancement and social interaction. The reason might be that after being diagnosed of HIV, the participants might have lost a sense of belonging, hence physical training for them became a source of interaction with like people whom they could openly interact with without shying anyone.\u003c/p\u003e \u003cp\u003eParticipants fairly agreed with many of the barrier items indicating that most of these items were an actual presentation of the barriers to physical exercise participation among the participants. Participants agreed the most with, \u0026lsquo;it costs too much to exercise\u0026rsquo; with a mean of 3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88. Therefore, these participants are less likely to exercise due to the perception that they have to go somewhere and pay for the services to be physically active. PLWH felt that family discouragement was the most perceived barrier to physical exercise among all the barrier sub-scales. This is of concern as the results of this present study indicates that these participants were more likely not to engage in physical exercise due to the lack of support from their family members. Another possible explanation could be social cultural beliefs or systems of sick-role, care giving, interdependence and over-protective care givers which promote less activity in PLWH as highlighted among stroke patients [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParticipants had a limited perception of time expenditure as a barrier to exercise. This limited perception of time expenditure as a barrier to physical exercise is positive as this indicates potential time to engage in physical exercise among the study participants [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The study results showed that a statistically significant association existed between the perceived barriers and age (p\u0026thinsp;=\u0026thinsp;0.000) which suggest that those who are older were less likely to engage in physical exercise. Furthermore, the finding that a statistically significant association existed between the perceived benefits and employment (p\u0026thinsp;=\u0026thinsp;0.006), suggests that employed individuals are more likely to exercise as they perceive less barriers than unemployed individuals. In addition, it is socially accepted in the Zimbabwean context that vigorous activity is associated with the young age, moreover employment opportunities favor young adults than those who would have grown up and working towards retirement.\u003c/p\u003e \u003cp\u003eA statistically significant association existed between levels of physical activity and CD4 cell counts (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035), which suggests that participants who have high CD4 cell counts were more likely to have physical endurance to exercise than those with lower CD4 cell counts in this present study. Evidence also exists that support that regular physical activity participation results in an increase in CD4\u0026thinsp;+\u0026thinsp;cell counts [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A statistically significant association existed between employment status and levels of physical activity (p\u0026thinsp;=\u0026thinsp;0.000). The possible explanation could be that employed people are more likely to be physically active than unemployed because the physical activity involved with them is mostly work related, where as physical activity related with structured programs like training or aerobics is less likely practiced. Moreover, the employment opportunities are very low, considering the economic challenges, thus most of the available jobs are labour related not office related, or they maybe self-employed as working directors molding bricks or farming.\u003c/p\u003e \u003cp\u003eThis present study had several limitations. Comparisons with other studies was difficult as different questionnaires were used to measure the levels of physical activity. The study participants were from one hospital in Chitungwiza thus limiting the generalisation of these results to other settings like rural areas. The questionnaire used to measure physical activity levels was also a limitation as it subjectively measures physical activity and there is a tendency of participants to over-estimate or under-estimate the time, they spend doing a particular activity. In addition, the cross-sectional design could not establish cause and effect.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIt is clearly evident that the majority of the participants in this study were highly active, it is of importance to promote and encourage an active life among PLWH as they are burdened by the disease and the side effects of HAART and the effects the virus poses on their health. It is also important to create interventions that promote physical activity considering what this population considers as perceived benefits and barriers to exercise. It is therefore essential for rehabilitation personnel in conjunction with health education and promotion personnel to design health education and promotion programmes on the importance of physical exercise to increase physical activity levels among adults living with HIV. Rehabilitation personnel should also design and implement structured exercise programmes in hospitals for HIV infected people. It would also be useful to investigate the physical activity levels and anthropometric measurements like height, weight and BMI in relation to physical activity and find any associations between these measurements and level of physical activity in our setting. The actual facilitators and barriers to physical exercise must also be investigated in our setting so that development of exercise programs tailored specifically for this population will be put in place considering these factors. It would also be useful for health personnel including rehabilitation personnel to train and specialise in HIV.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHIV: \u0026nbsp;Human Immunodeficiency Virus.\u003c/p\u003e\n\u003cp\u003eAIDS: Acquired Immunodeficiency Syndrome\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUNSAIDS: Joints United Nations Programme on HIV/AIDS\u003c/p\u003e\n\u003cp\u003eOI: \u0026nbsp;Opportunistic Infections\u003c/p\u003e\n\u003cp\u003ePLWH-People Living With HIV \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWHO; World Health Organisation\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;HAART: Highly Active Antiretroviral Therapy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eART: Antiretroviral Therapy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCCH: Chitungwiza Central Hospital\u003c/p\u003e\n\u003cp\u003eEBBS: Exercise Benefits/Barrier Scale\u003c/p\u003e\n\u003cp\u003eIPAQ: International Physical Activity Questionnaire\u003c/p\u003e\n\u003cp\u003eJREC -Joint University of Zimbabwe, College of Health Sciences and Parirenyatwa Group of Hospitals Ethics Committee\u003c/p\u003e\n\u003cp\u003eMRCZ - Medical Research Council of Zimbabwe \u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe authors hereby declare that a\u003cstrong\u003ell methods were carried out in accordance with relevant guidelines and regulations.\u003c/strong\u003eEthical approval was obtained from the Joint University of Zimbabwe, Faculty of Medicine and Health Sciences and Parirenyatwa Group of Hospitals Ethics Committee (JREC 258/15) and Medical Research Council of Zimbabwe (MRCZ/B/1001).\u0026nbsp;Informed consent was provided by the participants\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was sought for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eF Kaseke and P Pamire \u0026ndash; conceptualization of research and data collection. T Mlambo\u0026nbsp;and C Nhunzvi- data analysis. All authors \u0026ndash; write up. F Kaseke contributed to the editing of the final manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWould like to thank all the people who contributed to the success of this project; hospital staff and the patients attending the OI clinic at Chitungwiza Central Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors details: \u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003eUniversity of Zimbabwe, Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, Rehabilitation Sciences Unit. P.O Box A178 Avondale, Harare, Zimbabwe. Corresponding author: Farayi Kaseke +263 772 890 865 / +250 792400642. farayi.kaseke @gmail.com\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGlobal. 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Response Progress Report. \u003cem\u003eGlobal AIDS Response Country Progress Report Zimbabwe.\u003c/em\u003e 2014. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ei\u0026gt;https://www.unaids.org/sites/default/files/country/documents/ZWE_narrative_report_2014.pdf.\u0026lt;/i\u003c/span\u003e\u003cspan address=\"http://i%3Ehttps://www.unaids.org/sites/default/files/country/documents/ZWE_narrative_report_2014.pdf.%3C/i\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 17 April 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePullen SD, Chigbo NN, Nwigwe EC, Chukwuka CJ, Amah CC, Idu SC. Physiotherapy intervention as a complementary treatment for people living with HIV/AIDS. HIV AIDS (Auckl). 2014 Jun 2;6:99\u0026ndash;107. doi: 10.2147/HIV.S62121. PMID: 24936132; PMCID: PMC4047833.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinghania R, Kotler D. 2011. Lipodystrophy in HIV patients: its challenges and management approaches. \u003cem\u003eHIV/AIDS\u003c/em\u003e - \u003cem\u003eResearch and Palliative Care\u003c/em\u003e, 3, pp.135\u0026ndash;143. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3257972\u003c/span\u003e\u003cspan address=\"http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3257972\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u0026amp;tool=pmcentrez\u0026amp;rendertype=abstract.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChu C, Selwyn PA. Complications of HIV infection: A systems-based approach. Am Family Phys. 2011;83(4):395\u0026ndash;406.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNixon S, O'Brian K, Glazier R, Tyan AM. Aerobic exercise interventions for adults living with HIV / AIDS (Review). 2009 (1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFillipas S, Bowtell-Harris CA, Oldmeadow LB, Cicuttini F, Holland AE, Cherry CL. Physical activity uptake in patients with HIV: who does how much? \u003cem\u003eInternational J STD AIDS\u003c/em\u003e. 2008;19(8):514\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLovell GP, Ansari WEL, Parker JK. Perceived exercise benefits and barriers of non-exercising female university students in the United Kingdom. Int J Environ Res Public Health. 2010;7(3):784\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrantz JM, Murenzi A. The physical activity levels among people living with human immunodeficiency virus/acquired immunodeficiency syndrome receiving high active antiretroviral therapy in Rwanda. J Social Aspects HIV/AIDS. 2013;10(3\u0026ndash;4):113\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.tandfonline.com/doi/abs/\u003c/span\u003e\u003cspan address=\"http://www.tandfonline.com/doi/abs/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/17290376.2014.886081\u003c/span\u003e\u003cspan address=\"10.1080/17290376.2014.886081\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLittlewood R, Vanable P, Michael P. The Association of Benefit Finding to Psychosocial and Health Behavior Adaptation Among HIV + Men and Women. J Behav Med. 2011;18(11):1492\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFillipas S, Cicuttini FM, Holland AE, Cherry CL. Physical Activity Participation and Cardiovascular Fitness in People Living with Human Immunodeficiency Virus: A One- Year Longitudinal Study. \u003cem\u003eJournal of AIDS\u003c/em\u003e \u0026amp; \u003cem\u003eClinical Research\u003c/em\u003e. 2013;04(04):2\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.omicsonline.org/physical-activity-participation-and-cardiovascular-fitness-in-people-living-with-human-immunodeficiency-virus-a-one-year-longitudinal-study-2155-6113.S\u003c/span\u003e\u003cspan address=\"http://www.omicsonline.org/physical-activity-participation-and-cardiovascular-fitness-in-people-living-with-human-immunodeficiency-virus-a-one-year-longitudinal-study-2155-6113.S\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e9-002.php?aid=13298.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress. Clin Psychol Rev. 2001;21(1):33\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMudzi W. Impact of caregiver education on stroke survivors and their caregivers, PhD Thesis, University of Witwatersrand. 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuz E, Sampaio E, Souza R. A Randomized Clinical Trial to Evaluate the Impact of Regular Physical Activity on the Quality of Life, Body Morphology and Metabolic Parameters of Patients With AIDS in Salvador, Brazil. J Acquir Immunedeficiency Syndrome. 2011;57(Supplement 3):179\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Physical activity, Exercise, Physical exercise, HIV/AIDS, Perceived benefits, Perceived barriers","lastPublishedDoi":"10.21203/rs.3.rs-2377762/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2377762/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRegular physical activity and exercise have been shown to be of benefit in managing the HIV disease, its complications and the side effects of HAART. The perceptions of those living with HIV toward physical activity and exercises is a key factor in advocating for participation of rehabilitation personnel in the management of this disease. However, this domain remains underexplored in Zimbabwe\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional quantitative study was conducted with 327 people living with HIV. participants. Participants were consecutively sampled from Chitungwiza Central Hospital Opportunistic Clinic. The International Physical Activity Questionnaire (IPAQ) and the Exercise Benefits/Barriers Scale (EBBS) were respectively used to measure the physical activity level and perceived benefits/barriers of physical exercise among adults living with HIV. The tools were self-administered. The analyses were done for 323 participants using the Statistical Package for the Social Sciences (SPSS) version 21.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age was 41.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0. Females constituted n\u0026thinsp;=\u0026thinsp;225; (69.7%) of the sample. The majority of participants (n\u0026thinsp;=\u0026thinsp;184; 57%) described themselves as being highly physically active (3204(IQR\u0026thinsp;=\u0026thinsp;2139\u0026ndash;4441 MET-minutes/week). Most of the participants agreed that physical activity prevented heart attacks with a mean value of 3.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65. The majority perceived psychological outlook as the greatest benefit from physical activity among the benefit sub-scales. Furthermore, most of the participants agreed that it cost too much for them to exercise which had a mean of 3.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88. Family discouragement was the most agreed perceived barrier to physical activity with a mean of 2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.67. Those who perceived physical activity as being beneficial reported less barriers. A statistically significant association was found between level of physical activity and CD4 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035) cell count as well as with employment status (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000). No statistically significant association was reported between the perceived benefits and the level of physical activity (p\u0026thinsp;=\u0026thinsp;0.214). A statistically significant association was reported between the perceived barriers and age (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) as well as with employment status (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAdults living with HIV receiving HAART at Chitungwiza Central Hospital are highly active when compared to other studies done in Sub-Saharan Africa. It is also important to create interventions that promote physical activity considering what this population considers as perceived benefits and barriers to physical activity.\u003c/p\u003e","manuscriptTitle":"Perspectives of adults living with HIV attending the opportunistic infections clinic at Chitungwiza Central Hospital in Zimbabwe towards Physical activity: -A Cross- sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-03 14:27:52","doi":"10.21203/rs.3.rs-2377762/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-03-15T08:42:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-09T17:53:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1f305bdf-baaa-4062-a741-73043c260581","date":"2023-02-28T15:11:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1d036532-0a3c-45c4-8614-951db66b9f85","date":"2023-01-16T13:18:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"0a4ff269-368f-4313-922a-e236aa350b35","date":"2023-01-14T14:41:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-01-11T07:47:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-01-11T07:43:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-12-23T10:08:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-12-23T09:55:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2022-12-14T12:04:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ccda1be7-b853-497e-98ec-f935ef852964","owner":[],"postedDate":"January 3rd, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T20:46:52+00:00","versionOfRecord":{"articleIdentity":"rs-2377762","link":"https://doi.org/10.1186/s13102-023-00676-6","journal":{"identity":"bmc-sports-science-medicine-and-rehabilitation","isVorOnly":false,"title":"BMC Sports Science, Medicine and Rehabilitation"},"publishedOn":"2023-05-01 20:40:30","publishedOnDateReadable":"May 1st, 2023"},"versionCreatedAt":"2023-01-03 14:27:52","video":"","vorDoi":"10.1186/s13102-023-00676-6","vorDoiUrl":"https://doi.org/10.1186/s13102-023-00676-6","workflowStages":[]},"version":"v1","identity":"rs-2377762","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2377762","identity":"rs-2377762","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}