Factors Influencing Physical Activity Engagement in Individuals Living With HIV in Nigeria

Factors Influencing Physical Activity Engagement in Individuals Living With HIV in Nigeria | 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 Factors Influencing Physical Activity Engagement in Individuals Living With HIV in Nigeria Temitope Oladejo, Hellen Myezwa, Adedayo Ajidahun, Sam Ibeneme This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4046304/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Physical activity has been reported to be a useful non-pharmacological intervention for improving quality of life and reducing long-term problems associated with HIV infection and ART. Despite their known benefits, the data on the factors driving the uptake of physical activity among the HIV population in Nigeria are insufficient. Thus, since variations exist in healthcare, cultural and societal structures, caution must be used in drawing comparisons from other settings. To develop a contextually sensitive intervention programme, understanding the factors responsible for physical activity engagement among people living with HIV is vital. Objective : The study aimed to explore the barriers to and facilitators of physical activity participation among people living with HIV. Method : A qualitative research methodology was adopted to explore the barriers of and facilitators to physical activity participation among people living with HIV. A semi-structured interview guide was used to interview people living with HIV (PLWH) attending HIV testing and treatment centers in [location masked for blind review] from March to July 2022; a saturation point was reached after the 20th interview. All interviews were audio-recorded and were subjected to a deductive content analysis framework for data analysis. Results : Twenty (20) PLWH aged 19 to 54 years participated in this study. The majority perceived physical activity as beneficial to their health. Commonly reported barriers to physical activity in PLWH were lack of time, fatigue, an unsupportive environment, lack of funding, and other social commitments. The physical activity facilitators included perceived benefits, habits, influence by others, and the health benefits of illness prevention and pain relief. C onclusion : Our findings reveal that the key barriers to physical activity participation (lack of time, unsupportive environment, fatigue, and lack of funding) are modifiable. Addressing these factors is likely to facilitate physical activity participation. Thus, efforts to develop a physical activity intervention program for PLWH in Nigeria must consider environmental and interpersonal variables. HIV physical activity participation barriers facilitators Figures Figure 1 Introduction Despite evidence of the vital role that physical activity plays in improving physical, cognitive, and psychological health, the global prevalence rates for physical activity among people living with HIV are low [ 1 , 2 ]. Although people living with HIV are now living longer lives as a result of the effectiveness of antiretroviral therapy (ART), there is currently a public health concern about the prevalence of ageing-related health concerns (e.g., osteoarthritis, dementia, cardiovascular diseases, and frailty); ART side effects (e.g., fatigue, metabolic disorders, lipodystrophy and diabetes); and non-ART poly-pharmacology leading to the double burden of managing HIV and comorbid health conditions [ 3 ]. Thus, physical activity has been recommended as a non-pharmacological approach to aid in preventing and managing HIV-related disabilities [ 4 , 5 , 6 ]. Engaging in physical activity is beneficial to PLWH as physical activity has been shown to impart positive health benefits such as improved endurance, strength, and vitality, reduced blood pressure and depressive symptoms, and an overall improvement in quality of life and function [ 7 , 4 ]. The physiological health benefits of physical activity are evident in conditions such as obesity, in which regular PA causes a reduction in fat mass [ 8 ]; in sarcopenia, where regular PA improves muscle mass and function [ 9 ]; and in osteoporosis, where regular PA improves bone health, thus reducing frailty, the risk of falls and predisposition to fracture [ 10 ]. Furthermore, studies conducted on mental health, cognition and memory have reported that there is an increase in blood flow to the brain and promotion of neurogenesis when individuals engage in exercise [ 11 ], thus supporting the theory that physical exercise is beneficial to both body and mind. However, despite the many long-term health benefits of physical activity, about one-third of PLWH do not meet the recommended physical activity standards [ 5 ]. Several factors have been highlighted as determinants of physical activity participation among the general population [ 12 ]. These determinants have been classified into modifiable (behavioural and personality traits, environmental situations, and community settings) and those presumed to be unmodifiable (age, gender, race, and ethnicity). Among people living with HIV (PLWH), social determinants of health, such as the opportunity of engaging in exercise, the socioeconomic status of individuals, and stigma susceptibility, have been identified as influential in understanding physical activity participation [ 13 ]. In a systematic review by [ 14 ], physical activity participation in sub-Saharan Africa is influenced by several complex factors. Within the Nigerian context, the lack of a physical activity surveillance system poses a challenge to effective planning and intervention [ 15 ]. While the reported physical activity prevalence among the general population was estimated at 58% [ 16 ], it is unclear how much physical activity PLWH engage in. Studies on physical activity levels among PLWH in Nigeria are limited, and existing studies are mostly focused on prevalence studies among the general population and the beneficial effects of physical activity on quality of life [ 17 , 18 , 19 ]. Despite these established benefits, individual and societal physical activity patterns can be influenced by various modifiable and non-modifiable factors [ 20 ]. In general, researchers found that the perceived determinants of physical activity participation can be largely categorized as those that are invariable (age, gender, race, ethnicity) and those that are amenable to change (behavioural and personality characteristics, environmental circumstances, and community settings) [ 21 , 22 ]. [ 23 ] explored the limitations to physical activity among people living with HIV and found barriers in three categories, namely physical (e.g., respiratory complaints, low energy levels), psychological (e.g., stress levels, poor motivation) and environmental (family responsibilities, adverse weather conditions). Fewer factors were shown to be PA facilitators, including external support, such as walking with family or friends, and community involvement, such as access to parks or sports fields [ 23 ]. It is important to study interpersonal and environmental factors that influence physical activity behaviours to gain insight into what actions must be taken to improve physical activity participation behaviours in a given population, as physical activity has a strong potential to improve health outcomes. This study is a component of a larger study aimed at developing a contextually sensitive physical activity programme for people living with HIV. Thus, this study aims to explore the factors which can act as facilitators and barriers to engaging in physical activity in PLWH in Nigeria. Theoretical framework Identifying the factors responsible for engaging in physical activity is crucial in physical activity research. Several theoretical and behavioural methods have been adopted to understand and conceptualize the factors influencing the commencement, practice, and maintenance of physical activity [ 24 ]. One of these is the Health Belief Model (HBM), which is grounded in the theory of “expectancy-value”, taking into consideration that individuals are rational decision-makers and would weigh the advantages and disadvantages of acting against one another. The Health Belief Model, developed by a group of social psychologists (Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles and Howard Leventhal) in the 1950s was used to guide the process of this study. This framework is used to understand human behaviour and comprises the following elements: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The Health Belief Model's effectiveness in identifying critical decision-making points that impact health behaviour depends on each of these important components [ 25 ]. The Health Belief Model has been applied in studies that explore HIV/AIDS prevention and has been found to be the most commonly adopted theory in health education, illness prevention, and health promotion [ 25 ]. Existing evidence reveals that the HBM is effective in explaining cues for action in various population settings [ 26 , 27 ], while, on the other hand, individual decisions are influenced by health belief constructs, which lead to various outcomes of physical activity interaction (Fig. 1 ). Method Research design A qualitative research method was adopted to achieve the objectives of this study which were to determine the barriers to and facilitators of physical activity participation among PLWH. The qualitative research method is now commonly used in HIV/AIDS research as it is essential to providing insights into the socio-behavioural elements of HIV [ 28 , 29 ]. In the methodology, the HBM [ 12 ] was considered in understanding the barriers to and facilitators of physical activity among PLWH. Research setting The study was conducted at [location masked for blind review] Nigeria. It is one of the 24 hospitals under the management of the [location masked for blind review] Health Service Commission. It provides medical, surgical, maternal and child health services, nursing, dental, pharmaceutical, diagnostic, and rehabilitative health care. It also has an HIV/AIDS treatment and testing centre with a yearly patient enrolment of over 1,000 and serves as a referral site for people in the community needing HIV testing, counselling, and care. All interviews in this research setting were conducted face-to-face in a private counselling room set aside for the study. Study participants They were selected from the outpatient HIV clinic between March and July 2022 by applying a purposive sampling method. Only adults living with HIV, 18 years of age and above, who had been on antiretroviral therapy for at least six months and who were attending the Randle General Hospital HIV clinic, were approached personally by the principal investigator, and invited to participate in the study. The matron in charge and the clerical officer also helped briefly inform the participants about the study's objective, while the PLWH were attending their appointments. Study information sheets in English were provided, and participants were given verbal information on the research. Both written and verbal consents were obtained before data collection. A total of 22 participants were approached; however, a saturation point was reached at the 20th interview, and no new information was obtained from any subsequent interviews. Study procedure Before the interviews, the principal investigator (Physiotherapist/PhD candidate) and a research assistant (Physiotherapist/MSc candidate) visited the study setting to review the population to be interviewed, the days on which the clinics were open, the preferred times for participants to be approached, and to determine whether the environment was conducive to the interviews. The research assistant was briefed about the study objectives and procedure of the study and had observed the pilot interview sessions with the principal investigator before conducting any interviews. The interviews were conducted by the principal investigator in English as most of the participants were comfortable with this language, and in the Yoruba Language for participants who preferred to communicate in their mother tongue. The interviews were conducted using a Philips DVT digital dictaphone, and the recordings were saved in MP3 format. In addition to the audio recordings, the interviewer wrote additional notes, with reflective comments also being added at appropriate times during the interviews. The duration of each interview was between 30 and 45 minutes. The interviewer established rapport with the participants and informed them that confidentiality was assured. The participants were encouraged to feel relaxed and were informed that the interview could be paused and discontinued at their will. Data collection : A semi-structured interview guide was used. Following an extensive literature review, a list of potential questions to assess the perspectives of PLWH on barriers to and facilitators of physical activity participation was presented to each of the participants. In accordance with the pertinent guidelines for reporting qualitative research (Consolidated Criteria for Reporting Qualitative Studies checklist, COREQ), data management, coding, and collection were conducted according to an iterative process. Part A of the interview guide included questions on sociodemographic data, including age, sex, marital status, occupation, income range, and educational level. Part B included questions on the duration of the participants' HIV condition, ART adherence, and current health status. Part C of the interview explored the knowledge, participation, benefits, barriers to and facilitators of physical activity. Examples of questions included for Part B were as follows: “How long have you been living with HIV?”; “In what ways does HIV affect your health?”; and for Part C: “Can you describe your day-to-day activities for me?”; “What is your typical day like?”; “What do you do on a daily basis?”; “What types of exercises/physical activity are you aware of?”; “What discourages you from engaging in exercise?"; “What limits you from participating in physical activity?” (Probe: “What stops you?”). Open-ended questions were designed to give interviewees the best opportunity to express themselves. The authors reviewed the drafted interview guide and modified it after several rounds of discussion. In addition to determining whether a specific set of questions was useful in retrieving objective information, the interview guide was pre-tested by conducting pilot interviews with PLWH. Finally, the interview guide was updated to include specific probes identified during the pilot interviews. However, the results of the pilot interviews were not included in the data presented. The 17th interview discovered no new codes or themes, but data collection was continued to enhance the data. It was discontinued at the 20th interview owing to the practicalities of limited resources, time, and space. (The research period coincided with the commencement of renovation construction in the HIV department of the hospital.) Data analysis All the data were anonymized using pseudonyms linking the participants’ interview transcripts to their biodata and field notes during the data collection and analysis phases of the research. Following the completion of the interview, the audio recordings were uploaded to a password-protected file on the computer and deleted from the digital audio recording device. Three of the interviews were conducted in the Yoruba language. These were first translated into English by an independent translator; the translation was then screened by the first and second authors. All audio recordings were transcribed into text by an independent translator who ensured consistent formatting of the transcriptions, secure storage, and the transfer of the transcribed files. The transcripts were screened and reviewed by the first and second authors. All transcribed data were exported to a computer-assisted qualitative data analysis software programme (MAXQDA version 22.3.0), and themes were identified from the data. A thematic content analysis approach was used to analyse the data and explore the participants’ experiences. Ethical considerations Permission to conduct the study at the HIV/AIDS testing and treatment clinic in [location masked for blind review], was received from the [location masked for blind review] Hospital Service Commission (LSHSC/2222/VOLIV/14; 23 June 2021). The Human Research Ethics Committee of the [location masked for blind review] approved the study (Clearance Certificate M200906; 15 April 2021) Trustworthiness The four trustworthiness criteria - transferability for applicability, credibility for veracity, dependability for consistency, and confirmability for transparency to outside examination and verification - were applied. Transferability Purposive sampling of the participants ensured transferability. A description of the population sample and participant characteristics was provided using a mixed sample that listed the age, sex, and background of the participants to examine the transfer criterion. The suitability of the interviews was examined, and the accuracy of the interpretations drawn from the interviews was confirmed. Credibility Prior to the interviews and data collection process, the study site was visited to address the credibility criterion. Furthermore, two researchers independently analysed the transcript, completed the coding, and identified major themes and sub-themes before discussing them in order to avoid single-researcher bias. To avoid the risk of data deviation from the research objectives, a prolonged engagement was ensured until the scope of the data was covered. Dependability The study methodology was thoroughly recorded and explained to the research assistant in order to address the dependability criterion. The interview guidelines were reviewed by experienced researchers (Author 3 and Author 4). An independent translator transcribed the interviews; in this way, the insights of external observers were used. Confirmability Additional issues were brought up during meetings with the research team and considered for confirmability. A third independent reviewer who had not previously been involved in the project was invited to analyse the raw data and compare the various categories and themes, thereby facilitating the peer review process and improving the confirmability of the research. To assess inter-coder agreement and strengthen the reliability of the results, the independent reviewer cross-checked the codes. Rigour Member checking and inter-coder agreements were respected to develop rigour. This was done by recapping the questions and responses with the participants and allowing the responses to be validated. The participants were asked to highlight any contradictions observed to further strengthen the validation process. Reflexivity As a physiotherapist in the field of public health and community physiotherapy, the researcher kept and updated a reflexive diary to discern knowledge from the data, and allow reflection on her contribution, as well as her thoughts on integrating rehabilitation services in HIV management. During the data collection process, the researcher observed that both the service users and the service providers at the HIV testing and treatment centres rely majorly on pharmacological approaches to health management, with little attention paid to health promotion and disease prevention in people with chronic conditions such as HIV. Results Part A: Sociodemographic profile of the participants A total of 20 participants was involved in the study. The mean age of the participants was 36.2 ± 9.27 years, with a range of 19 to 54 years. The mean time since their HIV diagnoses was 6.5 ± 6.20 years, ranging from 2001 to 2022. Table 1 summarizes the sociodemographic information obtained from the participants during the interviews. Table 1 Sociodemographic profile of participants Description N % Gender Male 9 45 Female 11 55 Employment Yes 17 85 No 3 15 Educational level No formal education 2 10 Primary 2 10 Secondary 8 40 Tertiary 8 40 Marital status Married 9 47.4 Single 9 47.4 Widowed 1 5.3 Income (in Naira) ₦≤30,000 7 53.8 ₦30,000 – ₦100,000 4 30.8 ₦≥100,000 2 15.4 Results Overview Twenty-five (25) categories were identified. The categories were further abstracted into nine subthemes and two themes. Participants in this study had similar understandings of physical activity and exercise and used the terms interchangeably during the interview. All the participants concurred on the benefits of physical activity to all individuals, irrespective of HIV status. The barriers to physical activity that were most commonly mentioned were lack of time, financial constraints, and an unsupportive environment. Despite the presence of a physiotherapy department in the next building, PLWH reported that they were not aware of a referral pathway to physiotherapy, and they had not been receiving any public health information promoting physical activity. Theme 1: Attitudes, Knowledge, and Preferences in respect of Physical Activity Attitudes towards physical activity PLWH demonstrated positive attitudes towards their participation in physical activities, expressing their willingness and interest to engage in order to derive health benefits. “Two things: - the health benefits; then the second thing is that it makes me ready for the day’s activities” (Male, 42 years old) “It makes one physically fit. Some things that people who do not exercise cannot do, you will be able to do them. Especially that road walk, it is good for everyone; you’ll be able to walk some distance and not get tired. Some people cannot even stand for a long period, I can stand the whole day and not get tired. This is part of the benefit of exercise” (Male, 34 years old) Knowledge of Physical Activity The term ‘exercise’ was more relatable to participants than ‘physical activity’ and was used more frequently by all participants. While some participants could highlight the various forms of physical activity that they were aware of, others simply described exercise as leisure-time activities done at a set time to increase strength, endurance, or losing weight. “When I was growing up, I played hockey; so, it is a sport. So, when I go for training in Unilag Sport Centre…. We run around the track. Running is an exercise; jogging is an exercise. I am aware of sit-ups; there was a time when I was growing up, I was working on my stomach, and I was doing seat-ups, press-ups, and push-ups…. [they] are exercising”. (Female, 30 years old) “Walking too is part of exercise. Sometimes, it’s not every trekkable distance one should take bikes or tricycles to…. trekking those distances will make one very fit ” (Male, 34 years old) “Is that work I’m doing? not exercise? Even the washing of clothes, sweeping, you know how housework can be?... mopping; they are all exercise.” (Female, 54 years old) Preferences for Physical Activity Walking was described as the most preferred form of physical activity. Participants also reported that transportation and occupational physical activity were sufficient for them, as these forms were perceived to be very demanding and time-consuming, thus, leaving no time or energy for other forms of physical activity. “Indoor exercises like cycling, walking on a machine, carrying of weights…. My most preferred is walking”. (Male, 42 years old) “When you go to the market and buy, walk down to deliver to customers, it’s more than exercise now. I don’t know any exercise more than that one”. (Female, 35 years old) “I normally do. Mainly press-up. It was before I used to do road walk, like jogging, but now I don’t have time for that one, I do only press-up. I just do small exercise inside my house”. (Male, 34 years old) Theme 2: Barriers to physical activity participation Using a framework approach and thematic analysis, the issues which were identified as barriers to physical activity participation were subdivided into primary and, where relevant, secondary sub-themes. The most recurring barrier to participation in physical activity cited by the participants was ‘ lack of time.’ Lack of time and other commitments Participants reported that they could not set time aside for physical activity as work-related activities were a priority and consumed most of their daylight time. “Not everybody can do that every day. Maybe there are some other commitments, when you get back, you won’t even have time, you would have forgotten. There are some things that you just forget sometimes because of what you have gone through throughout that day. So maybe it is only in the evening you have time to do what they told you to do in the morning, because of time, everything we deal with is time; time is money” (Male, 48 years old) “ I agree that it is good, but there’s no time. I pray; God, give us peace of mind. Before one wakes up, attend to the children, coupled with the fact that I leave home by 5am and get back home around 10pm; there’s nothing like Saturday or Sunday in my schedule; how will I have time for exercise? I know it is good, I used to exercise when things were okay, I was fat then and wasn’t doing any work that’s stressful; my husband and I used to go to the stadium every Saturday back then when we were in Lagos; but now, I don’t do any exercise ”. (Female, 43 years old) Priority for other activities Although participants agreed that physical activity is beneficial,, most participants classified it on the Eisenhower matrix as ‘Important, but Not Urgent.’ “If I am looking for money, I can't be jogging. When you are OK, you can do exercises till 10am; nobody will hold you [back], but whew, that is struggling, and you are doing exercises… Is it exercises that will feed you? For example, now, you want to do test; it is money. If money is not important, hospital is supposed to be free” (Female, 34 years old) “There’s no one that wouldn’t like to, but there’s no time regarding my trade, except I decide to say I’m not going out to trade in a day and that would be like once in three months.… It’s not easy, I cater for four children all by myself and only one of them is out of school. It will be really hard” (Female, 43 years old) “I would have to leave whatever I’m doing to go and be doing something [like] that (exercise)” (Female, 40 years old) Fatigue Fatigue among people living with HIV is a common symptom that could limit individuals from carrying out their daily tasks. Participants in this study commented that they cannot engage in physical activity when tired. “The only discouragement is when I’m tired from work” (Male, 34 years old) “Also, when you have over-walked. Even car itself…., there are sometimes car must rest. Everything has to rest. This is a locomotor system. When you walk, you are exercising your joint, you cannot keep on walking the whole day; there are sometimes that you feel tired, and you just rest ” (Male, 47 years old) “Because I’m weak, I cannot do it.” (Female, 37 years old) Lack of motivation According to participants, the lack of knowledge about guidelines for physical activity for PLWH was considered a barrier as they are unsure of the frequency and intensity of the exercise that they are engaging in. In addition, participants highlighted that they are not motivated to participate in physical activity owing to the lack of social groups and support from health professionals. “If I had somebody to guide me, it will motivate me to exercise” (Female, 26 years old) “If I am actually exercising without an instructor or a coach, I cannot go far, If I do it alone, I can go for like two minutes or five minutes for a particular programme, but with the aid of an instructor or coach, I can go for like seven minutes way beyond my normal timing” (Male, 19 years old) “ Maybe in the evening when you have done all your business, and have nowhere else to go, then you can do your exercise and go to sleep” (Male, 47 years old) Built environment and related factors The lack of safe open spaces in the community for physical activity was reported as one of the barriers to physical activity. Participants also highlighted that they do not have access to parks, fields, and gyms for physical activities. “The thing is that, especially Lagos, everywhere is very rough, but if you are doing it, one has to be careful because the road is narrow and there’s always rush here and there for people going to work and all. So, one must be careful while on the road; except you do it early morning before people start rushing out. So, if you’re going for something like that, it’s not advisable to hold cash or any other things that are valuable to you. The only way it can be safe is for you not to have valuables on you, even your phones. But some people usually hold their phones while jogging. In such scenario, one would have to use a less expensive phone such that they won’t even think of hijacking it from you or [you] feel pained if it’s being hijacked. But for me, there’s nothing they can collect from me, because I do that without any valuables on me. They usually steal early in the morning” (Male, 34 years old) “It is not ok, like in my area, cars are always on the move” (Female, 34 years old) “Another one again is weather condition. I remember a time I was exercising; it was during harmattan period, and I was getting all dried up. The things you do in normal weather condition gets limited and the duration gets shortened in harsh weather condition.” (Male, 19 years old) Other health conditions Participants in our study commented that they are limited in their ability to participate in physical activity on account of the double burden of HIV and their associated condition . “Why I don’t engage in exercise is because of the reason I told you: my mind believes that since I have Hepatitis B, and it’s affecting my liver, I believe that if I lose any calorie, I can’t get it back”. (Female, 30 years old) “The only other condition affecting me is that I have mild asthma; that’s the other thing that stops me” (Male, 19 years old) “Well, they do gym around my area, they lift weights. But with this my back, I don’t think I can lift weight, if I go and lift something that is heavier than me, I don’t know what it can cause” (Male, 47 years old) Finance Participants described the importance of financial comfortability using Maslow’s Hierarchy of Needs. They implied that financial stability is a higher priority than engaging in physical activity. Thus, their low economic status hinders them from participating in physical activity. “If I am looking for money, I can't be jogging”. (Female, 34 years old) “All of this tends to money because you have to get registered, getting the equipment needed; everything still boils down to money” (Male, 19 years old) “The only issue I’m having is my income is not enough, I’m just managing it”. (Female, 26 years old) Facilitators of physical activity When participants were asked about their perceived facilitators of physical activity participation, the following themes emerged: Perceived benefits Participants felt motivated to engage in physical activities because they believe it is beneficial towards achieving their fitness goals. The desire to appear healthy and avoid being recognized as having HIV was also a motivating factor. “It’s the body for me. I just want to build that body; that’s the motivation. I'm into the body building type, so I just want to get this muscular shape, that’s my aim” (Male, 19 years old) “Because I want to be strong and have good health” (Female, 27 years old) “Two things: the health benefits; then the second thing is that it makes me ready for the day’s activities” (Male, 42 years old) “Good life and good health. My doctor advised me to. I just do it to keep fit” (Male, 45 years old) Habit Participants in our study revealed that habit and their engaging in childhood physical activities were instrumental in motivating them to engage in physical activity. “Habits, from my secondary school days. I used to like doing exercises” (Female, 34 years old) “Well for me, while I was very young, I used to play ball. I used to participate in sport activities, I do back flips and I believe I can still do them even though I’m older now. Although I’ve not done them in a long while, but I believe it has become a part of me” (Male, 34 years old) Influence by others (supportive social environment and relationships) Another factor influencing the participation of PLWH in physical activity was the support and encouragement of family and friends. Thus, there is a correlation between positive influencing factors and motivation for physical activity participation. “Another motivation too is my friend. There’s this friend of mine that was looking so out of shape and within three months of exercising, he’s looking back in shape and better. That one too is another kind of motivation; so, if he could do it, then I can do it too” (Male, 19 years old) “When I see people who do it, they look smart and I like to look like them” (Male, 35 years old) “When I see people doing it, I also like to do it” (Male, 39 years old) Illness prevention According to the participants, engaging in physical activity benefited PLWH and the general population in improving their health and preventing illness. “I don’t want to sit down in one place, because if I sit in a spot, I feel weak; but whenever I’m working, I have more strength.” (Female, 37 years old) “…. when you are not doing anything (exercising), you start feeling minor issues of your system not working well” (Male, 47 years old) “As a student, I learned a little bit about human anatomy, the neurons, and muscles. and I know that as we keep ageing, exercise is mostly good for our bodies. because if we are dormant, it damages the cells in our body. To my understanding, that will rapidly make the cells in the body to die” (Male, 42 years old) Pain relief For PLWH, pain is a limiting factor in performing daily activities. However, participants in our study commented that they engage in physical activity to help manage musculoskeletal pain. “Yes, sometimes I have joint pain but when I do [physical activity], I get relief. I do exercise because it helps my leg pain, but not every day. It helps [my] skin to be healthy and [my]blood to circulate well.” (Female, 19 years old) “I don't like taking medicine, I like to exercise myself. Let me say my leg is paining me now or any part of my body; I like to start exercising my body”. (Female, 34 years old) “I learnt that if I don't do exercise and start again, I will feel body pain in my muscle; but if I continue it will be better.” (Male, 52 years old) Discussion The aim of this study was to explore the barriers to and facilitators of physical activity among people living with HIV in Nigeria. The results of the qualitative analysis of data revealed that most of the PLWH in [location masked for blind review] understand the benefits of physical activity and have positive attitudes to physical activity participation. According to the Health Belief Model, the likelihood of an individual engaging in a particular health behaviour can be predicted by their belief in a personal threat of an illness and their belief in the effectiveness of the recommended health behaviour. Such perceptions of health behaviour, in combination with modifying factors, which include sociodemographic factors, are instrumental in determining their likelihood to engage in physical activity programmes designed to optimize their health. An analysis of the modifying factors can assist in understanding physical activity behaviour among people living with HIV. The mean age of participants in our study was 36.2 ± 9.27 years and the range was19 to 54 years. Moreover, this age group constitutes the major workforce of the nation. Furthermore, with a national unemployment rate as high as 33.3% [ 30 ], it is not surprising that many individuals, as evidenced in this study, are self-employed so that they can sustain themselves financially. Findings from our study are consistent with reports indicating that only 17% of workers in Nigeria earn adequate salaries to enable them to escape poverty [ 31 ]. Most participants (53.8%) who had an income source earned less than the national minimum wage of #30,000 (66.73 USD) per month, while only two participants (10%) earned more than #100,000 per month (222.43 USD). Thus, socioeconomic factors are vital in influencing physical activity participation as people earning an adequate income, as indicated above, can afford some costs associated with engaging in physical activity. In Nigeria, as with most developing countries, individuals with no formal education or only an elementary education are the group most affected by poverty [ 32 ]. In our study, only 42% of the participants had a post-secondary education. The association between educational level and physical activity has been examined in a systematic review by [ 33 ], with reports of existing correlations between educational level, health literacy and physical activity behaviour. Thus, level of education, the sociodemographic profile of the participant, cultural influences, and financial capacity are major factors influencing physical activity participation. Although several studies have highlighted that men are generally more active than women [ 34 – 36 ], most of the women in our study classified themselves as being sufficiently active as they consider occupational physical activity and the household chores which they engage in daily as the highest level of physical activity. [ 37 ] also reported that when monitored, with the actual measurements of their exercises based on the total volume of PA, women are more active than they are when measured based on the current PA recommendations. This is because they are more inclined to engage in light -duties and occasional PA, both of which are connected to their lifestyle (e.g. doing housework). Similarly, other studies [ 37 , 38 ] indicate that individuals view such tasks as physically productive and are usually exhausted or feel ‘too lazy’ to engage in any additional structured physical activity. These are just a few selections of some background variables that were chosen as this study's focus. The potential effects of other background factors not captured in this study need further consideration. The factors influencing physical activity in this population were investigated at various levels and based on the thematic findings that emanated from the interviews. The “likelihood for action” refers to the perceived benefits minus the perceived barriers to engaging in the recommended activities [ 39 ]. These are assumed to affect behavioural intentions and the consequent behaviour around the performance of the physical activity in question. The participants reported a range of barriers limiting physical activity participation, the most predominant being lack of time. From studies conducted nationally and globally in Nigeria [ 40 , 17 ], the UK [ 41 ], Sri-Lanka [ 42 ], the USA [ 43 ], Australia [ 44 ], lack of time is frequently cited as a limiting factor in engaging in physical activity. A probable reason for this claim is that individuals calculate the cost of engaging in exercise before deciding to participate in any physical activity, particularly in environments where income is dependent on the time put into the job. For example, a participant in our study commented that the time she would be jogging could have been spent “looking for money”. Another identified barrier was the state of the built environment in [location masked for blind review] state. [location masked for blind review] has a population of 21 million and is regarded as a mega city, but it lacks accessible facilities for individuals to engage in recreational physical activity and, therefore, also in public health concerns [ 45 ]. Thus, individuals who engage in physical activity use other types of public space, such as roads, bridges, and vacant land. However, in this context, the dangers highlighted by participants in this study are the lack of safety in these spaces, as well as human and vehicle traffic congestion. [ 46 ] highlighted four key environmental factors influencing physical activity: walking ability, green space, traffic-related air pollution and heat. [ 45 ] observed that the municipal structures of [location masked for blind review] are unsupportive and potentially harmful to individuals who choose to engage in leisure-time physical activity as they need to navigate dangers such as air pollution, robberies, traffic injury, etc. Thus, it is not surprising that individuals would strongly evaluate the benefit of physical activity against the potential risk of harm before deciding to participate in physical activity. In our study, one participant commented that the only factor limiting him from engaging in physical activity is fatigue, as there are days when he just wakes up tired. It is unclear whether this type of fatigue is due to HIV or the existence of other HIV-related health conditions. The impact of fatigue in influencing physical activity participation should not be underestimated as there is an association between HIV-related fatigue and psychological factors such as life stress, anxiety, and depression [ 47 – 49 ]. Furthermore, it has been reported that some HIV medications can cause fatigue [ 50 ], thus requiring non-pharmacological interventions such as physical activity and cognitive behavioural therapy to treat or prevent fatigue [ 51 ]. Recent studies reveal that physical activity is linked less to fatigue among PLWH [ 52 ]. Findings from our study revealed multiple motivators for physical activity participation. On an individual level, participants felt that the perceived benefits of engaging in physical activity serve as the most important facilitator since they believe that physical activity contributes to healthier, longer lives, improves fitness, aids relaxation, promotes sleep, and prevents illness. Historically, maintaining good health has been a major motivation for physical activity participation. [ 53 , 42 ]. Participants referred to a supportive environment and access to resources and external social support as vital facilitators. These results are consistent with the literature and explore the influence of modifiable factors on physical activity [ 23 , 54 ]. Although some studies view modifiable factors as secondary or complementary to non-modifiable factors [ 55 ], the impact of external factors in influencing physical activity participation cannot be overlooked [ 56 ]. [ 54 ] highlighted that the justification behind exercise considerably impacts individuals' ability to maintain consistent physical activity throughout time. Furthermore, since it is known that adolescent sports participation is linked to a high level of physical activity in adulthood [ 34 , 15 , 36 ], participants in our study highlighted that they engaged in physical activity as it is a habit which they had picked up from their adolescence, when they were actively involved in sports. Thus, sociodemographic variables and psychological characteristics significantly influence the likelihood of participating in physical activity. These results suggest that a supportive socio-cultural environment and the priorities of individuals are crucial to physical activity participation, further strengthening the narrative that voluntary participation in physical activity is motivated by the complex interaction of several factors such as motivation, time, choice of physical activity, environment, and availability of resources. There is, however, an existing debate as to which limiting factors to physical activity participation could be classified as genuine barriers or ‘excuses. This issue can be determined by assessing the barriers while motivation is present [ 57 , 58 , 42 ]. The barriers revealed in this study may help develop interventions that will help PLWH increase their physical activity levels in this situation and reduce the long-term effects of non-communicable diseases. Conclusion Reflecting on the determinants of physical activity behaviour identified in this study, it is reasonable to conclude that although background variables were identified as perceived and actual barriers to physical activity participation, PLWH are motivated to engage in physical activity and can be supported to improve their physical activity levels through health promotion interventions. Environmental factors, fatigue, and financial priorities are barriers to physical activity participation, but could be alleviated by individual motivation, the certainty of each individual’s own value, and the creation of a personalized physical activity programme to be conducted in a more supportive environment. Likewise, social support, positive interprofessional relationships, and perceived health benefits are vital to increasing physical activity participation among PLWH. Implications for research Contextual factors must be considered in exercise designs and prescriptions for PLWH. Interventions such as organizing exercise classes that would include group sessions for peer support would be beneficial. In relation to PLWH, the findings from this study highlight the fact that cultural attributes, including gender definitions and socioeconomic expectations, may influence physical activity participation and could be more complex than the traditional views regarding gender roles in physical activities, as suggested by previous research in Africa. Furthermore, this study provides contextually based findings for academics, researchers, and policymakers, aiming to develop interventions to improve physical activity levels among PLWH in Nigeria. Declarations Acknowledgements The authors acknowledge the input of the research assistants, staff and service users of the HIV/AIDS treatment and testing centres involved in the study. Competing interests The authors declare no competing interests. Author contributions T.O. and H.M. conceived of the presented idea. T.O. collected the data, H.M., A.A., S.I. were involved in planning and supervised the work. T.O. and A.A. processed the data, and performed the analysis, T.O drafted the manuscript and designed the figures. S.I. aided in interpreting the results and worked on the manuscript. All authors discussed the results and commented on the manuscript. Funding The authors received no financial support for the research, authorship, and/or publication of this article. Data availability statement Data are available on reasonable request. Anonymised data will be shared on reasonable request to the corresponding author. Disclaimer The views expressed in the submitted article are those of the authors and not an official position of the institution. References Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World health organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine [Internet]. 2020;54(24):1451–62. Available from: https://bjsm.bmj.com/content/54/24/1451 Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants. The Lancet Child & Adolescent Health [Internet]. 2020;4(1):23–35. Available from: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642( 19)30323-2/fulltext Justice AC, Gordon KS, Skanderson M, Edelman EJ, Akgün KM, Gibert CL, et al. Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals. AIDS (London, England) [Internet]. 2018 Mar 27 [cited 2023 Jan 12];32(6):739–49. Available from: https://pubmed.ncbi.nlm.nih.gov/29543653/ Ibeneme SC, Omeje C, Myezwa H, Ezeofor SN, Anieto EM, Irem F, et al. Effects of physical exercises on inflammatory biomarkers and cardiopulmonary function in patients living with HIV: a systematic review with meta-analysis. BMC Infectious Diseases. 2019;19(1). Montoya JL, Jankowski CM, O’Brien KK, Webel AR, Oursler KK, Henry BL, et al. Evidence-informed practical recommendations for increasing physical activity among persons living with HIV. AIDS. 2019;33(6):931–9. Ajidahun AT, Myezwa H, Ibeneme SC, Magobotha S, Fortwengel G, Jingo M, et al. Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial. Medicine [Internet]. 2020 Dec 11 [cited 2023 Feb 2];99(50):e23206. Available from: https://pubmed.ncbi.nlm.nih.gov/33327237/ Voigt N, Cho H, Schnall R. Supervised Physical Activity and Improved Functional Capacity among Adults Living with HIV: A Systematic Review. Journal of the Association of Nurses in AIDS Care. 2018;29(5):667–80. Mika A, Macaluso F, Barone R, Di Felice V, Sledzinski T. Effect of Exercise on Fatty Acid Metabolism and Adipokine Secretion in Adipose Tissue. Frontiers in Physiology [Internet]. 2019;10. Available from: https://www.frontiersin.org/articles/ 10.3389/fphys.2019.00026/full Ibeneme SC, Uwakwe VC, Myezwa H, Irem FO, Ezenwankwo FE, Ajidahun TA, et al. Impact of exercise training on symptoms of depression, physical activity level and social participation in people living with HIV/AIDS: a systematic review and meta-analysis. BMC Infectious Diseases. 2022;22(1). Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. BioMed Research International [Internet]. 2018;2018(4840531):1–10. Available from: https://www.hindawi.com/journals/bmri/2018/4840531/ Di Liegro CM, Schiera G, Proia P, Di Liegro I. Physical Activity and Brain Health. Genes [Internet]. 2019;10(9):720. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770965/ Yen HY, Li C. Correction: Determinants of physical activity: A path model based on an ecological model of active living. PLOS ONE. 2019;14(9):e0222625. Safa F, McClellan N, Bonato S, Rueda S, O’Brien KK. The Role of the Social Determinants of Health on Engagement in Physical Activity or Exercise among Adults Living with HIV: A Scoping Review. International Journal of Environmental Research and Public Health [Internet]. 2022;19(20):13528. Available from: https://www.mdpi.com/ 1660-4601/19/20/13528/htm Vancampfort D, Stubbs B, Mugisha J. Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels. African Health Sciences. 2018;18(2). Oyeyemi AL, Oyeyemi AY, Omotara BA, Lawan A, Akinroye KK, Adedoyin RA, et al. Physical activity profile of Nigeria: implications for research, surveillance and policy. The Pan African Medical Journal [Internet]. 2018;30(175). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235484/ Adeloye D, Ige-Elegbede JO, Auta A, Ale BM, Ezeigwe N, Omoyele C, et al. Epidemiology of physical inactivity in Nigeria: a systematic review and meta-analysis. Journal of Public Health. 2022;44(3):595–605. Oyeyemi AL, Ishaku CM, Oyekola J, Wakawa HD, Lawan A, Yakubu S, et al. Patterns and Associated Factors of Physical Activity among Adolescents in Nigeria. Yu H, editor. PLOS ONE. 2016;11(2):e0150142. Ugwueze FC, Agbaje OS, Umoke PCI, Ozoemena EL. Relationship Between Physical Activity Levels and Psychological Well-Being Among Male University Students in South East, Nigeria: A Cross-Sectional Study. American Journal of Men’s Health. 2021;15(2):155798832110083. Aduroja PE, John-Akinola YO, Oluwasanu MM, Oladepo O. Prevalence of physical activity and dietary patterns as risk factors for cardiovascular diseases among semi-urban dwellers in Ibadan, Nigeria. African Health Sciences [Internet]. 2022;22(3):336–48. Available from: https://www.ajol.info/index.php/ahs/article/view/234926 Oluyinka S, Endozo A. Factors Affecting Physical Activity Participation Among University Students. JOURNAL OF SOCIAL SCIENCE RESEARCH. 2019;14:3161–70. Gretebeck KA, Black DR, Blue CL, Glickman LT, Huston SA, Gretebeck RJ. Physical Activity and Function in Older Adults: Theory of Planned Behavior. American Journal of Health Behavior. 2007;31(2):203–14. Kókai LL, van der Bijl MF, Hagger MS, Ó Ceallaigh DT, Rohde KIM, van Kippersluis H, et al. Perceived determinants of physical activity among women with prior severe preeclampsia: a qualitative assessment. BMC Women’s Health. 2022;22(1). Roos R, Myezwa H, van Aswegen H. “Not easy at all but I am trying”: barriers and facilitators to physical activity in a South African cohort of people living with HIV participating in a home-based pedometer walking programme. AIDS Care. 2014;27(2):235–9. World Health Organization. a Vital Investment. World Health [Internet]. 2005;202. Tarkang E, Zotor F. Application of the Health Belief Model (HBM) in HIV Prevention: A Literature Review. Central African Journal of Public Health. 2015;1(1):1–8. Chatzisarantis, Nikos L. D, Frederick C, Stuart, Hagger MS, Smith B. Influences of volitional and forced intentions on physical activity and effort within the theory of planned behaviour. Journal of Sports Sciences [Internet]. 2007;25(6):699–709. Available from: https://doi.org/10.1080/02640410600818523 Gorin AA, Buchan DS, Ollis S, Thomas NE, Baker JS. Physical Activity Behaviour: An Overview of Current and Emergent Theoretical Practices. Journal of Obesity [Internet]. 2012;2012:546459. Available from: https://doi.org/10.1155/2012/546459 Doyal L. A decade of researching the social aspects of HIV and AIDS. The Lancet. 2014;384(9960):2102–3. Syed IA, Syed Sulaiman SA, Hassali MA, Thiruchelvum K, Lee CKC. A qualitative insight of HIV/AIDS patients’ perspective on disease and disclosure. Health Expectations. 2014;18(6):2841–52. Nigerian Stat. NATIONAL BUREAU OF STATISTICS [Internet]. nigerianstat.gov.ng. 2023 [cited 2023 Jan 10]. Available from: https://nigerianstat.gov.ng/ Lian JW, Vishwanath T. A Better Future for All Nigerians: Nigeria Poverty Assessment 2022 – Launch Event Presentation [Internet]. World Bank. 2022 [cited 2023 Jan 10]. Available from: http://documents.worldbank.org/curated/en/099040004052238213/P1763010cf 39710ab0b56306cbc10fd09a1 Sulaimon MD. Determinants of multidimensional poverty in Nigeria: a state level analysis. International Journal of Sustainable Economy. 2022;14(2):151. Buja A, Rabensteiner A, Sperotto M, Grotto G, Bertoncello C, Cocchio S, et al. Health Literacy and Physical Activity: A Systematic Review. Journal of Physical Activity and Health. 2020;17(12):1259–74. Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet [Internet]. 2012 Jul [cited 2019 Apr 8];380(9838):247–57. Available from: https://www.sciencedirect.com/science/article/pii/S0140673612606461 Sallis JF, Bull F, Guthold R, Heath GW, Inoue S, Kelly P, et al. Progress in physical activity over the Olympic quadrennium. The Lancet. 2016;388(10051):1325–36. Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. The Lancet Global Health [Internet]. 2018;6(10):e1077–86. Available from: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X( 18)30357-7/fulltext Amagasa S, Fukushima N, Kikuchi H, Takamiya T, Oka K, Inoue S. Light and sporadic physical activity overlooked by current guidelines makes older women more active than older men. International Journal of Behavioral Nutrition and Physical Activity. 2017;14(1). Hoodbhoy Z, Qureshi RN, Iqbal R, Muhabat Q. Household chores as the main source of physical activity: Perspectives of pregnant Pakistani women. JPMA The Journal of the Pakistan Medical Association [Internet]. 2018 Apr 1 [cited 2023 Jan 10];68(4):565–9. Available from: https://pubmed.ncbi.nlm.nih.gov/29808046/ Mckellar K, Sillence E. Chapter 2 - Current Research on Sexual Health and Teenagers [Internet]. ScienceDirect. Academic Press; 2020. p. 5–23. Available from: https://www.sciencedirect.com/science/article/pii/B9780128169698000023 Abaraogu UO, Edeonuh JC, Frantz J. Promoting Physical Activity and Exercise in Daily Practice: Current Practices, Barriers, and Training Needs of Physiotherapists in Eastern Nigeria. Physiotherapy Canada. 2016;68(1):37–45. Withall J, Jago R, Fox KR. Why some do but most don’t. Barriers and enablers to engaging low-income groups in physical activity programmes: a mixed methods study. BMC Public Health. 2011;11(1). Perera M, Arambepola C, Gillison F, Peacock O, Thompson D. Perceived barriers and facilitators of physical activity in adults living in activity-friendly urban environments: A qualitative study in Sri Lanka. Metwally AM, editor. PLOS ONE. 2022;17(6):e0268817. Lee C, Ory MG, Yoon J, Forjuoh SN. Neighborhood Walking Among Overweight and Obese Adults: Age Variations in Barriers and Motivators. Journal of Community Health. 2012;38(1):12–22. Ashton LM, Hutchesson MJ, Rollo ME, Morgan PJ, Thompson DI, Collins CE. Young adult males’ motivators and perceived barriers towards eating healthily and being active: a qualitative study. International Journal of Behavioral Nutrition and Physical Activity. 2015;12(1). Lawanson T, Foley L, Assah F, Mogo E, Mapa-Tassou C, Ogunro T, et al. The urban environment and leisure physical activity during the COVID-19 pandemic: a view from Lagos. Cities & Health. 2020;5(sup1):204–7. Giles LV, Koehle MS, Saelens BE, Sbihi H, Carlsten C. When physical activity meets the physical environment: precision health insights from the intersection. Environmental Health and Preventive Medicine. 2021;26(1). Barroso J, Hammill BG, Leserman J, Salahuddin N, Harmon JL, Pence BW. Physiological and Psychosocial Factors that Predict HIV-Related Fatigue. AIDS and Behavior. 2010;14(6):1415–27. Barroso J, Leserman J, Harmon JL, Hammill B, Pence BW. Fatigue in HIV-Infected People: A Three-Year Observational Study. Journal of Pain and Symptom Management. 2015;50(1):69–79. Loades ME, Kagee A. Exploring our understanding of fatigue among adolescents living with HIV: Highlighting the unknown. Journal of Health Psychology. 2017;24(1):125–36. Voss J, Barroso J, Wang T. A Critical Review of Symptom Management Nursing Science on HIV-Related Fatigue and Sleep Disturbance. International Journal of Environmental Research and Public Health. 2021;18(20):10685–5. Bernard P, Romain AJ, Caudroit J, Chevance G, Carayol M, Gourlan M, et al. Cognitive behavior therapy combined with exercise for adults with chronic diseases: Systematic review and meta-analysis. Health Psychology. 2018;37(5):433–50. Webel AR, Jenkins T, Longenecker CT, Vest M, Davey CH, Currie J, et al. Relationship of HIV Status and Fatigue, Cardiorespiratory Fitness, Myokines, and Physical Activity. The Journal of the Association of Nurses in AIDS Care: JANAC [Internet]. 2019 [cited 2023 Feb 6];30(4):392–404. Available from: https://pubmed.ncbi.nlm.nih.gov/31241504/ Brunet J, Sabiston CM. Exploring motivation for physical activity across the adult lifespan. Psychology of Sport and Exercise. 2011;12(2):99–105. Geller K, Renneke K, Custer S, Tigue G. Intrinsic and Extrinsic Motives Support Adults’ Regular Physical Activity Maintenance. Sports Medicine International Open. 2018;02(03):E62–6. Anderson E, Durstine JL. Physical activity, exercise, and chronic diseases: A brief review. Sports Medicine and Health Science [Internet]. 2019;1(1):3–10. Available from: https://www.sciencedirect.com/science/article/pii/S266633761930006X Aaltonen S, Leskinen T, Morris T, Alen M, Kaprio J, Liukkonen J, et al. Motives for and Barriers to Physical Activity in Twin Pairs Discordant for Leisure Time Physical Activity for 30 Years. International Journal of Sports Medicine. 2012;33(02):157–63. Sjörs C, Bonn SE, Trolle Lagerros Y, Sjölander A, Bälter K. Perceived Reasons, Incentives, and Barriers to Physical Activity in Swedish Elderly Men. interactive Journal of Medical Research [Internet]. 2014;3(4):e15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285757/ Koh YS, Asharani PV, Devi F, Roystonn K, Wang P, Vaingankar JA, et al. A cross-sectional study on the perceived barriers to physical activity and their associations with domain-specific physical activity and sedentary behaviour. BMC Public Health. 2022;22(1). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4046304","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":294691542,"identity":"69987919-03b3-4e63-8f31-251422d85eb3","order_by":0,"name":"Temitope Oladejo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYJCCAwwMFiAygeEDA5AgBHggWiTAWhhnEKuFAaqFgZmHGC327N2JBxgqJOT5jjc8fGzbZpfHz97A+OFjDh5beM5uOMBwRsJw5pkDyca5bcnFkj0HmCVnbsOjRSJ3wwHGNgnGDTcS0qRz25gTgQw2Zl58WuTfgrXYb7j/IE3asq2eCC0SvGAtQJUMadKMbYeJ0HIG6LCEMxLJM88kJBv2nDueOLPnYDNev7C3n9384UOFjW3f8TOJD36UVSf2szcf/PARjxYwSIBYmMDAyAZiMDYQUI+w8AADwx9iFY+CUTAKRsFIAgCXclhmWaCxwQAAAABJRU5ErkJggg==","orcid":"","institution":"University of the Witwatersrand","correspondingAuthor":true,"prefix":"","firstName":"Temitope","middleName":"","lastName":"Oladejo","suffix":""},{"id":294691543,"identity":"9f50e772-eb65-4821-8bdd-8b99668ed3a5","order_by":1,"name":"Hellen Myezwa","email":"","orcid":"","institution":"University of the Witwatersrand","correspondingAuthor":false,"prefix":"","firstName":"Hellen","middleName":"","lastName":"Myezwa","suffix":""},{"id":294691544,"identity":"1ce37708-4d5a-45fd-8988-560e35d56866","order_by":2,"name":"Adedayo Ajidahun","email":"","orcid":"","institution":"University of the Witwatersrand","correspondingAuthor":false,"prefix":"","firstName":"Adedayo","middleName":"","lastName":"Ajidahun","suffix":""},{"id":294691545,"identity":"b56dcf81-11a2-4fc8-96f0-3a5de9c358af","order_by":3,"name":"Sam Ibeneme","email":"","orcid":"","institution":"University of Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Sam","middleName":"","lastName":"Ibeneme","suffix":""}],"badges":[],"createdAt":"2024-03-08 15:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4046304/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4046304/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55340996,"identity":"adf9143e-4340-4b9b-99af-da02e78fe097","added_by":"auto","created_at":"2024-04-26 02:08:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":154587,"visible":true,"origin":"","legend":"\u003cp\u003eThe Health Belief Model [12].\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4046304/v1/17bd1513ab824ed93ae8938b.png"},{"id":55341550,"identity":"b7c4208a-1987-465c-8f2c-b9adda6137d5","added_by":"auto","created_at":"2024-04-26 02:16:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":616421,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4046304/v1/f1004a0c-555d-49db-9750-223137f048cf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFactors Influencing Physical Activity Engagement in Individuals Living With HIV in Nigeria\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite evidence of the vital role that physical activity plays in improving physical, cognitive, and psychological health, the global prevalence rates for physical activity among people living with HIV are low [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although people living with HIV are now living longer lives as a result of the effectiveness of antiretroviral therapy (ART), there is currently a public health concern about the prevalence of ageing-related health concerns (e.g., osteoarthritis, dementia, cardiovascular diseases, and frailty); ART side effects (e.g., fatigue, metabolic disorders, lipodystrophy and diabetes); and non-ART poly-pharmacology leading to the double burden of managing HIV and comorbid health conditions [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Thus, physical activity has been recommended as a non-pharmacological approach to aid in preventing and managing HIV-related disabilities [\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].\u003c/p\u003e \u003cp\u003eEngaging in physical activity is beneficial to PLWH as physical activity has been shown to impart positive health benefits such as improved endurance, strength, and vitality, reduced blood pressure and depressive symptoms, and an overall improvement in quality of life and function [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The physiological health benefits of physical activity are evident in conditions such as obesity, in which regular PA causes a reduction in fat mass [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]; in sarcopenia, where regular PA improves muscle mass and function [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; and in osteoporosis, where regular PA improves bone health, thus reducing frailty, the risk of falls and predisposition to fracture [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Furthermore, studies conducted on mental health, cognition and memory have reported that there is an increase in blood flow to the brain and promotion of neurogenesis when individuals engage in exercise [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], thus supporting the theory that physical exercise is beneficial to both body and mind.\u003c/p\u003e \u003cp\u003eHowever, despite the many long-term health benefits of physical activity, about one-third of PLWH do not meet the recommended physical activity standards [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Several factors have been highlighted as determinants of physical activity participation among the general population [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These determinants have been classified into modifiable (behavioural and personality traits, environmental situations, and community settings) and those presumed to be unmodifiable (age, gender, race, and ethnicity). Among people living with HIV (PLWH), social determinants of health, such as the opportunity of engaging in exercise, the socioeconomic status of individuals, and stigma susceptibility, have been identified as influential in understanding physical activity participation [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a systematic review by [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], physical activity participation in sub-Saharan Africa is influenced by several complex factors. Within the Nigerian context, the lack of a physical activity surveillance system poses a challenge to effective planning and intervention [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. While the reported physical activity prevalence among the general population was estimated at 58% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], it is unclear how much physical activity PLWH engage in. Studies on physical activity levels among PLWH in Nigeria are limited, and existing studies are mostly focused on prevalence studies among the general population and the beneficial effects of physical activity on quality of life [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Despite these established benefits, individual and societal physical activity patterns can be influenced by various modifiable and non-modifiable factors [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn general, researchers found that the perceived determinants of physical activity participation can be largely categorized as those that are invariable (age, gender, race, ethnicity) and those that are amenable to change (behavioural and personality characteristics, environmental circumstances, and community settings) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] explored the limitations to physical activity among people living with HIV and found barriers in three categories, namely physical (e.g., respiratory complaints, low energy levels), psychological (e.g., stress levels, poor motivation) and environmental (family responsibilities, adverse weather conditions). Fewer factors were shown to be PA facilitators, including external support, such as walking with family or friends, and community involvement, such as access to parks or sports fields [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is important to study interpersonal and environmental factors that influence physical activity behaviours to gain insight into what actions must be taken to improve physical activity participation behaviours in a given population, as physical activity has a strong potential to improve health outcomes. This study is a component of a larger study aimed at developing a contextually sensitive physical activity programme for people living with HIV. Thus, this study aims to explore the factors which can act as facilitators and barriers to engaging in physical activity in PLWH in Nigeria.\u003c/p\u003e"},{"header":"Theoretical framework","content":"\u003cp\u003eIdentifying the factors responsible for engaging in physical activity is crucial in physical activity research. Several theoretical and behavioural methods have been adopted to understand and conceptualize the factors influencing the commencement, practice, and maintenance of physical activity [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. One of these is the Health Belief Model (HBM), which is grounded in the theory of \u0026ldquo;expectancy-value\u0026rdquo;, taking into consideration that individuals are rational decision-makers and would weigh the advantages and disadvantages of acting against one another. The Health Belief Model, developed by a group of social psychologists (Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen Kegeles and Howard Leventhal) in the 1950s was used to guide the process of this study. This framework is used to understand human behaviour and comprises the following elements: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The Health Belief Model's effectiveness in identifying critical decision-making points that impact health behaviour depends on each of these important components [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Health Belief Model has been applied in studies that explore HIV/AIDS prevention and has been found to be the most commonly adopted theory in health education, illness prevention, and health promotion [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Existing evidence reveals that the HBM is effective in explaining cues for action in various population settings [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], while, on the other hand, individual decisions are influenced by health belief constructs, which lead to various outcomes of physical activity interaction (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e \u003cstrong\u003eResearch design\u003c/strong\u003e \u003cp\u003eA qualitative research method was adopted to achieve the objectives of this study which were to determine the barriers to and facilitators of physical activity participation among PLWH. The qualitative research method is now commonly used in HIV/AIDS research as it is essential to providing insights into the socio-behavioural elements of HIV [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In the methodology, the HBM [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] was considered in understanding the barriers to and facilitators of physical activity among PLWH.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch setting\u003c/strong\u003e \u003cp\u003eThe study was conducted at [location masked for blind review] Nigeria. It is one of the 24 hospitals under the management of the [location masked for blind review] Health Service Commission. It provides medical, surgical, maternal and child health services, nursing, dental, pharmaceutical, diagnostic, and rehabilitative health care. It also has an HIV/AIDS treatment and testing centre with a yearly patient enrolment of over 1,000 and serves as a referral site for people in the community needing HIV testing, counselling, and care. All interviews in this research setting were conducted face-to-face in a private counselling room set aside for the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy participants\u003c/strong\u003e \u003cp\u003eThey were selected from the outpatient HIV clinic between March and July 2022 by applying a purposive sampling method. Only adults living with HIV, 18 years of age and above, who had been on antiretroviral therapy for at least six months and who were attending the Randle General Hospital HIV clinic, were approached personally by the principal investigator, and invited to participate in the study. The matron in charge and the clerical officer also helped briefly inform the participants about the study's objective, while the PLWH were attending their appointments. Study information sheets in English were provided, and participants were given verbal information on the research. Both written and verbal consents were obtained before data collection. A total of 22 participants were approached; however, a saturation point was reached at the 20th interview, and no new information was obtained from any subsequent interviews.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy procedure\u003c/strong\u003e \u003cp\u003e Before the interviews, the principal investigator (Physiotherapist/PhD candidate) and a research assistant (Physiotherapist/MSc candidate) visited the study setting to review the population to be interviewed, the days on which the clinics were open, the preferred times for participants to be approached, and to determine whether the environment was conducive to the interviews. The research assistant was briefed about the study objectives and procedure of the study and had observed the pilot interview sessions with the principal investigator before conducting any interviews.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e The interviews were conducted by the principal investigator in English as most of the participants were comfortable with this language, and in the Yoruba Language for participants who preferred to communicate in their mother tongue. The interviews were conducted using a Philips DVT digital dictaphone, and the recordings were saved in MP3 format. In addition to the audio recordings, the interviewer wrote additional notes, with reflective comments also being added at appropriate times during the interviews. The duration of each interview was between 30 and 45 minutes. The interviewer established rapport with the participants and informed them that confidentiality was assured. The participants were encouraged to feel relaxed and were informed that the interview could be paused and discontinued at their will.\u003c/p\u003e \u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e: A semi-structured interview guide was used. Following an extensive literature review, a list of potential questions to assess the perspectives of PLWH on barriers to and facilitators of physical activity participation was presented to each of the participants. In accordance with the pertinent guidelines for reporting qualitative research (Consolidated Criteria for Reporting Qualitative Studies checklist, COREQ), data management, coding, and collection were conducted according to an iterative process. Part A of the interview guide included questions on sociodemographic data, including age, sex, marital status, occupation, income range, and educational level. Part B included questions on the duration of the participants' HIV condition, ART adherence, and current health status. Part C of the interview explored the knowledge, participation, benefits, barriers to and facilitators of physical activity. Examples of questions included for Part B were as follows: \u0026ldquo;How long have you been living with HIV?\u0026rdquo;; \u0026ldquo;In what ways does HIV affect your health?\u0026rdquo;; and for Part C: \u0026ldquo;Can you describe your day-to-day activities for me?\u0026rdquo;; \u0026ldquo;What is your typical day like?\u0026rdquo;; \u0026ldquo;What do you do on a daily basis?\u0026rdquo;; \u0026ldquo;What types of exercises/physical activity are you aware of?\u0026rdquo;; \u0026ldquo;What discourages you from engaging in exercise?\"; \u0026ldquo;What limits you from participating in physical activity?\u0026rdquo; (Probe: \u0026ldquo;What stops you?\u0026rdquo;). Open-ended questions were designed to give interviewees the best opportunity to express themselves. The authors reviewed the drafted interview guide and modified it after several rounds of discussion.\u003c/p\u003e \u003cp\u003eIn addition to determining whether a specific set of questions was useful in retrieving objective information, the interview guide was pre-tested by conducting pilot interviews with PLWH. Finally, the interview guide was updated to include specific probes identified during the pilot interviews. However, the results of the pilot interviews were not included in the data presented.\u003c/p\u003e \u003cp\u003eThe 17th interview discovered no new codes or themes, but data collection was continued to enhance the data. It was discontinued at the 20th interview owing to the practicalities of limited resources, time, and space. (The research period coincided with the commencement of renovation construction in the HIV department of the hospital.)\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData analysis\u003c/strong\u003e \u003cp\u003eAll the data were anonymized using pseudonyms linking the participants\u0026rsquo; interview transcripts to their biodata and field notes during the data collection and analysis phases of the research. Following the completion of the interview, the audio recordings were uploaded to a password-protected file on the computer and deleted from the digital audio recording device.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThree of the interviews were conducted in the Yoruba language. These were first translated into English by an independent translator; the translation was then screened by the first and second authors. All audio recordings were transcribed into text by an independent translator who ensured consistent formatting of the transcriptions, secure storage, and the transfer of the transcribed files. The transcripts were screened and reviewed by the first and second authors.\u003c/p\u003e \u003cp\u003eAll transcribed data were exported to a computer-assisted qualitative data analysis software programme (MAXQDA version 22.3.0), and themes were identified from the data. A thematic content analysis approach was used to analyse the data and explore the participants\u0026rsquo; experiences.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical considerations\u003c/strong\u003e \u003cp\u003ePermission to conduct the study at the HIV/AIDS testing and treatment clinic in [location masked for blind review], was received from the [location masked for blind review] Hospital Service Commission (LSHSC/2222/VOLIV/14; 23 June 2021). The Human Research Ethics Committee of the [location masked for blind review] approved the study (Clearance Certificate M200906; 15 April 2021)\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTrustworthiness\u003c/strong\u003e \u003cp\u003eThe four trustworthiness criteria - transferability for applicability, credibility for veracity, dependability for consistency, and confirmability for transparency to outside examination and verification - were applied.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTransferability\u003c/strong\u003e \u003cp\u003ePurposive sampling of the participants ensured transferability. A description of the population sample and participant characteristics was provided using a mixed sample that listed the age, sex, and background of the participants to examine the transfer criterion. The suitability of the interviews was examined, and the accuracy of the interpretations drawn from the interviews was confirmed.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCredibility\u003c/strong\u003e \u003cp\u003ePrior to the interviews and data collection process, the study site was visited to address the credibility criterion. Furthermore, two researchers independently analysed the transcript, completed the coding, and identified major themes and sub-themes before discussing them in order to avoid single-researcher bias. To avoid the risk of data deviation from the research objectives, a prolonged engagement was ensured until the scope of the data was covered.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDependability\u003c/strong\u003e \u003cp\u003eThe study methodology was thoroughly recorded and explained to the research assistant in order to address the dependability criterion. The interview guidelines were reviewed by experienced researchers (Author 3 and Author 4). An independent translator transcribed the interviews; in this way, the insights of external observers were used.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConfirmability\u003c/strong\u003e \u003cp\u003eAdditional issues were brought up during meetings with the research team and considered for confirmability. A third independent reviewer who had not previously been involved in the project was invited to analyse the raw data and compare the various categories and themes, thereby facilitating the peer review process and improving the confirmability of the research. To assess inter-coder agreement and strengthen the reliability of the results, the independent reviewer cross-checked the codes.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRigour\u003c/strong\u003e \u003cp\u003eMember checking and inter-coder agreements were respected to develop rigour. This was done by recapping the questions and responses with the participants and allowing the responses to be validated. The participants were asked to highlight any contradictions observed to further strengthen the validation process.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eReflexivity\u003c/strong\u003e \u003cp\u003eAs a physiotherapist in the field of public health and community physiotherapy, the researcher kept and updated a reflexive diary to discern knowledge from the data, and allow reflection on her contribution, as well as her thoughts on integrating rehabilitation services in HIV management. During the data collection process, the researcher observed that both the service users and the service providers at the HIV testing and treatment centres rely majorly on pharmacological approaches to health management, with little attention paid to health promotion and disease prevention in people with chronic conditions such as HIV.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePart A: Sociodemographic profile of the participants\u003c/h2\u003e \u003cp\u003eA total of 20 participants was involved in the study. The mean age of the participants was 36.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27 years, with a range of 19 to 54 years. The mean time since their HIV diagnoses was 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20 years, ranging from 2001 to 2022. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the sociodemographic information obtained from the participants during the interviews.\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\u003eSociodemographic profile of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncome (in Naira)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e₦\u0026le;30,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e₦30,000 \u0026ndash; ₦100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e₦\u0026ge;100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResults Overview\u003c/h3\u003e\n\u003cp\u003eTwenty-five (25) categories were identified. The categories were further abstracted into nine subthemes and two themes. Participants in this study had similar understandings of physical activity and exercise and used the terms interchangeably during the interview. All the participants concurred on the benefits of physical activity to all individuals, irrespective of HIV status. The barriers to physical activity that were most commonly mentioned were lack of time, financial constraints, and an unsupportive environment. Despite the presence of a physiotherapy department in the next building, PLWH reported that they were not aware of a referral pathway to physiotherapy, and they had not been receiving any public health information promoting physical activity.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Attitudes, Knowledge, and Preferences in respect of Physical Activity\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eAttitudes towards physical activity\u003c/h2\u003e \u003cp\u003ePLWH demonstrated positive attitudes towards their participation in physical activities, expressing their willingness and interest to engage in order to derive health benefits.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Two things: - the health benefits; then the second thing is that it makes me ready for the day\u0026rsquo;s activities\u0026rdquo;\u003c/em\u003e (Male, 42 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It makes one physically fit. Some things that people who do not exercise cannot do, you will be able to do them. Especially that road walk, it is good for everyone; you\u0026rsquo;ll be able to walk some distance and not get tired. Some people cannot even stand for a long period, I can stand the whole day and not get tired. This is part of the benefit of exercise\u0026rdquo;\u003c/em\u003e (Male, 34 years old)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge of Physical Activity\u003c/h2\u003e \u003cp\u003eThe term \u0026lsquo;exercise\u0026rsquo; was more relatable to participants than \u0026lsquo;physical activity\u0026rsquo; and was used more frequently by all participants. While some participants could highlight the various forms of physical activity that they were aware of, others simply described exercise as leisure-time activities done at a set time to increase strength, endurance, or losing weight.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When I was growing up, I played hockey; so, it is a sport. So, when I go for training in Unilag Sport Centre\u0026hellip;. We run around the track. Running is an exercise; jogging is an exercise. I am aware of sit-ups; there was a time when I was growing up, I was working on my stomach, and I was doing seat-ups, press-ups, and push-ups\u0026hellip;. [they] are exercising\u0026rdquo;.\u003c/em\u003e (Female, 30 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Walking too is part of exercise. Sometimes, it\u0026rsquo;s not every trekkable distance one should take bikes or tricycles to\u0026hellip;. trekking those distances will make one very fit\u003c/em\u003e\u0026rdquo; (Male, 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Is that work I\u0026rsquo;m doing? not exercise? Even the washing of clothes, sweeping, you know how housework can be?... mopping; they are all exercise.\u0026rdquo;\u003c/em\u003e (Female, 54 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePreferences for Physical Activity\u003c/h2\u003e \u003cp\u003eWalking was described as the most preferred form of physical activity. Participants also reported that transportation and occupational physical activity were sufficient for them, as these forms were perceived to be very demanding and time-consuming, thus, leaving no time or energy for other forms of physical activity.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Indoor exercises like cycling, walking on a machine, carrying of weights\u0026hellip;. My most preferred is walking\u0026rdquo;.\u003c/em\u003e (Male, 42 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When you go to the market and buy, walk down to deliver to customers, it\u0026rsquo;s more than exercise now. I don\u0026rsquo;t know any exercise more than that one\u0026rdquo;.\u003c/em\u003e (Female, 35 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I normally do. Mainly press-up. It was before I used to do road walk, like jogging, but now I don\u0026rsquo;t have time for that one, I do only press-up. I just do small exercise inside my house\u0026rdquo;.\u003c/em\u003e (Male, 34 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Barriers to physical activity participation\u003c/h2\u003e \u003cp\u003eUsing a framework approach and thematic analysis, the issues which were identified as barriers to physical activity participation were subdivided into primary and, where relevant, secondary sub-themes. The most recurring barrier to participation in physical activity cited by the participants was \u003cb\u003e\u0026lsquo;\u003c/b\u003elack of time.\u0026rsquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLack of time and other commitments\u003c/h2\u003e \u003cp\u003eParticipants reported that they could not set time aside for physical activity as work-related activities were a priority and consumed most of their daylight time.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Not everybody can do that every day. Maybe there are some other commitments, when you get back, you won\u0026rsquo;t even have time, you would have forgotten. There are some things that you just forget sometimes because of what you have gone through throughout that day. So maybe it is only in the evening you have time to do what they told you to do in the morning, because of time, everything we deal with is time; time is money\u0026rdquo;\u003c/em\u003e (Male, 48 years old)\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI agree that it is good, but there\u0026rsquo;s no time. I pray; God, give us peace of mind. Before one wakes up, attend to the children, coupled with the fact that I leave home by 5am and get back home around 10pm; there\u0026rsquo;s nothing like Saturday or Sunday in my schedule; how will I have time for exercise? I know it is good, I used to exercise when things were okay, I was fat then and wasn\u0026rsquo;t doing any work that\u0026rsquo;s stressful; my husband and I used to go to the stadium every Saturday back then when we were in Lagos; but now, I don\u0026rsquo;t do any exercise\u003c/em\u003e\u0026rdquo;. (Female, 43 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePriority for other activities\u003c/h2\u003e \u003cp\u003eAlthough participants agreed that physical activity is beneficial,, most participants classified it on the Eisenhower matrix as \u0026lsquo;Important, but Not Urgent.\u0026rsquo;\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If I am looking for money, I can't be jogging. When you are OK, you can do exercises till 10am; nobody will hold you [back], but whew, that is struggling, and you are doing exercises\u0026hellip; Is it exercises that will feed you? For example, now, you want to do test; it is money. If money is not important, hospital is supposed to be free\u0026rdquo;\u003c/em\u003e (Female, 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There\u0026rsquo;s no one that wouldn\u0026rsquo;t like to, but there\u0026rsquo;s no time regarding my trade, except I decide to say I\u0026rsquo;m not going out to trade in a day and that would be like once in three months.\u0026hellip; It\u0026rsquo;s not easy, I cater for four children all by myself and only one of them is out of school. It will be really hard\u0026rdquo;\u003c/em\u003e (Female, 43 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I would have to leave whatever I\u0026rsquo;m doing to go and be doing something [like] that (exercise)\u0026rdquo;\u003c/em\u003e (Female, 40 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFatigue\u003c/h2\u003e \u003cp\u003eFatigue among people living with HIV is a common symptom that could limit individuals from carrying out their daily tasks. Participants in this study commented that they cannot engage in physical activity when tired.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The only discouragement is when I\u0026rsquo;m tired from work\u0026rdquo;\u003c/em\u003e (Male, 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Also, when you have over-walked. Even car itself\u0026hellip;., there are sometimes car must rest. Everything has to rest. This is a locomotor system. When you walk, you are exercising your joint, you cannot keep on walking the whole day; there are sometimes that you feel tired, and you just rest\u003c/em\u003e\u0026rdquo; (Male, 47 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Because I\u0026rsquo;m weak, I cannot do it.\u0026rdquo;\u003c/em\u003e (Female, 37 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLack of motivation\u003c/h2\u003e \u003cp\u003e According to participants, the lack of knowledge about guidelines for physical activity for PLWH was considered a barrier as they are unsure of the frequency and intensity of the exercise that they are engaging in. In addition, participants highlighted that they are not motivated to participate in physical activity owing to the lack of social groups and support from health professionals.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If I had somebody to guide me, it will motivate me to exercise\u0026rdquo;\u003c/em\u003e (Female, 26 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If I am actually exercising without an instructor or a coach, I cannot go far, If I do it alone, I can go for like two minutes or five minutes for a particular programme, but with the aid of an instructor or coach, I can go for like seven minutes way beyond my normal timing\u0026rdquo;\u003c/em\u003e (Male, 19 years old)\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eMaybe in the evening when you have done all your business, and have nowhere else to go, then you can do your exercise and go to sleep\u0026rdquo;\u003c/em\u003e (Male, 47 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eBuilt environment and related factors\u003c/h2\u003e \u003cp\u003eThe lack of safe open spaces in the community for physical activity was reported as one of the barriers to physical activity. Participants also highlighted that they do not have access to parks, fields, and gyms for physical activities.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The thing is that, especially Lagos, everywhere is very rough, but if you are doing it, one has to be careful because the road is narrow and there\u0026rsquo;s always rush here and there for people going to work and all. So, one must be careful while on the road; except you do it early morning before people start rushing out. So, if you\u0026rsquo;re going for something like that, it\u0026rsquo;s not advisable to hold cash or any other things that are valuable to you. The only way it can be safe is for you not to have valuables on you, even your phones. But some people usually hold their phones while jogging. In such scenario, one would have to use a less expensive phone such that they won\u0026rsquo;t even think of hijacking it from you or [you] feel pained if it\u0026rsquo;s being hijacked. But for me, there\u0026rsquo;s nothing they can collect from me, because I do that without any valuables on me. They usually steal early in the morning\u0026rdquo;\u003c/em\u003e (Male, 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It is not ok, like in my area, cars are always on the move\u0026rdquo;\u003c/em\u003e (Female, 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Another one again is weather condition. I remember a time I was exercising; it was during harmattan period, and I was getting all dried up. The things you do in normal weather condition gets limited and the duration gets shortened in harsh weather condition.\u0026rdquo;\u003c/em\u003e (Male, 19 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eOther health conditions\u003c/h2\u003e \u003cp\u003e Participants in our study commented that they are limited in their ability to participate in physical activity on account of the double burden of HIV and their associated condition .\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Why I don\u0026rsquo;t engage in exercise is because of the reason I told you: my mind believes that since I have Hepatitis B, and it\u0026rsquo;s affecting my liver, I believe that if I lose any calorie, I can\u0026rsquo;t get it back\u0026rdquo;.\u003c/em\u003e (Female, 30 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The only other condition affecting me is that I have mild asthma; that\u0026rsquo;s the other thing that stops me\u0026rdquo;\u003c/em\u003e (Male, 19 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, they do gym around my area, they lift weights. But with this my back, I don\u0026rsquo;t think I can lift weight, if I go and lift something that is heavier than me, I don\u0026rsquo;t know what it can cause\u0026rdquo;\u003c/em\u003e (Male, 47 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eFinance\u003c/h2\u003e \u003cp\u003eParticipants described the importance of financial comfortability using Maslow\u0026rsquo;s Hierarchy of Needs. They implied that financial stability is a higher priority than engaging in physical activity. Thus, their low economic status hinders them from participating in physical activity.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If I am looking for money, I can't be jogging\u0026rdquo;.\u003c/em\u003e (Female, 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;All of this tends to money because you have to get registered, getting the equipment needed; everything still boils down to money\u0026rdquo;\u003c/em\u003e (Male, 19 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The only issue I\u0026rsquo;m having is my income is not enough, I\u0026rsquo;m just managing it\u0026rdquo;.\u003c/em\u003e (Female, 26 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFacilitators of physical activity\u003c/h2\u003e \u003cp\u003eWhen participants were asked about their perceived facilitators of physical activity participation, the following themes emerged:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePerceived benefits\u003c/h2\u003e \u003cp\u003eParticipants felt motivated to engage in physical activities because they believe it is beneficial towards achieving their fitness goals. The desire to appear healthy and avoid being recognized as having HIV was also a motivating factor.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It\u0026rsquo;s the body for me. I just want to build that body; that\u0026rsquo;s the motivation. I'm into the body building type, so I just want to get this muscular shape, that\u0026rsquo;s my aim\u0026rdquo;\u003c/em\u003e (Male, 19 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Because I want to be strong and have good health\u0026rdquo;\u003c/em\u003e (Female, 27 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Two things: the health benefits; then the second thing is that it makes me ready for the day\u0026rsquo;s activities\u0026rdquo;\u003c/em\u003e (Male, 42 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Good life and good health. My doctor advised me to. I just do it to keep fit\u0026rdquo;\u003c/em\u003e (Male, 45 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eHabit\u003c/h2\u003e \u003cp\u003eParticipants in our study revealed that habit and their engaging in childhood physical activities were instrumental in motivating them to engage in physical activity.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Habits, from my secondary school days. I used to like doing exercises\u0026rdquo;\u003c/em\u003e (Female, 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well for me, while I was very young, I used to play ball. I used to participate in sport activities, I do back flips and I believe I can still do them even though I\u0026rsquo;m older now. Although I\u0026rsquo;ve not done them in a long while, but I believe it has become a part of me\u0026rdquo;\u003c/em\u003e (Male, 34 years old)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eInfluence by others (supportive social environment and relationships)\u003c/h2\u003e \u003cp\u003eAnother factor influencing the participation of PLWH in physical activity was the support and encouragement of family and friends. Thus, there is a correlation between positive influencing factors and motivation for physical activity participation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Another motivation too is my friend. There\u0026rsquo;s this friend of mine that was looking so out of shape and within three months of exercising, he\u0026rsquo;s looking back in shape and better. That one too is another kind of motivation; so, if he could do it, then I can do it too\u0026rdquo;\u003c/em\u003e (Male, 19 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When I see people who do it, they look smart and I like to look like them\u0026rdquo;\u003c/em\u003e (Male, 35 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When I see people doing it, I also like to do it\u0026rdquo;\u003c/em\u003e (Male, 39 years old)\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eIllness prevention\u003c/h2\u003e \u003cp\u003eAccording to the participants, engaging in physical activity benefited PLWH and the general population in improving their health and preventing illness.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I don\u0026rsquo;t want to sit down in one place, because if I sit in a spot, I feel weak; but whenever I\u0026rsquo;m working, I have more strength.\u0026rdquo;\u003c/em\u003e (Female, 37 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;\u0026hellip;. when you are not doing anything (exercising), you start feeling minor issues of your system not working well\u0026rdquo;\u003c/em\u003e (Male, 47 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;As a student, I learned a little bit about human anatomy, the neurons, and muscles. and I know that as we keep ageing, exercise is mostly good for our bodies. because if we are dormant, it damages the cells in our body. To my understanding, that will rapidly make the cells in the body to die\u0026rdquo;\u003c/em\u003e (Male, 42 years old)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003ePain relief\u003c/h2\u003e \u003cp\u003eFor PLWH, pain is a limiting factor in performing daily activities. However, participants in our study commented that they engage in physical activity to help manage musculoskeletal pain.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, sometimes I have joint pain but when I do [physical activity], I get relief. I do exercise because it helps my leg pain, but not every day. It helps [my] skin to be healthy and [my]blood to circulate well.\u0026rdquo;\u003c/em\u003e (Female, 19 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I don't like taking medicine, I like to exercise myself. Let me say my leg is paining me now or any part of my body; I like to start exercising my body\u0026rdquo;.\u003c/em\u003e (Female, 34 years old)\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I learnt that if I don't do exercise and start again, I will feel body pain in my muscle; but if I continue it will be better.\u0026rdquo;\u003c/em\u003e (Male, 52 years old)\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this study was to explore the barriers to and facilitators of physical activity among people living with HIV in Nigeria. The results of the qualitative analysis of data revealed that most of the PLWH in [location masked for blind review] understand the benefits of physical activity and have positive attitudes to physical activity participation. According to the Health Belief Model, the likelihood of an individual engaging in a particular health behaviour can be predicted by their belief in a personal threat of an illness and their belief in the effectiveness of the recommended health behaviour. Such perceptions of health behaviour, in combination with modifying factors, which include sociodemographic factors, are instrumental in determining their likelihood to engage in physical activity programmes designed to optimize their health. An analysis of the modifying factors can assist in understanding physical activity behaviour among people living with HIV.\u003c/p\u003e \u003cp\u003eThe mean age of participants in our study was 36.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.27 years and the range was19 to 54 years. Moreover, this age group constitutes the major workforce of the nation. Furthermore, with a national unemployment rate as high as 33.3% [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], it is not surprising that many individuals, as evidenced in this study, are self-employed so that they can sustain themselves financially. Findings from our study are consistent with reports indicating that only 17% of workers in Nigeria earn adequate salaries to enable them to escape poverty [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Most participants (53.8%) who had an income source earned less than the national minimum wage of #30,000 (66.73 USD) per month, while only two participants (10%) earned more than #100,000 per month (222.43 USD). Thus, socioeconomic factors are vital in influencing physical activity participation as people earning an adequate income, as indicated above, can afford some costs associated with engaging in physical activity.\u003c/p\u003e \u003cp\u003eIn Nigeria, as with most developing countries, individuals with no formal education or only an elementary education are the group most affected by poverty [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In our study, only 42% of the participants had a post-secondary education. The association between educational level and physical activity has been examined in a systematic review by [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], with reports of existing correlations between educational level, health literacy and physical activity behaviour. Thus, level of education, the sociodemographic profile of the participant, cultural influences, and financial capacity are major factors influencing physical activity participation.\u003c/p\u003e \u003cp\u003eAlthough several studies have highlighted that men are generally more active than women [\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], most of the women in our study classified themselves as being sufficiently active as they consider occupational physical activity and the household chores which they engage in daily as the highest level of physical activity. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] also reported that when monitored, with the actual measurements of their exercises based on the total volume of PA, women are more active than they are when measured based on the current PA recommendations. This is because they are more inclined to engage in light -duties and occasional PA, both of which are connected to their lifestyle (e.g. doing housework). Similarly, other studies [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] indicate that individuals view such tasks as physically productive and are usually exhausted or feel \u0026lsquo;too lazy\u0026rsquo; to engage in any additional structured physical activity.\u003c/p\u003e \u003cp\u003eThese are just a few selections of some background variables that were chosen as this study's focus. The potential effects of other background factors not captured in this study need further consideration. The factors influencing physical activity in this population were investigated at various levels and based on the thematic findings that emanated from the interviews. The \u0026ldquo;likelihood for action\u0026rdquo; refers to the perceived benefits minus the perceived barriers to engaging in the recommended activities [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. These are assumed to affect behavioural intentions and the consequent behaviour around the performance of the physical activity in question. The participants reported a range of barriers limiting physical activity participation, the most predominant being lack of time. From studies conducted nationally and globally in Nigeria [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], the UK [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], Sri-Lanka [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], the USA [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], Australia [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], lack of time is frequently cited as a limiting factor in engaging in physical activity. A probable reason for this claim is that individuals calculate the cost of engaging in exercise before deciding to participate in any physical activity, particularly in environments where income is dependent on the time put into the job. For example, a participant in our study commented that the time she would be jogging could have been spent \u0026ldquo;looking for money\u0026rdquo;.\u003c/p\u003e \u003cp\u003eAnother identified barrier was the state of the built environment in [location masked for blind review] state. [location masked for blind review] has a population of 21\u0026nbsp;million and is regarded as a mega city, but it lacks accessible facilities for individuals to engage in recreational physical activity and, therefore, also in public health concerns [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Thus, individuals who engage in physical activity use other types of public space, such as roads, bridges, and vacant land. However, in this context, the dangers highlighted by participants in this study are the lack of safety in these spaces, as well as human and vehicle traffic congestion. [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] highlighted four key environmental factors influencing physical activity: walking ability, green space, traffic-related air pollution and heat. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] observed that the municipal structures of [location masked for blind review] are unsupportive and potentially harmful to individuals who choose to engage in leisure-time physical activity as they need to navigate dangers such as air pollution, robberies, traffic injury, etc. Thus, it is not surprising that individuals would strongly evaluate the benefit of physical activity against the potential risk of harm before deciding to participate in physical activity.\u003c/p\u003e \u003cp\u003eIn our study, one participant commented that the only factor limiting him from engaging in physical activity is fatigue, as there are days when he just wakes up tired. It is unclear whether this type of fatigue is due to HIV or the existence of other HIV-related health conditions. The impact of fatigue in influencing physical activity participation should not be underestimated as there is an association between HIV-related fatigue and psychological factors such as life stress, anxiety, and depression [\u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Furthermore, it has been reported that some HIV medications can cause fatigue [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e], thus requiring non-pharmacological interventions such as physical activity and cognitive behavioural therapy to treat or prevent fatigue [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Recent studies reveal that physical activity is linked less to fatigue among PLWH [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFindings from our study revealed multiple motivators for physical activity participation. On an individual level, participants felt that the perceived benefits of engaging in physical activity serve as the most important facilitator since they believe that physical activity contributes to healthier, longer lives, improves fitness, aids relaxation, promotes sleep, and prevents illness. Historically, maintaining good health has been a major motivation for physical activity participation. [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Participants referred to a supportive environment and access to resources and external social support as vital facilitators. These results are consistent with the literature and explore the influence of modifiable factors on physical activity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Although some studies view modifiable factors as secondary or complementary to non-modifiable factors [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e], the impact of external factors in influencing physical activity participation cannot be overlooked [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e] highlighted that the justification behind exercise considerably impacts individuals' ability to maintain consistent physical activity throughout time. Furthermore, since it is known that adolescent sports participation is linked to a high level of physical activity in adulthood [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], participants in our study highlighted that they engaged in physical activity as it is a habit which they had picked up from their adolescence, when they were actively involved in sports. Thus, sociodemographic variables and psychological characteristics significantly influence the likelihood of participating in physical activity.\u003c/p\u003e \u003cp\u003eThese results suggest that a supportive socio-cultural environment and the priorities of individuals are crucial to physical activity participation, further strengthening the narrative that voluntary participation in physical activity is motivated by the complex interaction of several factors such as motivation, time, choice of physical activity, environment, and availability of resources. There is, however, an existing debate as to which limiting factors to physical activity participation could be classified as genuine barriers or \u0026lsquo;excuses. This issue can be determined by assessing the barriers while motivation is present [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The barriers revealed in this study may help develop interventions that will help PLWH increase their physical activity levels in this situation and reduce the long-term effects of non-communicable diseases.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eReflecting on the determinants of physical activity behaviour identified in this study, it is reasonable to conclude that although background variables were identified as perceived and actual barriers to physical activity participation, PLWH are motivated to engage in physical activity and can be supported to improve their physical activity levels through health promotion interventions. Environmental factors, fatigue, and financial priorities are barriers to physical activity participation, but could be alleviated by individual motivation, the certainty of each individual\u0026rsquo;s own value, and the creation of a personalized physical activity programme to be conducted in a more supportive environment. Likewise, social support, positive interprofessional relationships, and perceived health benefits are vital to increasing physical activity participation among PLWH.\u003c/p\u003e "},{"header":"Implications for research","content":"\u003cdiv id=\"Sec27\" class=\"Section2\"\u003e\u003cp\u003eContextual factors must be considered in exercise designs and prescriptions for PLWH. Interventions such as organizing exercise classes that would include group sessions for peer support would be beneficial. In relation to PLWH, the findings from this study highlight the fact that cultural attributes, including gender definitions and socioeconomic expectations, may influence physical activity participation and could be more complex than the traditional views regarding gender roles in physical activities, as suggested by previous research in Africa. Furthermore, this study provides contextually based findings for academics, researchers, and policymakers, aiming to develop interventions to improve physical activity levels among PLWH in Nigeria.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge the input of the research assistants, staff and service users of the HIV/AIDS treatment and testing centres involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT.O. and H.M. conceived of the presented idea. T.O. collected the data, H.M., A.A., S.I. were involved in planning and supervised the work. T.O. and A.A. processed the data, and performed the analysis, T.O drafted the manuscript and designed the figures. S.I. aided in interpreting the results and worked on the manuscript. All authors discussed the results and commented on the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are available on reasonable request. Anonymised data will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe views expressed in the submitted article are those of the authors and not an official position of the institution.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World health organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine [Internet]. 2020;54(24):1451\u0026ndash;62. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bjsm.bmj.com/content/54/24/1451\u003c/span\u003e\u003cspan address=\"https://bjsm.bmj.com/content/54/24/1451\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1\u0026middot;6 million participants. The Lancet Child \u0026amp; Adolescent Health [Internet]. 2020;4(1):23\u0026ndash;35. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(\u003c/span\u003e\u003cspan address=\"https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e19)30323-2/fulltext\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJustice AC, Gordon KS, Skanderson M, Edelman EJ, Akg\u0026uuml;n KM, Gibert CL, et al. Nonantiretroviral polypharmacy and adverse health outcomes among HIV-infected and uninfected individuals. AIDS (London, England) [Internet]. 2018 Mar 27 [cited 2023 Jan 12];32(6):739\u0026ndash;49. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/29543653/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/29543653/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIbeneme SC, Omeje C, Myezwa H, Ezeofor SN, Anieto EM, Irem F, et al. Effects of physical exercises on inflammatory biomarkers and cardiopulmonary function in patients living with HIV: a systematic review with meta-analysis. BMC Infectious Diseases. 2019;19(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontoya JL, Jankowski CM, O\u0026rsquo;Brien KK, Webel AR, Oursler KK, Henry BL, et al. Evidence-informed practical recommendations for increasing physical activity among persons living with HIV. AIDS. 2019;33(6):931\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAjidahun AT, Myezwa H, Ibeneme SC, Magobotha S, Fortwengel G, Jingo M, et al. Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions: A randomized controlled trial. Medicine [Internet]. 2020 Dec 11 [cited 2023 Feb 2];99(50):e23206. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/33327237/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/33327237/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVoigt N, Cho H, Schnall R. Supervised Physical Activity and Improved Functional Capacity among Adults Living with HIV: A Systematic Review. Journal of the Association of Nurses in AIDS Care. 2018;29(5):667\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMika A, Macaluso F, Barone R, Di Felice V, Sledzinski T. Effect of Exercise on Fatty Acid Metabolism and Adipokine Secretion in Adipose Tissue. Frontiers in Physiology [Internet]. 2019;10. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.frontiersin.org/articles/\u003c/span\u003e\u003cspan address=\"https://www.frontiersin.org/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fphys.2019.00026/full\u003c/span\u003e\u003cspan address=\"10.3389/fphys.2019.00026/full\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIbeneme SC, Uwakwe VC, Myezwa H, Irem FO, Ezenwankwo FE, Ajidahun TA, et al. Impact of exercise training on symptoms of depression, physical activity level and social participation in people living with HIV/AIDS: a systematic review and meta-analysis. BMC Infectious Diseases. 2022;22(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. BioMed Research International [Internet]. 2018;2018(4840531):1\u0026ndash;10. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.hindawi.com/journals/bmri/2018/4840531/\u003c/span\u003e\u003cspan address=\"https://www.hindawi.com/journals/bmri/2018/4840531/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Liegro CM, Schiera G, Proia P, Di Liegro I. Physical Activity and Brain Health. Genes [Internet]. 2019;10(9):720. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770965/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770965/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYen HY, Li C. Correction: Determinants of physical activity: A path model based on an ecological model of active living. PLOS ONE. 2019;14(9):e0222625.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSafa F, McClellan N, Bonato S, Rueda S, O\u0026rsquo;Brien KK. The Role of the Social Determinants of Health on Engagement in Physical Activity or Exercise among Adults Living with HIV: A Scoping Review. International Journal of Environmental Research and Public Health [Internet]. 2022;19(20):13528. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.mdpi.com/\u003c/span\u003e\u003cspan address=\"https://www.mdpi.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e1660-4601/19/20/13528/htm\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVancampfort D, Stubbs B, Mugisha J. Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels. African Health Sciences. 2018;18(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOyeyemi AL, Oyeyemi AY, Omotara BA, Lawan A, Akinroye KK, Adedoyin RA, et al. Physical activity profile of Nigeria: implications for research, surveillance and policy. The Pan African Medical Journal [Internet]. 2018;30(175). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235484/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235484/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeloye D, Ige-Elegbede JO, Auta A, Ale BM, Ezeigwe N, Omoyele C, et al. Epidemiology of physical inactivity in Nigeria: a systematic review and meta-analysis. Journal of Public Health. 2022;44(3):595\u0026ndash;605.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOyeyemi AL, Ishaku CM, Oyekola J, Wakawa HD, Lawan A, Yakubu S, et al. Patterns and Associated Factors of Physical Activity among Adolescents in Nigeria. Yu H, editor. PLOS ONE. 2016;11(2):e0150142.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUgwueze FC, Agbaje OS, Umoke PCI, Ozoemena EL. Relationship Between Physical Activity Levels and Psychological Well-Being Among Male University Students in South East, Nigeria: A Cross-Sectional Study. American Journal of Men\u0026rsquo;s Health. 2021;15(2):155798832110083.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAduroja PE, John-Akinola YO, Oluwasanu MM, Oladepo O. Prevalence of physical activity and dietary patterns as risk factors for cardiovascular diseases among semi-urban dwellers in Ibadan, Nigeria. African Health Sciences [Internet]. 2022;22(3):336\u0026ndash;48. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ajol.info/index.php/ahs/article/view/234926\u003c/span\u003e\u003cspan address=\"https://www.ajol.info/index.php/ahs/article/view/234926\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOluyinka S, Endozo A. Factors Affecting Physical Activity Participation Among University Students. JOURNAL OF SOCIAL SCIENCE RESEARCH. 2019;14:3161\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGretebeck KA, Black DR, Blue CL, Glickman LT, Huston SA, Gretebeck RJ. Physical Activity and Function in Older Adults: Theory of Planned Behavior. American Journal of Health Behavior. 2007;31(2):203\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eK\u0026oacute;kai LL, van der Bijl MF, Hagger MS, \u0026Oacute; Ceallaigh DT, Rohde KIM, van Kippersluis H, et al. Perceived determinants of physical activity among women with prior severe preeclampsia: a qualitative assessment. BMC Women\u0026rsquo;s Health. 2022;22(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoos R, Myezwa H, van Aswegen H. \u0026ldquo;Not easy at all but I am trying\u0026rdquo;: barriers and facilitators to physical activity in a South African cohort of people living with HIV participating in a home-based pedometer walking programme. AIDS Care. 2014;27(2):235\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. a Vital Investment. World Health [Internet]. 2005;202.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarkang E, Zotor F. Application of the Health Belief Model (HBM) in HIV Prevention: A Literature Review. Central African Journal of Public Health. 2015;1(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChatzisarantis, Nikos L. D, Frederick C, Stuart, Hagger MS, Smith B. Influences of volitional and forced intentions on physical activity and effort within the theory of planned behaviour. Journal of Sports Sciences [Internet]. 2007;25(6):699\u0026ndash;709. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/02640410600818523\u003c/span\u003e\u003cspan address=\"10.1080/02640410600818523\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGorin AA, Buchan DS, Ollis S, Thomas NE, Baker JS. Physical Activity Behaviour: An Overview of Current and Emergent Theoretical Practices. Journal of Obesity [Internet]. 2012;2012:546459. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1155/2012/546459\u003c/span\u003e\u003cspan address=\"10.1155/2012/546459\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoyal L. A decade of researching the social aspects of HIV and AIDS. The Lancet. 2014;384(9960):2102\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSyed IA, Syed Sulaiman SA, Hassali MA, Thiruchelvum K, Lee CKC. A qualitative insight of HIV/AIDS patients\u0026rsquo; perspective on disease and disclosure. Health Expectations. 2014;18(6):2841\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNigerian Stat. NATIONAL BUREAU OF STATISTICS [Internet]. nigerianstat.gov.ng. 2023 [cited 2023 Jan 10]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://nigerianstat.gov.ng/\u003c/span\u003e\u003cspan address=\"https://nigerianstat.gov.ng/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLian JW, Vishwanath T. A Better Future for All Nigerians: Nigeria Poverty Assessment 2022 \u0026ndash; Launch Event Presentation [Internet]. World Bank. 2022 [cited 2023 Jan 10]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://documents.worldbank.org/curated/en/099040004052238213/P1763010cf\u003c/span\u003e\u003cspan address=\"http://documents.worldbank.org/curated/en/099040004052238213/P1763010cf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e39710ab0b56306cbc10fd09a1\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSulaimon MD. Determinants of multidimensional poverty in Nigeria: a state level analysis. International Journal of Sustainable Economy. 2022;14(2):151.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuja A, Rabensteiner A, Sperotto M, Grotto G, Bertoncello C, Cocchio S, et al. Health Literacy and Physical Activity: A Systematic Review. Journal of Physical Activity and Health. 2020;17(12):1259\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet [Internet]. 2012 Jul [cited 2019 Apr 8];380(9838):247\u0026ndash;57. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S0140673612606461\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S0140673612606461\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSallis JF, Bull F, Guthold R, Heath GW, Inoue S, Kelly P, et al. Progress in physical activity over the Olympic quadrennium. The Lancet. 2016;388(10051):1325\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1\u0026middot;9 million participants. The Lancet Global Health [Internet]. 2018;6(10):e1077\u0026ndash;86. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(\u003c/span\u003e\u003cspan address=\"https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e18)30357-7/fulltext\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmagasa S, Fukushima N, Kikuchi H, Takamiya T, Oka K, Inoue S. Light and sporadic physical activity overlooked by current guidelines makes older women more active than older men. International Journal of Behavioral Nutrition and Physical Activity. 2017;14(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoodbhoy Z, Qureshi RN, Iqbal R, Muhabat Q. Household chores as the main source of physical activity: Perspectives of pregnant Pakistani women. JPMA The Journal of the Pakistan Medical Association [Internet]. 2018 Apr 1 [cited 2023 Jan 10];68(4):565\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/29808046/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/29808046/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMckellar K, Sillence E. Chapter 2 - Current Research on Sexual Health and Teenagers [Internet]. ScienceDirect. Academic Press; 2020. p. 5\u0026ndash;23. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/B9780128169698000023\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/B9780128169698000023\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbaraogu UO, Edeonuh JC, Frantz J. Promoting Physical Activity and Exercise in Daily Practice: Current Practices, Barriers, and Training Needs of Physiotherapists in Eastern Nigeria. Physiotherapy Canada. 2016;68(1):37\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWithall J, Jago R, Fox KR. Why some do but most don\u0026rsquo;t. Barriers and enablers to engaging low-income groups in physical activity programmes: a mixed methods study. BMC Public Health. 2011;11(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerera M, Arambepola C, Gillison F, Peacock O, Thompson D. Perceived barriers and facilitators of physical activity in adults living in activity-friendly urban environments: A qualitative study in Sri Lanka. Metwally AM, editor. PLOS ONE. 2022;17(6):e0268817.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee C, Ory MG, Yoon J, Forjuoh SN. Neighborhood Walking Among Overweight and Obese Adults: Age Variations in Barriers and Motivators. Journal of Community Health. 2012;38(1):12\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAshton LM, Hutchesson MJ, Rollo ME, Morgan PJ, Thompson DI, Collins CE. Young adult males\u0026rsquo; motivators and perceived barriers towards eating healthily and being active: a qualitative study. International Journal of Behavioral Nutrition and Physical Activity. 2015;12(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawanson T, Foley L, Assah F, Mogo E, Mapa-Tassou C, Ogunro T, et al. The urban environment and leisure physical activity during the COVID-19 pandemic: a view from Lagos. Cities \u0026amp; Health. 2020;5(sup1):204\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiles LV, Koehle MS, Saelens BE, Sbihi H, Carlsten C. When physical activity meets the physical environment: precision health insights from the intersection. Environmental Health and Preventive Medicine. 2021;26(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarroso J, Hammill BG, Leserman J, Salahuddin N, Harmon JL, Pence BW. Physiological and Psychosocial Factors that Predict HIV-Related Fatigue. AIDS and Behavior. 2010;14(6):1415\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarroso J, Leserman J, Harmon JL, Hammill B, Pence BW. Fatigue in HIV-Infected People: A Three-Year Observational Study. Journal of Pain and Symptom Management. 2015;50(1):69\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoades ME, Kagee A. Exploring our understanding of fatigue among adolescents living with HIV: Highlighting the unknown. Journal of Health Psychology. 2017;24(1):125\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVoss J, Barroso J, Wang T. A Critical Review of Symptom Management Nursing Science on HIV-Related Fatigue and Sleep Disturbance. International Journal of Environmental Research and Public Health. 2021;18(20):10685\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernard P, Romain AJ, Caudroit J, Chevance G, Carayol M, Gourlan M, et al. Cognitive behavior therapy combined with exercise for adults with chronic diseases: Systematic review and meta-analysis. Health Psychology. 2018;37(5):433\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWebel AR, Jenkins T, Longenecker CT, Vest M, Davey CH, Currie J, et al. Relationship of HIV Status and Fatigue, Cardiorespiratory Fitness, Myokines, and Physical Activity. The Journal of the Association of Nurses in AIDS Care: JANAC [Internet]. 2019 [cited 2023 Feb 6];30(4):392\u0026ndash;404. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/31241504/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/31241504/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrunet J, Sabiston CM. Exploring motivation for physical activity across the adult lifespan. Psychology of Sport and Exercise. 2011;12(2):99\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeller K, Renneke K, Custer S, Tigue G. Intrinsic and Extrinsic Motives Support Adults\u0026rsquo; Regular Physical Activity Maintenance. Sports Medicine International Open. 2018;02(03):E62\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson E, Durstine JL. Physical activity, exercise, and chronic diseases: A brief review. Sports Medicine and Health Science [Internet]. 2019;1(1):3\u0026ndash;10. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S266633761930006X\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S266633761930006X\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAaltonen S, Leskinen T, Morris T, Alen M, Kaprio J, Liukkonen J, et al. Motives for and Barriers to Physical Activity in Twin Pairs Discordant for Leisure Time Physical Activity for 30 Years. International Journal of Sports Medicine. 2012;33(02):157\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSj\u0026ouml;rs C, Bonn SE, Trolle Lagerros Y, Sj\u0026ouml;lander A, B\u0026auml;lter K. Perceived Reasons, Incentives, and Barriers to Physical Activity in Swedish Elderly Men. interactive Journal of Medical Research [Internet]. 2014;3(4):e15. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285757/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285757/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoh YS, Asharani PV, Devi F, Roystonn K, Wang P, Vaingankar JA, et al. A cross-sectional study on the perceived barriers to physical activity and their associations with domain-specific physical activity and sedentary behaviour. BMC Public Health. 2022;22(1).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV, physical activity participation, barriers, facilitators","lastPublishedDoi":"10.21203/rs.3.rs-4046304/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4046304/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eIntroduction\u003c/b\u003e: Physical activity has been reported to be a useful non-pharmacological intervention for improving quality of life and reducing long-term problems associated with HIV infection and ART. Despite their known benefits, the data on the factors driving the uptake of physical activity among the HIV population in Nigeria are insufficient. Thus, since variations exist in healthcare, cultural and societal structures, caution must be used in drawing comparisons from other settings. To develop a contextually sensitive intervention programme, understanding the factors responsible for physical activity engagement among people living with HIV is vital.\u003c/p\u003e \u003cp\u003e \u003cb\u003eObjective\u003c/b\u003e: The study aimed to explore the barriers to and facilitators of physical activity participation among people living with HIV.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethod\u003c/b\u003e: A qualitative research methodology was adopted to explore the barriers of and facilitators to physical activity participation among people living with HIV. A semi-structured interview guide was used to interview people living with HIV (PLWH) attending HIV testing and treatment centers in [location masked for blind review] from March to July 2022; a saturation point was reached after the 20th interview. All interviews were audio-recorded and were subjected to a deductive content analysis framework for data analysis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e: Twenty (20) PLWH aged 19 to 54 years participated in this study. The majority perceived physical activity as beneficial to their health. Commonly reported barriers to physical activity in PLWH were lack of time, fatigue, an unsupportive environment, lack of funding, and other social commitments. The physical activity facilitators included perceived benefits, habits, influence by others, and the health benefits of illness prevention and pain relief.\u003c/p\u003e \u003cp\u003eC\u003cb\u003eonclusion\u003c/b\u003e: Our findings reveal that the key barriers to physical activity participation (lack of time, unsupportive environment, fatigue, and lack of funding) are modifiable. Addressing these factors is likely to facilitate physical activity participation. Thus, efforts to develop a physical activity intervention program for PLWH in Nigeria must consider environmental and interpersonal variables.\u003c/p\u003e","manuscriptTitle":"Factors Influencing Physical Activity Engagement in Individuals Living With HIV in Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-26 02:08:41","doi":"10.21203/rs.3.rs-4046304/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b3dc2cd4-2e5d-4ac7-a08b-a3986afeee6f","owner":[],"postedDate":"April 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-26T02:08:41+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-26 02:08:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4046304","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4046304","identity":"rs-4046304","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}