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)