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Journal ArticleDOI

A six week contextualised physical activity intervention for women living with HIV and AIDS of low socioeconomic status: a pilot study.

TL;DR: The findings of the pilot study suggest that the intervention was effective in producing significant increases in PA in a sample of PLWHA of low SES over six weeks, and careful consideration of behavioural constructs, such as self-efficacy, can help WLWHA to adopt regular PA as a complementary therapy for managing their health.
Abstract: Research has consistently shown the benefits of regular physical activity (PA) for women living with HIV and AIDS (WLWHA). This study is a pilot, randomised controlled crossover trial, reporting th...

Summary (2 min read)

Introduction

  • Amongst people living with HIV and AIDS , physical activity (PA) is associated with improvements in mental and physical well-being (Fillipas, Cicuttini, Holland, & Cherry, 2013; MacArthur, Levine, & Birk, 1993; Neidig, Smith, & Brashers, 2003) .
  • Given the foregoing, the purpose of this study was to evaluate the effect of a six-week pilot PA intervention amongst PLWHA of low SES.

Setting and sample

  • The study was conducted at a community centre caring for HIV positive Black African Xhosa-speaking women in a low-income community in the Western Cape Province, SA.
  • Study participants belonged to an HIV support group who consented to participate in the study.

Eligibility/inclusion criteria

  • Participants needed to be between 18 and 65 years, HIV positive, as confirmed through medical records, and cleared on the Physical Activity Readiness Questionnaire (PAR-Q).
  • All participants had to be unemployed and not have attained any tertiary education.
  • Additional exclusions were any history of coronary heart disease and/or diabetes, opportunistic infection, pregnancy, and orthopaedic conditions that made PA unsafe.

Protocol

  • An information session and information sheets were used to inform participants about the study, and participant written informed consent was obtained.
  • Height was measured with a stadiometer, and body weight using a calibrated weight scale with participants wearing minimal clothing.
  • Study measurements were total moderate-to-vigorous PA by the Global Physical Activity Questionnaire (GPAQ) (World health Organisation, 2006), total weekly steps (TWS) by an Omron HJ-720IT-E2 pedometer, self-efficacy for PA using the Physical Exercise Self-efficacy scale (Schwarzer & Renner, 2008) , and the stages of motivational readiness for change (SOC) (Marcus & Simkin, 1993) .
  • Two Xhosa-speaking research assistants helped the participants to complete the questionnaires.
  • The standard care group received nutritional information on healthy eating (Gibney & Vorster, 2001) designed by a dietician in a once-off 2-hour session.

The contextualised physical activity intervention

  • The PA intervention was developed in a previous study (Mabweazara, Leach, & Ley, 2017) and informed by Social Cognitive Theory (SCT) (Bandura, 1986 ) and the Transtheoretical model (TTM) (Prochaska & DiClemente, 1983) .
  • The PA intervention was delivered in the indigenous Xhosa language, and food packs were used to promote adherence.
  • The intervention employed low-cost activities of daily living (ADLs) using local resources and opportunities.
  • The PA intervention was two hours each week for six weeks that comprised a combination of educational activities (60 min), home-based activities (30 min) and a 30-minute group aerobics session.
  • All exercise activities were in line with the American College of Sport Medicine (ACSM) guidelines for individuals infected with HIV (ACSM, 2013).

Data analysis

  • Descriptive statistics were used to summarise the participants' demographic and clinical characteristics.
  • Levene's test was computed to assess equality of means.
  • Independent t-tests and multivariate analysis of covariance were used to assess differences between groups, and statistical significance was set at an alpha level of < .05.

Sample characteristics

  • Tables 1 and 2 show TMVPA, TWS and self-efficacy at baseline, after six weeks and post-crossover.
  • The results for SOC showed two participants in the precontemplative stage, 11 in the contemplative stage, four in the preparatory stage and one in the action stage.

Discussion

  • The purpose of this study was to evaluate the effects of a six week contextualised intervention aimed at increasing physical activity and self-efficacy for physical activity among HIV positive women of low SES.
  • Compared to standard care, participants in the physical activity intervention, informed by SCT and TTM, had significant increases in total moderate-to-vigorous physical activity, total weekly steps and self-efficacy for physical activity.
  • Theory-based behaviour change interventions are found to be effective (Sparling, Owen, Lambert, & Haskell, 2000) .
  • Moreover, increased perceived enjoyment of physical activity may result in increased self-efficacy, which may lead to a greater prospect of increasing physical activity behaviour (Lewis et al., 2016) .
  • Also, educating participants on where to find safe environments to walk very likely assisted them to be more physically active (Tuso, 2015) .

Study limitations

  • The study sample consisted of a relatively small group.
  • It was a pilot study and statistical power was not calculated at the outset.
  • Furthermore, the intervention period was for six weeks only.
  • The study does not report on the effect of the intervention to mental or physical health of the participants.
  • Further examination of the intervention is still needed before widespread implementation of the intervention.

Conclusion

  • The contextualised physical activity intervention resulted in significant increases in total moderate-to-vigorous physical activity, total weekly steps and self-efficacy for physical activity in women living with HIV and AIDS of low SES.
  • Including constructs, such as selfefficacy, participant exercise preferences and social support, can help PLWHA of low SES to adopt regular physical activity, and can serve as adjunct therapy for the management of HIV and AIDS.

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Mabweazara, S.Z. et al. (2018). A six week contextualised physical activity intervention for
women living with HIV and AIDS of low socioeconomic status: a pilot study.
AIDS Care, 2018.
http://dx.doi.org/10.1080/09540121.2018.1470309
University of the Western Cape Research Repository smabweazara@uwc.ac.za
A six week contextualised physical activity intervention for women
living with HIV and AIDS of low socioeconomic status: a pilot study
S. Z. Mabweazara, L. L. Leach, C. Ley and M. Smith
Abstract
Research has consistently shown the benefits of regular physical activity (PA) for women
living with HIV and AIDS (WLWHA). This study is a pilot, randomised controlled crossover
trial, reporting the effects of a contextualised PA intervention amongst a sample of 21 HIV
positive Xhosa-speaking women of low socioeconomic status (SES). The study determined
total moderate-to-vigorous PA (TMVPA) as measured subjectively by the Global Physical
Activity Questionnaire (GPAQ), total weekly steps (TWS) as measured by a pedometer, and
self-efficacy for PA as measured by the Physical Exercise Self-efficacy scale (PESES).
Multivariate analysis of covariance (MANCOVA) was used to compute the impact of the
intervention on TMVPA, TWS, and self-efficacy for PA from baseline to six weeks, and
baseline to 12 weeks post-intervention controlling for pre-test differences in TMVPA. Results
showed that participants exposed to the intervention had significant increases in PA as
measured by TMVPA (p = .027), TWS (p = .032), as well as exercise self-efficacy (p = .000)
from pre-test to 6 weeks. Insignificant findings were reported for all three variables when
measured from baseline to 12 weeks. In conclusion, the findings of the pilot study suggest
that the intervention was effective in producing significant increases in PA in a sample of
PLWHA of low SES over six weeks. Careful consideration of behavioural constructs, such as
self-efficacy, can help WLWHA of low SES to adopt regular PA as a complementary therapy
for managing their health.
Introduction
Amongst people living with HIV and AIDS (PLWHA),
physical activity (PA) is associated
with improvements
in mental and physical well-being (Fillipas, Cicuttini,
Holland, &
Cherry, 2013; MacArthur, Levine, & Birk,
1993; Neidig, Smith, & Brashers, 2003). Aerobic
and
strength training improve the profile of lymphocytes
(OBrien, Nixon, Glazier, &
Tynan, 2004), body composition, muscle strength and quality of life (Spence, Galantino,
Mossberg, & Zimmerman, 1990).
In Africa, Murenzi (2011) reported that PLWHA, particularly women (Smit et al., 2006),
engage in insufficient
PA, which may be related to low socioeconomic status (SES)
(Economic and Social Research Council, 2014).

2
Given the foregoing, the purpose of this study was to
evaluate the effect of a six-week pilot
PA intervention amongst PLWHA of low SES.
Methods
Design
The study was a crossover trial. Participants were randomly placed in either a 6-week PA
intervention or standard care. After a 2 week washout period, participants were crossed-
over for another 6 weeks. At week
15, the study terminated.
Setting and sample
The study was conducted at a community centre caring for HIV positive Black African
Xhosa-speaking
women in a low-income community in the Western Cape Province, SA.
Study participants belonged to an
HIV support group who consented to participate in the
study.
Eligibility/inclusion criteria
Participants needed to be between 18 and 65 years,
HIV positive, as confirmed through
medical records,
and cleared on the Physical Activity Readiness Questionnaire (PAR-Q).
All participants had to be unemployed and not have attained any tertiary education.
Additional exclusions were any history of coronary heart disease and/or diabetes,
opportunistic infection,
pregnancy, and orthopaedic conditions that made PA
unsafe.
Protocol
An information session and information sheets were
used to inform participants about the
study, and participant written informed consent was obtained. An interviewer-administered
questionnaire was used for
recording participant demographic information. Height was
measured with a stadiometer, and body weight
using a calibrated weight scale with
participants wearing
minimal clothing. Blood pressure was measured, while
sitting quietly
for approximately 5 min, using a sphygmomanometer. Omron pedometers counted the
number
of steps per day for seven consecutive days.
Study measurements were total moderate-to-vigorous
PA (TMVPA) by the Global Physical
Activity Questionnaire (GPAQ) (World health Organisation, 2006), total weekly steps
(TWS) by an Omron HJ-720IT-E2 pedometer, self-efficacy for PA using the Physical
Exercise
Self-efficacy scale (PESES) (Schwarzer & Renner,
2008), and the stages of
motivational readiness for
change (SOC) (Marcus & Simkin, 1993). Two Xhosa-speaking
research assistants helped the participants to
complete the questionnaires.
The standard care group received nutritional information on healthy eating (Gibney &
Vorster, 2001)
designed by a dietician in a once-off 2-hour session.
The PA intervention
group received logbooks for recording daily PA, and a PA manual with information on
home-based exercise activities, the benefits and barriers to PA, and strategies for improving
exercise self-efficacy.
Figure 1 shows the flow of the study.
http://repository.uwc.ac.za

3
The contextualised physical activity intervention
The PA intervention was developed in a previous study
(Mabweazara, Leach, & Ley, 2017)
and informed by
Social Cognitive Theory (SCT) (Bandura, 1986) and
the Transtheoretical
model (TTM) (Prochaska & DiClemente, 1983). The PA intervention was delivered in the
indigenous Xhosa language, and food packs were used to promote adherence. The
intervention employed low-cost activities
of daily living (ADLs) using local resources and
opportunities.
The PA intervention was two hours each week for six
weeks that comprised a combination of
educational activities (60 min), home-based activities (30 min) and
a 30-minute group
aerobics session. All exercise activities
were in line with the American College of Sport
Medicine (ACSM) guidelines for individuals infected with
HIV (ACSM, 2013).
Ethics statement
Ethics approval was obtained from the Ethics Committee of the University of the Western
Cape (registration number: 14/10/33).
Data analysis
Descriptive statistics were used to summarise the participants demographic and clinical
characteristics. Levenes
test was computed to assess equality of means. Independent t-tests
and multivariate analysis of covariance were
used to assess differences between groups, and
statistical
significance was set at an alpha level of < .05.
Results
Sample characteristics
The mean (±SD) age of the participants was 37.57 (8.64)
years, height was 1.61 (0.06) m,
weight was 84.52 (22.48)
kg, and BMI was 32.21 (7.89) kg
.
m
2
. For education,
4.8%
attended school up to Grade 7; 33% up to Grade 10; and 61.9% up to Grade12. The mean
CD4
+
cell
count was 469.68 (SD = 157.48) cells/µL (n = 19). Tables
1 and 2 show TMVPA, TWS
and self-efficacy at baseline, after six weeks and post-crossover.
http://repository.uwc.ac.za

4
http://repository.uwc.ac.za

5
The results for SOC showed two participants in the precontemplative stage, 11 in the
contemplative stage,
four in the preparatory stage and one in the action stage.
Baseline assessments
Levenes tests for TMVPA (F = .145, p = .708), TWS (p
= .612) and self-efficacy for PA (p =
.891) were not
significant and, thus, equal variances were assumed.
Baseline comparison
revealed insignificant findings
between groups on TWS (t = .647, p = .527) and self-efficacy (t
= 2.167, p = .05), but a significant difference on
TMVPA (t = .116, p = .042). Thus, pre-
existing
differences on TMVPA were controlled as a covariate. Table 3 indicates that there
were significant differences
between groups on all three outcome variables
(TMVPA: F =
http://repository.uwc.ac.za

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01 Jan 2020
TL;DR: The levels of physical activity significantly differed by sociodemographic factors, health- related factors, and psychological health-related factors and there was also a difference in the physical activity levels according to the age and sex per each domain ofPhysical activity.
Abstract: Research on physical activity and health is actively being conducted. In the Korea National Health and Nutrition Examination Survey (KNHANES), the Global Physical Activity Questionnaire (GPAQ) was newly introduced in 2014. The purpose of this study was to investigate the levels of physical activity and related factors in Koreans who were assessed through the GPAQ by dividing the physical activity by occupation, leisure, and transport domain. This study used data from the KNHANES (2014-2016), the study population of which included 17,357 participants aged 12 to 80 years. We compared the differences in physical activity by sociodemographic factors, health-related factors, and psychological health-related factors. Moreover, we also compared the mean metabolic equivalent of task and daily sitting time according to physical activity domain by sex and age group. Finally, we investigated the sociodemographic factors, health-related factors, and psychological health-related factors that significantly affect the average physical activity per week. The various factors were found to differ in the frequency of physical activity levels. In addition, there was a difference in the amount of physical activity per occupation, leisure, and transport domain in each age group. Finally, age, sex, high-density lipoprotein cholesterol levels, arthritis, allergic rhinitis and sinusitis, sleeping time, and perceived health status significantly affected physical activity. The levels of physical activity significantly differed by sociodemographic factors, health-related factors, and psychological health-related factors. There was also a difference in the physical activity levels according to the age and sex per each domain of physical activity.

24 citations

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Abstract: Physical activity is beneficial for persons with HIV infection but little is known about the relationships between physical activity, HIV treatment and injection drug use (IDU). This study compared physical activity levels between HIV-negative and HIV-positive injection drug users (IDUs) and between HIV-positive participants not on any treatment and participants on highly active antiretroviral therapy (HAART). Anthropometric measurements were obtained and an interviewer-administered modified Paffenbarger physical activity questionnaire was administered to 324 participants in a sub-study of the AIDS Linked to Intravenous Experiences (ALIVE) cohort, an ongoing study of HIV-negative and HIV-positive IDUs. Generalized linear models were used to obtain univariate means and to adjust for confounding (age, gender, employment and recent IDU). Vigorous activity was lower among HAART participants than HIV-positive participants not on treatment (p=0.0025) and somewhat lower than HIV-negative participants (p=0.11). Injection drug use and viral load were not associated with vigorous activity. Energy expenditure in vigorous activity was also lower among HAART participants than both HIV-negative and HIV-positive participants not on treatment. Thus, HIV-positive participants on HAART spend less time on vigorous activity independent of recent IDU. More research is needed into the reasons and mechanism for the lack of vigorous activities, including behavioral, psychological and physiological reasons.

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TL;DR: In this paper, a face-to-face context-sensitive regular physical activity intervention employing 14 behavioural change techniques was designed for women living with HIV and AIDS (WLWHA) of low socioeconomic status.
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9 citations

References
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01 Jul 2014
TL;DR: A report produced for the Joseph Rowntree Foundation as discussed by the authors reviewed the evidence on transport and poverty with a focus on the UK, with the focus on London and the UK South East.
Abstract: A report produced for the Joseph Rowntree Foundation reviewing the evidence on transport and poverty with a focus on the UK.

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TL;DR: HIV-positive participants on HAART spend less time on vigorous activity independent of recent IDU, suggesting that the reasons and mechanism for the lack of vigorous activities are complex, including behavioral, psychological and physiological reasons.
Abstract: Physical activity is beneficial for persons with HIV infection but little is known about the relationships between physical activity, HIV treatment and injection drug use (IDU). This study compared physical activity levels between HIV-negative and HIV-positive injection drug users (IDUs) and between HIV-positive participants not on any treatment and participants on highly active antiretroviral therapy (HAART). Anthropometric measurements were obtained and an interviewer-administered modified Paffenbarger physical activity questionnaire was administered to 324 participants in a sub-study of the AIDS Linked to Intravenous Experiences (ALIVE) cohort, an ongoing study of HIV-negative and HIV-positive IDUs. Generalized linear models were used to obtain univariate means and to adjust for confounding (age, gender, employment and recent IDU). Vigorous activity was lower among HAART participants than HIV-positive participants not on treatment (p=0.0025) and somewhat lower than HIV-negative participants (p=0.11). Injection drug use and viral load were not associated with vigorous activity. Energy expenditure in vigorous activity was also lower among HAART participants than both HIV-negative and HIV-positive participants not on treatment. Thus, HIV-positive participants on HAART spend less time on vigorous activity independent of recent IDU. More research is needed into the reasons and mechanism for the lack of vigorous activities, including behavioral, psychological and physiological reasons.

35 citations


"A six week contextualised physical ..." refers background in this paper

  • ...In Africa, Murenzi (2011) reported that PLWHA, particularly women (Smit et al., 2006), engage in insufficient PA, which may be related to low socioeconomic status (SES) (Economic and Social Research Council, 2014)....

    [...]

01 Jan 2020
TL;DR: The levels of physical activity significantly differed by sociodemographic factors, health- related factors, and psychological health-related factors and there was also a difference in the physical activity levels according to the age and sex per each domain ofPhysical activity.
Abstract: Research on physical activity and health is actively being conducted. In the Korea National Health and Nutrition Examination Survey (KNHANES), the Global Physical Activity Questionnaire (GPAQ) was newly introduced in 2014. The purpose of this study was to investigate the levels of physical activity and related factors in Koreans who were assessed through the GPAQ by dividing the physical activity by occupation, leisure, and transport domain. This study used data from the KNHANES (2014-2016), the study population of which included 17,357 participants aged 12 to 80 years. We compared the differences in physical activity by sociodemographic factors, health-related factors, and psychological health-related factors. Moreover, we also compared the mean metabolic equivalent of task and daily sitting time according to physical activity domain by sex and age group. Finally, we investigated the sociodemographic factors, health-related factors, and psychological health-related factors that significantly affect the average physical activity per week. The various factors were found to differ in the frequency of physical activity levels. In addition, there was a difference in the amount of physical activity per occupation, leisure, and transport domain in each age group. Finally, age, sex, high-density lipoprotein cholesterol levels, arthritis, allergic rhinitis and sinusitis, sleeping time, and perceived health status significantly affected physical activity. The levels of physical activity significantly differed by sociodemographic factors, health-related factors, and psychological health-related factors. There was also a difference in the physical activity levels according to the age and sex per each domain of physical activity.

24 citations

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TL;DR: Evidence of its initial efficacy to improve physical activity in PLWH is provided and SystemCHANGE™-HIV is an innovative intervention for PLWH, representing a new paradigm in health behavior change.
Abstract: The purpose of this paper was to describe SystemCHANGE ™ -HIV, a novel self-management intervention for people living with HIV (PLWH) and provide evidence of its initial efficacy to improve physical activity. The rationale and design of the SystemCHANGE ™ -HIV intervention were reviewed. Intervention detail, including its historical use, learning exercises and content, were provided. Forty PLWH participated in this pilot study, using a randomized clinical trial design. Intervention participants increased their physical activity by 300 Metabolic Equivalent minutes per week, compared to the control condition. Additionally, 70% of intervention participants increased their physical activity, whereas 65% of control subjects either had no change or experienced a decrease in physical activity. SystemCHANGE ™ -HIV is an innovative intervention for PLWH, representing a new paradigm in health behavior change. Findings support its potential to increase physical activity in PLWH. Future work should refine and rigorously test the effect of this intervention.

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Related Papers (5)
Frequently Asked Questions (18)
Q1. What contributions have the authors mentioned in the paper "A six week contextualised physical activity intervention for women living with hiv and aids of low socioeconomic status: a pilot study" ?

This study is a pilot, randomised controlled crossover trial, reporting the effects of a contextualised PA intervention amongst a sample of 21 HIV positive Xhosa-speaking women of low socioeconomic status ( SES ). The study determined total moderate-to-vigorous PA ( TMVPA ) as measured subjectively by the Global Physical Activity Questionnaire ( GPAQ ), total weekly steps ( TWS ) as measured by a pedometer, and self-efficacy for PA as measured by the Physical Exercise Self-efficacy scale ( PESES ). In conclusion, the findings of the pilot study suggest that the intervention was effective in producing significant increases in PA in a sample of PLWHA of low SES over six weeks. 

Including constructs, such as selfefficacy, participant exercise preferences and social support, can help PLWHA of low SES to adopt regular physical activity, and can serve as adjunct therapy for the management of HIV and AIDS. 

increased perceived enjoyment of physical activity may result in increased self-efficacy, which may lead to a greater prospect of increasing physical activity behaviour (Lewis et al., 2016). 

Aerobic and strength training improve the profile of lymphocytes (O’Brien, Nixon, Glazier, & Tynan, 2004), body composition, muscle strength and quality of life (Spence, Galantino, Mossberg, & Zimmerman, 1990). 

In Africa, Murenzi (2011) reported that PLWHA, particularly women (Smit et al., 2006), engage in insufficient PA, which may be related to low socioeconomic status (SES) (Economic and Social Research Council, 2014). 

An information session and information sheets were used to inform participants about the study, and participant written informed consent was obtained. 

educating participants on where to find safe environments to walk very likely assisted them to be more physically active (Tuso, 2015). 

Participants needed to be between 18 and 65 years, HIV positive, as confirmed through medical records, and cleared on the Physical Activity Readiness Questionnaire (PAR-Q). 

Height was measured with a stadiometer, and body weight using a calibrated weight scale with participants wearing minimal clothing. 

The PA intervention group received logbooks for recording daily PA, and a PA manual with information on home-based exercise activities, the benefits and barriers to PA, and strategies for improving exercise self-efficacy. 

Amongst people living with HIV and AIDS (PLWHA), physical activity (PA) is associated with improvements in mental and physical well-being (Fillipas, Cicuttini, Holland, & Cherry, 2013; MacArthur, Levine, & Birk, 1993; Neidig, Smith, & Brashers, 2003). 

The purpose of this study was to evaluate the effects of a six week contextualised intervention aimed at increasing physical activity and self-efficacy for physical activity among HIV positive women of low SES. 

Similar to this study, Webel and colleagues included PA self-monitoring, goal-setting, inclusion of physical activity into activities of daily living, social support and strategies for overcoming barriers to engaging in physical activity, such as the effective use of personal time. 

The mean (±SD) age of the participants was 37.57 (8.64) years, height was 1.61 (0.06) m, weight was 84.52 (22.48) kg, and BMI was 32.21 (7.89) kg.m−2. 

Compared to standard care, participants in the physical activity intervention, informed by SCT and TTM, had significant increases in total moderate-to-vigorous physical activity, total weekly steps and self-efficacy for physical activity. 

Moore, Hanson, and Salata (2013) reported that participants increased their physical activity by 300 MET-minutes per week compared to the standard care group. 

Theories assist the researcher to identify the most effective behaviour change techniques (Glanz, Burke, & Rimer, 2011) and form the base for the development of evidence-based interventions (Sparling et al., 2000). 

http://repository.uwc.ac.za4http://repository.uwc.ac.za5The results for SOC showed two participants in the precontemplative stage, 11 in the contemplative stage, four in the preparatory stage and one in the action stage.