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
(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).
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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.
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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. 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.
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.
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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
Levene’s 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 =
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