Clemens Ley

Effects of an exercise programme with people living with HIV: research in a disadvantaged setting

This study aimed to analyse the physical health effects of a community based 10-week physical activity programme with people living with HIV. It was developed, implemented and evaluated in a disadvantaged community in South Africa. A pre-post research design was chosen. Major recruitment and adherence challenges resulted in a small sample. Among the 23 participants who took part in both baseline and final testing, compliant participants (n = 12) were compared to non-compliant participants (n = 11). Immunological (CD4, viral load), anthropometric (height, weight, skinfolds and waist to hip ratio), muscular strength (h1RM) and cardiopulmonary fitness (time on treadmill) parameters were measured. The compliant and non-compliant groups were not different at baseline. Muscular strength was the parameter most influenced by compliance with the physical activity programme (F = 4.516, p = 0.047). Weight loss and improvement in cardiopulmonary fitness were restricted by the duration of the programme, compliance and influencing factors (e.g. nutrition, medication). The increase in strength is significant and meaningful in the context, as the participants’ goals were to look healthy and strong to avoid HIV related stigma. The improvements in appearance were a motivational factor, especially since the changes were made visible in a short time. Practical implications for health promotion are described. More research contextualised in disadvantaged settings is needed.

Evaluation of a psychosocial health programme in the context of violence and conflict

A psychosocial health programme using movement, games and sport was developed and evaluated in the rural area of Guatemala, with two groups of women who suffered violence. Participatory observation and 32 interviews were conducted; 33 of the 56 participants filled out initial and final questionnaires. Research challenges were discussed and contextualised. Various health factors such as sense of coherence and self-esteem improved. The psychosocial approach and culturally grounded use of movement, games and sport as active and participatory tools in combination with verbal expression, provide a significant way to foster health in the context of violence and conflict.

A narrative review of research on the effects of physical activity on people living with HIV and opportunities for health promotion in disadvantaged settings

The article explores different types and effects of physical activity for people living with HIV. Considering the lack of studies done in African contexts and the disparity between research settings and natural settings, a narrative review of the literature was conducted and contextualised to South Africa. Various physical, psychological and social-cultural constraints impair the wellbeing of people living with HIV, in part by restricting their participation in physical activities. Apart from the well-studied immediate physiological benefits on health, we argue that physical-sportive group activities, such as sport or recreational games, can improve psychosocial factors and generate holistic health effects for people living with HIV. Group-activity effects could improve individuals’ motivation and adherence to participating in physical activities, provided that positive interaction and non-stigmatisation are guaranteed. However, most studies in this field have been limited to the benefits of aerobic exercise and resistance training. There has been little research on the types and different effects of physical activity and adherence to physical activity of people living with HIV in African contexts. Based on an analysis of the different types and effects, we suggest opportunities for and challenges to implementing physical activities for people living with HIV, especially in disadvantaged settings, and also identify gaps in the research to date.

Social-Ecological, Motivational and Volitional Factors for Initiating and Maintaining Physical Activity in the Context of HIV.

Sport and exercise can have several health benefits for people living with HIV. These benefits can be achieved through different types of physical activity, adapting to disease progression, motivation and social-ecological options. However, physical activity levels and adherence to exercise are generally low in people living with HIV. At the same time, high drop-out rates in intervention studies are prevalent; even though they often entail more favourable conditions than interventions in the natural settings. Thus, in the framework of an intervention study, the present study aims to explore social-ecological, motivational and volitional correlates of South African women living with HIV with regard to physical activity and participation in a sport and exercise health promotion programme. The qualitative data was produced in the framework of a non-randomised pre-post intervention study that evaluated structure, processes and outcomes of a 10-week sport and exercise programme. All 25 participants of the programme were included in this analysis, independent of compliance. Data was produced through questionnaires, participatory group discussions, body image pictures, research diaries and individual semi-structured interviews. All participants lived in a low socioeconomic, disadvantaged setting. Hence, the psychological correlates are contextualised and social-ecological influences on perception and behaviour are discussed. The results show the importance of considering social-cultural and environmental influences on individual motives, perceptions and expectancies, the fear of disclosure and stigmatisation, sport and exercise-specific group dynamics and self-supporting processes. Opportunities and strategies to augment physical activity and participation in sport and exercise programmes in the context of HIV are discussed.

“In the Sport I Am Here”: Therapeutic Processes and Health Effects of Sport and Exercise on PTSD

Current evidence suggests positive effects of exercise on posttraumatic stress symptoms; however, knowledge about how these effects are achieved is limited. Thus, this study aims to contribute to a more holistic understanding of these effects. We performed a single case study of a war and torture survivor, who was diagnosed with posttraumatic stress disorder (PTSD) and depression, and who was participant of the sport and exercise therapy program Movi Kune. Participant observation was conducted as well as semi-structured interviews with the participant and his psychotherapist. Data analysis resulted in the proposal of different processes: The focus on bodily sensations related to an exposure effect, contributing to improvements in body awareness, coping behavior, and affect regulation, whereas the focus on playing related to an improved performance, presence, enjoyment, and mastery experiences, pointing toward distraction and motivational-restorative effects. The findings also advice to be cautious as participants may be exposed to negative sensations and trauma-related triggers.

Movement and sport therapy with women in Guatemalan context of violence and conflict

The programme of ‘psychosocial activity through movement, games and sport with women’ (APM) who suffer or suffered violence was developed and evaluated with two groups of Mayan women in rural area of Guatemala. We highlight the use of principals and methods of movement and sport therapy, a psychosocial approach, participatory group techniques, cultural sensitive methodologies and the model of Salutogenesis. Both qualitative (participatory observation, semi-structured interviews) and quantitative (questionnaire) research methods were used. Through ongoing evaluation we analysed key factors and intervention processes, based on verbal and non-verbal techniques. The outcome evaluation showed significant improvements on several psychosocial health aspects (Sense of Coherence, self-esteem).

Editorial Physical Activity and HIV in Africa

Over the past decades evidence has emerged regarding the benefits of exercise on physical health and quality of life of people living with HIV [1-4]. Regular exercise training is considered safe for people living with HIV and important complementary means to address effectively health problems and side effects of medication. Therefore, it is strongly recommended that people living with HIV augment their physical activity levels, adequate information and awareness is spread among health workers and trainers, and corresponding opportunities for physical activity are built and maintained. However, many questions still remain unanswered, such as how to achieve these positive effects in the diverse and specific living contexts of the people, and particularly in Africa, where the main burden of HIV is found, but where few studies have been conducted. “Conclusions drawn from women [with HIV] living in a Western society will not necessarily reflect those found in sub-Saharan Africa where socio-economic factors and ethnicity could influence body composition changes” [5, 6]. In that regard, the international conference on Physical Activity and Sports for Health and Development in Africa (PASHDA) was celebrated in March 2014 in order to discuss particularly the situation of physical activity and health in Africa, but also what other countries can learn from Africa and vice versa. The conference was attended by 223 delegates coming from 14 countries and covering topics of Physical Activity in Africa related to Health, Urban Planning, Sedentary, Aging and Management of Non-Communicable diseases (NCDs), as well as Body Culture and Games in the African Traditional Societies. A specific symposium on Physical Activity and HIV was conducted during the conference to dialogue about the state-of-the-art and the role of physical activity in regards to HIV. Research from African countries and Brazil was discussed from different angles and disciplines obtaining a holistic view on this complex topic. Some of the results from the symposium are presented in this thematic issue: The first article raises the issue of cardiac diseases in people living with HIV. While the life expectancy of people with HIV is increasing, the relationship between HIV infection and risks for cardiac diseases is gaining weight. This is also true in some countries in Southern Africa where obesity is becoming an increasing problem [7]. The intro-ductory research letter from Dr. Mocumbi (Mozambique) is followed by a systematic review, conducted by Dr. Leach and colleagues (South Africa), focusing on the effects of exercise on body composition in people living with HIV. The review discusses the existing evidence and calls for further research on this particularly topic for people living with HIV. Three original research articles respond to this call, presenting data from three different studies in Mozambique, South Africa and Brazil. The first discusses effects of a supervised exercise program on body composition and muscular performance, which was conducted throughout two years in the laboratory of Physical Activity and Health Promotion at the Rio de Janeiro State University. This program included aerobic, strength and flexibility exercises; meanwhile the research conducted at the Pedagogic University Mozambique compared different types of exercise, including also active games. Playful exercising seems as effective as regular exercising and might therefore be used as an alternative. Comparing different types of physical activity aims to optimise the choice of exercise and the implementation of adequate programs in different contexts. The last article addresses challenges for practising sport and exercise in the context of HIV, especially referring to HIV-related stigma and motives. It explores social-ecological, motivational and volitional factors for initiating and maintaining physical activity among people living with HIV and concludes practical recommendations. In total, the symposium showed the importance to maintain a holistic work and research approach. It concluded that the actual state-of-the-art must be increased through the conduction of holistic and multiples studies. On the one hand, there is a need to increase the understanding of the effects of exercise on physical and psychosocial health of people living with HIV, particularly in Africa and in relationship with non-communicable diseases and risk factors. Networking and coordinated research in various countries are envisaged. On the other hand, further knowledge is required to understand how these effects are most appropriately achieved in the specific living contexts. Therefore, further research should investigate the effects of different types of physical activity, particularly those types of physical activity that are more likely to be implemented and maintained in the particular setting. It seems critical to obtain a best fit between possible effects and real opportunities to achieve the recommendations, considering social-ecological influences, barriers and motivation of people living with HIV. This is crucial to increment their physical activity levels, to optimise their participation in sport and exercise, and to achieve and maintain on long term the positive effects.

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

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.

International dialogue : Exploring potential criteria for the measurement of safety and crime prevention

CITATION: Keim, M. & Clemens, L. (eds). 2010. Conference proceedings – International Dialogue: Exploring potential criteria for the measurement of safety and crime prevention. Cape Town, 21-22 September 2010, Universiity of the Western Cape, South Africa. doi:10.18820/9781919985534.

Promoting Health of Refugees in and through Sport and Physical Activity: A Psychosocial, Trauma-Sensitive Approach

While psychosocial interventions are underlined by most international models of refugee health care, few guidelines exist so far as to the implementation of specific programmes. In this chapter, a resource-oriented, trauma−sensitive approach to sport and physical activity is presented, aiming to promote health and psychosocial support among refugees. We first provide an overview of research on sport and physical activity with linguistically and culturally diverse migrants and with refugees from conflict regions in ‘new societies’ as well as in refugee camps. Furthermore, we outline some initiatives from the sport for development and peace field and different body- and movement-based approaches with people living with posttraumatic stress disorder. We then present some key issues relating to the implementation of sport and physical activity for promoting health and psychosocial support. Finally, we draw some conclusions regarding research needs and practical implications.