Theme 1: Perceptions of and the attitudes towards PA and exercise

The perceptions of and attitudes towards exercise were explored in order to better understand how HIVPS view sport, exercise and PA. According to the Oxford dictionary perceptions are defined as ―the way in which something is regarded, understood or interpreted‖ while attitude is defined as ―a settled way of thinking or feeling about something (Oxford dictionary online). Furthermore, Eagly and Chaiken (in McLeod, 2009) defined attitude as ―a psychological tendency that is expressed by evaluating a particular entity with some degree of favour or disfavour‖. In the context of PA, it was found that attitudes, while not predicting behaviour, can influence participation in exercise (Portman, in Pethkar, Naik and Sonawane, 2010:34). Although attitudes are formed early on, they can be changed either by increased knowledge or by repeated exposure to a stimulus (Kuh; Schuller; Lewis, in Pethkar, et al., 2010:33). In the context of this study, the perceptions that the HIVPS have of PA and exercise can influence their attitude towards PA and exercise and therefore ultimately affect their participation levels.

Research has been conducted on the attitude of university students towards exercise (Mack & Shaddox, 2004:587; Walter, 2008:121); however, it is not known whether being diagnosed with HIV has any impact on the attitudes towards, and perceptions of exercise. In order to gain more insight into lifestyle exercise behaviours, participants in the present study were asked about the role that sport and exercise plays in their lives, and their history of participation in sports and exercise. They were also asked about participation patterns of family and friends, as well as the perceived benefits and barriers to participation, specifically in the context of living with HIV. Their words were recorded and transcribed verbatim by the researcher and direct quotes are italicized.

106 The transcripts were read and re-read repeatedly and analysed carefully in order to identify dominant themes and sub-themes. Table 30 provides an outline of Theme 1 and its accompanying categories.

Table 30: Attitudes towards and perceptions of exercise and physical activity

Theme Categories

Perceptions of and the attitudes

towards PA and exercise Understanding the terminology

Knowledge and importance of exercise Benefits

Intentions and motivations

- Participation in sport at school - Parental influence

- Influence of being diagnosed with HIV

Source of information Diagnosis and attitude

Encouraging others to participate

Three of the HIVPS in the present study participated in regular exercise as defined by Caspersen, et al. (1985:128) in Chapter 2, section 2.6. The majority of the HIVPS interviewed (n = 13) acknowledged the benefits of exercise, and had a positive attitude towards PA and exercise, while only one participant was indifferent and did not know the reasons why she should exercise.

5.3.1.1 Understanding the terminology

The data revealed that some of the HIVPS interviewed were able to differentiate between sport, exercise and lifestyle-related PA, despite using the words PA and exercise interchangeably. When asked what role sport and exercise played in their lives, their responses were:

107 P3: I don‟t do sport, uhm, or exercise. I just walk now and then, go to the shop and then

from school, that‟s it. (The word ―school‖ is often used by students to describe

―university‖)

P14: ... I don‟t do much sport and I don‟t do much exercise. So, physically, I am not a

very physical person.

P9: I don‟t exercise. I don‟t think I (pause), because the thing is I walk a lot and I think

that it‟s now becoming better and I‟m person who likes dancing, I dance a bit, so I think that contributes to my mode of exercise.

P12: ... I don‟t really have time, so the only exercise I get is going up and down stairs

and going from my house to where the transport picks me up. I don‟t really have sporting time... I was told I need to exercise... But then, exercise is walking, so it didn‟t really make a difference when they said exercising, because my heart rate goes up all the time. I‟m guessing I do that in any case and I take the stairs more than the elevator, so it should count for something.

5.3.1.2 Knowledge and importance of PA and exercise

The HIVPS acknowledged that PA and exercise is important for everybody, regardless of HIV status. While they did not differentiate between these two groups in terms of the need for exercise, they did feel that exercise could result in additional benefits for PLWHIV. Some of the benefits of exercise included improvements in overall health, a stronger immune system, and stress relief and relaxation, as well as reducing fatigue.

P2: Even if, even if one isn‟t HIV or other diseases, it‟s still the most important thing one

has to do. So I think that‟s top of them all, it‟s top of the list.

P14: … so it is very important. I think so even though I don‟t do it myself, It‟s very

important because at the end of the day you have to take care of this body that feeds you that makes sure you are the person you are, so not exercising, not eating healthy and having the burden of this HIV living inside of you, it could take a lot out

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of a person. So exercise for me and I‟d say any other person living with HIV is very important, it‟s crucial in fact.

P9: I think it is important in the sense that, like I mentioned before, it can stabilize your

situation, not going further to AIDS itself. So if you want to like keep yourself healthy, you just have to exercise. It‟s not a matter of you want, but you just need to.

P5: I think this is a tricky one, let me think. It is, to an extent. It keeps you healthy and

prevents colds and that. So someone who is fit and all that wouldn‟t be more susceptible to, let‟s say, to a common cold and to catching things that could weaken their immune system. So I think it‟s important, ja. And things like TB, which we are very, very, very susceptible to.

P10: But then in terms of its significance; it‟s very good in terms of my health and other

stuff.

P1: I think it‟s very important, because I think that it boosts your, it helps your immune

system, so ja, it very important.

P13: … exercise would play an important role, also, in terms of boosting your immune

system, so that the side-effects (of ARV‘s) aren‟t as bad…

P8: Ja, it is; and for me it‟s to live longer, especially now that I have this, it‟s to live

longer and make sure that my immune system is healthy and that my blood, whatever flows, heart everything.

P7: I think, I think it‟s very important, because you see if you don‟t; if you are HIV

negative, sorry, if you are HIV infected your body is vulnerable so to say, so if you don‟t exercise then diseases will come to you. So if you do exercise then you will avoid such things, ja, because your body will be as fresh as ever.

109 P11: I think it is important in the sense that, like I mentioned before, it can stabilize your

situation, not going further to AIDS itself. So if you want to like keep yourself healthy, you just have to exercise. It‟s not a matter of you want, but you just need to.

P12: First-off, I don‟t know about people who are taking it negatively though, but it‟s a

great stress relief because come to think of it, when you exercise, it doesn‟t matter if you are positive or not you probably do the same exercises as everybody else. You are probably exercising the same amount of time as everybody else. So that‟s of the things you can look at and think ok, this is one thing I still do the same as everybody else, you know. And then the benefits; when you exercise you drink a lot of water, it‟s good for your kidneys. If one day you have to end up taking ARV‟s, they test your kidneys before you take ARV‟s, then they‟ll find there is nothing wrong with you other than the fact that you just have to take ARV‟s, you know. And exercise prevents any other, you know, HIV is enough, it‟s a handful on its own. I get that. It‟s a handful, when you think, ok, if I don‟t take care of myself and I don‟t restrict myself from certain things then it might just blow into HIV, you know and if I don‟t visit the doctor and go to the clinic regularly, it might just blow into HIV, but then that‟s the only thing you have to worry about, you know?

P14: …currently I am experiencing a lot of fatigue, you know, I just generally don‟t have

the energy to do anything, so I think joining a gym, doing some exercises, eating right, it would really benefit me…

P4 agreed that exercise is important, but she did not necessarily see it as important for herself specifically:

P4: Well, they say it is very important, but I‟m not quite sure how important it is, but I

guess it is important.

5.3.1.3 Benefits of Exercise

The HIVPS recognized the benefits of regular exercise or increased PA. They acknowledged that participation in exercise was beneficial to everybody, regardless of

110 HIV status, but cited that PLWHIV could benefit more. Despite not all participating in structured exercise, participants had some knowledge regarding the benefits of exercise which included physiological, aesthetic and psychological benefits.

P6: Uhm, to me, it helps one to avoid obesity, uhm, it helps to balance your heart rate

as well. It helps you as part of your relaxation, dealing with stress and stuff, jah (P6

had a BMI of 36.11 kg/m², which is classified as obese).

P8: Uh-ha, I think that‟s about it; to have a good body obviously (laughs), it‟s good for

your heart… Ooh I‟ve gained weight lately (and) I believe in in appearance (P8 was

classified as being overweight with a BMI of 25.27 kg/m²).

P10: Not only in brainstorming, you also become academically good in school too

P5: Uhm, I think this is a tricky one, let me think. It is, to an extent. It keeps you healthy

and prevents colds and that. So someone who is fit and all that wouldn‟t be more susceptible to, let‟s say, to a common cold and to catching things that could weaken their immune system. So I think it‟s important, ja. And things like TB, which we are very, very, very susceptible to. Ja, so your body, I think, when exercising, your body acts much faster than a non-exercising person in terms of fighting off disease and all that. That‟s what I think.

P14: A lot, because currently I am experiencing a lot of fatigue, you know, I just

generally don‟t have the energy to do anything, so I think joining a gym, doing some exercises, eating right, it would really benefit me, because the exams are coming up for instance. I can‟t be fatigued all the time; I can‟t not have energy all the time, so I think it would benefit me a lot. But I regard it as very important hey, it is because at the end of the day you need to be healthy, you need to take care, you know studies are there, they need your time, they need this body and they need this brain.

P12: ... it‟s a great stress relief because come to think of it, when you exercise, it

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everybody else... because exercise is exercise for everyone, it‟s got benefits for everyone and it just so happens that they are just a bit extra for people with HIV,...You exercise and then you find ok, you‟ve been able to keep your weight at a certain level, ... and you prevent having to deal with heart problems and all the other diseases and sickness that come, apart from HIV; because HIV is not what kills you, it‟s all the other small diseases and sicknesses that gather up and they are helping HIV towards killing you, .... and then they (the HIV) get in there and they find, your immune system is not strong, “wow, this is easy” and if you are not exercising, “ok so it‟s a couch potato so I can go around her body whichever way I like and nothing is stopping me”. So it‟s beneficial to exercise and make sure that your blood flow is steady, because exercise strengthens you heart, your blood flow is steady. It‟s like you don‟t have clots and all those weird things that other people have some times. And then you find that, when you are exercising you sweat a lot. Besides the fact that you are losing fat from that sweat and whatever else you are losing in that sweat, you drink a lot of water, which helps your organs, which helps strengthen your immune system in the process. So it‟s beneficial to exercise rather than not to.

P13: Well, like I said, my Gran is a nurse…in primary school it was like, you know

exercise is very good for you. It‟s good for, I‟m quite a book person, so she‟d be like: it‟s good for, well it releases oxygen and da, da, da, so it‟s good for you mentally and it stimulates you, blah, blah, blah, it stimulates you; so she would encourage it, right. But then as she saw just how much it was draining me, it would be like: ok maybe you should take it easy…it (exercise) would definitely make that transition (to taking

ARVs) a lot smoother, because it like, right we said that everything needs to work

together, the medication, the diet, the exercise, all three. Yes you getting a good diet and eventually you will be on the ARV‟s, but then the exercise would play an important role also in terms of boosting your immune system, so that the side effects aren‟t as bad. So say for example, the things that I struggle with, in terms of side- effects, are my calves. They get very sore sometimes, like now they are very, very sore. So obviously if I were exercising perhaps if I were exercising I would build up like enough, I don‟t know what the correct term is, but like enough strong muscle… so that would be, ja, it would definitely make that transition smoother.

112 5.3.1.4 Intentions and motivations

While all of the HIVPS in the present study walked regularly as a form of transportation, most expressed their intention to start an exercise routine in the future. The transtheoretical model (TTM) of behaviour change developed by Prochaska and DiClementi (in Basta, 2006:5) describes how people intentionally change behaviour. According to the theory, individuals move sequentially through five stages of change. By assessing the individual‘s stage of change and intention to change behaviours, appropriate intervention strategies can be designed, based on the individual‘s motivation to bring about a change in behaviour. Pethkar, et al. (2010:32) summarised the five stages which are categorised as pre-contemplation (not physically active and not thinking about changing), contemplation (not physically active but with an intention to start), preparation (doing some exercise, but not regularly), action (they are active, but have only started recently) and maintenance (currently active and have been so for about six months). In their study on the stages of change among persons living with HIV, Basta, Reece and Wilson (2008:1702) classified their participants based on their responses to a question about their exercise habits: maintenance stage (yes, I have been exercising for more than six months), action stage (yes, I have been exercising for less than six months), preparation (no, but I intend to in the next 30 days), contemplation (no, but I intend to in the next six months), pre-contemplation (no, and I do not intend to in the next six months).

Based on the classifications by Basta, et al. (2008:1702) four (28.6%) of the HIVPS in the present study, could be classified as being in the pre-contemplation stage, as they had not yet considered starting a structured exercise program. Two (14.3%) HIVPS had considered starting a structured exercise program with thoughts of joining a gym, but had not yet made any plans. By having done enquiries at a gym facility and taking active steps towards starting a regular exercise programme, two (14.3%) HIVPS could be classified as being in the preparation stage. Three (21.4%) of the HIVPS in the present study were classified as being in the action stage. These three would exercise (action), stop for a while and think about exercising again (contemplation), relapse back

113 to the stages of contemplation, preparation and action. Finally, three participants are in the maintenance stage, as they had been exercising regularly for some time.

P3: Like they will open, they are gonna open a gym (at the Missionvale Campus), I‟ll

join, I am gonna join and exercise. But you know it‟s been a while since I‟ve been waiting. The manager said, the manager at the gym said they‟ll be open in June, but they haven‟t, so we‟re still waiting… Uhm (pause), I think (pause), when I‟m working I‟ll exercise, because I think I‟ll have time to exercise, and I think the lots of work that I‟ll have will maybe be quite stressful, and I think I will maybe need to exercise to relieve some stress (laughs).

P4: Sometimes I think that I‟m gonna give it a shot, but then I don‟t really do it, I do think

of doing it, but not too much… I have thought about getting into gym since they said I am overweight. I have been thinking about going to gym… “Well I would start going to the gym, first of all. That is one thing that I think I should do.

P6: Hmm, I actually plan on starting gym at the end of this month, uhm, for health

reasons and uhm for the fun part of it, because it‟s fun… I actually have decided that I don‟t care how far it is, after the end of this month, I‟m actually joining the gym. I‟ve actually drawn up a plan in my mind. I attend part-time, so during the day, actually in the morning would be the best time for me to go to gym. There is a gym where I stay, nearby. So I actually did go and get information about the costs and all the times, so I will attend gym from a Monday to a Thursday, every morning. I‟ll only have one session because I have evening classes. Then during the weekends I dedicate my time to church, so I won‟t be available to go to gym. So that‟s the plan that I have and I am not going to allow anybody to stop me, and I can actually afford it because it‟s not that expensive.

P9: Well, it‟s not a priority now, but I think around December, around January, I think I

114 P10: Maybe after completing my degree I would be able to go back to sport again;

maybe I‟m not sure.

One student in particular expressed her intentions to join a gym and that she would draw up a healthy eating plan and exercise program, but she did not have any history of participating in sports or exercise due to a history of asthma. At the same time, she said that it had not occurred to her to try exercise.

P14: … I haven‟t really got around to the idea of actually taking a step, taking steps to

ensure that my health is in good condition; my exercise is up to date. I get around