The impact of a therapeutic exercise intervention on depression and body self-image in HIV-positive women in sub-Saharan Africa

Abstract

IntroductionAttitudes, responses, and reactions of HIV-positive women in three sub-Saharan African regions toward a therapeutic exercise intervention, aimed to determine the presence of depression and low body self-image, were captured. This provided insight into body satisfaction and desire to exercise (Stage 1, n=60), body self-image and depression (Stage 2, n=60), and overall concerns around the often adverse side effects of antiretroviral treatment (ART). A program of therapeutic (specialty) exercise was developed for the experimental design (Stage 2), to quantify the psychological side effects of these variables.MethodologyStage 1 constituted a qualitative exploration into attitudes and perceptions around ART, toxicity, health concerns, metabolic irregularities (lipodystrophy), body shape and size dissatisfaction, and cultural attitudes toward exercise. This stage deployed brief informal face-to-face interviews, based on the World Health Organization (WHO)/United Nations Fund for Population Activities (UNFPA) AIDS Inventory, in three sub-Saharan African regions (including provincial and district hospitals, nongovernmental organizations, voluntary counseling and testing/HIV and testing centers, and primary care outpatient clinics). Stage 2 of the study comprised a quantitative experimental design, conducted on a sample of HIV-positive women (mean age=39.0 years; mean years on ART=5.5; 86% black) in three selected HIV outpatient clinics in Johannesburg, South Africa.Data analysisThe collated data sets from both stages of the research were presented, analyzed, and interpreted (thematic analyses [Stage 1] and statistical analyses [Stage 2]) using the body self-image questionnaire and Beck’s depression inventory.ResultsStage 1 outlined participants’ concerns and reports around 1) body shape and size, including long-term effects of ART and 2) attitudes toward exercise, as a function of HIV status. Stage 2 represented pre- and posttest statistics, showing low statistical means for both the experiment and the control groups, with statistical significance for four out of nine items of subscales of body self-image questionnaire.

Effectiveness of Exercise Training on Mental Health, Physical Activity Level and Social Participation in People Living with HIV/AIDS: A Systematic Review and Meta-Analysis

“…For aerobic exercises: Neidig, Smith [38] has a "usual activity" control, Aweto, Aiyegbusi [35] engaged "only counselling" control and a study [34] maintained a "no intervention" control. For therapeutic exercises: Daniels and Van Niekerk [39] utilised a "read prescribed materials" control.…”

“…Mental health A total of 346 participants were included in this review Participants were within the age range of 18 years and above, and the majority (222 or 64.16%) had asymptomatic HIV (Stage one) based on the WHO clinical staging for HIV/AIDS [40], The location of studies varied as two studies were located in the USA [36,38] and one study each in Nigeria [35], Iran [23], Australia [37], South Africa [39] and Ireland [34] ( Table 1) Physical activity Level…”

“…Overall, based on the PEDro scale, four studies [23,34,35,39] were judged as fair/moderate quality studies (Table 3). Two studies [37,38] were judged as high-quality studies and one study [36] Table 4 Outcome values for PA level…”

“…Three (42.9%) studies reported adequate follow-up [34,37,39] (Table 3). Overall, 84 out of 346 participants at baseline withdrew from the included studies accounting for ~24% of the total number of participants.…”

“…However, one study [39] reported that no participant withdrew from the study. Two (28.57%) studies have a low risk of incomplete outcome bias by having a retention rate ranging from 87.5% to 100% due to low attrition [37,39]. The withdrawal rate between comparison groups was similar in most groups.…”