We assessed the level of physical activity and the associated factors among HIV patients attending ART clinics of public hospitals in South Ethiopia. The current study showed a high proportion of physically inactive HIV patients, and women participants take the largest share of this proportion. Being an urban resident and a longer duration of treatment were also factors that were associated with physical inactivity.
In the current study, a high proportion (68%) of HIV patients attending the ART clinic was physically inactive. This result is consistent with studies conducted in Rwanda and Malawi, which showed percentages of 70% and 40%, respectively [25, 26]. These earlier studies indicated that being older was a leading reason for low PA among PLWHA [14]. In our study the majority of participants (89%) were younger aged (< 50 years) with the mean age of 38.7 years. In addition, we excluded pregnant and lactating women. Therefore, being pregnant did not explain the lower PA in the current study. Since the lower PA level was observed among younger and productive groups of the society, this poses a challenge in the economy of the country in addition to exposing them to an associated risk of chronic comorbidities. Therefore, physical activity interventions should get attention in the routine HIV management programs of the country.
In our study, a higher number of women were physically inactive. Consistent findings were seen in several studies conducted elsewhere in Africa [25, 27, 28]. In contrary, a study conducted in developed countries reported no difference in the prevalence of physical inactivity between men and women [29]. In the current study area, men are involved more often in intensive manual labors, like agricultural activities, construction and often carrying heavy weights, than women. In addition, in the current study set up, women have less chance to engage in different recreational and regular physical exercise activities. Therefore, interventions aimed at promoting physical activity should target adult female HIV patients.
In the current study, participants residing in urban areas had higher odds of low PA than those in rural areas. This finding is in line with the studies conducted in sub-Saharan Africa countries, Northern Tanzania and Vietnam [27, 30, 31]. In Ethiopia, people living in the rural area are more often involved in vigorous and moderate activities than urban people, because more manual labor and agricultural activities are found in the rural area than urban. In addition, most Ethiopian rural setups do not have transportation access, and due to that people walk long distances from one farm site to another or from place to place for various social issues. In addition, rural dwellers tend to practice manual work and active travel, which insures vigorous and moderate PA, while their urban counterparts seem to adopt sedentary lifestyles. Therefore, to avoid the additional burden of chronic comorbidity, it is vital to promote physical activity among urban PLWH as an intervention strategy.
The other variable that has shown a significant association with physical inactivity was the duration of treatment. Physical inactivity was more common among participants who stayed on ART for more than 2 years. Our finding is consistent with a study conducted in Rwanda [26]. The possible reason could be that patients may have more commitment at the initiation of treatment due to their health condition and the frequent counseling and follow-up they get from health care providers. Maybe, when their health status is stable in the later stages, they become less compliant to adhere to the care taken. Health care providers should consider regular follow-up and awareness creation to increase the level of physical activity and overall health status.
As a limitation, during our assessment of physical activity level, data were collected based on self-reported information, which is subjected to social desirability bias and results in over reporting of physical activity. Since participants were asked about their physical activity of one-week duration, their response may also be subjected to recall bias. To minimize the bias, clear instruction was given on the objective, benefit and drawback of the study both for participants and data collectors.