Perceptions of physical activity for health promotion among people living with HIV in Uganda: A qualitative study

Abstract

Background

Promoting health and quality of life for people living with HIV (PLHIV) in low-resource settings is vital. Understanding perceptions of physical activity (PA) and factors influencing participation can guide culturally appropriate interventions. This study explored how PLHIV in Central Uganda perceive PA, factors affecting its acceptability, and views on integrating PA into antiretroviral treatment (ART) services.

Methods

A qualitative exploratory design was used. Semi-structured interviews were conducted with 12 adults (7 women, 5 men) on ART for at least 1 year. Data were analysed using content analysis, guided by the socio-ecological model.

Results

Perceptions of PA were shaped by intersecting factors across multiple levels. Individual factors included perceived weakness, comorbidities, fear of health risks, low awareness of PA benefits, body image concerns, competing demands, and seasonal food insecurity. Family and community-level barriers included stigma, gender norms, and lack of support. Institutional barriers involved limited health worker engagement and absence of PA-related incentives.

Conclusions

Reshaping perceptions and improving PA acceptability requires stronger health system involvement. Embedding PA promotion into routine HIV care and engaging health workers can help address barriers across levels. A multi-level public health approach is needed to integrate PA into biopsychosocial HIV care.

Keywords

Body image gender norms HIV physical activity stigma

Background

For over four decades, HIV has posed a persistent global public health challenge, with approximately 37 million people currently living with HIV worldwide.¹ Despite advancements in prevention and treatment, HIV continues to account for nearly one million deaths annually, disproportionately affecting Sub-Saharan Africa.¹ While global HIV prevalence has declined in many regions, trends in Sub-Saharan Africa remain concerning, with several countries witnessing either a stagnation or increase in new infections.^1,2

Uganda has been facing an HIV epidemic since the early 1980s.³ Although considerable progress has been made in reducing prevalence from the catastrophic levels of the 1990s, the current prevalence remains high at 6.5%, with approximately 1.4 million adults and children living with HIV in the country.⁴ The scale-up of antiretroviral therapy (ART) has significantly improved life expectancy among people living with HIV. For instance, in Uganda, the life expectancy deficit due to HIV among adults declined markedly between the early 1990s and the 2010s; from 16.1 to 6.0 years for women and from 16.0 to 2.8 years for men.^5,6 However, extended life expectancy has brought new challenges. People living with HIV now face an increased burden of non-communicable diseases, multimorbidity, and reduced health-related quality of life.^7,8 In response, calls have been made for a paradigm shift in HIV care, from focusing solely on viral suppression and survival to promoting overall wellbeing and quality of life.^9–11

Physical activity (PA) has emerged as a key strategy in this wellbeing-oriented approach. Evidence indicates that regular PA confers numerous physical,^12–14 mental,^15,16 cognitive,^14,17 and quality of life¹⁸ benefits in people living with HIV. Nevertheless, participation in PA remains suboptimal, particularly in low-income settings such as Sub-Saharan Africa.¹⁹ In Uganda, for example, only 20% of people living with HIV meet the World Health Organization’s recommendation of at least 150 minutes of moderate-to-vigorous physical activity per week.²⁰ To effectively promote PA, it is essential to understand the multilevel factors that influence behaviour. The social-ecological model offers a comprehensive framework for analysing the individual, interpersonal, organizational, community, and policy-level determinants of PA.²¹ In Sub-Saharan Africa, consistent individual-level barriers include low socioeconomic status, advanced age, and comorbid mental and physical health conditions.^19,22,23 However, there is a lack of robust quantitative data on the social and structural determinants of PA among people living with HIV in this context.

While quantitative studies help identify trends and correlations, qualitative research is uniquely suited to explore the lived experiences, social meanings, and contextual influences on PA behaviours.²⁴ Yet, qualitative research on PA among people living with HIV in Sub-Saharan Africa is sparse and limited to upper-middle-income settings such as South Africa. Findings from these studies highlight barriers such as HIV-related stigma, unsafe environments, adverse weather, domestic violence, and sedentary work conditions. Facilitators include social support and access to recreational spaces.^25,26 Given the significant socio-economic and healthcare disparities between South Africa and lower-income countries, these findings cannot be readily generalized to settings like Uganda.

Developing culturally relevant PA promotion strategies tailored to people living with HIV in low-income Sub-Saharan African countries requires localized evidence. Understanding how they perceive PA as a component of health promotion is critical for designing sustainable interventions.²⁷ To our knowledge, no previous qualitative study has explored these perceptions in Uganda or other low-income countries in the region. Therefore, the aim of the present study was to explore in depth the perceptions of physical activity uptake among people living with HIV residing in a resource-constrained community in central Uganda, with a focus on identifying the enablers and barriers to engagement in PA as a health-promoting behaviour.

Methods

The methods section is elaborated in detail in Supplemental Material 1.

Design

This study employed a qualitative exploratory design,²⁸ was situated within an interpretivist paradigm²⁸ and adhered to the Consolidated Criteria for Reporting Qualitative Research to ensure transparency and rigor in the design, data collection, and analysis processes.²⁹ Ethical approval was obtained from the ethical committee of Mengo Hospital, Kampala, Uganda. This study was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to participation.

Study population

The study was conducted in Buikwe District, located in central Uganda.³⁰ Current HIV prevalence rates in Buikwe District and the exact number of people living with HIV, including those on antiretroviral therapy (ART), were not available.

Sampling and selection

Participants were selected using purposive sampling. Eligible informants were adult men and women who had been receiving ART for at least 3 years and were residents of the community within the same time frame. Participants were identified by experienced health workers at two major health facilities in the district providing ART services. The interviews were conducted in a private room within the health facilities, each lasting between 25 and 35 min. In line with Green and Thorogood’s recommendation that most qualitative studies achieve data saturation within the first 12 interviews, we aimed to recruit at least 12 participants and continued interviewing until no new themes emerged.³¹

Study instrument

A semi-structured interview guide was developed by the research team to facilitate the interviews. To enhance contextual relevance and clarity, the guide was reviewed prior to data collection by senior health workers and professionals working in community development (see Supplemental Material 2). No further revisions were required following this review. The guide was not pilot tested with patients.

Data analysis

Data were audio recorded and transcribed verbatim; no field notes were taken. For convenience reasons, interview transcripts were not returned to participants for review. Data were analysed using content thematic analysis as outlined by Braun and Clarke. This method involves identifying, analysing, and reporting patterns (themes) within data.³² The socio-ecological model²¹ was employed as a guiding framework to explore factors influencing physical activity at individual, family, community, and health system levels. The initial coding process began with the first author developing preliminary codes, which were then reviewed and refined through collaborative discussions with the second author. Emerging themes and subthemes were systematically compared across all interviews, with iterative refinements made throughout the analysis process to ensure rigor and depth of interpretation.

Results

Participants

Of 14 individuals invited, 12 consented to participate (7 women; age 32–57 years). Reasons for the two refusals were not recorded, and none of the 12 participants who began the interviews withdrew. Self-reported duration of diagnosed HIV of the 12 included participants ranged from 3 to 28 years, and all participants were receiving ART for at least 1 year in one of the two selected centres.

Themes

The coding tree (see Supplemental Material 2) reflected one overarching theme (cultural understandings of physical activity) and four main levels of influence: individual, family, community, and institutional/health system. Within these, multiple subthemes were inductively identified, as described below. Participants were not invited to provide feedback on the findings.

Cultural understandings of physical activity

There is no single term in the local language that fully encapsulates the concept of physical activity or its’ structured form exercise for health. However, several words and expressions were used by participants to describe it. The most frequently cited term was “duyiro”, which was interpreted as “any activity that involves vigorous body movement or makes the heart beat faster.” This cultural interpretation aligns closely with the scientific definition of physical activity as “any bodily movement produced by skeletal muscles that results in energy expenditure”.³³ Participants most commonly associated physical activity with walking or running, but none mentioned indoor forms of exercise such as aerobics. This omission may reflect both the rural setting and prevailing socio-economic constraints. Traditional daily tasks such as digging, grazing animals, or brick-making were generally seen as labour for income generation rather than as physical activity for health. However, for some participants, these activities were also recognized as contributing to physical fitness and strength, especially when done regularly.

“Duyiro is when your body works hard, like when you're running.” Woman, 32 years

“For us, duyiro means when the body is working hard, like digging. It makes your heart beat faster, so I think it helps the body stay strong, especially when you’re living with this illness.” Man, 48 years

“We dig to earn, not to exercise. We don’t think of it as keeping your health.” Man, 45 years.

Factors influencing participation in physical activity

Themes emerging from participant narratives were organized using the socio-ecological model, covering individual, family, community, and institutional-level factors.²¹

Individual factors

Six themes were identified, i.e. (a) perceived physical weakness and comorbidities, (b) perceived risks and health concerns, (c) negative self-perception and body image, (d) limited knowledge about physical activity benefits, (e) competing priorities, i.e. work versus health, and (f) seasonal variations and food security.

Perceived physical weakness and comorbidities

Participants commonly noted that individuals who are newly initiated on ART often experience fatigue or other ailments that reduce their capacity to engage in physical activity.

“Even small chores left me tired in these days. If I tried to carry water, I had to stop and rest along the way.” Woman, 44 years.

Conversely, sustained ART treatment was described as gradually restoring physical capacity, which then created opportunities for increased physical activity.

“When the drugs start working, you begin feeling stronger, then maybe you can join others to fetch water.” Woman, 44 years.

Perceived risks and health concerns

Physical activity was sometimes perceived as risky, especially for those with ongoing health challenges. Participants feared collapse or exacerbation of symptoms such as body pain.

“I sometimes feel dizzy in the mornings. If I walk too far, I worry I might faint on the road and no one would know what happened.” Man, 50 years.

Negative self-perception and body image

Some participants expressed concern over their physical appearance, particularly skin changes and weight loss, leading to withdrawal from public life.

“People look at your skin and start guessing. That makes you want to stay inside.” Woman 32 years

“People asked if I was sick again because I had become thin. I started avoiding church and markets because I didn’t want to hear those comments.” Woman, 40 years.

This self-consciousness was observed in particular in women and was described as especially pronounced during the early stages of treatment. Older women in particular were reported to value modesty and self-image, preferring forms of activity that allowed them to remain within the confines of the home.

“At my age, I can’t go outside to walk. People will talk. I just do small things at home.” Woman 57 years.

Limited knowledge about physical activity

A number of participants lacked awareness of the health benefits of physical activity, relying instead on medication as their primary health strategy.

“I just take my medicine. No one told me that walking could also help.” Man 45 years

Competing priorities: work versus health

Survival needs often overshadowed health-promoting behaviours. Many people living with HIV working in informal sectors reported having little time or energy for physical activity after long work hours.

“We live day to day. Every moment is about survival. Finding what to eat, making some money. Physical activity is not something we plan for. That’s for people who have free time and no worries. For us, being active is just part of survival, not something we do for fun or health.” Man 38 years.

Seasonal variations and food security

Seasonality affected both energy levels and available time for activity. During planting seasons, individuals spent long hours in the garden and lacked the energy for additional activity. Food scarcity during dry seasons further diminished strength and mobility.

“In the rainy season, we dig all day. No energy left to do anything else and sometimes in dry season we have not enough food. How can you be active when you’re hungry? Man 45 years

Family factors

Two themes were identified. On one hand family support can enable physical activity, on the other gender norms and roles within the family are considered a barrier.

Family support

Family encouragement was highlighted as a key enabler of physical activity, particularly for those experiencing weakness or low motivation.

“My wife reminds me to walk around the compound when I’ve been sitting too long. She says, ‘You need to keep your body active so the medicine works better.” Man, 48 years

Gender norms and roles within the family context

Cultural expectations around gender also shaped engagement. Participation in community-based activities, especially in the evenings or in mixed-gender settings, was sometimes discouraged by spouses or perceived as culturally inappropriate.

“My husband doesn’t like it when I go out in the evening. He says I should stay home.” Woman 38 years.

Cultural ideals around motherhood were also cited, where a woman is expected to prioritize household duties and caregiving.

“A good woman is one who stays home, looks after the children, and works in the garden. Leaving the house is for those who don’t have the same responsibilities.” Man 41 years.

Community factors

Two themes were identified, i.e. (a) community stigma, (b) community leadership and affiliation, and (c) lack of well-maintained and safe community infrastructure.

Community stigma

Despite public health efforts, HIV-related stigma remained a strong barrier. Many participants avoided public activities out of fear of being labelled.

“When you would join a group, people start whispering. They ask why you’re suddenly so active.” Woman 38 years

Older individuals living with HIV, particularly women, often face community stigma, being perceived as having lived irresponsibly in their youth.

“When you're old and still on these drugs, people think you were careless. They judge you.” Woman 57 years

Such stigma served as a deterrent to participating in visible community activities.

Community leadership and affiliation

Active local leadership and community-based groups were seen as essential for fostering participation. Trusted local figures and mentors were described as important in organizing and encouraging culturally appropriate physical activity.

“If the church group or LC1 (village head) organizes a clean-up to collect litter, we would join in.” Man 41 years

Lack of well-maintained and safe community infrastructure

Both rural and congested urban communities often lacked infrastructure such as community centres or open and safe spaces that could support recreational activities.

“Once you’re done with your work, it gets dark, and you don’t risk your life just for exercise. Walking in the dark isn’t safe with no proper streetlights or clear paths. You can’t put your health at risk just to walk around.” Woman 46 years

Rural vs urban residence

Urban areas were perceived to have more recreational opportunities, such as gyms and sports groups, which were largely unavailable in rural settings.

“In town, they have gyms and football clubs. Here, we only have the bush and the garden.” Man 38 years

Institutional and health system factors

Two themes were identified, i.e. (a) limited outreach and promotion by health workers, (b) and lack of incentives.

Limited outreach and promotion by health workers

Participants reported an absence of targeted outreach or health education around physical activity from the formal healthcare system.

“They tell us about taking tablets, not about exercise. No one has ever talked to me about that.” Man 39 years.

Health workers were reported to have little training, time or motivation to promote physical activity, leading to missed opportunities for intervention.

“The health workers at the clinic are very busy with many patients. They don’t have time to talk about physical activity or help us with it because they are always busy.”Woman 39 years.

Lack of incentives

While some ART programs included incentives such as food supplements or transport vouchers, there were no similar provisions to promote physical activity.

“When they give food or money for the matatu (public transport), we come. But there’s nothing like that for exercise.” Woman 40 years

Discussion

Understanding community perceptions of physical activity is crucial for designing culturally sensitive and sustainable interventions. Guided by the socio-ecological model,²¹ this study explored how factors at the individual, family, community, and institutional levels influence the uptake of physical activity among people living with HIV in rural Uganda. There was strong coherence between the data and findings. The central theme of cultural understandings of physical activity, and the four levels of influence, were grounded in participants’ narratives. Within each level, multiple subthemes were substantiated by data excerpts, enhancing the trustworthiness of the analysis. While grounded in Buikwe District, the identified barriers and enablers are reflective of broader structural and social determinants of health. Findings may therefore be transferable to other Ugandan and sub-Saharan African contexts with similar socio-economic and health system conditions, though caution is warranted when applying them beyond this setting.

At the individual level, engagement was shaped by perceived weakness, comorbidities, fears about health risks, negative self-perceptions, limited knowledge of benefits, and competing priorities like work and caregiving. Seasonal demands, food insecurity, and fluctuating health also influenced activity. These findings align with prior research highlighting the interplay of mental, physical, and psychosocial barriers to participation.³⁴

Family-level enablers were evident. Several participants reported that encouragement from family members played a critical role, especially when motivation was low. Emotional support and accompaniment helped participants overcome inertia, particularly relevant in rural areas with limited formal support.

At the community level, norms influenced perceptions of activity. Tasks like digging or brick-making were often viewed as survival labor rather than health-promoting. Few participants recognized these as exercise, highlighting a knowledge gap. Public health messaging that frames daily labor as legitimate physical activity could reshape perceptions. HIV-related stigma also limited public engagement. However, community groups and leaders were seen as trusted platforms that could promote activity and reduce stigma. These groups offer opportunities for peer-led programming and behavior change. Infrastructure limitations, including unsafe environments, lack of equipment, and few organized opportunities, were further constraints.

At the institutional level, barriers included limited promotion of physical activity by health workers and absence of incentives. Many participants reported never being advised about activity’s role in HIV care, suggesting missed opportunities for integration into ART services. While structural constraints like staff shortages persist, task-shifting to lay health workers or community leaders could enhance reach. Encouragingly, peer support emerged as a promising facilitator. Participants valued the emotional and motivational aspects of shared activity. Peer-led models are supported by existing evidence showing mental health and social inclusion benefits.³⁵ Another opportunity involves integrating physical activity into microfinance groups. These platforms offer existing social capital structures. Though data are limited among people with HIV, pilot studies in Kenya suggest such integration may reduce stigma and foster cohesion.³⁶

Based on these insights, several recommendations emerge (a) reframe local labor (e.g., farming, digging): as beneficial physical activity; (b) leverage community groups and microfinance platforms for delivery; (c) adopt peer-led approaches to foster support; (d) involve family members to reinforce routines and motivation; (e) train lay health workers to promote safe activity; and (f) reduce stigma by embedding physical activity into daily life. Integrating physical activity into Uganda’s HIV care guidelines and primary healthcare packages is essential for sustainability. Utilizing local spaces like churchyards or schools can enable low-cost group-based activities. Ultimately, physical activity should be seen not as a luxury, but as a culturally adaptable, empowering strategy to improve health and quality of life for people living with HIV in Uganda and beyond.

Some limitations should be acknowledged. The sample size limited to one rural district, which may affect generalizability. The qualitative design relied on self-reported experiences, which may be subject to bias. Future research should include more diverse populations and consider mixed methods to quantify activity alongside perceptions. Investigating tailored, sustainable interventions integrated into HIV care and exploring digital tools for remote support may also be valuable. Longitudinal studies could help assess changes over time in response to interventions.

In conclusion, this study highlights the complex, multilevel factors shaping physical activity perceptions and participation among people living with HIV. Addressing individual barriers, while strengthening family, community, and system-level support, is essential. Integrating culturally relevant activity promotion into existing care and community structures offers a promising path to improving health and well-being in this population.

Supplemental Material

Supplemental material - Perceptions of physical activity for health promotion among people living with HIV in Uganda: A qualitative study

Supplemental material for Perceptions of physical activity for health promotion among people living with HIV in Uganda: A qualitative study by Davy Vancampfort and James Mugisha in International Journal of STD & AIDS

Footnotes

Acknowledgements

The authors sincerely thank all the participants for their valuable contributions, as well as the healthcare workers who facilitated participant recruitment.

ORCID iD

Davy Vancampfort

Ethics considerations

The study was approved by the ethical committee of Mengo Hospital and by the Uganda National Council for Science and Technology.

Consent to participate

Written informed consent was obtained from all participants prior to their involvement in the study.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Vlaamse Interuniversitaire Raad, Belgium (Global Minds O6313).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

References

Frank

Carter

Jahagirdar

, et al. Global burden of HIV, 1990–2017: a systematic analysis. Lancet HIV 2019; 6(12): e831–859.

Vithalani

Herreros-Villanueva

. HIV/AIDS: global trends, disease burden, and efforts to control the pandemic. J Global Infect Dis 2018; 10(3): 113–114.

Uganda Ministry of Health, Centres for Disease Control and Prevention . Uganda HIV/AIDS sero-behavioural survey 2004–2005. Kampala: Uganda Ministry of Health and CDC, 2006.

UNAIDS . Uganda country factsheet. (2021) [cited 2025 Jul 12]. Available from: https://www.unaids.org/en/regionscountries/countries/uganda

Asiki

Reniers

Newton

, et al. Adult life expectancy trends in the era of antiretroviral treatment in Uganda. Popul Health Metr 2016; 14(1): 1–9.

Trickey

May

Vehreschild

, et al. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV 2017; 4(8): e349–356.

Engelhard

EAN

Smit

van den Born

BJH

, et al. Health-related quality of life of people living with HIV: an updated review. HIV Med 2018; 19(4): 255–265.

Miners

Phillips

Kreif

, et al. Health-related quality-of-life of people with HIV in the era of combination antiretroviral treatment: a cross-sectional comparison with the general population. Lancet HIV 2014; 1(1): e32–40.

Lazarus

Safreed-Harmon

Barton

, et al. Beyond viral suppression of HIV–the new quality of life frontier. BMC Med 2021; 19(1): 1–5.

10.

Safreed-Harmon

, Advancing the global HIV response beyond 2020: perspectives from people living with HIV. J Int AIDS Soc 2019; 22(10): e25456.

11.

Serwadda

. From control to elimination: the changing face of the HIV epidemic in sub-Saharan Africa. Lancet HIV 2019; 6(7): e418–419.

12.

Bonato

Turrini

Galli

, et al. The role of physical activity for the management of people living with HIV. Eur Rev Aging Phys Act 2020; 17(1): 1–13.

13.

Ibeneme

Eni

Ezuma

, et al. Effects of physical activity on health-related quality of life of people living with HIV/AIDS: a systematic review. BMC Public Health 2019; 19(1): 1–10.

14.

Quigley

O'Brien

Parker

, et al. Physical activity interventions for adults living with HIV/AIDS: a systematic review. J HIV AIDS Soc Serv 2019; 18(3): 261–282.

15.

Heissel

Zech

Rapp

, et al. Effects of exercise on depression and anxiety in persons living with HIV: a meta-analysis. J Psychosom Res 2019; 126: 109823.

16.

Nosrat

Whitworth

Ciccolo

. Exercise and mental health of people living with HIV: a narrative review. J Psychiatr Res 2017; 99: 13–20.

17.

Winston

Swanson

Capuano

, et al. Cognitive function in adults with HIV: a systematic review and meta-analysis. AIDS Behav 2020; 24(5): 1421–1431.

18.

Neto

OCC

Silva

Ribeiro

, et al. The effect of physical exercise on quality of life of people living with HIV/AIDS: a meta-analysis. J Phys Activ Health 2021; 18(1): 22–29.

19.

Vancampfort

Mugisha

Richards

, et al. Physical activity correlates in people living with HIV/AIDS: a systematic review of 45 studies. Disabil Rehabil 2018; 40(14): 1618–1629.

20.

Wright

, Physical activity and its correlates among adults living with HIV in Uganda. AIDS Care 2020; 32(4): 471–478.

21.

Bauman

Reis

Sallis

, et al.

Correlates of physical activity: why are some people physically active and others not?

Lancet 2012; 380(9838): 258–271.

22.

Vancampfort

Stubbs

Mugisha

. Barriers to physical activity in people living with HIV: a cross-sectional, multicentre study in African countries. BMC Public Health 2018; 18(1): 1–7.

23.

Vancampfort

, Physical activity and sedentary behavior in people living with HIV in low- and middle-income countries: a systematic review and meta-analysis. J Assoc Nurses AIDS Care 2020; 31(3): 259–270.

24.

Jones

Brown

Holloway

. Qualitative research in health care. Chichester: John Wiley & Sons, 2012.

25.

Ley

Barrio

Leach

. Social-ecological, motivational and volitional determinants of physical activity in people living with HIV and AIDS: a review of reviews. Afr J AIDS Res 2015; 14(3): 175–184.

26.

Roos

Myezwa

van Aswegen

. ‘Not easy at all but I am trying’: barriers and facilitators to physical activity in a South African cohort of people living with HIV. BMC Public Health 2015; 15(1): 1–10.

27.

Mabweazara

Leach

Ley

. Development of a context-sensitive physical activity intervention for people living with HIV and AIDS in low-resource settings: a South African experience. Afr J AIDS Res 2019; 18(3): 225–233.

28.

Creswell

Poth

. Qualitative inquiry and research design: choosing among five approaches. 4th ed. Thousand Oaks: Sage Publications, 2018.

29.

Tong

Sainsbury

Craig

. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19(6): 349–357.

30.

Uganda Bureau of Statistics . National population and housing census 2014 – area specific profile: moroto district. Kampala, Uganda: Uganda Bureau of Statistics, 2017.

31.

Green

Thorogood

. Qualitative methods for health research. 4th ed. Thousand Oaks: Sage Publications, 2018.

32.

Braun

Clarke

. Using thematic analysis in psychology. Qual Res Psychol 2006; 3(2): 77–101.

33.

Caspersen

Powell

Christenson

. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Publ Health Rep 1985; 100(2): 126–131.

34.

Ayano

Yohannes

Mohammed

. Internalized stigma and associated factors among people with mental illness: a systematic review and meta-analysis. Ann Gen Psychiatr 2018; 17(1): 1–14.

35.

Vancampfort

Byansi

Namutebi

, et al. The efficacy of a lay health workers–led physical activity counselling program in patients with HIV and mental health problems: a real-world intervention from Uganda. AIDS Care 2021; 33(9): 1189–1195.

36.

Dong

Mulyasari

Muhardi

, et al. Exploring the impact of community-based self-help groups on health and social inclusion in people with chronic conditions in Kenya. BMC Public Health 2021; 21: 965.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.17 MB