H/A: Physical Activity (2009)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To describe and explore physical activity behaviors in a sample of persons living with HIV disease. The following research questions were posed:

  1. What types of physical activity behaviors are performed by people living with HIV disease?
  2. What is the frequency and duration of specific physical activity behaviors for people living with HIV disease?
  3. What demographic and social factors are associated with participation in physical activity behaviors for people living with HIV disease?
Inclusion Criteria:
  • 18 years of age or older
  • Self-disclosed infection with HIV
  • No hospitalizations within the previous four-week period
  • Able to read or understand English.
Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:


Convenience sample of persons were surveyed from two outpatient settings: An infectious disease clinic (N=68) and a community service organization for HIV-positive individuals (N=10).


Descriptive Correlational Study 

Blinding used (if applicable)

Intervention (if applicable)

Statistical Analysis

Not described


Data Collection Summary:

Timing of Measurements

Data were collected during normally scheduled clinic and agency hours.

Dependent Variables

  • Demographic and health-related information collected through Personal Profile Form
  • Physical activity information collected through Physical Activity Questionnaire
  • Social support assessed with the Norbeck Social Support Survey
  • Quality of life measured with the Medical Outcomes Study-HIV (MOS-HIV).

Independent Variables

HIV infection

Control Variables


Description of Actual Data Sample:

Initial N

78 persons, 70 male, eight female

Attrition (final N)



Mean 40.4 years (range 23-70 years)


59% African American

Other relevant demographics

  • Mean CD4 count: 386.2±321.7 cells/mm3 (range two to 1,200)
  • Mean HIV-RNA: 32,108.2±73,326 (range undetectable-300,000).



Urban area of the northern Great Lakes region of the United States


Summary of Results:


Days Per Week Performing Activities (Mode) Participants (N)
Walking 5 23
Strengthening 3 16
Moderate physical activity 3 15
Vigorous physical 3 7

Other Findings

  • 30.8% of participants identified that their occupationally related physical activity included mostly sitting or standing
  • 15.4% worked in occupations involving walking and 15.4% worked in occupations that included heavy labor or physically demanding work
  • 86% of participants identified walking at least 10 minutes at work or anytime during the usual day
  • Only 28.2% of participants met Healthy People 2010 recommendations for moderate physical activity
  • 19.2% of the participants reported meeting Healthy People 2010 recommendations for vigorous physical activity
  • 39.7% did not meet any of the Healthy People 2010 recommendations
  • Results showed somewhat fewer of the participants met Healthy People 2010 physical activity recommendations than persons in the general population
  • Walking was the preferred physical activity
  • Average functional social support was significantly correlated with weekly frequency of performing moderate 30-minute physical activity (r=0.38, P<0.01) and HIV-RNA viral load values (r= -0.37, P, 0.05)
  • Significant correlations were also found between scores on general health status self-reported CD4+ cell counts (0.33, P<0.05) and HIV-RNA (0.39, P<0.05) values
  • Total friend functional social support was significantly correlated (0.32, P<0.01) with weekly frequency of moderate or vigorous physical activity. 
Author Conclusion:

Developing and maintaining a healthy lifestyle for persons living with HIV disease is important and can influence both the quality and quantity of life. Aerobic physical activity is considered safe for 20 minutes three times per week. In light of recommendations and health-related benefits, nurses and other health care providers, particularly those in community and home care settings, should assess the type, frequency and duration of physical activities, as well as social support resources. It is important for clinicians to teach persons living with HIV disease to incorporate physical activity behaviors associated with established guidelines into lifestyle health promotion. Researchers who focus on developing relational ties with communities of patients and clinicians can work toward empowering individuals and communities.

Funding Source:
University/Hospital: Cain Center for Nursing Research at the University of Texas School of Nursing
Reviewer Comments:

Statistical analysis not described. Authors note the following limitations:

  • Data collected were self-reported and include measurement error
  • Study was limited to participants who attended a clinic and a community service organization where counseling was more readily accessible
  • Study did not attempt to identify intensity of physical activity behaviors
  • Physical activity behaviors may have been influenced as a result of winter months in a northern Midwest location
  • Sample of predominantly male participants.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? ???
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? ???
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? No
  8.1. Were statistical analyses adequately described and the results reported appropriately? No
  8.2. Were correct statistical tests used and assumptions of test not violated? ???
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? ???
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes