3. Electronic Theses and Dissertations (ETDs) - All submissions
Permanent URI for this communityhttps://wiredspace.wits.ac.za/handle/10539/45
Browse
5 results
Search Results
Item A prospective pedometer study of doctors working in an Emergency department(2018) Beringer, Craig BrianObjective The positive impact of physical activity and exercise on health is well known; conversely a lack of physical activity has been clearly demonstrated to increase the risk of several non-communicable diseases. Individuals who walk 10 000 steps per day or more are likely to meet recommended physical activity guidelines. Very little is known about the physical activity levels of doctors at work, in particular those working in busy Emergency Departments (ED). Our primary objective was to determine how many steps per shift doctors working in a South African ED took. The secondary objectives were to assess what factors influenced the number of steps taken. Methods This was a prospective observational cohort study undertaken at Helen Joseph Hospital ED, Johannesburg, South Africa over a one-month period. The 32 participating doctors wore pedometers during their day shifts in the ED and the number of steps taken during their shifts were measured; as well as the number and triage category of patients seen; and whether chest compressions were performed. Results The median number of steps taken per shift was 6328 (Interquartile Range [IQR] 4646-8409). This was significantly less than the 10 000 recommended steps per day (p<0.0001). In only 11.7% (37/317) of shifts did the number of steps taken exceed the target of 10 000 steps. Factors which significantly increased the number of steps taken included shift duration and the performance of chest compressions. Each additional hour of shift led to a mean increase of 600 steps (95% CI: 548-772 steps). The mean number of steps for shift with chest compressions was 8308 (95% CI:7479- 9137) while the mean number of steps for shifts without chest compressions was 6503 (95% CI: 6121-6885). A low patient per hour rate was shown with an average rate, for all participants over the one month period of 0.9. Conclusions The results show that doctors working in the ED are not achieving the recommended number of daily steps while at work. Failing to meet the current physical activity guidelines can be explained by the overall low rate of patients seen per hour as well as the general layout of the ED. With little time outside of working hours for exercise and further physical activity, achieving the desired steps per day seems unlikely, which could potentially increase the risk of ill health and burnout.Item Physical activity and sedentary behaviour patterns in patients with knee osteoarthritis(2017) Kaoje, Yusuf SuleimanObjective: Physical activity (PA) is recommended in the management of osteoarthritis (OA) to reduce pain and improve function. Total volumes of PA and sedentary behaviour (SB) have been described in people with knee OA, but detailed information about the patterns of accumulation of PA and SB in knee OA populations is lacking. The purpose of this study was to objectively assess the patterns of accumulation of PA and SB and to explore associations with subjectively measured functional outcomes and quality of life in patients with knee OA. Methods: End-stage knee OA patients (n = 87, 65 ± 8.8 (mean ± SD) years, body mass index 34.4 ± 7.8 kg/m2) with Kellgren-Lawrence-defined grade 3-4 radiographic OA, wore an Actigraph and an activPAL accelerometer for 24 hours a day for 7 consecutive days. Total volumes of SB, light physical activity (LPA), moderate to vigorous physical activity (MVPA), and different bouts of SB, LPA, and MVPA were assessed. Self-report questionnaires were used to assess patient-experienced pain, function, quality of life and activities of daily living were the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and the Knee Injury Osteoarthritis Outcome Score (KOOS). Results: Of the 87 knee OA patients only 76 and 65 had complete Actigraph and activPAL data respectively. The participants had a mean (SD) age of 65.0 (8.8) years, were mostly women and most were classified as being obese with an average BMI of 34.4 (7.8) kg/m2. The Actigraph mean (95% CI) of awake wear time was 15.6 (15.1-16) hours/day, SB 10.9 (10.5-11.4) hours/day, LPA 4.5 (4.1-5) hours/day and MVPA 8.2 (3.3-13) min/day. Approximately 7% of patients met the current recommended PA guidelines. The activPAL mean (95% CI) of sitting time, standing time, stepping time and number of steps were 9.3 (8.5 – 10.1) hours per day, 5.0 (4.4 – 5.6) hour per day, 76.5 (66.6 – 86.3) minutes per day and 2489 (2130 – 2848) minutes per day respectively. There were variations in the hourly patterns of movement behaviours. Participants were significantly less sedentary between 6 am and 9 am compared to the grand mean of sedentary time per hour over the day (p<0.01) and were significantly more sedentary per hour from 3 pm to 7 pm (p<0.05). Significant correlations were found between WOMAC pain scores and Actigraph measured SB (r=0.277, p=0.031), LPA (r=-0.240, p=0.043), MVPA (r=-0.242. p=0.042), number of steps (r=-0.282, p=0.020), number of breaks in bouts of SB greater than 20 minutes (r=-0.292, x p=0.016), average duration of breaks in SB (r=-0.277, p=0.024), average duration of MVPA bouts (r=-0.326, p=0.012). Significant correlations were also found between WOMAC activity of daily living scores and Actigraph measured LPA (r=-0.206, p=0.048), MVPA (r=-0.246, p=0.029), number of steps (r=-0.286, p=0.010) and average duration of MVPA bouts (r=-0.383, p=0.002). Significant correlations were found between WOMAC pain scores and activPAL sitting time (r=0.029, p=0.02), and stepping time (r=-0.029, p=0.01), between self-reported WOMAC activity of daily living score and stepping time (r=-0.309, p=0.02), between KOOS activity of daily living score and stepping time (r=-0.276, p=0.004), and between KOOS quality of life score and stepping time (r=-0.263, p=0.008). Conclusion: This study describes novel detail of the patterns of activity and sedentary behaviour in patients with knee OA. The use of two accelerometers gives a detailed account of daily activity and the variation throughout the day, highlighting when interventions to improve activity might be most effective. Therefore, interventions should target the long bouts of inactivity in this population. Since even healthy populations of older adults struggle to meet current recommended PA guidelines, it may be important to shift attention from meeting recommendations of MVPA to creating feasible suggestions of doing more light activity and breaking more sedentary time in knee OA patients.Item Physical activity context preferences of HIV-positive individuals at United Bulawayo hospitals(2016) Exavier, KamitsaAim: the aim of the research was to determine the physical activity context preferences of HIV-positive individuals at United Bulawayo Hospitals (UBH). Objectives: the objectives of the research were to identify the physical activity format, location and social setting preferences of HIV-positive individuals at UBH. We also wanted to determine the association between physical activity context preferences and self-reported health status. Methodology: the research team had 109 participants at UBH’s opportunistic infections clinic taking part in the study. Besides responding to socio-demographic questions, they also indicated, on a Likert scale, the extent of agreement or disagreement with a preference for each of the 19 contexts relating to format, location and social setting. One of the questions on the socio-demographic section requested them to rate their health status. Descriptive statistics were used to describe, organise and summarise data and they included frequencies and percentages for categorical data, descriptions of central tendency (mean) and descriptions of relative position (range and standard deviation) for continuous data. Kendall’s tau b analysis was done to determine if there was an association between the preference for the 19 physical activity contexts and self-reported health status. Results: the respondents agreed with a preference for all the physical activity contexts except for activities that are vigorous or involve competition. There was no association between the preferences for all the 19 physical activity contexts and self-reported health status except the preference for activities that are done with people of the same gender. Conclusion and recommendations: policy makers and healthcare practitioners should take note of the preferred physical activity contexts by HIV-positive individuals. Future investigations should explore the stage of HIV infection so that physical activity context preferences at every stage of the disease are known. Future studies should also include members of the society who are economically advantaged as most of the participants live below the poverty datum level.Item The efficacy of a 12-week exercise intervention in 11-16 year old adolescents with autism spectrum disorder(2016-10-17) Neophytou, NataliaBACKROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, which often results in an array of motor impairments. These motor impairments often lead to reduced performance in activities of daily living (ADLs) as well as in societal tasks which require specific motor abilities and skills. Individuals with ASD have also been reported to have significantly lower physical activity levels compared to typically developing individuals. Motor impairments and these lower physical activity levels have led to various health problems including obesity, cardiovascular disease and insulin resistance syndrome. It may therefore be necessary to intervene in the population, to reduce sedentary-related health risks as well as attempt to improve motor impairments. Since exercise has been shown to be an effective therapeutic modality in reducing motor impairments and improving cardiovascular fitness, the efficacy of exercise interventions within the ASD population needs to be established. OBJECTIVE: To determine the efficacy of a 12 week exercise intervention by assessing the change in posture, body composition, balance, coordination, agility, gait and physical fitness pre- and post-exercise intervention in adolescents with autism aged 11 to 16 years. METHODS: A randomised control trial was conducted to assess the efficacy of an exercise intervention programme in 27 adolescents with ASD (mental age 5.6 ± 1.8 years). The sample was divided into 2 groups (intervention (n=16) and control (n=11)) using randomisation software. Validation of a 12-week exercise intervention was conducted by an expert panel via an online form. The intervention included an aerobic warm up, upper, core and lower body exercises, balance exercises, agility drills, fine motor skill training and a brief aerobic cooldown. All participants were tested pre- and post-intervention, and the intervention group participated in the exercise intervention bi-weekly for 12 weeks, while the control group received their usual standard care. Posture was assessed using a posture grid, and scores out of 10 were given per body area, where good posture = 10, average posture = 5 and poor posture = 0. Body composition, and physical fitness were assessed using the Brockport Physical Fitness Test (BPFT), and balance and coordination were assessed using the MABC-2 test and checklist. Gait was assessed using Dartfish two-dimensional video analysis, and agility was assessed using a standard agility T-test. Data analysis was performed using Stata version 13.1. Descriptive data were expressed as means and standard deviations. To compare variables during pre-and post- intervention within groups for continuous variables, the Wilcoxon signed-rank test was used. To compare variables during pre and post intervention within groups, for categorical variables, Mc Nemar’s test for symmetry was used. Fisher’s exact test was used for categorical variables. Significance was accepted at 95% (p< 0.05). RESULTS: Overall compliance to the intervention was 88.78%; high functioning individuals demonstrated 97.24% compliance, while low functioning individuals demonstrated 77.89% compliance. Posture: there was a significant increase in the overall posture scores (p=0.0004), specifically in the ankle area (p=0.0183) in the intervention group. Cardiovascular fitness: the intervention group showed significant decreases in resting systolic blood pressure (p=0.0069), and systolic blood pressure taken one minute following exercise (p=0.0007). A significant decrease in resting Heart rate (p=0.0046), as well as in heart rate taken one minute following exercise (p=0.0096) was also seen. Anthropometry: although the intervention groups’ weight and body fat percentage did not significantly decrease, there was a significant reduction in BMI (p=0.0130) post intervention. Strength: handgrip strength significantly increased in the non-dominant hand only (p=0.0289), yet there was an overall increase in strength in both hands. The intervention group improved significantly in the amount of curl-ups they were able to perform following the intervention (p=0.0094). Flexibility: for the majority of the flexibility parameters, no significant changes were seen from pre to post testing besides in the intervention group for the sit and reach test for the non-dominant limb (p=0.0088). Manual dexterity: In the MABC-2 test (for age-band 3) there was a significant difference seen in the intervention group (p = 0.200) for the turning pegs item for the non-dominant hand in the intervention group. Coordination: a significant difference was seen in the intervention (p=0.0007) and control group (p=0.0112) for the throwing activity. No conclusive information regarding the efficacy of exercise for this component was however noted. Balance: the intervention group was able to hold their balance for a significantly (p=0.0028) longer time post intervention (17.0 ± 11.0 s) compared to pre intervention (10.5 ± 9.2 s) in the two-board balance task. Agility: there was a significant (p=0.0061) improvement in the agility times from pre (27.4 ± 12.1s) to post (23.0 ± 9.9s) intervention in the intervention group. Gait: there were no significant differences seen following the intervention for all gait parameters. CONCLUSION: A 12 week exercise intervention significantly improved overall posture, cardiovascular fitness, BMI, hamstring flexibility, coordination, balance and agility in individuals with ASD. Handgrip strength and manual dexterity also improved . This therefore suggests that exercise may be a viable therapeutic intervention in the ASD population.Item Risk factors and the effect of physical activity modification for ischemic heart disease in individuals living with HIV(2015-04-21) Roos, RonelBackground: Individuals infected with the human immunodeficiency virus (HIV) are living longer due to effective disease management with highly active antiretroviral therapy (HAART). International literature suggest that mortality in people living with HIV and AIDS (PLWHA) is shifting to non-AIDS defining diseases such as cardiovascular disease. It is suggested that PLWHA are at an increased risk for developing ischemic heart disease (IHD) due to HIV mediated processes, traditional risk factors of IHD and factors related to HAART exposure. In the South African context risk factors for IHD are reported to be on the increase in the general population but published information regarding the risk factors for IHD in PLWHA is limited. Human immunodeficiency virus infection is a significant Sub-Saharan Africa challenge with 5.26 million people living in South Africa (SA) reported to be infected with HIV. Only Swaziland, Lesotho and Botswana report higher prevalence rates of HIV infection. Due to the high prevalence rate of HIV in SA, the reported increase in risk factors for IHD in the general population and the suggested increased risk for IHD in PLWHA, screening these risk factors in PLWHA in the South African context may be necessary. Innovative prevention strategies for IHD are also required to manage the risk for IHD in PLWHA in SA due to the high prevalence rate. A home-based education and pedometer walking programme could be such a strategy. The aims of the research project were therefore firstly to screen selected risk factors for IHD in PLWHA attending a primary care clinic and secondly to evaluate said individuals’ self-perception regarding their risk of IHD. Lastly the project set out to determine the effects of an individualised education and home-based pedometer walking programme on the risk of IHD as a potential prevention management strategy for IHD in PLWHA. Methodology: The research project consisted of four studies divided into phase 1 (study 1, 2, 3) and phase 2 (study 4). The study aims, methods and data analysis approaches were: Study 1: Aimed to screen a sample of PLWHA (on HAART) for physical activity and selected risk factors of IHD using the Yamax SW200 pedometer and other appropriate methods respectively. This study was an observational study and data analysis consisted of descriptive analysis and reviewing associations with univariate logistic regression analysis. A p–value less than 0.05 was considered statistically significant. Study 2: Aimed to evaluate participants’ self-perception and behaviour in relation to the risk of IHD using a semi-structured interview and card sort technique. This study was a qualitative study and data analysis consisted of descriptive and conventional content analysis. Study 3: Aimed to develop the education physical activity diary that was used in phase 2. The methodological processes included a literature review, a review of the education material to be included in the physical activity diary by an academic peer–review panel, review by a clinician working with PLWHA and a sample of PLWHA. Following these activities the diary was constructed and translated into isiZulu. Study 4: Aimed to assess the effects of an education and home-based pedometer walking programme on the risk factors of IHD in a sample of PLWHA (on HAART) with an increased risk for IHD as determined in study 1. The study was a randomised controlled trial consisting of an intervention and control group. Assessments were done at baseline, six and 12 months. Control participants continued with standard clinic care and were phoned once a month for five months during the baseline and six month interval. The intervention participants received a Yamax SW200 pedometer, an education physical activity diary, individualised walking programme and had once a month face-to-face education sessions in the baseline to six month interval. Intervention participants were instructed to continue with their physical activity modification programme during the six to 12 months period. No contact was made with control or intervention participants during this time. Intention-to-treat analysis was the primary approach for study 4. Data analysis consisted of descriptive analysis (mean [±SD] and frequencies [percentages]) and randomisation to group allocation was assessed using a two sample/ independent t-test or Wilcoxon rank–sum (Mann– Whitney) for non-normally distributed continuous data. Categorical data were evaluated with the Pearson Chi Square test. A p–value less than 0.05 was considered statistically significant. To evaluate the effect of time on outcomes assessed, repeated measures ANOVA for within-group changes were performed. To evaluate the effect of the programme on outcomes assessed, repeated measures ANCOVA with baseline values as co-variates were performed to highlight the between-group effect. To assess the associations between dependent variables and the time and intervention/control interaction the pedometer data were log-transformed due to skewness. The generalised estimation equation (GEE) and mixed effects model (MEM) approaches were used to fit the univariate and multivariable models. The correlation structure selected was the exchangeable option with the identity link function suitable for Gaussian data. The relationship between high sensitivity C-reactive protein (hs-CRP) at baseline and evaluated risk factors for IHD was assessed with the Pearson correlation coefficient and univariate logistic regression in MEM respectively on log-transformed hs-CRP. Results: Study 1: Two hundred and five PLWHA (on HAART) were screened for selected risk factors for IHD. The demographic characteristics of participants consisted of the following: mean age (38.2 [±9.5] years), gender (men [n=47; 22.9%] and women [n=158; 77.1%]), most participants had a secondary educational level (n=95; 46.3%), were employed (n=115; 56.1%) and were supporting dependents (n=158; 85.4%). The majority of participants perceived their general health as good (n=120; 58.5%), but felt their body shape had changed in the last six months (n=123; 60%). This was mostly due to a reported increase in weight (n=132; 64.4%). The mean time on HAART was 8.7 (±2.3) months, with the majority of participants being diagnosed as HIV positive between 2009 to 2011 (n=134; 66%). The majority of participants were on Lamivudine, Efavirenz and Tenofovir (n=139; 67.8%) therapy with a mean CD4 count of 285.1 (±157) cells/mm3 and viral load of 12 513.2 (±59 710.6) copies/ml. The physical activity levels of participants were reduced with the mean pedometer step count per day found to be 7 673.2 (±4 017.7) with men being more active (10 076.3 [±4 885.6] steps per day) than women (6 993.3 [±3 462.6] steps per day). The majority of study participants (n=150; 77%) took less than 10 000 steps per day. Taking less than 10 000 steps per day was related to waist circumference (WC) (odds ratio=1.04; 95% CI: 1.00–1.08; p=0.03) when adjusted for age and gender. Eight participants (3.9%) participated in formal sporting activities that were supervised and 123 participants (60%) tried to incorporate exercise into their daily lives. The preferred activity method for exercise was walking (n=56; 45.5%) and running (n=33; 26.8%). Perceived stress was moderately high with a mean Cohen’s Perceived Stress score at 19.2 (±7.8) with women reporting higher levels of stress (20 [±7.1]) than men (16.9 [±9.1]). A family history of IHD was low in participants (n=29; 14.2%) as well as a known diagnosis of diabetes mellitus (n=1; 0.005%), hypertension (n=19; 9%) and current smoking status (n=33; 16.1%). The majority of participants reported not being able to consume fish weekly (n=114; 55.6%) and reported weekly consumption of fruit and vegetables (n=110; 53.7%). Few participants were able to consume three to five vegetables and fruit combined per day (n=68; 33.2%). The mean resting heart rate (RHR) of the sample was slightly elevated (82.7 [±11.4] bpm) with having a RHR ≥ 80 bpm related to diastolic blood pressure (DBP) (odds ratio=1.07; 95% CI: 1.03–1.11; p<0.00) and physical activity (odds ratio=0.99; 95% CI: 0.99–0.99; p=0.02) as adjusted for age and gender. The sample as a whole was overweight with a mean body mass index (BMI) of 25.6 (±1.4) kg/m2. Having a BMI ≥ 25 kg/m2 was related to systolic blood pressure (SBP) (odds ratio=1.07; 95% CI: 1.04–1.10; p<0.00), WC (odds ratio=1.34; 95% CI: 1.22–1.46; p<0.00), hip circumference (odds ratio=1.53; 95% CI: 1.38–1.75; p<0.00) and CD4 count (odds ratio=1.00; 95% CI: 1.00–1.01; p=0.01) as adjusted for age and gender. Study 2: Thirty PLWHA (on HAART) were purposefully sampled according to the following criteria: individuals had to be on HAART for six to 12 months, between the ages of 20 and 65 years and ambulatory without an assistive device with no pre-existing history of cardiovascular disease, mental illness, current acute infection, current pregnancy or breast-feeding women. The demographic details of participants were as follows: median age 36.5 (31.8–45.0) years; women (n=25; 83.3%) and men (n=5; 16.7%); the majority of participants (n=16; 53.3%) had a secondary school education, were employed (n=17; 56.7%) and were supporting dependents (n=26; 86.7%). Knowledge and understanding related to IHD, insight into own risk for IHD and health character in the HIV context were identified as three prominent themes. An important finding that the study highlighted was that participants did not perceive themselves to be at risk for IHD due to being HIV+ or using HAART in any way. The majority of participants (n=15; 50%) did not perceive themselves to be at risk for IHD due to reporting having adequate coping behaviour and living a healthy lifestyle. Twelve (40%) participants did however perceive a risk for IHD due to physical symptoms experienced and their behaviour consisting of a poor diet, elevated stress levels and lack of exercise. Three (10%) participants were unsure concerning their risk for IHD in the future. Study 3: A selection of pages from the education physical activity diary can be found in Appendix 31. Study 4: Eighty four PLWHA (on HAART) participated in study 4. The education and home-based walking programme implemented in study 4 was successful in improving physical activity levels in both the control and intervention groups, as participants’ pedometer-determined step-count increased from baseline. The within-group change at six months were statistically significant (p=0.03) for both groups but not so for the 12 month period (control group [p=0.33] and intervention group [p=0.21]). It was however of clinical value in the intervention group, due to the group exceeding the step count aim of the programme, that being 3 000 steps above baseline at each assessment point. Translating the step count into time, would amount to approximately 30 minutes of added walking per day. The group therefore reached the Public Health recommendations for physical activity. Social support in the form of encouragement, motivation and participation from friends and family was noted as important enablers that assisted intervention participants to adhere to their programme. No significant differences were observed in the sociodemographic profile, HIV related clinical markers and antiretroviral therapy and IHD risk factors evaluated at baseline. The study highlighted that inflammation (hs-CRP) was a significant risk factor for IHD in the study cohort due to mean baseline values of 8.6 (±8.4) mg/l in the intervention and 5.4 (±6.5) mg/l in the control group. Inflammation (hs-CRP) was related to perceived stress (Pearson correlation [r=0.23; p=0.03] and MEM univariate logistic regression [log B=0.04; 95% CI: 0.0004– 0.08; p=0.03]), weight (Pearson correlation [r=2.8; p=0.01] and MEM univariate logistic regression [log B=0.02; 95% CI: 0.01–0.04; p=0.01]), BMI (Pearson correlation [r=0.35; p<0.00] and MEM univariate logistic regression [log B=0.07; 95% CI: 0.03–0.12; p<0.00]), WC (Pearson correlation [r=0.28; p=0.01] and MEM univariate logistic regression [log B=0.03; 95% CI: 0.06–0.36; p=0.01]) and hip circumference (Pearson correlation [r=0.28; p=0.01] and MEM univariate logistic regression [log B=0.02; 95% CI: 0.01–0.04; p=0.01]). The risk for IHD according to Framingham Risk Score (FRS) calculation was low as baseline FRS points were 3.3 (±6.5) points in the control group and 2.5 (±6.5) points in the intervention group. The education and home-based walking programme was effective in increasing physical function capacity (six-minute walk test mean difference: 15.70 [±9.33] meters), reducing waist: hip ratio (mean difference of -0.003 [±0.01] cm), reducing glucose level (mean difference of -0.12 [±0.09] mmol/l) and increasing HDL (mean difference of 0.07 [±0.05] mmol/l) as evaluated during betweengroup analysis. The within-group analysis indicated that a significant reduction in SBP occurred in both groups at the six months time period (control group: p=0.03 and intervention group: p<0.00). A slight increase in BMI occurred in both groups at the six and 12 month period that were statistically significant (p<0.00). A significant reduction in total cholesterol (p=0.04) and LDL (p<0.00) at the 12 month period were also noted in the control group. The log-transformed univariate logistic regression model highlighted many associations between the interaction (time and treatment: control or intervention group effect) and secondary outcomes assessed. The inverse associations between perceived stress levels (p<0.00) and BMI (p=0.02) with the six month time interval of the control and intervention groups compared to baseline control findings were confirmed during multivariable analysis in the log-transformed GEE model. Additionally an inverse association between perceived stress levels (p<0.00), BMI (p<0.00), LDL (p=0.01) and triglycerides (TG) (p=0.01) at the six month time interval of the intervention group compared to baseline control findings were confirmed in the multivariable analysis in the logtransformed MEM model. Conclusion: This project showed that physical inactivity, elevated perceived stress levels, inadequate diet of fruit, vegetable and fish intake, elevated RHR, increased BMI and raised hs-CRP were risk factors for IHD in the study cohort. These risk factors screened indicated an elevated risk for IHD in the future even though the FRS demonstrated a low risk for IHD. An IHD predictive model that incorporate hs-CRP when evaluating risk for IHD and which has been validated for use in PLWHA is therefore necessary to adequately evaluate the risk for IHD in this population. This is especially of relevance in the South African context considering the prevalence of HIV infection in women and the association of female gender with hs-CRP as indicated in the literature. The project highlighted that an elevated stress level was a significant risk factor for IHD in the study cohort and was also given as one reason why participants perceived themselves to be at risk for IHD. The positive association between perceived stress and hs-CRP was also of value. The stress lowering effect of the education and home-based pedometer walking programme was therefore of significant importance as it could manage this risk factor. Additionally if stress declines it could potentially also influence hs-CRP in the long term. The study therefore contributes to the body of knowledge related to the effects of exercise on psychological parameters in PLWHA. Additionally the project confirmed that an optimistic bias in individuals living with HIV is present regarding their future possibility for developing IHD. Their perception for the risk for IHD did not always align with the risk factors present as screened. This might be due to the fair application of knowledge related to IHD when evaluating their risk for IHD. It also confirmed that education strategies are needed to explain the risk factors for IHD and how HIV infection and HAART influence these risk factors of IHD. Lastly the project found that an education and individualised home-based pedometer walking programme was able to influence physical activity levels positively and was successful in reducing the risk of some factors for IHD in PLWHA at primary care level. Such a programme can be implemented as an innovative method to manage risk factors for IHD in PLWHA by physiotherapists especially in regions where physiotherapy numbers are low and HIV prevalence high.