title: Are you ready? Exploring readiness to engage in exercise among people living with HIV and multimorbidity in Toronto, Canada: a qualitative study.
abstract: OBJECTIVE
  Our aim was to explore readiness to engage in exercise among people living with HIV and multimorbidity.
  
  
  METHODS
  We conducted a descriptive qualitative study using face-to-face semistructured interviews with adults living with HIV.
  
  
  METHODS
  We recruited adults (18 years or older) who self-identified as living with HIV and 2 or more additional health-related conditions from a specialty hospital in Toronto, Canada.
  
  
  METHODS
  14 participants with a median age of 50 years and median number of 9 concurrent health-related conditions participated in the study. The majority of participants were men (64%) with an undetectable viral load (71%).
  
  
  METHODS
  We asked participants to describe their readiness to engage in exercise and explored how contextual factors influenced their readiness. We analysed interview transcripts using thematic analysis.
  
  
  RESULTS
  We developed a framework to describe readiness to engage in exercise and the interplay of factors and their influence on readiness among adults with HIV and multimorbidity. Readiness was described as a diverse, dynamic and fluctuating spectrum ranging from not thinking about exercise to routinely engaging in daily exercise. Readiness was influenced by the complex and episodic nature of HIV and multimorbidity comprised of physical impairments, mental health challenges and uncertainty from HIV and concurrent health conditions. This key factor created a context within which 4 additional subfactors (social supports, perceptions and beliefs, past experience with exercise, and accessibility) may further hinder or facilitate an individual's position along the spectrum of readiness to exercise.
  
  
  CONCLUSIONS
  Readiness to engage in exercise among people living with HIV is a dynamic and fluctuating construct that may be influenced by the episodic nature of HIV and multimorbidity and 4 subfactors. Strategies to facilitate readiness to exercise should consider the interplay of these factors in order to enhance physical activity and subsequently improve health outcomes of people with HIV and multimorbidity.
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alya
authors.initials: A
authors.lastname: Simonik
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kyle
authors.initials: K
authors.lastname: Vader
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Denine
authors.initials: D
authors.lastname: Ellis
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dirouhi
authors.initials: D
authors.lastname: Kesbian
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Leung
authors.affiliation: Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jachyra
authors.affiliation: Casey House, Toronto, Ontario, Canada.
authors.forename: Soo
authors.initials: S
authors.lastname: Chan Carusone
authors.affiliation: Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: O'Brien
mesh_terms: D002170:Canada; D015897:Comorbidity; D004185:Disability Evaluation; D015444:Exercise; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010465:Perception; D036301:Qualitative Research; D057566:Self Report; D012944:Social Support
keywords: QUALITATIVE RESEARCH; REHABILITATION MEDICINE; episodic disability; exercise; multi-morbidity