Qualitative Insights from an Online Community-Based Exercise Intervention for Persons Living with HIV

Francisco Ibanez-Carrasco¹Kiera McDuff²George Da Silva³Ahmed M Bayoumi^4,5,6Soo Chan Carusone⁷Mona Loutfy^5,6,8Ada Tang⁹Puja Ahluwalia³Lisa Avery^1,10Kelly K. O'Brien^11,2,6*

• ¹Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
• ²Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
• ³Realize Canada, Toronto, Ontario, Canada
• ⁴MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada
• ⁵Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
• ⁶Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
• ⁷McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
• ⁸Women's College Research Institute (WCRI), Toronto, Ontario, Canada
• ⁹School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
• ¹⁰Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
• ¹¹Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada

Introduction: Online community-based exercise (CBE) is a rehabilitation strategy that can promote health outcomes among people living with HIV. Our aim was to describe experiences implementing a community-based exercise (CBE) intervention with adults living with HIV.We conducted a longitudinal qualitative descriptive study involving interviews with adults living with HIV and persons implementing an online tele-coaching CBE intervention. Leveraging community-based research principles, the intervention aimed to improve physical activity engagement and health outcomes through online individualized coaching, online YMCA resources, and wearable fitness technology. We analyzed interviews with adults living with HIV and representatives involved in CBE implementation at baseline (month 0), end of intervention (6 months), and end of follow-up phase (12 months).Results: Thirteen adults living with HIV and eight representatives involved in CBE implementation participated in the study (43 interviews total). Key themes included the "four Cs": Cost, Care, Comfort, and Convenience that encapsulated participants' perceptions of financial barriers, need for holistic healthcare integration, importance of stigma-free and emotionally supportive environments, and accessibility of health interventions.Discussion: Results underscore the critical role of inclusive and adaptable exercise programs in addressing the complex needs of individuals with chronic, episodic conditions like HIV, and the value of participatory, community-driven methodologies in designing effective and equitable health interventions.