Table 1 Themes, subthemes and illustrative quotes of participants

Recommendation by health professional

“Well, my doctor mentioned that I must be physically active but I don’t usually do that but I never sit at home. I’m always working, I farm. Exercise is not something that I choose to do.”

“I realise that walking and things, it’s quite important if I do go to the centre in Pinetown. I don’t take the lifts. I use the stairs and I find that’s important because last year I had to undergo a major operation and the doctor wanted to know, do you ever go up a flight of stairs instead of the lift? It’s really important.”

“My doctor only advised me to remain physically active and not to allow myself to sit most of the time so that I don’t experience most of the negative effects of this sickness.”

Personal gratification

“Well I never thought about it, but it’s something I don’t think I can shy away from, because it will add another value to my life. I believe that psychologically it works you up because if you are 24/7 at home you keep on thinking of the small minor stupid things. And then whatever you are doing in order to boost yourself because of the worries that you have, then it takes a big toll. By the time you take tablets if ever you are taking tablets, they are not doing much because you are still stuck in that mystery that you are thinking about, you know. But maybe exercises help you to become fresher. I would say that it is a good thing to do because, as I’ve said, you won’t keep on thinking about stupid things most of the time because once you take tablets and then sometimes you are not going anywhere you sit down, then all these things are coming back but maybe if you are doing exercise, it goes away.”

“Without a doubt (referring to exercise) that’s the one reason I am still living today.”

“No one advised me on exercising. I took it upon myself to be physically active because I saw the need to. When I take my walks, I come back home feeling stronger and lighter and I’m able to spend more time in the garden doing some farming till it becomes dark outside.”

Activities of daily living as a driver

“Yes, I love farming. I have chickens at home. I wake up in the morning and clean the house and take care of the chickens. I’m very active. Remove the weeds and dirt in the garden. I water the garden as well and clean up after the chickens as well.”

“Weekly I’ve got a job at home. I’m doing my garden with my wife. Yesterday we were cleaning up the potatoes and today I’m going for my beans and tomorrow morning I’m going up to my daughter’s house in Pretoria to plant beans for my daughter because only me and my wife work in the garden. My daughters and sons know nothing about the garden. So, my job is to do the garden.”

“Anytime in the day I work in my garden. I can go home now and go work in my garden. Later on I watch the news at about 13:00. After 13:00 I come back in feed my fowls, clean the yard. Every day, I must feed my fowls. I look out for my goats. I walk around and see down in the garden and pull the wires and the poles.”

Community participation in a religious context

“Yes, it does happen that I walk long distances, especially on Sundays where I attend church. It’s very far from home.”

“At my church we do run around. I do a lot of running at church, worshipping at a Zion church. I definitely run. Everyone participates in church”

“A lot of work, yes. I even play the drums there or clap my hands as a form of instrument.”

Family responsibility and influence

“I would also keep very active when my grandchild was alive. I would bath him and exercise with him.”

“Yes exactly, my granddaughter, she does soccer so she trains most of the time, so when she’s at home to do what she does, she finds me lying (down) and she will… you know… she sorts of helps me in lot of things. I love to exercise with her.”

“I’m active and I wake up early. I live with my grandchildren and I always take them to school in the morning. One of my grandchildren, who is eight years old, I give her a bath and prepare her myself for school. I don’t mind working till the sun sets—I have no problem at all.”

HIV-related stigma

“Okay, and then in hindsight, say that you do have the facilities for exercise and people outside, they will be able identify that the people who are exercising here are the people who are HIV-positive. Well actually, I for one, even though this is something at times I’m not comfortable to talk about, and I can imagine if someone out there will have that notion, you know those people who are doing exercises there, those are the people who are HIV-positive and to demoralise the effort that you have and then… you know. This thing I don’t know where the bloody hell does this thing come from.”

“No no no, I’m not comfortable exercising in a group. I don’t have a friend; or rather, in my community they know that I fetch medication (referring to ARTs) but I never discuss this matter with anyone.”

Physical health issues

“It’s only one reason, sir. I enjoy it in such a way that, whether it hurts or not, I still do it again. The only thing that distances me from exercise is the pain in my back. There is a new pain that I never ever had before.”

“You see, my child, what would interrupt me usually would be the problem I experience in my legs. As we are older, we experience joint pains. Joint pains, muscle tension, when I can’t walk. That would usually prevent me.”

“Yes, I definitely enjoyed it (exercise) but the issue is that I got tired. But eventually I realised that I need to get up and start moving. My body is failing me and it’s too heavy to handle. You know if I exercise I feel that my blood is flowing and I feel good and become better.”

Personal circumstances

“The issue is that it is not easy because many people live under one roof. My children, the father of the house. Well the reason could be that I’m tired because the work that I do is quite a lot, you see. Sometimes, when it’s time to go to bed at night, I just want to go to bed, I don’t want to exercise because I’m tired.”

“Taking care of my home and my grandchildren means I am busy all day…morning till night. I have no time for exercise.”

“There is no urgency for me to exercise because I’m not experiencing complications and I’m feeling fine. I’m not really the running type and it’s not something that I did whilst growing up. Even when I walk, I cannot walk at a fast pace.”

Lack of proper instruction

“That’s my problem. Up until today I love to exercise but I’ve never been instructed thoroughly about it…up to date about the situation. Yes, that is what is worrying me.”

“I try to exercise but I don’t feel I am doing the right things, or enough. I try to read up on what to do but it’s not the same. Someone must show me how to do the exercise—the right guidance is important.”

Environmental factors

“If the time permits then I wouldn’t have a problem to attend exercise sessions. Another thing, it would be nice if there was a place where you install equipment in the community so we can exercise together and not me alone because there are many people who are in a similar situation as me—it’s very important.”

“I also want to run in a safe area. I don’t run in dangerous places where its dark.”

Aerobic exercise

“I realise that walking is quite important, especially if I do go to the centre in Pinetown, I don’t take the lifts. I use the stairs and I find that’s important because last year I had to undergo a major operation, so the doctor wants to know, do you ever go up a flight of stairs? So it’s really important.”

“Definitely, the walking has helped my heart to keep on pumping the right way. I’ve seen the difference. I’ve seen it.”

“I’m 58 years old and walking has definitely improved mobility and joint pains.”

Aerobic and flexibility

“Well, sometimes, I wake up at 5:00 am in the morning. Then I start around 5:30, am going to 6:00 am. So that by the time my grandchildren are awake I’m already done with my running and stretching.”

“Before I go to work, my children and I, we exercise a bit. Maybe we do 25 kicks and we move our bodies counting 25 times for each workout.”

Aerobic and strength

“I still do them, press-ups and walking. I do it every day, not as many press-ups as I used to, but I still do it.”

“Running helps me build stamina. When you engage in an exercise like running and some strength activity and you begin to like it you don’t tire easily. Nothing prevents me from running and doing strength exercises.”

Group exercise

“Walking together in a group or exercising together in a group is more beneficial. You forget about exercising and before you know you are done exercising.”

“Definitely, I prefer to exercise in a group. That’s where we get encouragement from and forget about the pain and stresses and we all go on this journey of exercising together.”

“If you create a programme that I can attend in a group and exercise in this hospital, then I would definitely attend. It will help me to be with my friends too.”