A qualitative study to explore perceptions of exercise as a smoking cessation tool among people with HIV who smoke...

Cigarette smoking remains disproportionately prevalent among people with HIV (PWH) and contributes substantially to preventable morbidity and mortality. Although exercise confers many health benefits, little is known about how PWH who smoke perceive exercise as a strategy to support smoking cessation. The purpose of this qualitative study was to explore barriers and facilitators to smoking cessation and exercise engagement, with particular attention to exercise as a potential cessation-support strategy.

Within this qualitative study, PWH were recruited from HIV clinics in Colorado and New England between September 2025 and February 2026, and were eligible if they were aged ≥21 years and current smokers. Guided by the Health Belief Model (HBM) and the Social Ecological Model (SEM), semi-structured interviews were transcribed verbatim and analyzed using a hybrid deductive-inductive framework.

Ten PWH (50.6 ± 8.8 years) participated. Participants demonstrated high awareness of smoking-related harms yet described persistent individual and structural barriers to quitting. Exercise was frequently perceived as a supportive strategy that reduced cravings, improved mood, and provided behavioral structure, particularly when embedded in socially supportive contexts. Multilevel barriers included addiction, stress, physical limitations, limited organizational attention to exercise, and resource constraints. Facilitators included peer accountability, structured group exercise, supportive counseling, and environmental incentives. Emergent themes highlighted behavioral substitution and autonomy as important.

PWH who smoke perceive exercise not only as a health behavior but as a potential cessation-support strategy when delivered within socially connected and autonomy-respecting environments. Additional work is needed to develop multidisciplinary interventions that may enhance smoking cessation efforts.