{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:18:37Z","timestamp":1778656717150,"version":"3.51.4"},"reference-count":27,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,9,11]]},"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Lifestyle may be associated with risk behaviours. This study compares gym exercise and sexual risk behaviour between men who have sex with men (MSM) and heterosexual men. The research was based on the assumption that men who become muscular and physically attractive increase their number of sex partners and consequently their risk of HIV or other sexually transmitted infections (STIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Five gyms in central Tel Aviv, Israel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>In 2012, a sample of 182 (48%) MSM and 197 (52%) heterosexual men who train in gyms completed anonymous questionnaires regarding their training, health and sexual behaviours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Participants in this cross-sectional study who exercised more than the median number of anaerobic training hours were defined as performing intensive anaerobic training (IAT), and those who had performed more than one act of unprotected anal\/vaginal intercourse in the preceding 6\u2005months with a partner whose HIV status was unknown were defined as high risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>MSM showed a stronger desire to become muscular than heterosexual men, were more likely to perform IAT, and used protein powders or anabolic steroids. They reported that improving their body shape and increasing their self-confidence were their main reasons for training, whereas heterosexual men indicated weight loss and health improvement as the main reasons for training. MSM engaged in riskier sexual behaviour than heterosexual men. Of all the high-risk men, 61.9% (N=70) performed IAT, while 38.1% (N=43) performed moderate anaerobic training (p&lt;0.01). The association between IAT and sexual risk was stronger in MSM than in heterosexual men (p&lt;0.01 vs p=0.05, respectively). The interaction between MSM and IAT in high-risk participants was multiplicative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MSM practised more IAT than heterosexual men, and their interaction between IAT and sexual risk was multiplicative. The MSM community could benefit from a holistic approach to sexual health and its association with body image and IAT. The gym MSM culture demonstrates how internal dynamics and social norms are possible factors driving MSM to high-risk behaviour for HIV\/STI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study registration<\/jats:title>\n                    <jats:p>The study was approved by the Wolfson Hospital Review Board, Holon, Israel (WOMC-0058-09).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2014-005205","type":"journal-article","created":{"date-parts":[[2014,11,24]],"date-time":"2014-11-24T23:30:59Z","timestamp":1416871859000},"page":"e005205","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Gym exercising patterns, lifestyle and high-risk sexual behaviour in men who have sex with men and in heterosexual men"],"prefix":"10.1136","volume":"4","author":[{"given":"Z","family":"Mor","sequence":"first","affiliation":[{"name":"Ramla Health Department, Ministry of Health, Ramla, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K","family":"Parfionov","sequence":"additional","affiliation":[{"name":"Eating Disorders Unit, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Department of Epidemiology, Faculty of Medicine, Ben Gurion University in the Negev, Beer Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Davidovitch","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Faculty of Medicine, Ben Gurion University in the Negev, Beer Sheva, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I","family":"Grotto","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Faculty of Medicine, Ben Gurion University in the Negev, Beer Sheva, Israel"},{"name":"Public Health Services, Ministry of Health, Jerusalem, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2014,11,24]]},"reference":[{"key":"2025121407502594000_4.11.e005205.1","doi-asserted-by":"publisher","DOI":"10.1080\/00918369.2011.540184"},{"key":"2025121407502594000_4.11.e005205.2","unstructured":"Badinter E . XY: on masculinity identity. (L. Davis, Trans) New York, NY: Columbia University Press, 1995."},{"key":"2025121407502594000_4.11.e005205.3","first-page":"238","article-title":"Body image, well-being and sexual satisfaction: a comparison between heterosexual and gay men","volume":"22","author":"Sharon","year":"2007","journal-title":"Sex Relationship Ther"},{"key":"2025121407502594000_4.11.e005205.4","doi-asserted-by":"publisher","DOI":"10.1177\/002214650804900405"},{"key":"2025121407502594000_4.11.e005205.5","doi-asserted-by":"crossref","unstructured":"Halikits PN . Masculinity in the age of AIDS seropositive gay men and the \u201cbuff agenda\u201d. In: Nardi P , ed. Coming on strong: gay masculinities. Newbury Park, CA: Sage, 1999:130\u201351.","DOI":"10.4135\/9781452233987.n7"},{"key":"2025121407502594000_4.11.e005205.6","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1037\/1524-9220.4.2.100","article-title":"Macho man: narcissism, homophobia, agency, communition, and authoritarianism-a comparative study among Israeli bodybuilders and a control group","volume":"4","author":"Rubinstein","year":"2007","journal-title":"Psychol Men Masculinity"},{"key":"2025121407502594000_4.11.e005205.7","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3149\/jmh.0301.27","article-title":"Masculinity, body image, and sexual behavior in HIV-seropositive gay men: a two-phase formative behavioral investigation using the internet","volume":"3","author":"Halkitis","year":"2004","journal-title":"Int J Mens Health"},{"key":"2025121407502594000_4.11.e005205.8","doi-asserted-by":"publisher","DOI":"10.1007\/s11199-008-9416-4"},{"key":"2025121407502594000_4.11.e005205.9","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1046\/j.1360-0443.2002.00031.x","article-title":"Use of anabolic steroids and associated health risks among gay men attending London gyms","volume":"97","author":"Bolding","year":"2001","journal-title":"Addiction"},{"key":"2025121407502594000_4.11.e005205.10","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.162.2.263"},{"key":"2025121407502594000_4.11.e005205.11","unstructured":"U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. http:\/\/www.health.gov\/paguidelines\/factsheetprof.aspx (accessed 19 May 2013)."},{"key":"2025121407502594000_4.11.e005205.12","unstructured":"Israeli Centres for Disease Control and Prevention. Health Status in Israel. Tel Hashomer, Israel: Ministry of Health, Publication #333, 2011."},{"key":"2025121407502594000_4.11.e005205.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2005.04.004"},{"key":"2025121407502594000_4.11.e005205.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-003078"},{"key":"2025121407502594000_4.11.e005205.15","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1097\/00002030-200207260-00011","article-title":"High- risk sexual behavior increases among London gay men between 1998 and 2001: what is the role of HIV optimism?","volume":"16","author":"Elford","year":"2000","journal-title":"AIDS"},{"key":"2025121407502594000_4.11.e005205.16","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1136\/sextrans-2011-050048","article-title":"High risk behavior in steady and in casual relationships among men who have sex with men in Israel","volume":"87","author":"Mor","year":"2011","journal-title":"Sexually Transm Infect"},{"key":"2025121407502594000_4.11.e005205.17","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1177\/00333549071220S107","article-title":"Surveillance of HIV risk and prevention behaviors of men who have sex with men-a national application of venue-based, time-space sampling","volume":"122","author":"MacKellar","year":"2007","journal-title":"Public Health Rep"},{"key":"2025121407502594000_4.11.e005205.18","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/00224490802204456","article-title":"Sexual practices of gay, bisexual, and other non-identified MSM attending New York City gyms: patterns of serosorting, strategic positioning, and context selection","volume":"45","author":"Halkitis","year":"2000","journal-title":"J Sex Res"},{"key":"2025121407502594000_4.11.e005205.19","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2011-050290"},{"key":"2025121407502594000_4.11.e005205.20","doi-asserted-by":"publisher","DOI":"10.1258\/ijsa.2008.008061"},{"key":"2025121407502594000_4.11.e005205.21","doi-asserted-by":"publisher","DOI":"10.1207\/s15327752jpa6601_2"},{"key":"2025121407502594000_4.11.e005205.22","doi-asserted-by":"publisher","DOI":"10.1207\/s15327752jpa6203_1"},{"key":"2025121407502594000_4.11.e005205.23","doi-asserted-by":"publisher","DOI":"10.1300\/J082v47n03_03"},{"key":"2025121407502594000_4.11.e005205.24","doi-asserted-by":"publisher","DOI":"10.3149\/jms.1503.331"},{"key":"2025121407502594000_4.11.e005205.25","doi-asserted-by":"publisher","DOI":"10.1007\/s10508-006-9059-x"},{"key":"2025121407502594000_4.11.e005205.26","doi-asserted-by":"publisher","DOI":"10.1080\/00224490701808142"},{"key":"2025121407502594000_4.11.e005205.27","doi-asserted-by":"publisher","DOI":"10.1093\/hsw\/hlu023"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2014-005205","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T15:50:33Z","timestamp":1765727433000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2014-005205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2014,11,24]]},"published-print":{"date-parts":[[2014,11]]}},"alternative-id":["10.1136\/bmjopen-2014-005205"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2014-005205","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11]]}}}