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Cook P, Jankowski C, Erlandson KM, Reeder B, Starr W, Flynn Makic MB. Low- and High-Intensity Physical Activity Among People with HIV: Multilevel Modeling Analysis Using Sensor- and Survey-Based Predictors. JMIR Mhealth Uhealth 2022; 10:e33938. [PMID: 35436236 PMCID: PMC9135322 DOI: 10.2196/33938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/13/2022] [Accepted: 02/17/2022] [Indexed: 01/02/2023] Open
Abstract
Background
High-intensity physical activity improves the health of people with HIV. Even when people have good intentions to engage in physical activity, they often find it difficult to maintain physical activity behavior in the long term. Two Minds Theory is a neurocognitive model that explains gaps between people’s intentions and behaviors based on the operations of 2 independent mental systems. This model predicts that everyday experiences will affect physical activity and that factors outside people’s awareness, such as sleep and stress, can have particularly strong effects on physical activity behaviors.
Objective
We designed this study to test the effects of daily experiences on physical activity among people with HIV, including measures of people’s conscious experiences using daily electronic surveys and measures of nonconscious influences using sensor devices.
Methods
In this study, 55 people with HIV wore a Fitbit Alta for 30 days to monitor their physical activity, sleep, and heart rate variability (HRV) as a physiological indicator of stress. Participants also used their smartphones to complete daily electronic surveys for the same 30 days about fatigue, self-efficacy, mood, stress, coping, motivation, and barriers to self-care. Time-lagged, within-person, multilevel models were used to identify the best prospective predictors of physical activity, considering the daily survey responses of people with HIV and sensor data as predictors of their physical activity the following day. We also tested baseline surveys as predictors of physical activity for comparison with daily variables.
Results
Different people had different average levels of physical activity; however, physical activity also varied substantially from day to day, and daily measures were more predictive than baseline surveys. This suggests a chance to intervene based on day-to-day variations in physical activity. High-intensity physical activity was more likely when people with HIV reported less subjective fatigue on the prior day (r=−0.48) but was unrelated to actual sleep based on objective sensor data. High-intensity physical activity was also predicted by higher HRV (r=0.56), indicating less stress, lower HIV-related stigma (r=−0.21), fewer barriers to self-care (r=−0.34), and less approach coping (r=−0.34). Similar variables predicted lower-level physical activity measured based on the number of steps per day of people with HIV.
Conclusions
Some predictors of physical activity, such as HRV, were only apparent based on sensor data, whereas others, such as fatigue, could be measured via self-report. Findings about coping were unexpected; however, other findings were in line with the literature. This study extends our prior knowledge on physical activity by demonstrating a prospective effect of everyday experiences on physical activity behavior, which is in line with the predictions of Two Minds Theory. Clinicians can support the physical activity of people with HIV by helping their patients reduce their daily stress, fatigue, and barriers to self-care.
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Affiliation(s)
- Paul Cook
- College of Nursing, University of Colorado, Aurora, CO, United States
| | | | | | - Blaine Reeder
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Whitney Starr
- School of Medicine, University of Colorado, Aurora, CO, United States
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Hanley S. Primary prevention of cardiovascular disease in South African women living with HIV. S Afr Fam Pract (2004) 2019; 61:273-275. [PMID: 31897325 PMCID: PMC6939387 DOI: 10.1080/20786190.2019.1657268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The colliding epidemics of HIV and cardiovascular disease (CVD) are of great public health concern. People living with HIV (PLHIV) are more predisposed to CVD development as a result of a multitude of contributors. Women living with HIV (WLHIV) appear to be at a higher risk of developing CVD given a heightened immune activation and, in South Africa particularly, a higher body mass index compared with their male counterparts. The World Health Organization (WHO) has made recommendations for the provision of a CVD risk assessment for all PLHIV and has developed regional CVD prediction charts to identify PLHIV who may require primary prevention strategies by means of interventions such as the WHO Package of Essential Non-communicable Disease Interventions for primary health care in low-resource settings (WHO PEN). However, methods of risk prediction and risk reduction integrated strategies for atherosclerotic CVD in PLHIV such as the WHO PEN, particularly in women who may have sex-specific risk factors and culture-specific perceptions of body image, remain a major research gap in developing countries. Further research is crucial in guiding primary health care policy in South Africa.
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Affiliation(s)
- S Hanley
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Umlazi Clinical Research Site, Nelson R Mandela School of Medicine, Durban, South Africa
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Davies TL, Gompels M, Johnston S, Bovill B, May MT. Mind the gap: difference between Framingham heart age and real age increases with age in HIV-positive individuals-a clinical cohort study. BMJ Open 2013; 3:e003245. [PMID: 24163202 PMCID: PMC3808785 DOI: 10.1136/bmjopen-2013-003245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To measure the excess risk of cardiovascular disease (CVD) in HIV-positive individuals by comparing 'heart age' with real age and to estimate associations of patients' characteristics with heart age deviation (heart age-real age). DESIGN Clinical Cohort Study. SETTING Bristol HIV clinic, Brecon Unit at Southmead Hospital, Bristol, UK. PARTICIPANTS 749 HIV-positive adults who attended for care between 2008 and 2011. Median age was 42 years (IQR 35-49), 67% were male and 82% were treated with antiretroviral therapy. MAIN OUTCOME MEASURES We calculated the Framingham 10-year risk of CVD and traced back to 'heart age', the age of an individual with the same score but ideal risk factor values. We estimated the relationship between heart age deviation and real age using fractional polynomial regression. We estimated crude and mutually adjusted associations of sex, age, CD4 count, viral load/treatment status and period of starting antiretroviral therapy with heart age deviation. RESULTS The average heart age for a male aged 45 years was 48 years for a non-smoker and 60 years for a smoker. Heart age deviation increased with real age and at younger ages was smaller for females than males, although this reversed after 48 years. Compared to patients with CD4 count <500 cells/mm(3), heart age deviation was 2.4 (95% CI 0.7 to 4.0) and 4.3 (2.3 to 6.3) years higher for those with CD4 500-749 cells/mm(3) and ≥750 cells/mm(3), respectively. CONCLUSIONS In HIV-positive individuals, the difference between heart age and real age increased with age and CD4 count and was very dependent on smoking status. Heart age could be a useful tool to communicate CVD risk to patients and the benefits of stopping smoking.
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Affiliation(s)
- Teri-Louise Davies
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Fuchs SC, Alencastro PR, Ikeda MLR, Barcellos NT, Wolff FH, Brandão ABM, Ximenes RAA, Miranda-Filho DDB, Lacerda HR, de Albuquerque MDFPM, Montarroyos UR, Nery MW, Turchi MD. Risk of coronary heart disease among HIV-infected patients: a multicenter study in Brazil. ScientificWorldJournal 2013; 2013:163418. [PMID: 24223499 PMCID: PMC3809373 DOI: 10.1155/2013/163418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 09/03/2013] [Indexed: 11/18/2022] Open
Abstract
Cardiovascular disease has emerged as a crescent problem among HIV-infected population. This study aimed to determine the 10-year risk of coronary heart disease using the Framingham risk score among HIV-infected patients from three regions of Brazil. This is a pooled analysis of three cohort studies, which enrolled 3,829 individuals, 59% were men, 66% had white skin color, and mean age 39.0 ± 9.9 years. Comparisons among regions showed that there were marked differences in demographic, socioeconomic, clinical, and HIV-related characteristics. Prevalence of Framingham score ≥10 was 4.5% in the Southern, 4.2% in the Midwest, and 3.9% in the Northeast of Brazil. The Framingham score ≥10 was similar between regions for males, patients aged ≥60 years, with obesity, central obesity, hypertension, and diabetes mellitus. Women were three times more likely to have coronary heart disease in 10 years than men. Hypertension and diabetes increased more than four times the risk of coronary heart disease, followed by central obesity, obesity, and prehypertension. The use of antiretroviral agents and time since HIV diagnosis were not risk factors for coronary artery disease in 10 years. In conclusion, hypertension and diabetes are the strongest independent predictors of 10-year risk of coronary heart disease among HIV-infected population.
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Affiliation(s)
- Sandra C. Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Clinical Research Center, No. 5 Andar, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil
- Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, 90035-003 Porto Alegre, RS, Brazil
- National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
| | - Paulo R. Alencastro
- National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
| | - Maria Letícia R. Ikeda
- Postgraduate Studies Program in Cardiology, School of Medicine, Clinical Research Center, No. 5 Andar, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil
| | - Nêmora T. Barcellos
- Postgraduate Studies Program in Cardiology, School of Medicine, Clinical Research Center, No. 5 Andar, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil
- National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
| | - Fernando H. Wolff
- Postgraduate Studies Program in Cardiology, School of Medicine, Clinical Research Center, No. 5 Andar, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, 90035-903 Porto Alegre, RS, Brazil
- National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
| | - Ajácio B. M. Brandão
- National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
| | - Ricardo A. A. Ximenes
- National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
- Department of Clinical Medicine, Universidade de Pernambuco, 50670-901 Recife, PE, Brazil
| | - Demócrito de B. Miranda-Filho
- National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
- Department of Clinical Medicine, Universidade de Pernambuco, 50670-901 Recife, PE, Brazil
- Department of Tropical Medicine, Universidade Federal de Pernambuco, 50610-110 Recife, PE, Brazil
| | - Heloísa Ramos Lacerda
- Department of Tropical Medicine, Universidade Federal de Pernambuco, 50610-110 Recife, PE, Brazil
| | | | | | - Max W. Nery
- Institute of Tropical Pathology and Public Health, Universidade Federal de Goiás, 74605050 Goiania, GO, Brazil
| | - Marilia D. Turchi
- National Institute for Health Technology Assessment (IATS/CNPq), Hospital de Clinicas de Porto Alegre, 90035-903 Porto Alegre, RS, Brazil
- Institute of Tropical Pathology and Public Health, Universidade Federal de Goiás, 74605050 Goiania, GO, Brazil
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