1
|
Ogundunmade BG, John DO, Chigbo NN. Ensuring quality of life in palliative care physiotherapy in developing countries. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1331885. [PMID: 38463610 PMCID: PMC10920222 DOI: 10.3389/fresc.2024.1331885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
Palliative care (PC) focuses on the body, mind, and spirit and can also provide pain and symptom relief, clarifying and focusing the provision of care on the patient's desires and goals, and helping them understand their disease and its treatment plans. Although PC is widely recognized for its applicability near the end of life or during terminal illness, it is also applicable and beneficial for patients with diseases in their earlier stages. Near the end of life, palliative care often focuses on providing continual symptom management and supportive care. Although palliative care has been noted to improve some life expectancy, its primary aim is to improve quality of life via focusing on the comfort of the patient, maintaining dignity, reducing intensive care utilization, and avoidance of expensive hospitalizations. One major challenge to quality of life for patients in PC is the physical and functional decline that occurs with disease progression. These issues can be addressed by specialized PC physiotherapy. Uniform provision of high-quality PC services (and physiotherapy in palliative care) faces substantial challenges in resource-challenged settings, including low- and middle-income countries. When properly integrated into PC teams and adequately supported, physiotherapy within PC can address common symptoms (pain, breathlessness, weakness) and assist patients to remain in an adapted home setting to optimize their quality of life, safety, and dignity.
Collapse
Affiliation(s)
| | - Davidson Okwudili John
- Department of Physiotherapy, Faculty of Health Sciences and Technology, David Umahi Federal University of Health Science, Uburu, Nigeria
| | - Nnenna Nina Chigbo
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Enugu, Nigeria
| |
Collapse
|
2
|
Gilles de la Londe J, Aïm-Eusébi A, Cadwallader D, Rincon Murillo G, Cadwallader JS, Aubert JP. The Experience of HIV-Positive Transgender Women Engaging in Physical Activity: An Interpretative Phenomenological Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3541-3552. [PMID: 37452265 DOI: 10.1007/s10508-023-02655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
Regular physical activity should benefit HIV-positive transgender women because they are a particularly vulnerable population. However, engaging in physical activity seems particularly difficult among this population. To inform the development of interventions to increase adherence to physical activity, we explored perceptions of physical activity in 10 semi-structured interviews with HIV-positive transgender women. Interviews were subjected to a qualitative approach named interpretative phenomenological analysis (IPA). Inspired by Cooley's theory, we chose to illustrate the results according to a three-level structure, i.e., confronting oneself to oneself with a specific identity, then confronting oneself with others on an interpersonal level, and eventually confronting oneself with society as a normative frame through the specific prism of physical activity, and thus relationship to one's body. The idea of practicing physical activity meant for them: having to face what they tried to be kept hidden, being ostracized by the cis population, and facing social heteronormativity. The fears about health were mostly about HIV and the transitioning process side effects. The psychological issues were mostly about the fear of developing male shaped bodies and worsened by traumatic life stories. External factors were often related to the passing concept and violence caused by stigma and discrimination. The group appeared as a strong motivation factor, facilitating self-acceptance and socialization.
Collapse
Affiliation(s)
| | - Amélie Aïm-Eusébi
- Département de Médecine Générale, Université Paris Cité, Paris, France
| | | | | | - Jean Sébastien Cadwallader
- Department of General Practice, Sorbonne University, Paris, France.
- Institut Pierre Louis d'Épidémiologie Et de Santé Publique, INSERM, Sorbonne University, 75012, Paris, France.
| | - Jean Pierre Aubert
- Département de Médecine Générale, Université Paris Diderot, Paris, France
| |
Collapse
|
3
|
Dos Santos ECM, de Lima LRA, Yoong S, Guerra PH, Segurado AC. Home-based interventions to promote physical activity for people living with HIV - a systematic review. AIDS Care 2023; 35:25-34. [PMID: 35735412 DOI: 10.1080/09540121.2022.2091102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although physical activity (PA) improves the physical, mental, and social outcomes of people living with HIV (PLH), multiple barriers prevent them from exercising. In this systematic review, we investigated the effect of home-based interventions to promote physical activity (HBI) among PLH. Randomised trials and quasi-experimental studies published in English until March 2020 were sought in five databases. Independent reviewers performed data extraction, risk of bias assessment and pragmatic-explanatory (PRECIS-2) evaluation of study characteristics. Outcomes included engagement in PA, body composition, cardiorespiratory fitness, strength, metabolic disturbances, and quality of life (QoL). Out of 480 retrieved references, six studies met inclusion criteria. Interventions lasted 12-48 weeks and involved 400 individuals (57.8% women). Ninety-eight (24.5%) participants completed interventions, but dropout rates varied considerably (5.0-54.5%). Resulted showed increased PA (two studies) and improved cardiorespiratory fitness or strength (three and two studies, respectively). Four studies demonstrated reduction of waist circumference and increase in lean body mass. QoL improved in two of three studies. We conclude HBI (aerobic and/or resistance exercises) may contribute to improve PA and/or cardiorespiratory fitness, body composition, strength and QoL of PLH. Further investigation using multi-centre standardised protocols is warranted to provide stronger evidence of their effectiveness in health promotion for PLH.
Collapse
Affiliation(s)
| | | | - Serene Yoong
- Faculty of Health, Art and Design, Swinburne University of Technology, Hawthorn, Australia
| | | | - Aluisio Cotrim Segurado
- Department/Division of Infectious Diseases (LIM-49), Faculdade de Medicina, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
4
|
Chetty L, Cobbing S, Chetty V. The perceptions of older people living with hiv/aids towards physical activity and exercise. AIDS Res Ther 2022; 19:67. [PMID: 36575436 PMCID: PMC9795653 DOI: 10.1186/s12981-022-00500-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Older people living with HIV (OPLWH) require significant levels of support, including healthcare and rehabilitation interventions. People living with HIV are living longer, but still experience health-related impairments that affect functional activity, participation in day-to-day interactions, livelihoods and overall quality of life. Physical activity and exercise should be included as part of the comprehensive medical management for OPLWH but the investigation of prior studies reveal a gap in understanding and prescription. Our study aimed to explore the perceptions of OPLWH about physical activity and exercise. METHODS The study adopted a phenomenological, qualitative design, using in-depth interviews, to understand OPLWH perceptions of physical activity and exercise, and their need for, and access to, physical activity and exercise programmes in a community in South Africa. Nine [9] males and seven [7] females participated in the study. RESULTS Sixteen individuals voluntarily participated in face-to-face, semi-structured interviews which took place at the healthcare facility where they received regular treatment. All participants were 50 years and older. Personal gratification and the ability to perform activities of daily living as well as participate in community activities were believed to be strong motivators for exercise participation, while barriers to exercise were attributed to physical health issues; lack of proper instruction as well as stigma associated with HIV status within their communities. Participants also favored a combination of aerobic, flexibility and strength activities, as well as proper supervision and instruction within a group exercise setting. CONCLUSION The qualitative nature of our study provided an in-depth understanding of the perceptions of OPLWH towards physical activity and exercise. Our study highlighted the factors that hinder adherence to physical activity and exercise in this population. Many indicated that they would love to engage in structured physical activity programmes, but did not know where, when or how to begin. Creating a suitable environment with proper supervision and instruction by suitably qualified health professionals are essential when developing a community-based exercise programme for OPLWH.
Collapse
Affiliation(s)
- Levin Chetty
- grid.16463.360000 0001 0723 4123Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 Westville South Africa
| | - Saul Cobbing
- grid.16463.360000 0001 0723 4123Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 Westville South Africa
| | - Verusia Chetty
- grid.16463.360000 0001 0723 4123Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 Westville South Africa
| |
Collapse
|
5
|
Pires KL, Baranda MSDM, Brum TMA, Pessôa B, Pupe CCB, do Nascimento OJM. HIV-associated painful neuropathy: where are we? ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:607-615. [PMID: 35946704 PMCID: PMC9387191 DOI: 10.1590/0004-282x-anp-2021-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND After the advent of combination antiretroviral therapy, infection with the human immunodeficiency virus (HIV) ceased to be a devastating disease, but sensory neuropathy resulting from the permanence of the virus and the side effects of treatment have worsened the morbidities of these patients. OBJECTIVE To investigate the quality of life of 64 HIV-positive patients: 24 with painful neuropathy (case group) and 40 without painful neuropathy (control group). The impact of other factors on quality of life was also assessed. METHODS To assess painful neuropathy, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, Douleur Neuropathique 4 (DN4) questions and Neuropathy Disability Score (NDS) were used. The Short Form Health Survey (SF-36) scale was used to assess quality of life. Factors related or unrelated to HIV were obtained through the medical history and analysis on medical records. RESULTS The quality of life of patients with neuropathic pain was worse in six of the eight domains of the SF-36 scale. The number of clinical manifestations related to HIV, length of time with detectable viral load since diagnosis, length of time since the diagnosis of HIV infection and length of time of HAART use had a negative impact on quality of life. Higher levels of CD4, education and family income had a positive impact. CONCLUSIONS Painful neuropathy related to HIV is a factor that worsens the quality of life of patients infected with this virus and should be included in the clinical evaluation.
Collapse
Affiliation(s)
- Karina Lebeis Pires
- Universidade Federal Fluminense, Departamento de Neurologia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Neurologia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
| | | | - Talita Mota Almeida Brum
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Neurologia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
| | - Bruno Pessôa
- Universidade Federal Fluminense, Departamento de Neurocirurgia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
| | - Camila Castelo Branco Pupe
- Universidade Federal Fluminense, Departamento de Neurologia, Unidade de Pesquisa Clínica, Niterói RJ, Brazil
| | | |
Collapse
|
6
|
Ibeneme SC, Uwakwe VC, Myezwa H, Irem FO, Ezenwankwo FE, Ajidahun TA, Ezuma AD, Okonkwo UP, Fortwengel G. Impact of exercise training on symptoms of depression, physical activity level and social participation in people living with HIV/AIDS: a systematic review and meta-analysis. BMC Infect Dis 2022; 22:469. [PMID: 35578192 PMCID: PMC9109396 DOI: 10.1186/s12879-022-07145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Symptoms of depression are prevalent in people living with human immune deficiency virus/acquired immune deficiency syndrome (PLWHA), and worsened by lack of physical activity/exercises, leading to restriction in social participation/functioning. This raises the question: what is the extent to which physical exercise training affected, symptoms of depression, physical activity level (PAL) and social participation in PLWHA compared to other forms of intervention, usual care, or no treatment controls? Method Eight databases were searched up to July 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Only randomised controlled trials involving adults who were either on HAART/HAART-naïve and reported in the English language, were included. Two independent reviewers determined the eligibility of the studies, extracted data, assessed their quality, and risk of bias using the Physiotherapy Evidence Database (PEDro) tool. Standardised mean difference (SMD) was used as summary statistics for the mean primary outcome (symptoms of depression) and secondary outcomes (PAL and social participation) since different measuring tools/units were used across the included studies. Summary estimates of effects were determined using a random-effects model (I2). Results Thirteen studies met the inclusion criteria with 779 participants (n = 596 participants at study completion) randomised into the study groups, comprising 378 males, 310 females and 91 participants with undisclosed gender, and with an age range of 18–86 years. Across the studies, aerobic or aerobic plus resistance exercises were performed 2–3 times/week, at 40–60 min/session, and for between 6-24 weeks, and the risk of bias vary from high to low. Comparing the intervention to control groups showed significant difference in the symptoms of depression (SMD = − 0.74, 95% confidence interval (CI) − 1.01, − 0.48, p ≤ 0.0002; I2 = 47%; 5 studies; 205 participants) unlike PAL (SMD = 0.98, 95% CI − 0.25, 2.17, p = 0.11; I2 = 82%; 2 studies; 62 participants) and social participation (SMD = 0.04, 95% CI − 0.65, 0.73, p = 0.91; I2 = 90%; 6 studies; 373 participants). Conclusion Physical exercise training could have an antidepressant-like effect in PLWHA but did not affect PAL and social participation. However, the high heterogeneity in the included studies, implies that adequately powered randomised controlled trials with clinical/methodological similarity are required in future studies. Trail Registration number INPLASY202040048. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07145-4.
Collapse
Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria. .,Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa. .,University of Nigeria, University of Nigeria Centre for Clinical Trials (UNNCET), 1 College Road, New Layout, Enugu, 400001, Nigeria. .,Department of Physiotherapy, Faculty of Health Sciences & Technology, King David University of Medical Sciences, Amasir i- Afikpo Road, Uburu, 491101, Ebonyi State, Nigeria.
| | - Victor Chukwuebuka Uwakwe
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria
| | - Hellen Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Franklin Onyedinma Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, 1 College Road, New Layout, Enugu, 400001, Nigeria
| | - Fortune Elochukwu Ezenwankwo
- Division of Exercise Science and Sports Medicine, University of Cape Town/Sports Science, Institute of South Africa, Boundary Road, Newlands, Cape Town, 7725, Western Cape, South Africa
| | - Tunde Adedayo Ajidahun
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, Gauteng, South Africa
| | - Amarachi Destiny Ezuma
- Department of Physiotherapy, University of Nigeria Teaching Hospital, KM 35 Enugu Port-Harcourt Expressway, Ituku/Ozalla, 400001, Enugu, Nigeria
| | - Uchenna Prosper Okonkwo
- Department of Medical Rehabilitation, Faculty of Health Sciences, Nnamdi Azikiwe University, Okofia, Nnewi Campus, Nnewi, 435101, Anambra State, Nigeria
| | - Gerhard Fortwengel
- Fakultat III, Hochschule Hannover - University of Applied Sciences and Arts, Expo Plaza, Hannover, 30539, Lower Saxony, Germany
| |
Collapse
|
7
|
Chisati EM, Constantinou D, Lampiao F. Effects of maximal strength training on bone mineral density in people living with HIV and receiving anti-retroviral therapy: a pilot study. BMC Sports Sci Med Rehabil 2020; 12:67. [PMID: 33110607 PMCID: PMC7585307 DOI: 10.1186/s13102-020-00216-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/18/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Anti-retroviral therapy (ART) is associated with low bone mineral density (BMD) among people living with HIV (PLWHIV). Although physical activity is recommended for improving bone health in patients with reduced BMD, data on effects of strength exercises on low BMD among PLWHIV is scarce. This study therefore aimed to determine the effects of a 12 weeks maximal strength training (MST) on BMD among PLWHIV in Blantyre, Malawi. METHODS Twenty-six PLWHIV with reduced BMD were randomised into a training group (TG, n = 15) and control group (CG, n = 11). The TG underwent 12 weeks of MST consisting of 4 sets of 3 to 5 repetitions at 85-90% of one repetition maximum (1RM) 3 times per week. The CG was advised to maintain their usual lifestyle. Measurements of BMD using dual-energy X-ray absorptiometry, 1RM using a squat machine, heart rate using a heart rate monitor, weight, height and body mass index were obtained before and after the intervention in the TG and CG. Descriptive statistics and student's t - tests were used to analyse data. RESULTS The study was conducted for 12 weeks. Data of 24 participants [14 (TG) and 10 (CG)] were analysed. At base line, there were no significant differences in age (p = 0.34), height (p = 0.91), weight (p = 0.43) and body mass index (p = 0.34) between participants in the TG and the CG. After the intervention, there were significant improvements in lumbar BMD (p < 0.001) and resting heart rate (p = 0.03) in the TG compared to the CG. There were significant improvements in muscle strength (1 RM) in both the TG (p < 0.001) and the CG (p = 0.01). CONCLUSIONS MST improves lumbar BMD and strength in PLWHIV receiving ART in Blantyre, Malawi. MST with a shorter exercise duration of 12 weeks seem to have the potential in treating reduced BMD in PLWHIV. TRIAL REGISTRATION PACTR201712002889203. Registered with the Pan African Clinical Trial Registry on 22nd December, 2017 at www. pactr.org.
Collapse
Affiliation(s)
- Enock M. Chisati
- Department of Physiotherapy, College of Medicine, University of Malawi, Blantyre, Malawi
- Consortium for Advanced Research Training in Africa, Nairobi, Kenya
| | - Demitri Constantinou
- Center for Exercise Science and Sports Medicine, FIMS Collaborating Center of Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Fanuel Lampiao
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
- Africa Centre of Excellence in Public Health and Herbal Medicine, Blantyre, Malawi
| |
Collapse
|
8
|
Chisati EM, Munthali F, Constantinou D, Lampiao F. Physical activity levels among Malawian adults living with HIV and receiving anti-retroviral therapy. Malawi Med J 2020; 32:8-12. [PMID: 32733653 PMCID: PMC7366159 DOI: 10.4314/mmj.v32i1.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Despite increasing life expectancy among people living with HIV (PLWHIV), anti-retroviral therapy (ART) side effects, HIV chronic inflammation and co-morbidities may limit functional abilities and reduced participation in exercises and physical activity (PA). PA improves wellbeing and overall quality of life of PLWHIV. In Malawi, there is paucity of information regarding PA levels among Malawians living with HIV and receiving ART. Therefore, this study aimed at determining PA levels among PLWHIV and receiving ART in Malawi. Methods A quantitative cross-sectional design was employed. Eligible participants were male and female adults aged 18–45 years living with HIV receiving ART for at least 1 year. The participants were recruited from Limbe Health Center, Gateway Health Center and Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. The International Physical Activity Questionnaire (IPAQ) was used to assess the PA levels. A Stadiometer (HS-DBS00361, Model: 1127154) was used to measure weight (kg) and height (cm) of the participants. Results A total of 213 participants were recruited. There were more females than male participants (n=132 females). Overall, the mean age of all participants was 37±6.5 years and they were within normal body weight (BMI=23±4.0). Many participants (n=85, 40%) had low PA levels followed by those who were moderately physically active (n=75, 36%). A larger proportion of the female participants (51%) had low PA levels compared to males (22%). Forty-two percent of participants with 1–3 years of ART had low PA whereas 39% with >3 years ART had low PA. Conclusion Most PLWHIV and receiving ART in the sample have low PA levels. The study has also revealed that proportionally more females than males had low PA levels.
Collapse
Affiliation(s)
- Enock M Chisati
- Department of Physiotherapy, College of Medicine, University of Malawi, Blantyre, Malawi.,Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
| | | | - Demitri Constantinou
- Center for Exercise Science and Sports Medicine, FIMS Collaborating Center of Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Fanuel Lampiao
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi.,Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM)
| |
Collapse
|
9
|
Effects of Aerobic and Resistance Exercise on Cardiovascular Parameters for People Living With HIV: A Meta-analysis. J Assoc Nurses AIDS Care 2020; 30:186-205. [PMID: 30822291 DOI: 10.1097/jnc.0000000000000006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
People living with HIV (PLWH) have limited exercise capacity because of anemia, neuromuscular disorders, and pulmonary limitations. We used a meta-analysis to examine the effect of aerobic and resistance exercise alone and in combination on cardiovascular parameters. Subgroup meta-analyses were conducted and long-term effects of exercise were investigated. A systematic literature search was conducted up to July/August 2017. The Physiotherapy Evidence Database-scale was used to rate quality and assess the risk of bias on the papers. Standardized mean differences (SMDs) were calculated to assess the effect of exercise. Posttreatment comparison between the exercise and control groups revealed moderate and large effect sizes in favor of the intervention group for VO2max (SMD = 0.66, p < .0001) and the 6-minute walk test (SMD = 1.11, p = .0001). Exercise had a positive effect on cardiovascular parameters in PLWH. Exercise can be a prevention factor for PLWH dealing with multiple comorbidities.
Collapse
|
10
|
Chetty L, Cobbing S, Chetty V. Physical activity and exercise for older people living with HIV: a protocol for a scoping review. Syst Rev 2020; 9:60. [PMID: 32197654 PMCID: PMC7085181 DOI: 10.1186/s13643-020-01327-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/10/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Older people living with HIV (OPLWH) are expected to live longer in the era of antiretroviral treatment, but at the same time, they are at risk for developing various health complications as a consequence of a life with the infection, exposure to medications that carry their own toxicity and side effects, and the natural effects of aging on the immune system. Because senescence is an inherent process that can be accelerated by HIV, it is important to identify strategies that can modify this phenomenon. Emerging data suggests that while physical activity and exercise may not have a positive impact on viral replication and on the immune system of people living with HIV, it can elicit improvements in cardiorespiratory fitness, strength, body composition, and overall quality of life. The purpose of this study is to map out empirical evidence on the effects of physical activity and exercise in OPLWH. METHODS The scoping review methods will be guided by the framework proposed by the Joanna Briggs Institute guidelines. Literature searches will be conducted in the following electronic databases (from inception onwards): PubMed/MEDLINE, Cochrane Library, and Google Scholar. Peer-reviewed journal papers will be included if they are written in English, involved human participants aged 50 years, and older with HIV and described a measure for physical, mental, or functional status of physical activity/exercise and/or the recommendations in OPLWH. Quantitative, qualitative, and mixed-method studies will be included in order to consider different aspects of measuring the effects of physical activity and exercise (e.g., quality of life, functional status, activities of daily living). Two reviewers will screen all citations and full-text articles. We will abstract data, organize them into themes and sub-themes, summarize them, and report the results using a narrative synthesis. The study methodological quality (or bias) will be appraised using a Mixed Methods Appraisal Tool. DISCUSSION The evidence gathered from the selected studies will be discussed in relation to the research questions using a narrative to identify and explore emergent themes. The review will provide a baseline of evidence on exercise and physical activity interventions for OPLWH. It will highlight gaps regarding the use of exercise and physical activity and contribute to the design of an effective intervention approach to the rehabilitation of OPLWH. SYSTEMATIC REVIEW REGISTRATION Open Science Framework (https://osf.io/728kp/).
Collapse
Affiliation(s)
- Levin Chetty
- Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 South Africa
| | - Saul Cobbing
- Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 South Africa
| | - Verusia Chetty
- Discipline of Physiotherapy, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000 South Africa
| |
Collapse
|
11
|
Wojkowski S, Ahluwalia P, Radassao K, Wharin C, Walker G, Rushford N. Role-Emerging Clinical Placements in a Community-Based HIV Organization - Opportunities for Interprofessional Collaboration: A Case Report. Physiother Can 2019. [PMID: 31762548 DOI: 10.3138/ptc.2018-57.e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: We describe the development, implementation, and outcomes of role-emerging (RE) clinical placements at Positive Living Niagara (PLN), a community-based HIV organization (CBHIVO), for two second-year, entry-level Master of Science (Physiotherapy) (MSc[PT]) students from McMaster University. Client Description: A national, not-for-profit organization, Realize, conducted outreach to identify CBHIVOs interested in developing physiotherapy (PT) student placements. Intervention: PLN responded to the outreach and worked with McMaster's MSc(PT) programme and Realize to establish two part-time RE PT student placements. The placement description and expectations were developed collaboratively by PLN, Realize, and the MSc(PT) programme. All PT students participating in their third 6-week clinical placement were eligible to apply. A registered occupational therapist and physiotherapist and PLN's programme services manager participated in a shared model to supervise the students' clinical and administrative activities. Measures and Outcome: These first RE PT placements in a Canadian CBHIVO were completed between November and December 2016. The evaluation of the student and placement included a learning contract and the Canadian Physiotherapy Assessment of Clinical Performance. Over 6 weeks, the students collaborated with people living with HIV (PLWHIV) who were members of PLN to identify a role for physiotherapists at PLN and led two health promotion workshops for PLN's members and staff. Implications: The RE PT placement identified future opportunities for physiotherapists at PLN. The experience also influenced one student's decision to apply after graduation for a newly created PT position that included working with PLWHIV.
Collapse
Affiliation(s)
- Sarah Wojkowski
- School of Rehabilitation Science, McMaster University, Hamilton
| | | | | | - Caitlin Wharin
- University Health Network, Toronto Rehabilitation Institute - Lyndhurst Centre, Toronto
| | - Glen Walker
- Positive Living Niagara, St. Catharines, Ont
| | - Nancy Rushford
- School of Rehabilitation Science, McMaster University, Hamilton
| |
Collapse
|
12
|
Wojkowski S, Ahluwalia P, Radassao K, Wharin C, Walker G, Rushford N. Role-Emerging Clinical Placements in a Community-Based HIV Organization - Opportunities for Interprofessional Collaboration: A Case Report. Physiother Can 2019; 71:384-390. [PMID: 31762548 DOI: 10.3138/ptc-2018-57.e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: We describe the development, implementation, and outcomes of role-emerging (RE) clinical placements at Positive Living Niagara (PLN), a community-based HIV organization (CBHIVO), for two second-year, entry-level Master of Science (Physiotherapy) (MSc[PT]) students from McMaster University. Client Description: A national, not-for-profit organization, Realize, conducted outreach to identify CBHIVOs interested in developing physiotherapy (PT) student placements. Intervention: PLN responded to the outreach and worked with McMaster's MSc(PT) programme and Realize to establish two part-time RE PT student placements. The placement description and expectations were developed collaboratively by PLN, Realize, and the MSc(PT) programme. All PT students participating in their third 6-week clinical placement were eligible to apply. A registered occupational therapist and physiotherapist and PLN's programme services manager participated in a shared model to supervise the students' clinical and administrative activities. Measures and Outcome: These first RE PT placements in a Canadian CBHIVO were completed between November and December 2016. The evaluation of the student and placement included a learning contract and the Canadian Physiotherapy Assessment of Clinical Performance. Over 6 weeks, the students collaborated with people living with HIV (PLWHIV) who were members of PLN to identify a role for physiotherapists at PLN and led two health promotion workshops for PLN's members and staff. Implications: The RE PT placement identified future opportunities for physiotherapists at PLN. The experience also influenced one student's decision to apply after graduation for a newly created PT position that included working with PLWHIV.
Collapse
Affiliation(s)
- Sarah Wojkowski
- School of Rehabilitation Science, McMaster University, Hamilton
| | | | | | - Caitlin Wharin
- University Health Network, Toronto Rehabilitation Institute - Lyndhurst Centre, Toronto
| | - Glen Walker
- Positive Living Niagara, St. Catharines, Ont
| | - Nancy Rushford
- School of Rehabilitation Science, McMaster University, Hamilton
| |
Collapse
|
13
|
Tumusiime DK, Stewart A, Venter FWD, Musenge E. The effects of a physiotherapist-led exercise intervention on peripheral neuropathy among people living with HIV on antiretroviral therapy in Kigali, Rwanda. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1328. [PMID: 31535052 PMCID: PMC6739563 DOI: 10.4102/sajp.v75i1.1328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/24/2019] [Indexed: 11/08/2022] Open
Abstract
Background HIV-associated peripheral neuropathy (PN) is common in people living with HIV. Its management is mostly symptomatic utilising pharmacological approaches. Objectives This study determined the effects of an exercise intervention on PN among Rwandan people living with HIV receiving antiretroviral therapy (ART). Methods A 12-week single-blinded randomised controlled trial using the Brief Peripheral Neuropathy Screen (BPNS) as the assessment tool tested the effects of an exercise intervention on PN, followed by a 12-week non-intervention period. A total of 120 people with HIV- associated PN on ART were randomised to an exercise or no exercise group. Both groups continued receiving routine care. A bivariate analysis using Pearson’s chi-square test for significant differences in PN symptoms and signs, between groups, at baseline, after the 12 weeks intervention and 12 weeks post-intervention using generalised linear regression models to determine predictors of treatment outcomes was undertaken, utilising an intention-to-treat analysis (alpha p ≤ 0.05). Results At 12 weeks, the intervention group compared to the control: neuropathic pain 70% versus 94% (p < 0.005), PN symptoms severity – mild and/or none in 85% versus 60% (p < 0.001) and radiation of PN symptoms reduced, 80% versus 37% (p < 0.001). There were no differences in PN signs at 12 weeks intervention and at 12 weeks post-intervention. Having changed the antiretroviral (ARV) and having developed PN symptoms after the start on ARVs predicted treatment improvement, while demographic factors did not predict any treatment outcome. Conclusion A physiotherapist-led exercise intervention improved PN symptoms, but with non-significant improvement in PN signs. Factors related to early diagnosis and treatment of PN were facilitators for the improvement of PN symptoms. Clinical implications Physiotherapist-led exercises should be integrated into the routine management of people living with HIV on ART with PN symptoms.
Collapse
Affiliation(s)
- David K Tumusiime
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Aimée Stewart
- Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois W D Venter
- Witwatersrand Reproductive Health and HIV Institute (WRHI), Johannesburg, South Africa.,Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Eustasius Musenge
- Division of Biostatistics and Epidemiology, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
14
|
Sookan T, Motala A, Ormsbee M, Antonio J, Magula N, Lalloo U, McKune A. Improvement in Muscular Strength in HIV-Infected Individuals Receiving Antiretroviral Therapy. J Funct Morphol Kinesiol 2019; 4:E66. [PMID: 33467381 PMCID: PMC7739231 DOI: 10.3390/jfmk4030066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study investigated (1) the effect of a progressive resistance training (PRT) program and whey protein intake on maximal muscle strength in human immunodeficiency virus (HIV)-infected individuals receiving antiretroviral therapy (ART) and (2) alterations in maximal strength 12 wks after the cessation of PRT with continued supplementation. METHODS Sixty HIV-infected individuals were recruited. Whole body PRT was performed twice weekly for 12 wks. Participants received, in a double-blind placebo controlled manner, either 20 g whey or placebo (maltodextrin) before and immediately after each session. Both PRT groups continued to take either whey protein or placebo for a further 12 wks following the exercise intervention to examine the effects of detraining. RESULTS Forty participants (mean and standard deviation (SD) age 40.8 (±7.7) years, weight 70.8 (±16) kg, body mass index (BMI) 30.9 (±7.2) kg m2); whey protein /PRT (n = 13), placebo/PRT (n = 17), and a control group (n = 10) completed the study. A significant main effect for time occurred for the bench press (p = 0.02), the squat (p < 0.0001), the deadlift (p = 0.001) and the shoulder press (p = 0.02) one-repetition maximum (1RM) in the intervention groups. CONCLUSION The PRT program increased maximal strength regardless of whey protein intake. The detraining period demonstrated minimal strength loss, which is beneficial to this population.
Collapse
Affiliation(s)
- Takshita Sookan
- Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal College of Health Sciences, Durban 4000, KwaZulu Natal, South Africa; (M.O.); (A.M.)
| | - Ayesha Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal College of Health Sciences, Durban 4013, KwaZulu Natal, South Africa;
| | - Michael Ormsbee
- Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal College of Health Sciences, Durban 4000, KwaZulu Natal, South Africa; (M.O.); (A.M.)
- Department of Nutrition, Food, and Exercise Sciences, Florida State University, Tallahassee, FL 32306, USA
| | - Jose Antonio
- Exercise and Sport Science, Nova Southeastern University, Davie FL 33328, USA;
| | - Nombulelo Magula
- Department of Internal Medicine Durban, University of KwaZulu-Natal College of Health Sciences, Durban 4013, KwaZulu Natal, South Africa;
| | - Umesh Lalloo
- Department of Pulmonology Durban, University of KwaZulu-Natal College of Health Sciences, Durban 4013, KwaZulu Natal, South Africa;
| | - Andrew McKune
- Biokinetics, Exercise and Leisure Sciences, University of KwaZulu-Natal College of Health Sciences, Durban 4000, KwaZulu Natal, South Africa; (M.O.); (A.M.)
- Discipline of Sport and Exercise Science, University of Canberra, Canberra 2617, Australia
| |
Collapse
|
15
|
Ibeneme SC, Irem FO, Iloanusi NI, Ezuma AD, Ezenwankwo FE, Okere PC, Nnamani AO, Ezeofor SN, Dim NR, Fortwengel G. Impact of physical exercises on immune function, bone mineral density, and quality of life in people living with HIV/AIDS: a systematic review with meta-analysis. BMC Infect Dis 2019; 19:340. [PMID: 31014262 PMCID: PMC6480814 DOI: 10.1186/s12879-019-3916-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 03/18/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Compromised immune function, associated with human immune deficiency virus(HIV) infection, is improved by antiretroviral therapy(ART) which also decreases bone mineral density(BMD), and possibly the quality of life(QoL). However, physical(aerobic/resistance) exercises, were reported to induce reverse effects in uninfected individuals and were appraised in the literature for evidence of similar benefits in people living with HIV/AIDS(PLWHA). The main study objective was to evaluate the impact of physical (aerobic and resistance) exercises on CD4+ count, BMD and QoL in PLWHA. METHODS A systematic review was conducted using the Cochrane Collaboration protocol. Searching databases, up to June 2017, only randomized control trials investigating the effects of either aerobic, resistance or a combination of both exercise types with a control/other intervention(s) for a period of at least 4 weeks among adults living with HIV, were included. Two independent reviewers determined the eligibility of the studies. Data were extracted and risk of bias(ROB) was assessed with the Cochrane Collaboration ROB tool. Meta-analyses were conducted using random effect models using the Review Manager(RevMan) computer software. RESULTS Nineteen studies met inclusion criteria(n = 491 participants at study completion) comprising male and female with age range 22-66 years. Two meta-analyses across 13 sub-group comparisons were performed. However, there were no RCTs on the impact of physical exercises on BMD in PLWHA. The result showed no significant change in CD4+ count unlike a significant effect of 5.04 point(95%CI:-8.49,-3.74,p = 0.00001) for role activity limitation due to physical health(QoL sub-domain). Overall, the GRADE evidence for this review was of moderate quality. CONCLUSIONS There was evidence that engaging in moderate intensity aerobic exercises (55-85% Maximum heart rate-MHR), for 30-60 min, two to five times/week for 6-24 weeks significantly improves role activity limitation due to physical health problems, otherwise physical(aerobic or/and resistance) exercises have no significant effects on CD4+ count and other domains of QoL. Also, there is lack of evidence on the impact of exercises on BMD in PLWHA due to the paucity of RCTs. The moderate grade evidence for this review suggests that further research may likely have an important impact on our confidence in the estimate of effects and may change the estimate.
Collapse
Affiliation(s)
- Sam Chidi Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa
| | - Franklin Onyedinma Irem
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Nneka Ifeyinwa Iloanusi
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
| | - Amarachi Destiny Ezuma
- Exercise Immunology/Palliative care unit, Department of Physiotherapy, University of Nigeria, Teaching Hospital, Ituku/Ozalla, Enugu State, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
| | - Fortune Elochukwu Ezenwankwo
- Department of Medical Rehabilitation, Faculty of Health Sciences, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Philip Chinedu Okere
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
| | - Amaka Obiageli Nnamani
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
| | - Salome Nwaelom Ezeofor
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
| | - Ngozi Regina Dim
- Department of Radiation Medicine, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
| | - Gerhard Fortwengel
- Fakultaat III, Hochschhule Hannover University of Applied Sciences & Arts, Expo Plaza 12, 30539 Hannover, Germany
- Department of Physiotherapy, Faculty of Health Sciences, School of Therapeutic Studies, University of the Witwatersrand, 7 York Road, Parktown, 2193 Johannesburg, South Africa
| |
Collapse
|
16
|
Does a Rehabilitation Program of Aerobic and Progressive Resisted Exercises Influence HIV-Induced Distal Neuropathic Pain? Am J Phys Med Rehabil 2019; 97:364-369. [PMID: 29189306 DOI: 10.1097/phm.0000000000000866] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Distal symmetrical polyneuropathy is a common neurological sequela after HIV, which leads to neuropathic pain and functional limitations. Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown. This study explored the safety and effect of moderate-intensity aerobic exercises and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain. DESIGN A randomized pretest, posttest of 12 wks of aerobic exercise or progressive resisted exercise compared with a control. Outcome measures were assessed using the subjective periphery neuropathy, brief peripheral neuropathy screening, and numeric pain rating scale. Pain was assessed at baseline, 6 and 12 wks. Data between groups were compared using Kruskal-Wallis, Mann-Whitney U test, and within-groups Friedman and Wilcoxon signed rank tests. RESULTS There were 136 participants (mean [SD] age = 36.79 [8.23] yrs) and the exercise groups completed the protocols without any adverse effects. Pain scores within and between aerobic exercise and progressive resisted exercise groups showed significant improvement (P < 0.05) from baseline to 6 and 12 wks compared with the control (P > 0.05). CONCLUSIONS This study supports a rehabilitation program of moderate-intensity aerobic exercise and progressive resisted exercise being safe and effective for reducing neuropathic pain and is beneficial with analgesics for HIV-induced distal symmetrical polyneuropathy.
Collapse
|
17
|
Human Immunodeficiency Virus in Southern and East Africa the Pandemic and Interface with Rehabilitation. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
HIV Disease and Rehabilitation. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Deresz LF, Schöler CM, de Bittencourt PIHJ, Karsten M, Ikeda MLR, Sonza A, Dal Lago P. Exercise training reduces oxidative stress in people living with HIV/AIDS: a pilot study. HIV CLINICAL TRIALS 2018; 19:152-157. [PMID: 30369300 DOI: 10.1080/15284336.2018.1481247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Exercise training has been shown to be an effective strategy to balance oxidative stress status; however, this is underexplored in people living with HIV/AIDS (PLWHA). OBJECTIVE To evaluate the effects of exercise training on oxidative stress in PLWHA receiving antiretroviral therapy. METHODS Patients performed 24 sessions (3 times per week, 8 weeks) of either aerobic (AT), resistance (RT), or concurrent training (CT). Glutathione disulphide to glutathione ratio (GSSG/GSH) in circulating erythrocytes and thiobarbituric acid-reactive substances (TBARS) in plasma samples were assessed as oxidative stress markers. Eight PLWAH completed the training protocol (AT =3, RT =3, CT =2). The GSSG/GSH and TBARS values were logarithmically transformed to approximate a normal distribution. A paired t-test was used to determine the differences between baseline and post-training values. RESULTS Data-pooled analysis showed a decrease in GSSG/GSH and TBARS after the training period: log GSSG/GSH= -1.26 ± 0.57 versus -1.54 ± 0.65, p = .01 and log TBARS =0.73 ± 0.35 versus 0.43 ± 0.21, p = .01. This was paralleled by a rise in peak oxygen uptake (VO2peak = 29.14 ± 5.34 versus 32.48 ± 5.75 ml kg-1 min-1, p = .04). All the subjects who performed resistance exercises showed an average gain of 37 ± 8% in muscle strength with no difference between performing single or multiple sets in terms of muscle strength gain. The results reinforce the clinical importance of exercise as a rehabilitation intervention for PLWHA and emphasizes the safety of exercise at the physiological level with the potential to mediate health outcomes.
Collapse
Affiliation(s)
- Luís Fernando Deresz
- a Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , RS , Brazil.,b Physical Education Department, Institute of Life Sciences , Universidade Federal de Juiz de Fora, Campus Governador Valadares , MG , Brazil
| | - Cinthia Maria Schöler
- c Laboratory of Cellular Physiology, Institute of Basic Health Sciences , Universidade Federal do Rio Grande do Sul , Porto Alegre , RS , Brazil
| | | | - Marlus Karsten
- d Physical Therapy Department , Universidade do Estado de Santa Catarina (UDESC) , Florianópolis , SC , Brazil
| | - Maria Letícia Rodrigues Ikeda
- e Nursing Department , Universidade do Vale do Rio dos Sinos , São Leopoldo , RS , Brazil.,f Health Secretariat of State of Rio Grande do Sul , Porto Alegre , RS , Brazil
| | - Anelise Sonza
- d Physical Therapy Department , Universidade do Estado de Santa Catarina (UDESC) , Florianópolis , SC , Brazil
| | - Pedro Dal Lago
- a Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , RS , Brazil.,g Physical Therapy Department , UFCSPA , Porto Alegre , RS , Brazil
| |
Collapse
|
20
|
Pérez Chaparro CGA, Zech P, Schuch F, Wolfarth B, Rapp M, Heiβel A. Effects of aerobic and resistance exercise alone or combined on strength and hormone outcomes for people living with HIV. A meta-analysis. PLoS One 2018; 13:e0203384. [PMID: 30180202 PMCID: PMC6122835 DOI: 10.1371/journal.pone.0203384] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023] Open
Abstract
Background Infection with human immunodeficiency virus (HIV) affects muscle mass, altering independent activities of people living with HIV (PLWH). Resistance training alone (RT) or combined with aerobic exercise (AE) is linked to improved muscle mass and strength maintenance in PLWH. These exercise benefits have been the focus of different meta-analyses, although only a limited number of studies have been identified up to the year 2013/4. An up-to-date systematic review and meta-analysis concerning the effect of RT alone or combined with AE on strength parameters and hormones is of high value, since more and recent studies dealing with these types of exercise in PLWH have been published. Methods Randomized controlled trials evaluating the effects of RT alone, AE alone or the combination of both (AERT) on PLWH was performed through five web-databases up to December 2017. Risk of bias and study quality was attained using the PEDro scale. Weighted mean difference (WMD) from baseline to post-intervention changes was calculated. The I2 statistics for heterogeneity was calculated. Results Thirteen studies reported strength outcomes. Eight studies presented a low risk of bias. The overall change in upper body strength was 19.3 Kg (95% CI: 9.8–28.8, p< 0.001) after AERT and 17.5 Kg (95% CI: 16–19.1, p< 0.001) for RT. Lower body change was 29.4 Kg (95% CI: 18.1–40.8, p< 0.001) after RT and 10.2 Kg (95% CI: 6.7–13.8, p< 0.001) for AERT. Changes were higher after controlling for the risk of bias in upper and lower body strength and for supervised exercise in lower body strength. A significant change towards lower levels of IL-6 was found (-2.4 ng/dl (95% CI: -2.6, -2.1, p< 0.001). Conclusion Both resistance training alone and combined with aerobic exercise showed a positive change when studies with low risk of bias and professional supervision were analyzed, improving upper and, more critically, lower body muscle strength. Also, this study found that exercise had a lowering effect on IL-6 levels in PLWH.
Collapse
Affiliation(s)
- Camilo Germán Alberto Pérez Chaparro
- University Outpatient Clinic–Center for Sports Medicine, Department Sports & Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
- * E-mail:
| | - Philipp Zech
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Felipe Schuch
- Post-graduate Program in Health and Human Development, La Salle University, Canoas, RS, Brazil
| | - Bernd Wolfarth
- Department of Sports Sciences, Division of Sports Medicine, Humboldt Universität zu Berlin, Berlin, Germany
| | - Michael Rapp
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Andreas Heiβel
- Social and Preventive Medicine, Department Exercise and Health Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| |
Collapse
|
21
|
Chisati EM, Constantinou D, Lampiao F. Management of Reduced Bone Mineral Density in HIV: Pharmacological Challenges and the Role of Exercise. Front Physiol 2018; 9:1074. [PMID: 30131721 PMCID: PMC6090029 DOI: 10.3389/fphys.2018.01074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022] Open
Abstract
Low bone mineral density is becoming more common among people living with HIV following the use of current antiretroviral therapy drugs such as tenofovir. Although pharmacological therapies used to treat low bone mineral density are associated with adverse effects and may increase the pill burden in people living with HIV who are already burdened by antiretroviral therapy drugs, non-pharmacological strategies to prevent and treat reduced bone mineral density resulting from antiretroviral therapy drugs in people living with HIV have not been fully explored. Despite evidence that exercise is effective in increasing bone mineral density, effects of exercise on low bone mineral density resulting from antiretroviral therapy drugs in HIV infected individuals are still unknown. This review highlights gaps in the strategies used to manage reduced bone mineral density resulting from antiretroviral therapy drugs and focuses on exercise as an alternative or adjunctive strategy.
Collapse
Affiliation(s)
- Enock M. Chisati
- Department of Physiotherapy, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Demitri Constantinou
- Center for Exercise Science and Sports Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Fanuel Lampiao
- Physiology Unit, Department of Biomedical Sciences, College of Medicine, Blantyre, Malawi
| |
Collapse
|
22
|
Daniels AK, Van Niekerk RL. The impact of a therapeutic exercise intervention on depression and body self-image in HIV-positive women in sub-Saharan Africa. HIV AIDS (Auckl) 2018; 10:133-144. [PMID: 30038525 PMCID: PMC6053174 DOI: 10.2147/hiv.s167005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Attitudes, responses, and reactions of HIV-positive women in three sub-Saharan African regions toward a therapeutic exercise intervention, aimed to determine the presence of depression and low body self-image, were captured. This provided insight into body satisfaction and desire to exercise (Stage 1, n=60), body self-image and depression (Stage 2, n=60), and overall concerns around the often adverse side effects of antiretroviral treatment (ART). A program of therapeutic (specialty) exercise was developed for the experimental design (Stage 2), to quantify the psychological side effects of these variables. METHODOLOGY Stage 1 constituted a qualitative exploration into attitudes and perceptions around ART, toxicity, health concerns, metabolic irregularities (lipodystrophy), body shape and size dissatisfaction, and cultural attitudes toward exercise. This stage deployed brief informal face-to-face interviews, based on the World Health Organization (WHO)/United Nations Fund for Population Activities (UNFPA) AIDS Inventory, in three sub-Saharan African regions (including provincial and district hospitals, nongovernmental organizations, voluntary counseling and testing/HIV and testing centers, and primary care outpatient clinics). Stage 2 of the study comprised a quantitative experimental design, conducted on a sample of HIV-positive women (mean age=39.0 years; mean years on ART=5.5; 86% black) in three selected HIV outpatient clinics in Johannesburg, South Africa. DATA ANALYSIS The collated data sets from both stages of the research were presented, analyzed, and interpreted (thematic analyses [Stage 1] and statistical analyses [Stage 2]) using the body self-image questionnaire and Beck's depression inventory. RESULTS Stage 1 outlined participants' concerns and reports around 1) body shape and size, including long-term effects of ART and 2) attitudes toward exercise, as a function of HIV status. Stage 2 represented pre- and posttest statistics, showing low statistical means for both the experiment and the control groups, with statistical significance for four out of nine items of subscales of body self-image questionnaire.
Collapse
Affiliation(s)
- Andrea K Daniels
- School of Community Psychosocial Research (COMPRES), Faculty of Health Sciences, North West University, Potchefstroom, South Africa,
| | - Rudolph L Van Niekerk
- Department of Human Movement Science, Faculty of Health Sciences, University of Fort Hare, Alice, South Africa
| |
Collapse
|
23
|
Vingren JL, Curtis JH, Levitt DE, Duplanty AA, Lee EC, McFarlin BK, Hill DW. Adding Resistance Training to the Standard of Care for Inpatient Substance Abuse Treatment in Men With Human Immunodeficiency Virus Improves Skeletal Muscle Health Without Altering Cytokine Concentrations. J Strength Cond Res 2018; 32:76-82. [PMID: 29257793 DOI: 10.1519/jsc.0000000000002289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Vingren, JL, Curtis, JH, Levitt, DE, Duplanty, AA, Lee, EC, McFarlin, BK, and Hill, DW. Adding resistance training to the standard of care for inpatient substance abuse treatment in men with human immunodeficiency virus improves skeletal muscle health without altering cytokine concentrations. J Strength Cond Res 32(1): 76-82, 2018-Substance abuse and human immunodeficiency virus (HIV) infection can independently lead to myopathy and related inflammatory alterations; importantly, these effects seem to be additive. Resistance training (RT) can improve muscle health in people living with HIV (PLWH), but the efficacy of this intervention has not been examined for PLWH recovering from substance abuse. The purpose of this study was to determine the effect of RT on muscle health markers (mass, strength, and power) and basal circulating biomarkers for men living with HIV undergoing substance abuse treatment. Men living with HIV undergoing 60-day inpatient substance abuse treatment completed either RT (3×/wk) or no exercise training (control) for 6 weeks. Muscle mass, strength, and power, and fasting circulating cytokines (interferon γ, tumor necrosis factor-α, interleukin (IL)-1β, IL-2, IL-4, IL-6, and IL-10), vascular cellular adhesion molecule-1, and cortisol were measured before (PRE) and after (POST) the 6-week period. Both groups received the standard of care for HIV and substance abuse treatment determined by the inpatient facility. Muscle mass, strength, and power increased (p ≤ 0.05) from PRE to POST for RT but were unchanged for control. No differences were found for circulating biomarkers. Adding RT to the standard of care for substance abuse treatment improved aspects of muscle health (mass, strength, and power) in men living with HIV. These improvements are associated with a lower risk of a number of health conditions. Therefore, practitioners should consider implementing RT interventions as part of substance abuse treatment programs in this population to help manage long-term health.
Collapse
Affiliation(s)
- Jakob L Vingren
- 1Applied Physiology Laboratory, Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, Texas;2Department of Biological Sciences, University of North Texas, Denton, Texas;3Department of Kinesiology, Texas Woman's University, Denton, Texas; and4Department of Kinesiology, University of Connecticut, Storrs, Connecticut
| | | | | | | | | | | | | |
Collapse
|
24
|
Vancampfort D, Stubbs B, Mugisha J. Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels. Afr Health Sci 2018; 18:394-406. [PMID: 30602967 PMCID: PMC6306981 DOI: 10.4314/ahs.v18i2.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Self-management strategies such as physical activity (PA) can address disability and optimize mental, physical, social and economic outcomes for persons living with HIV (PLWH). Understanding factors that influence PA behavior in PLWH is a first step in order to devise effective interventions. Objective The present review provides a systematic review of the correlates of PA in PLWH in sub-Saharan Africa. Methods Electronic databases were searched till April 2016. Keywords included ‘physical activity’ or ‘exercise’ or ‘sports’ and ‘AIDS’ or ‘HIV’. Results Ten correlates were identified in 6 studies including 1,015 (329♂) PLWH (mean age range=30.5–40.8years). Lower levels of PA were associated with older age (2/2 studies), a lower number of CD4 cells/µl (1/1), a more severe HIV-stage (1/1), a higher HIV load (1/1), the presence of opportunistic infections (1/1) and a higher BMI (1/1). Fisher's exact tests showed there were more significant correlates in objective tools versus subjective self-report (P=0.03). Conclusion The current review shows that participation in PA by PLWH in sub-Saharan Africa is associated with a range of complex factors which should be considered in the daily care of PLWH. This however might require repackaging of the current interventions for PLWH to allow a focus on PA.
Collapse
Affiliation(s)
- Davy Vancampfort
- KU Leuven — University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- KU Leuven — University of Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - James Mugisha
- Butabika National Referral and Mental Health Hospital, Kampala, Uganda
- Kyambogo University, Kampala, Uganda
| |
Collapse
|
25
|
Nosrat S, Whitworth JW, Ciccolo JT. Exercise and mental health of people living with HIV: A systematic review. Chronic Illn 2017; 13:299-319. [PMID: 29119865 DOI: 10.1177/1742395317694224] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective Mental illness is highly prevalent among people living with HIV. Poor mental health is linked to HIV disease progression, making the treatment of mental illness alongside HIV essential. While the benefits of exercise on the physical health of people living with HIV are well established, the effect of exercise on mental health in this population is less examined. Therefore, this study aimed to conduct a systematic literature review of the effects of exercise on mental health in people living with HIV. Methods A search of electronic databases (PubMed, Web of Science, PsycINFO) through 30 November 2016 was completed. The methodological framework for scoping studies was used to conduct the review process. RISMA guidelines were used to report the results. Results The search resulted in 2273 articles and 52 were determined to be relevant. After review of the full text of potentially relevant studies, 24 studies were included for the analysis. Discussion Both aerobic and resistance exercise have independent and combined positive effects on various indicators of mental health in people living with HIV. Major limitations include high attrition rate, small sample size, and poor study designs. Higher quality studies with more diverse populations such as women, older adults, and transgender individuals are required.
Collapse
Affiliation(s)
- Sanaz Nosrat
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - James W Whitworth
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Joseph T Ciccolo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| |
Collapse
|
26
|
Kamitani E, Sipe TA, Higa DH, Mullins MM, Soares J. Evaluating the Effectiveness of Physical Exercise Interventions in Persons Living With HIV: Overview of Systematic Reviews. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2017; 29:347-363. [PMID: 28825859 PMCID: PMC5942186 DOI: 10.1521/aeap.2017.29.4.347] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Physical exercise (PE) has not been well studied in persons living with HIV (PLHIV). We conducted an overview of systematic reviews to assess the effectiveness of PE and to determine the most appropriate PE regimen for PLHIV. We used the CDC's Prevention Research Synthesis Project's database and manual searches to identify systematic reviews published between 1996 and 2013. We qualitatively synthesized the findings from five reviews to assess the effectiveness of PE and conducted meta-analyses on CD4 counts to identify the best PE regimen. PE is associated with reduced adiposity and depression, but was not associated with a decrease in HIV viral load. CD4 counts were improved by interventions with interval aerobic or 41-50 minutes of exercise three times per week compared with other modes and duration of exercise. PE appears to benefit PLHIV, but more research is needed to help develop appropriate PE strategies specifically for PLHIV.
Collapse
Affiliation(s)
- Emiko Kamitani
- ORISE Fellow, Prevention Research Branch, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa Ann Sipe
- Prevention Research Branch, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention
| | - Darrel H Higa
- Prevention Research Branch, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention
| | - Mary M Mullins
- Prevention Research Branch, Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention
| | - Jesus Soares
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity and Obesity, U.S. Centers for Disease Control and Prevention
| |
Collapse
|
27
|
Effectiveness of Progressive Resistive Exercise (PRE) in the context of HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis 2017; 17:268. [PMID: 28403830 PMCID: PMC5389006 DOI: 10.1186/s12879-017-2342-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 03/25/2017] [Indexed: 11/10/2022] Open
Abstract
Background HIV is increasingly considered a chronic illness. More individuals are living longer and aging with the health-related consequences associated with HIV and multi-morbidity. Exercise is a self-management approach that can promote health for people aging with HIV. We examined the safety and effectiveness of progressive resistive exercise (PRE) interventions on immunological, virological, cardiorespiratory, strength, weight, body composition, and psychological outcomes in adults living with HIV. Methods We conducted a systematic review using the Cochrane Collaboration protocol. Searching databases up to April 2013, we included randomized controlled trials that compared PRE with no exercise or another intervention performed at least three times per week for at least four weeks with adults living with HIV. Two reviewers independently determined study eligibility. We extracted data from included studies and assessed risk of bias using the Cochrane Collaboration risk of bias tool. Meta-analyses were conducted using random effects models with Review Manager (RevMan) computer software. Results Twenty studies met inclusion criteria (n = 764 participants at study completion); the majority of participants were men (77%) taking antiretroviral therapy (14/20 included studies). Exercise interventions included PRE alone (8 studies) or a combination of resistive and aerobic exercise (12 studies) ranging from 6 to 52 weeks in duration. Thirty-four meta-analyses were performed. Results demonstrated statistically significant improvements in cardiorespiratory status (maximum oxygen consumption, exercise time), strength (chest press, knee flexion), weight, and body composition (arm and thigh girth, leg muscle area) among exercisers versus non-exercisers. We found no significant differences in change in CD4 count and viral load. We were unable to perform meta-analyses for psychological outcomes however results from individual studies demonstrated improvements in health-related quality of life with exercisers compared with non-exercisers. Conclusions Performing progressive resistive exercise (PRE) or a combination of resistive and aerobic exercise at least three times per week for at least six weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, weight, and body composition for adults with HIV. Exercise may be considered a safe and beneficial for enhancing the health of medically stable adults aging with HIV. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2342-8) contains supplementary material, which is available to authorized users.
Collapse
|
28
|
Montgomery CA, Henning KJ, Kantarzhi SR, Kideckel TB, Yang CFM, O'Brien KK. Experiences participating in a community-based exercise programme from the perspective of people living with HIV: a qualitative study. BMJ Open 2017; 7:e015861. [PMID: 28377397 PMCID: PMC5387963 DOI: 10.1136/bmjopen-2017-015861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Our aim was to explore the experiences of engaging in a community-based exercise programme (CBEP) from the perspective of people living with HIV (PLWH). DESIGN We conducted a descriptive qualitative study using semistructured interviews. SETTING We recruited adults living with HIV who participated in a 16-week CBEP in Toronto, Canada. PARTICIPANTS 11 participants, the majority men (64%), with a median age of 52 years, and living with a median of 5 concurrent health conditions in addition to HIV participated in the study. OUTCOME MEASURES We asked participants about their overall experiences: strengths, limitations and perceived benefits of the CBEP; factors influencing participation and current level of exercise after completion of the CBEP. We administered a self-reported demographic questionnaire followed by the Rapid Assessment of Physical Activity (RAPA) questionnaire. We analysed interview data using thematic analysis. RESULTS We developed a framework that describes the experiences before, during and after the CBEP; and the perceived impact of the CBEP on health, which influenced the intent to, engagement in and sustainability of exercise among PLWH. Participants described the positive impact of the CBEP on their physical, mental and social health. Interviews were completed at a median of 6 months after the CBEP, when 9 participants reported ongoing engagement in exercise, but to a lesser extent than during the CBEP. Intrinsic and extrinsic factors facilitated or hindered engagement in exercise throughout all phases of the CBEP. The episodic nature of HIV and multimorbidity influenced engagement in exercise and posed challenges to re-engagement after periods of inactivity. CONCLUSIONS CBEPs provide an opportunity to enhance physical activity, perceived health outcomes and knowledge about exercise for PLWH. Community-based exercise is a strategy that may be used by health providers to promote engagement in sustained physical activity for PLWH.
Collapse
Affiliation(s)
| | - Katherine J Henning
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sarah R Kantarzhi
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Tamar B Kideckel
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl F M Yang
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Research on rehabilitation interventions for adults living with HIV: a scoping review. Int J Rehabil Res 2017; 39:106-16. [PMID: 27028287 DOI: 10.1097/mrr.0000000000000166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this paper is to use a scoping review to investigate the extent, range, and nature of research on rehabilitation interventions for adults living with HIV. Electronic databases (MEDLINE, EMBASE, CINAHL, AMED, and PsychINFO) and reference lists of the included articles were searched. Authors were emailed when possible for unavailable articles. A total of 897 titles and abstracts were retrieved. Thirty-three articles were included. There were 27 different rehabilitation interventions delivered by 18 professions. The studies were completed in four different countries. Most studies were published in 2008. A randomized-controlled trial was the most used method. The nature of the studies was analyzed according to the three-core concepts of the International Classification of Functioning, Disability and Health: 28 studies addressed impairments; six studies addressed activity limitations; and 14 studies addressed participation restrictions. This scoping study advances the knowledge of research on rehabilitation interventions for adults living with HIV. More research on rehabilitation interventions is needed in sub-Saharan Africa and other low-income and middle-income countries to ensure that these individuals are receiving the best possible care. There is a need for the HIV field to recognize the important contribution of rehabilitation toward the HIV care continuum.
Collapse
|
30
|
Li A, McCabe T, Silverstein E, Dragan S, Salbach NM, Zobeiry M, Beldick S, Godi C, O'Brien KK. Community-Based Exercise in the Context of HIV: Factors to Consider when Developing and Implementing Community-Based Exercise Programs for People Living with HIV. J Int Assoc Provid AIDS Care 2017; 16:267-275. [PMID: 28074681 DOI: 10.1177/2325957416686836] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify factors to consider for developing and implementing a community-based exercise (CBE) program for people living with HIV (PLWH). METHODS We conducted a qualitative descriptive study using semi-structured interviews with PLWH, rehabilitation professionals, and recreation providers from Canada and the United Kingdom. We asked participants to describe their experience with exercise, facilitators, and barriers to accessing and participating in exercise, and factors to consider in developing a CBE program for PLWH. Interviews were analyzed using content analytical techniques. RESULTS We developed a Framework of CBE in the Context of HIV that describes (1) exercise experiences of PLWH (nature of exercise, motivators for initiating or sustaining exercise, perceived benefits, and barriers and facilitators to exercise) and (2) 11 factors to consider in developing and implementing a CBE program for PLWH. CONCLUSION Recommendations for the development and implementation of an accessible and feasible CBE program may enhance exercise participation among PLWH.
Collapse
Affiliation(s)
- Anna Li
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,2 Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Taylor McCabe
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Erin Silverstein
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Dragan
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Nancy M Salbach
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,3 Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Chris Godi
- 5 Toronto People With AIDS Foundation, Toronto, Ontario, Canada
| | - Kelly K O'Brien
- 1 Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,3 Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,6 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
31
|
Schäfer J, Young J, Calmy A, Nicca D, Hasse B, Brun Del Re C, Cavassini M, Bernasconi E, Schmidt-Trucksäss A, Bucher HC. High prevalence of physical inactivity among patients from the Swiss HIV Cohort Study. AIDS Care 2017; 29:1056-1061. [PMID: 28052699 DOI: 10.1080/09540121.2016.1274016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Physical activity (PA) can improve cardiorespiratory status, strength, body composition and quality of life for patients infected with HIV. Evidence from HIV-uninfected populations also shows that PA is associated with a lower risk of mortality, primarily death due to cardiovascular causes. There is, however, a lack of data on how physically active HIV-infected patients are. In this study, we assessed levels of self-reported PA over time in patients enrolled in the Swiss HIV Cohort Study, a large multicentre prospective observational cohort study. We included a total of 10,540 patients who completed at least one report of PA between December 2009 and November 2014 during routine clinical follow-up (scheduled every 6 months). In the first year after December 2009 there was a higher rate of non-response so these data are of a lesser reliability. Over the next four years, the percentage of patients reporting no free-time PA at all declined from 49% to 44%. In contrast, in two "Sport Switzerland" surveys of the general population in 2008 and 2014, the percentage of individuals reporting no sports activities at all was considerably lower and relatively stable over time (27% in 2008; 26% in 2014). In our analysis, the percentage of patients reporting sedentary activity at work increased from 23% to 26% over the four years. Subgroup findings suggest differences between women and men and between patients classified by their age, stage of infection and CD4 cell count. Integrating PA counselling into the routine care of HIV-infected patients and promoting PA among this population has the potential to improve the general state of health and quality of life for HIV-infected patients and reduce their risk of cardiovascular disease.
Collapse
Affiliation(s)
- Juliane Schäfer
- a Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel , Basel , Switzerland.,b Department of Sport, Exercise and Health, Sports and Exercise Medicine , University of Basel , Basel , Switzerland
| | - Jim Young
- a Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel , Basel , Switzerland
| | - Alexandra Calmy
- c Division of Infectious Diseases , University Hospital Geneva , Geneva , Switzerland
| | - Dunja Nicca
- d Division of Infectious Diseases and Hospital Epidemiology , Cantonal Hospital St Gallen , St Gallen , Switzerland.,e Institute of Nursing Science, University of Basel , Basel , Switzerland
| | - Barbara Hasse
- f Division of Infectious Diseases and Hospital Epidemiology , University Hospital Zurich and University of Zurich , Zurich , Switzerland
| | - Claudia Brun Del Re
- g Department of Infectious Diseases , Bern University Hospital and University of Bern , Bern , Switzerland
| | - Matthias Cavassini
- h Division of Infectious Diseases , University Hospital Lausanne , Lausanne , Switzerland
| | - Enos Bernasconi
- i Division of Infectious Diseases , Regional Hospital of Lugano , Lugano , Switzerland
| | - Arno Schmidt-Trucksäss
- b Department of Sport, Exercise and Health, Sports and Exercise Medicine , University of Basel , Basel , Switzerland
| | - Heiner C Bucher
- a Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel , Basel , Switzerland.,j Division of Infectious Diseases and Hospital Epidemiology , University Hospital Basel, University of Basel , Basel , Switzerland
| | | |
Collapse
|
32
|
Abstract
Die Effektivität von körperlicher Aktivität in der Primär- als auch Sekundär- und Tertiärprävention ist hinlänglich bekannt. Das Immunsystem spielt eine entscheidende Rolle bei einer Vielzahl von Erkrankungen, da es durch seine Botenfunktion (z. B. durch Zytokine) in einer Vielzahl der Regulationsprozesse mit involviert ist. So kommt es durch moderat-intensive körperliche Aktivität zu einer Stärkung des Immunsystems mit konsekutiv verminderter Infektanfälligkeit sowie eher anti-inflammatorischen Effekten, wohingegen langandauernde und höher intensive Belastungen zu einer Schwächung der Abwehrfunktion sowie einem pro-inflammatorischen Effekt führen. Somit stellt eine adäquat dosierte körperliche Aktivität eine erfolgversprechende Therapieoption bei Erkrankungen des infektiologischen Formenkreises sowie des Immunsystems dar.
Collapse
|
33
|
Poton R, Polito M, Farinatti P. Effects of resistance training in HIV-infected patients: A meta-analysis of randomised controlled trials. J Sports Sci 2016; 35:2380-2389. [PMID: 28001474 DOI: 10.1080/02640414.2016.1267389] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The relative effects of resistance training (RT) upon muscle fitness and immune function among HIV-infected patients are uncertain. The purpose of this study was to perform a meta-analysis to determine the effects of RT upon muscle strength, muscle mass and CD4 cells count and to identify potential moderators of those outcomes in HIV-infected patients. Meta-analyses use random or fixed-effects model depending on the heterogeneity of effect sizes, complemented with Hedge's g correction factor. Thirteen trials were meta-analysed. Overall, RT increased muscle strength (35.5%, P < 0.01) and CD4 cell count (26.1%, P = 0.003) versus controls (P < 0.03), but not muscle mass (P = 0.051). Meta-regression followed by subgroup moderator analysis showed that gains in muscle strength followed a dose-response pattern with largest increase detected among trials with longer (24 weeks; 49.3%) than shorter intervention (<12 weeks; 39%), higher (Physiotherapy Evidence-Based Database [PEDro] scale = 6; 38.3%) than lower (PEDro = 5; 28.1%) quality, and longer (12 months; 59.7%) than shorter time under highly active antiretroviral therapy (HAART) (<6 months; 37.1%), (P < 0.01). RT appears to be efficacious to improve muscular strength (~35.5%) and CD4 cell count (~26.1%), but not muscle mass of HIV-infected patients. Effects upon strength were greater in studies with higher quality and among trials with longer RT and HAART.
Collapse
Affiliation(s)
- Roberto Poton
- a Research Group of Cardiovascular Response and Exercise , Londrina State University , Londrina , Brazil
| | - Marcos Polito
- a Research Group of Cardiovascular Response and Exercise , Londrina State University , Londrina , Brazil
| | - Paulo Farinatti
- b Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports , University of Rio de Janeiro State , Rio de Janeiro , Brazil.,c Physical Activity Sciences Graduate Program , Salgado Oliveira University , Niteroi , Brazil
| |
Collapse
|
34
|
Cobbing S, Hanass-Hancock J, Myezwa H. Home-based rehabilitation interventions for adults living with HIV: a scoping review. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2016; 15:77-88. [PMID: 27002360 DOI: 10.2989/16085906.2016.1159968] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Home-based rehabilitation (HBR) has been shown to improve the lives of people living with a wide range of chronic diseases in resource-rich settings. This may also be a particularly effective strategy in resource-poor settings, where access to institution-based rehabilitation is limited. This review aimed to summarise and discuss the evidence related to the effectiveness of home-based rehabilitation (HBR) interventions designed specifically for adults living with HIV. A scoping review methodology was employed, involving systematic search techniques and appraisal of appropriate evidence. English-language journal articles that assessed the quality of life or functional ability outcomes of HBR interventions for adults living with HIV were considered for this review. Out of an initial 1 135 publications retrieved from the search of databases, six articles met this review's inclusion criteria. While this review highlights the scarcity of empirical evidence related to HBR interventions for adults living with HIV, the findings of these six articles are that HBR is a safe management option that may confer a number of physical and psychological benefits for this population. Future research on HBR interventions should include a wider range of assessment measures, including cost-benefit analyses and specific tools designed to assess the functional ability and participation in activities of daily living of participants involved in these programmes. In particular, more research on HBR is required in resource-poor environments, such as sub-Saharan Africa where HIV is endemic, to assess whether this is a feasible strategy that is both effective and practical in the areas that may need it most.
Collapse
Affiliation(s)
- Saul Cobbing
- a Department of Physiotherapy , University of KwaZulu-Natal , Durban , South Africa
| | - Jill Hanass-Hancock
- b Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal
| | - Hellen Myezwa
- c Department of Physiotherapy , University of the Witwatersrand , Johannesburg , South Africa
| |
Collapse
|
35
|
Vancampfort D, Mugisha J, De Hert M, Probst M, Firth J, Gorczynski P, Stubbs B. Global physical activity levels among people living with HIV: a systematic review and meta-analysis. Disabil Rehabil 2016; 40:388-397. [PMID: 27929355 DOI: 10.1080/09638288.2016.1260645] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE It is unclear how much physical activity people living with HIV (PLWH) engage in. We conducted a meta-analysis to investigate physical activity levels and its predictors in PLWH. METHODS PubMed, PsycARTICLES, and CINAHL Plus were searched by two independent reviewers from inception till 1 April 2016 using the keywords: "HIV" OR "AIDS" AND "physical activity" OR "exercise" OR "sports". A random effects meta-analysis was conducted. RESULTS Across 24 studies including 34 physical activity levels there were 3780 (2471♂) PLWH (mean age range: 37-58 years). PLWH spent 98.9 (95%CI = 64.8-133.1) minutes per day being physically active which is lower than in most other populations with chronic diseases. 50.7% (95%CI = 39.3-62%) (n = 2052) of PLWH complied with the physical activity guidelines of 150 min moderate intensity physical activity per week. The number of steps walked per day in 252 PLWH was 5899 (95%CI = 5678-6418), which is below the 10,000 steps per day recommendation. CONCLUSIONS Our data demonstrate that a considerable proportion of PLWH are insufficiently physically active. Future lifestyle interventions specifically targeting the prevention of physical inactivity in PLWH are warranted. Implications for Rehabilitation Many people living with HIV do not comply with general health recommendations. Physical activity counseling should be key in the rehabilitation of people living with HIV.
Collapse
Affiliation(s)
- Davy Vancampfort
- a Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium.,b University Psychiatric Center KU Leuven, KU Leuven - University of Leuven , Leuven , Kortenberg , Belgium
| | - James Mugisha
- c Butabika National Referral and Mental Health Hospital , Kampala , Uganda.,d Kyambogo University , Kampala , Uganda
| | - Marc De Hert
- b University Psychiatric Center KU Leuven, KU Leuven - University of Leuven , Leuven , Kortenberg , Belgium
| | - Michel Probst
- a Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium
| | - Joseph Firth
- e Institute of Brain, Behaviour and Mental Health , University of Manchester , Manchester , UK
| | - Paul Gorczynski
- f Department of Sport and Exercise Science , University of Portsmouth , Portsmouth , Hampshire , UK
| | - Brendon Stubbs
- g Department of Physiotherapy , South London and Maudsley NHS Foundation Trust , London , UK.,h Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK
| |
Collapse
|
36
|
Cardiorespiratory fitness levels and moderators in people with HIV: A systematic review and meta-analysis. Prev Med 2016; 93:106-114. [PMID: 27713101 DOI: 10.1016/j.ypmed.2016.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
Cardiorespiratory fitness (CRF) is a modifiable risk factor for cardiovascular disease and premature mortality. CRF levels and moderators among people living with HIV (PLWH) are unknown. The aim of the current meta-analysis was to (1) determine mean CRF in PLWH and compare levels with age- and gender-matched healthy controls (HCs), (2) explore moderators of CRF, (3) and (4) explore moderators of CRF outcomes following physical activity (PA) interventions. Major electronic databases were searched systematically for articles reporting CRF expressed as maximum or peak oxygen uptake (ml/min/kg) in PLWH. A random effects meta-analysis calculating the pooled mean CRF including subgroup- and meta-regression analyses was undertaken. Across 21 eligible studies, the CRF level was 26.4ml/kg/min (95% CI=24.6 to 28.1) (n=1010; mean age=41years). There were insufficient data to compare CRF levels with HCs. A higher body mass index (β=-0.99, 95% CI=-1.93 to -0.06, P=0.04), older age (β=-0.31, 95% CI=-0.58 to -0.04, P=0.02) and the presence of lipodystrophy (β=-4.63, 95% CI=-7.88 to -1.39, P=0.005) were significant moderators of lower CRF levels. Higher CD4+ counts (β=0.004, 95% CI=0.0007 to 0.007, P=0.016), supervised interventions (P<0.001) and interventions with a lower frequency of weekly sessions (2 or 3 versus 4 times) (P<0.001) predicted a better CRF-outcome following PA. CRF levels of PLWH are among the lowest in comparison to other vulnerable populations. More research on the most optimal physical activity intervention characteristics is needed.
Collapse
|
37
|
De A, Xu X, White J, Sunil TS, Okulicz JF. Physical fitness characteristics of active duty US Air Force members with HIV infection. Medicine (Baltimore) 2016; 95:e5227. [PMID: 27858872 PMCID: PMC5591120 DOI: 10.1097/md.0000000000005227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection is associated with reduced muscle mass and adverse metabolic effects. We evaluated the impact of HIV infection on longitudinal exercise performance in US Air Force (USAF) members with HIV infection.USAF members perform standardized fitness assessments every 6 to 12 months with a composite score comprised of abdominal circumference, push-ups, sit-ups, and 1.5-mile run. Fitness tests between 2004 and 2014 for male USAF members with HIV infection (n = 172) were compared with male HIV-negative controls (∼10 per case; n = 1636) matched by age and rank category at service entry.Fitness tests for cases (n = 1821) were divided into 2 groups, before (pre-HIV) and after (post-HIV) diagnosis, and compared with control fitness assessments (n = 30,443) by paired t tests. Random-effects regression analyses were also performed to compare fitness components.Mean composite scores for cases were higher post-HIV (87.06 ± 9.10) compared with pre-HIV (84.92 ± 8.36; P = 0.004) and did not differ from respective controls. Compared with pre-HIV, mean push-up (51.50 ± 9.67 vs 50.35 ± 11.18; P = 0.018) and sit-up (51.66 ± 7.81 vs 50.57 ± 9.19; P < 0.001) counts improved post-HIV, whereas run times were similar (11:53 ± 1:42 vs 11:51 ± 2:05; P = 0.056). Regression analyses demonstrated that cases had significantly lower predicted abdominal circumference and push-up counts over time compared with controls, regardless of pre-HIV or post-HIV status (P < 0.05 for all).Although functional limitations may occur in the setting of HIV infection, vigorous exercise performance can be both preserved and improved in HIV-infected individuals at a level comparable with HIV-uninfected persons.
Collapse
Affiliation(s)
- Asha De
- Internal Medicine Residency, San Antonio Military Medical Center, Fort Sam Houston University of Texas San Antonio, Department of Sociology, San Antonio Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, Texas, USA
| | | | | | | | | |
Collapse
|
38
|
O'Brien KK, Bayoumi AM, Solomon P, Tang A, Murzin K, Chan Carusone S, Zobeiry M, Nayar A, Davis AM. Evaluating a community-based exercise intervention with adults living with HIV: protocol for an interrupted time series study. BMJ Open 2016; 6:e013618. [PMID: 27798038 PMCID: PMC5073553 DOI: 10.1136/bmjopen-2016-013618] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Our aim was to evaluate a community-based exercise (CBE) intervention with the goal of reducing disability and enhancing health for community-dwelling people living with HIV (PLWH). METHODS AND ANALYSIS We will use a mixed-methods implementation science study design, including a prospective longitudinal interrupted time series study, to evaluate a CBE intervention with PLWH in Toronto, Canada. We will recruit PLWH who consider themselves medically stable and safe to participate in exercise. In the baseline phase (0-8 months), participants will be monitored bimonthly. In the intervention phase (8-14 months), participants will take part in a 24-week CBE intervention that includes aerobic, resistance, balance and flexibility exercise at the YMCA 3 times per week, with weekly supervision by a fitness instructor, and monthly educational sessions. In the follow-up phase (14-22 months), participants will be encouraged to continue to engage in unsupervised exercise 3 times per week. Quantitative assessment: We will assess cardiopulmonary fitness, strength, weight, body composition and flexibility outcomes followed by the administration of self-reported questionnaires to assess disability and contextual factor outcomes (coping, mastery, stigma, social support) bimonthly. We will use time series regression analysis to determine the level and trend of outcomes across each phase in relation to the intervention. Qualitative assessment: We will conduct a series of face-to-face interviews with a subsample of participants and recreation providers at initiation, midpoint and completion of the 24-week CBE intervention. We will explore experiences and anticipated benefits with exercise, perceived impact of CBE for PLWH and the strengths and challenges of implementing a CBE intervention. Interviews will be audio recorded and analysed thematically. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto HIV/AIDS Research Ethics Board. Knowledge translation will occur with stakeholders in the form of presentations and publications in open access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02794415; Pre-results.
Collapse
Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kate Murzin
- Realize (formally known as the Canadian Working Group on HIV and Rehabilitation (CWGHR)), Toronto, Ontario, Canada
| | | | - Mehdi Zobeiry
- Toronto Central Grosvenor Street YMCA, Toronto, Ontario, Canada
| | - Ayesha Nayar
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Health Care and Outcomes, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
39
|
Cutrono SE, Lewis JE, Perry A, Signorile J, Tiozzo E, Jacobs KA. The Effect of a Community-Based Exercise Program on Inflammation, Metabolic Risk, and Fitness Levels Among Persons Living with HIV/AIDS. AIDS Behav 2016; 20:1123-31. [PMID: 26607928 DOI: 10.1007/s10461-015-1245-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The human immunodeficiency virus (HIV) pandemic remains a top national health priority. Chronic inflammation may be a critical component in the disease course of HIV as C-reactive protein (CRP) is elevated and associated with increased mortality. This study examined the effect of 3 months of combined aerobic and resistance exercise training among a diverse cohort of HIV-infected men and women. The fixed effect of time for CRP was found to be non-significant (F[1,57.3] = 1.7, p = 0.19). There was a significant fixed effect for time for upper body (F[1,51.6] = 18.1, p < 0.05) and lower body strength (F[1,48.0] = 15.7, p < 0.05) and significant declines in diastolic blood pressure (p = 0.002) and waist circumference (p = 0.027). Though levels of CRP were not impacted after 3 months training, participants demonstrated a significant increase in muscular strength as well as beneficial changes in metabolic risk factors. Future studies should focus on determining the optimal exercise intervention length and mode to reduce inflammation among individuals living with HIV.
Collapse
|
40
|
O'Brien KK, Tynan AM, Nixon SA, Glazier RH. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol. BMC Infect Dis 2016; 16:182. [PMID: 27112335 PMCID: PMC4845358 DOI: 10.1186/s12879-016-1478-2] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 03/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with HIV are living longer with the health-related consequences of HIV, multi-morbidity, and aging. Exercise is a key strategy that may improve or sustain health for people living with HIV. Our aim was to examine the safety and effectiveness of aerobic exercise interventions on immunological, virological, cardiorespiratory, strength, weight, body composition, and psychological outcomes in adults living with HIV. METHODS We conducted a systematic review using the Cochrane Collaboration protocol. We searched databases up to April 2013. We included randomized controlled trials comparing aerobic exercise with no exercise or another intervention performed at least three times per week for at least four weeks among adults living with HIV. Two reviewers independently determined study eligibility. Data were extracted from studies that met inclusion criteria using standardized forms. We assessed risk of bias using the Cochrane Collaboration's tool for assessing risk of bias. Outcomes were analyzed as continuous and meta-analyses conducted using random effects models with Review Manager (RevMan) computer software. RESULTS Twenty-four studies met inclusion criteria (n = 936 participants at study completion); the majority of participants were men (73 %) and the majority were taking antiretroviral therapy (19/24 included studies). The exercise intervention included aerobic exercise alone (11 studies) or a combination of aerobic and resistive exercise (13 studies) ranging from 5 to 52 weeks. Fifty-eight meta-analyses were performed. Main results indicated statistically significant improvements in selected outcomes of cardiorespiratory status (maximum oxygen consumption, exercise time), strength (chest press, knee flexion), body composition (lean body mass, percent body fat, leg muscle area), depression symptoms, and quality of life (SF-36 questionnaire) among exercisers compared with non-exercisers. No significant differences in change in CD4 count and viral load were found. CONCLUSIONS Performing aerobic exercise or a combination of aerobic and resistive exercise at least three times per week for at least five weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, body composition and quality of life for adults with HIV. Aerobic exercise is safe and beneficial for adults living with HIV who are medically stable.
Collapse
Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada. .,Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.
| | - Anne-Marie Tynan
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Stephanie A Nixon
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada.,Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada
| | - Richard H Glazier
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.,Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, G1 06 2075 Bayview Ave, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, Canada
| |
Collapse
|
41
|
Simonik A, Vader K, Ellis D, Kesbian D, Leung P, Jachyra P, Chan Carusone S, O'Brien KK. Are you ready? Exploring readiness to engage in exercise among people living with HIV and multimorbidity in Toronto, Canada: a qualitative study. BMJ Open 2016; 6:e010029. [PMID: 26956163 PMCID: PMC4785327 DOI: 10.1136/bmjopen-2015-010029] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our aim was to explore readiness to engage in exercise among people living with HIV and multimorbidity. DESIGN We conducted a descriptive qualitative study using face-to-face semistructured interviews with adults living with HIV. SETTING We recruited adults (18 years or older) who self-identified as living with HIV and 2 or more additional health-related conditions from a specialty hospital in Toronto, Canada. PARTICIPANTS 14 participants with a median age of 50 years and median number of 9 concurrent health-related conditions participated in the study. The majority of participants were men (64%) with an undetectable viral load (71%). OUTCOME MEASURES We asked participants to describe their readiness to engage in exercise and explored how contextual factors influenced their readiness. We analysed interview transcripts using thematic analysis. RESULTS We developed a framework to describe readiness to engage in exercise and the interplay of factors and their influence on readiness among adults with HIV and multimorbidity. Readiness was described as a diverse, dynamic and fluctuating spectrum ranging from not thinking about exercise to routinely engaging in daily exercise. Readiness was influenced by the complex and episodic nature of HIV and multimorbidity comprised of physical impairments, mental health challenges and uncertainty from HIV and concurrent health conditions. This key factor created a context within which 4 additional subfactors (social supports, perceptions and beliefs, past experience with exercise, and accessibility) may further hinder or facilitate an individual's position along the spectrum of readiness to exercise. CONCLUSIONS Readiness to engage in exercise among people living with HIV is a dynamic and fluctuating construct that may be influenced by the episodic nature of HIV and multimorbidity and 4 subfactors. Strategies to facilitate readiness to exercise should consider the interplay of these factors in order to enhance physical activity and subsequently improve health outcomes of people with HIV and multimorbidity.
Collapse
Affiliation(s)
- Alya Simonik
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kyle Vader
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Denine Ellis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Dirouhi Kesbian
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla Leung
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Jachyra
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Mkandla K, Myezwa H, Musenge E. The effects of progressive-resisted exercises on muscle strength and health-related quality of life in persons with HIV-related poly-neuropathy in Zimbabwe. AIDS Care 2016; 28:639-43. [PMID: 26729347 DOI: 10.1080/09540121.2015.1125418] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Distal symmetrical poly-neuropathy (DSP) is a neurological complication associated with HIV/AIDS and stavudine (d4T) containing antiretroviral therapy. People with DSP experience pain, numbness and muscle weakness, which affect their quality of life (QOL). The purpose of this study was to establish the effect of a progressive-resisted exercise (PRE) intervention on health-related quality of life (HR-QOL) in people living with HIV/AIDS-related DSP. An assessor-blinded randomised controlled trial was conducted, with participants sourced from 10 clinics with HIV services, the family care clinic at Wilkins Hospital and 2 large hospitals in Harare, Zimbabwe. A 12-week PRE intervention was conducted twice weekly for 80 participants, while the control group with 80 participants continued with usual daily activities. The main outcome variable was HR-QOL for which we controlled for demographic and clinical measures in generalised estimating equation population-averaged models. Data were summarised and analysed using an intention to treat analysis approach using the Stata v10 program. Mean age of participants was 42.2 years (SD = 8.5). While d4T was used by 59% (n = 94), an equal proportion of the participants also had moderate to severe neuropathy. PRE was found to significantly improve HR-QOL in the intervention group based on the mean difference between the intervention group mean change and the mean change in the control group (F ratio 4.24; p = .04). This study established that PREs have positive effects on HR-QOL for people living with HIV/AIDS-related DSP.
Collapse
Affiliation(s)
- Khumbula Mkandla
- a Physiotherapy Department , University of Zimbabwe , Harare , Zimbabwe
| | - Hellen Myezwa
- b Physiotherapy Department, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Eustasius Musenge
- c Biostatistics and Epidemiology Department, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| |
Collapse
|
43
|
Monroe AK, Brown TT, Cox C, Reynolds SM, Wiley DJ, Palella FJ, Kingsley LA, Plankey MW. Physical Activity and Its Association with Insulin Resistance in Multicenter AIDS Cohort Study Men. AIDS Res Hum Retroviruses 2015; 31:1250-6. [PMID: 26334673 DOI: 10.1089/aid.2015.0027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The association between physical activity (PA), degree of insulin resistance (IR), and HIV infection is unclear. We hypothesized that PA might differentially affect the degree of IR through the direct and indirect influences of HIV, antiretroviral medications, and sociodemographic characteristics. The International Physical Activity Questionnaire (IPAQ) was administered to Multicenter AIDS Cohort Study (MACS) participants from 4/2010 to 3/2011 to generate metabolic equivalents (METs) total score and PA category. We determined the concurrent homeostatic model assessment IR (mmol/liter) (HOMA-IR) value from fasting glucose and insulin. We examined the HIV-PA relationship using quantile regression and the HIV-PA-HOMA-IR value relationship using linear regression. Among the 1,281 men, the proportions of men in the low (25% in HIV(+) vs. 23% in HIV(-)), moderate (26% vs. 27%), and high (49% vs. 49%) PA categories were similar by HIV status. The HOMA-IR value was higher among the HIV(+) men (p<0.001), and both HIV infection and low PA were associated with a higher degree of IR (p<0.0001 and p=0.0007). However, the PA-HOMA-IR value interaction was not different by HIV status. The HOMA-IR value was higher among HIV(+) men although the PA was similar. It is unknown if more exercise will overcome the metabolic derangements associated with HIV and its treatment.
Collapse
Affiliation(s)
- Anne K. Monroe
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd T. Brown
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher Cox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Dorothy J. Wiley
- School of Nursing, Division of Translational Science, UCLA, Los Angeles, California
| | - Frank J. Palella
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, Illinois
| | - Lawrence A. Kingsley
- Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | |
Collapse
|
44
|
Cobbing S, Hanass-Hancock J, Myezwa H. A home-based rehabilitation intervention for people living with HIV and disability in a resource-poor community, KwaZulu-Natal: study protocol for a randomised controlled trial. Trials 2015; 16:491. [PMID: 26525296 PMCID: PMC4630848 DOI: 10.1186/s13063-015-1025-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background In the era of highly active antiretroviral therapy HIV is now viewed as a chronic disease. Although people living with HIV are living longer lives, they are prone to a number of disabilities. Home-based rehabilitation has been shown to be an effective means of improving quality of life and function for people with a wide range of chronic diseases. There is a dearth of evidence, however, related to home-based rehabilitation interventions for people living with HIV, particularly in sub-Saharan Africa — the region with the highest global prevalence of HIV. Methods A randomised controlled trial design will be employed. Adults living with HIV who have been on antiretroviral therapy for at least six months and with defined limited mobility will be randomly allocated to either an intervention group or the control group. Pre and post-intervention testing will be conducted at a public hospital in KwaZulu-Natal, South Africa in order to assess the participants’ quality of life, perceived level of disability, functional ability and endurance. Individuals randomly allocated to the intervention group will participate in a four-month home-based rehabilitation programme, conducted once a week in their homes. This programme will be implemented by community workers who will be trained and supervised by a qualified physiotherapist. The participants in the control group will continue with the standard clinic management offered to them. On completion of the intervention, all participants will be re-assessed using the same outcome measures. Analysis of results will be carried out on intention-to-treat basis in order to identify any changes between intervention and control groups. Discussion The researchers aim to employ a novel task shifting approach to implement a needs-based home-based rehabilitation programme for people living with HIV in order to improve their quality of life and functional ability. It is hoped that this study will provide rehabilitation professionals and researchers with evidence that can be utilised to improve existing rehabilitation interventions for people living with HIV. Trial registration South African National Clinical Trials Register: NHREC#4094 (Date of registration: 21 July 2015).
Collapse
Affiliation(s)
- Saul Cobbing
- Department of Physiotherapy, University of KwaZulu-Natal, Private Bag X 54001, Durban, 4000, South Africa.
| | - Jill Hanass-Hancock
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa.
| | - Hellen Myezwa
- Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
45
|
Affiliation(s)
- Clemens Ley
- Institut für Sportwissenschaft, Universität Wien, Austria
| | - António Prista
- Centro de Investigação e Desenvolvimento do Desporto e Actividade Física, Universidade Pedagógica de Moçambique, Mozambique
| |
Collapse
|
46
|
Leach LL, Bassett SH, Smithdorf G, Andrews BS, Travill AL. A Systematic Review of the Effects of Exercise Interventions on Body Composition in HIV+ Adults. Open AIDS J 2015; 9:66-79. [PMID: 26587075 PMCID: PMC4645834 DOI: 10.2174/1874613601509010066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/08/2015] [Accepted: 08/16/2015] [Indexed: 11/22/2022] Open
Abstract
Over the years, physical activity and exercise have been used to positively impact the health and quality of life of persons infected with HIV and, more recently, has been associated with a spectrum of body composition changes. The aim of this review was to examine the effects of various exercise interventions on body composition in HIV positive adults, using a search strategy of randomized, controlled trials (RCTs). A systematic review was performed by five independent reviewers using a predetermined protocol adapted from previous research for assessing the articles for inclusion, the extracted data, and methodological quality. Eight RCTs involving 430 (26% female) HIV positive adults performing exercise a minimum of thrice weekly for at least six weeks were finally selected: Four were progressive resistance training (PRT) studies, three were aerobic training (AT) studies, and one involved yoga. In the PRT studies, there were significant increases in three anthropometric measures, namely, body mass, sum of skinfolds and sum of limb girths. In the AT studies, significant decreases were found in seven anthropometric measures, namely, body mass index, waist-hip ratio, body mass, triceps skinfold, waist circumference and sum of skinfolds. With yoga, the changes were non-significant. Exercise contributes to improved body composition and, when applied safely, appears to be beneficial for adults living with HIV/AIDS. However, these findings should be interpreted cautiously due to the relatively few RCTs published to date. Future studies would benefit from increased attention to sample size, female participants, participant follow-up, complete statistical analysis and intention-to-treat analysis.
Collapse
Affiliation(s)
- L L Leach
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - S H Bassett
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - G Smithdorf
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - B S Andrews
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| | - A L Travill
- Department of Sport, Recreation and Exercise Science, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
47
|
Paes LDS, Borges JP, dos Santos FM, de Oliveira TP, Dupin JG, Harris EA, Farinatti P. Effects of a 2-Year Supervised Exercise Program Upon the Body Composition and Muscular Performance of HIV-Infected Patients. Open AIDS J 2015; 9:80-8. [PMID: 26587076 PMCID: PMC4645897 DOI: 10.2174/1874613601509010080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/08/2015] [Accepted: 08/16/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a lack of research investigating long-term effects of exercise training upon the body composition and muscle function in HIV-infected patients (PHIV). The study investigated the influence of a 2-year supervised exercise program on body composition and strength of PHIV under highly active antiretroviral therapy (HAART). METHODS A training program including aerobic, strength and flexibility exercises was performed by 27 PHIV (17 men/ 10 women; age: 48.7±7.0 years; HAART: 150.7±65.3 months) during 1 year and 18 PHIV (10 men/ 8 women; age: 50.6±5.2 years; HAART: 176.6±53.1 months) during 2 years. Body composition and knee isokinetic strength were assessed at baseline and at the end of each year of intervention. RESULTS Body composition remained stable along the whole experiment vs baseline (1-year - total muscle mass: Δ men=1.1%, P=0.21; Δ women=1.4%, P=0.06; trunk fat: Δ men=-0.1%, P=0.65; Δ women=-1.5%, P=0.45; 2 years - total muscle mass: Δ men=2.7%, P=0.54; Δ women=-1.9%, P=0.71; trunk fat: Δ men=4.4%, P=0.96; Δ women=10.0%, P=0.30). After 1-year, peak torque increased in men (Δ extension=4.2%, P=0.01; Δ flexion=12.2%, P=0.04) and total work reduced in women (Δ extension=-15.4%, P=0.01, Δ flexion=-17.5%, P=0.05). All strength markers remained stable vs baseline after 2 years of intervention (P>0.05). Only men showed significant reduction in the risk of disability due to sarcopenia (P=0.05) after 1 year of intervention, which remained stable after 2 years. CONCLUSION Long-term exercise training preserved strength and muscle mass in PHIV under HAART. Exercise programs should be part of HIV therapy to prevent sarcopenia of this population along the years. TRIAL REGISTRATION ACTRN12610000683033; UTN U1111-1116-4416.
Collapse
Affiliation(s)
- Lorena da Silva Paes
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Juliana Pereira Borges
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Fernanda Monteiro dos Santos
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Taciana Pinto de Oliveira
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Jaciara Gomes Dupin
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Elizabeth Assumpção Harris
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
| | - Paulo Farinatti
- Laboratory of Physical Activity and Health Promotion, Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil
- Graduate Program in Physical Activity Sciences, Salgado de Oliveira University, Niteroi, RJ, Brazil
| |
Collapse
|
48
|
Gomes Neto M, Conceição CS, Carvalho VO, Brites C. Effects of Combined Aerobic and Resistance Exercise on Exercise Capacity, Muscle Strength and Quality of Life in HIV-Infected Patients: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0138066. [PMID: 26378794 PMCID: PMC4574781 DOI: 10.1371/journal.pone.0138066] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 08/25/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Many HIV-infected patients demonstrate disability and lower aerobic capacity. The inclusion of resistance training combined with aerobic exercise in a single program is known as combined aerobic and resistance exercise (CARE) and seems to be an effective strategy to improve muscle weakness, as well as aerobic capacity in HIV-infected patients. We performed a meta-analysis to investigate the effects of CARE in HIV-infected patients. METHODS We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, CINAHL (from the earliest date available to august 2014) for controlled trials that evaluated the effects of CARE in HIV-infected patients. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. RESULTS Seven studies met the study criteria. CARE resulted in improvement in Peak VO2 WMD (4.48 mL·kg-1·min-1 95% CI: 2.95 to 6.0), muscle strength of the knee extensors WMD (25.06 Kg 95% CI: 10.46 to 39.66) and elbow flexors WMD (4.44 Kg 95% CI: 1.22 to 7.67) compared with no exercise group. The meta-analyses also showed significant improvement in Health status, Energy/Vitality and physical function domains of quality of life for participants in the CARE group compared with no exercise group. A nonsignificant improvement in social function domain of quality of life was found for participants in the CARE group compared with no exercise group. CONCLUSIONS Combined aerobic and resistance exercise may improve peak VO2, muscle strength and health status, energy and physical function domains of quality of life and should be considered as a component of care of HIV-infected individuals.
Collapse
Affiliation(s)
- Mansueto Gomes Neto
- Departamento de Biofunçāo, Curso de Fisioterapia da Universidade Federal da Bahia, UFBA, Salvador, BA, Brazil
- Programa de Pós Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
- The GREAT Group (GRupo de Estudos em ATividade física), Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Cristiano Sena Conceição
- Departamento de Biofunçāo, Curso de Fisioterapia da Universidade Federal da Bahia, UFBA, Salvador, BA, Brazil
| | - Vitor Oliveira Carvalho
- The GREAT Group (GRupo de Estudos em ATividade física), Universidade Federal de Sergipe, Aracaju, SE, Brazil
- Departamento de Fisioterapia da Universidade Federal de Sergipe, UFS, Aracaju, SE, Brazil
| | - Carlos Brites
- Programa de Pós Graduação em Medicina e Saúde, UFBA, Salvador, BA, Brazil
| |
Collapse
|
49
|
Grace JM, Semple SJ, Combrink S. Exercise therapy for human immunodeficiency virus/AIDS patients: Guidelines for clinical exercise therapists. J Exerc Sci Fit 2015; 13:49-56. [PMID: 29541099 PMCID: PMC5812861 DOI: 10.1016/j.jesf.2014.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/15/2014] [Accepted: 10/27/2014] [Indexed: 02/04/2023] Open
Abstract
Human immunodeficiency virus (HIV) has infected > 60 million people since its discovery and 30 million people have died since the pandemic began. Antiretroviral therapy has transformed HIV infection from an acute to a chronic disease, increasing life expectancy but also adding to the potential side effects associated with drug therapy and the comorbidity accompanying longevity. Exercise can play a valuable role in the management of HIV/AIDS patients by addressing various symptoms and improving their quality of life, but the optimum mode, intensity, frequency, and duration of exercise that take the different clinical stages of the disease into consideration are inadequately known. Searches of Medline, Embase, Science Citation Index, CINAHL database, HealthSTAR, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Physiotherapy Evidence Database (PEDro), and SPORTDiscus were conducted between 2000 and January 2014. Searches of published and unpublished abstracts were conducted, as well as a hand search of reference lists and tables of contents of relevant journals and books. Identified studies were reviewed for methodological quality. A total of 33 studies met the inclusion criteria. Most studies failed to indicate the optimum type (mode), intensity, frequency, and duration of aerobic and progressive resistive exercise prescribed to HIV-infected individuals in relation to the different clinical stages of the disease. The purpose of this review is to provide evidence-based recommendations after revision of exercise guidelines for HIV patients, by highlighting practical guidelines that clinical exercise therapists should consider when prescribing exercise for patients in different stages of the disease.
Collapse
Affiliation(s)
- Jeanne M. Grace
- Faculty of Science and Agriculture, Department of Biokinetics and Sport Science, University of Zululand, Kwadlangezwa, South Africa
| | | | | |
Collapse
|
50
|
O’Brien KK, Ibáñez-Carrasco F, Solomon P, Harding R, Cattaneo J, Chegwidden W, Gahagan J, Baxter L, Worthington C, Gayle P, Merritt B, Baltzer-Turje R, Iku N, Zack E. Advancing research and practice in HIV and rehabilitation: a framework of research priorities in HIV, disability and rehabilitation. BMC Infect Dis 2014; 14:724. [PMID: 25551619 PMCID: PMC4304172 DOI: 10.1186/s12879-014-0724-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/17/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND HIV increasingly is experienced as a complex chronic illness where individuals are living longer with a range of physical, cognitive, mental and social health-related challenges associated with HIV, comorbidities and aging, a concept that may be termed 'disability'. Rehabilitation such as physical therapy and occupational therapy can help address disability and has the potential to improve quality of life in people living with HIV. Hence, the role for rehabilitation in the context of HIV, aging and comorbidities is emerging. Our aim was to establish a framework of research priorities in HIV, disability and rehabilitation. METHODS We convened people living with HIV, clinicians, researchers, service providers, representatives from community-based organizations and policy and funding stakeholders to participate in the first International Forum on HIV and Rehabilitation Research. We conducted a multi-stakeholder consultation to identify current and emerging issues in HIV, disability and rehabilitation. Data were collated and analyzed using content analytical techniques. RESULTS Ninety-two participants attended the Forum from Canada, United Kingdom (UK), Ireland and the United States. Situated within three overarching themes (episodic health and disability across the life course; rehabilitation; and methodological advances), the Framework of Research Priorities in HIV, Disability and Rehabilitation includes six research priorities: 1) episodic health and disability; 2) aging with HIV across the life course; 3) concurrent health conditions; 4) access to rehabilitation and models of rehabilitation service provision; 5) effectiveness of rehabilitation interventions; and 6) enhancing outcome measurement in HIV and rehabilitation research. The Framework includes methodological considerations and environmental and personal contextual factors (or lenses) through which to approach research in the field. Knowledge translation should be implemented throughout the development and application of research knowledge to inform HIV clinical practice, programming and policy. CONCLUSIONS These priorities highlight the emerging priorities of living long-term with HIV and outline a plan for HIV and rehabilitation research in resource-rich countries such as the UK and Canada.
Collapse
Affiliation(s)
- Kelly K O’Brien
- />Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
- />Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College Street, Toronto, ON Canada
- />School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON Canada
| | | | - Patricia Solomon
- />School of Rehabilitation Science, McMaster University, 1400 Main Street West, Room 403, Hamilton, ON Canada
| | - Richard Harding
- />Cicely Saunders Institute, School of Medicine, King’s College London, Bessemer Road, London, United Kingdom
| | - Jessica Cattaneo
- />AIDS Committee of Toronto, 399 Church Street, 4th Floor, Toronto, ON Canada
| | - William Chegwidden
- />Barts and the London NHS Trust, London, United Kingdom
- />University College Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jacqueline Gahagan
- />School of Health and Human Performance, Dalhousie University, Stairs House, 6230 South Street, Halifax, NS Canada
| | - Larry Baxter
- />Canadian Working Group on HIV and Rehabilitation, 600 Bay Street, Suite 600, Toronto, ON Canada
| | - Catherine Worthington
- />School of Public Health and Social Policy, University of Victoria, Human and Social Development Building, 3800 Finnerty Road, Victoria, BC Canada
| | | | - Brenda Merritt
- />School of Occupational Therapy, Dalhousie University, Forrest Building, Room 215, 5869 University Avenue, Halifax, NS Canada
| | | | - Nkem Iku
- />Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON Canada
| | - Elisse Zack
- />Canadian Working Group on HIV and Rehabilitation, 600 Bay Street, Suite 600, Toronto, ON Canada
| |
Collapse
|