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Jones R, Robinson AT, Beach LB, Lindsey ML, Kirabo A, Hinton A, Erlandson KM, Jenkins ND. Exercise to Prevent Accelerated Vascular Aging in People Living With HIV. Circ Res 2024; 134:1607-1635. [PMID: 38781293 PMCID: PMC11126195 DOI: 10.1161/circresaha.124.323975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Given advances in antiretroviral therapy, the mortality rate for HIV infection has dropped considerably over recent decades. However, people living with HIV (PLWH) experience longer life spans coupled with persistent immune activation despite viral suppression and potential toxicity from long-term antiretroviral therapy use. Consequently, PLWH face a cardiovascular disease (CVD) risk more than twice that of the general population, making it the leading cause of death among this group. Here, we briefly review the epidemiology of CVD in PLWH highlighting disparities at the intersections of sex and gender, age, race/ethnicity, and the contributions of social determinants of health and psychosocial stress to increased CVD risk among individuals with marginalized identities. We then overview the pathophysiology of HIV and discuss the primary factors implicated as contributors to CVD risk among PLWH on antiretroviral therapy. Subsequently, we highlight the functional evidence of premature vascular dysfunction as an early pathophysiological determinant of CVD risk among PLWH, discuss several mechanisms underlying premature vascular dysfunction in PLWH, and synthesize current research on the pathophysiological mechanisms underlying accelerated vascular aging in PLWH, focusing on immune activation, chronic inflammation, and oxidative stress. We consider understudied aspects such as HIV-related changes to the gut microbiome and psychosocial stress, which may serve as mechanisms through which exercise can abrogate accelerated vascular aging. Emphasizing the significance of exercise, we review various modalities and their impacts on vascular health, proposing a holistic approach to managing CVD risks in PLWH. The discussion extends to critical future study areas related to vascular aging, CVD, and the efficacy of exercise interventions, with a call for more inclusive research that considers the diversity of the PLWH population.
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Affiliation(s)
- Raymond Jones
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | | | - Lauren B. Beach
- Department of Medical Social Sciences, Northwestern, Chicago, IL
- Department of Preventive Medicine, Northwestern, Chicago, IL
| | - Merry L. Lindsey
- School of Graduate Studies, Meharry Medical College, Nashville, TN
- Research Service, Nashville VA Medical Center, Nashville, TN
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt Center for Immunobiology, Nashville, TN
- Vanderbilt Institute for Infection, Immunology and Inflammation, Nashville, TN
- Vanderbilt Institute for Global Health, Nashville, TN
| | - Antentor Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN
| | | | - Nathaniel D.M. Jenkins
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA
- Abboud Cardiovascular Research Center, University of Iowa, Iowa City, IA
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA
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Song D, Hightow-Weidman L, Yang Y, Wang J. Barriers and Facilitators of Physical Activity in People Living With HIV: A Systematic Review of Qualitative Studies. J Int Assoc Provid AIDS Care 2024; 23:23259582241275819. [PMID: 39155592 DOI: 10.1177/23259582241275819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Most people living with HIV (PLWH) are sedentary. This study aimed to synthesize the findings of qualitative studies to understand barriers and facilitators of physical activity (PA) among PLWH, categorized using the Capability, Opportunity, Motivation-Behavior (COM-B) model and Theoretical Domains Framework (TDF). METHODS Systematic searches of four databases were conducted to identify eligible studies. Thematic synthesis was used to inductively code, develop, and generate themes from the barriers and facilitators identified. Inductive data-driven themes were deductively categorized using the relevant domains of the COM-B model and the TDF. RESULTS Fourteen articles were included. The most prominent TDF domain for barriers was skills, particularly symptoms/health issues such as fatigue and pain, while the most prominent TDF domain for facilitators was reinforcement, particularly experiencing benefits from PA. CONCLUSION The breadth of factors identified suggests the need for comprehensive strategies to address these challenges effectively and support PLWH in adopting and sustaining PA routines.
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Affiliation(s)
- Dan Song
- College of Nursing, Florida State University College of Nursing, Tallahassee, FL, USA
| | - Lisa Hightow-Weidman
- College of Nursing, Florida State University College of Nursing, Tallahassee, FL, USA
| | - Yijiong Yang
- College of Nursing, Florida State University College of Nursing, Tallahassee, FL, USA
| | - Jing Wang
- College of Nursing, Florida State University College of Nursing, Tallahassee, FL, USA
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Jiancaro T, Bayoumi AM, Ibáñez-Carrasco F, Torres B, McDuff K, Brown DA, Chan Carusone S, Tang A, Loutfy M, Cobbing S, O’Brien KK. Factors influencing initial implementation of an online community-based exercise intervention with adults living with HIV: a systems approach. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1176960. [PMID: 37546578 PMCID: PMC10399961 DOI: 10.3389/fresc.2023.1176960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
Introduction Online community-based exercise (CBE) is a digital health intervention and rehabilitation strategy that promotes health among people living with HIV. Our aim was to describe the factors influencing initial implementation of a pilot online CBE intervention with adults living with HIV using a systems approach, as recommended by implementation science specialists. Methods We piloted the implementation of a 6-month online CBE intervention and 6-month independent exercise follow up, in partnership with the YMCA in Toronto, Canada. We recruited adults living with HIV who identified themselves as safe to engage in exercise. The intervention phase included personalized exercise sessions online with a personal trainer; exercise equipment; access to online exercise classes; and a wireless physical activity monitor. Two researchers documented implementation factors articulated by participants and the implementation team during early implementation, defined as recruitment, screening, equipment distribution, technology orientation, and baseline assessments. Data sources included communication with participants; daily team communication; weekly team discussions; and in-person meetings. We documented implementation factors in meeting minutes, recruitment screening notes, and email communication; and analyzed the data using a qualitative descriptive approach using a systems engineering method called Cognitive Work Analysis. Results Thirty-three adults living with HIV enrolled in the study (n = 33; median age: 52 years; cis-men: 22, cis-women: 10, non-binary: 1). Fifty-five factors influencing implementation, spanned five layers: (i) Natural, including weather and the COVID-19 virus; (ii) Societal, including COVID-19 impacts (e.g. public transit health risks impacting equipment pick-ups); (iii) Organizational, including information dissemination (e.g. tech support) and logistics (e.g. scheduling); (iv) Personal, including physical setting (e.g. space) and digital setting (e.g. device access); and (v) Human, including health (e.g. episodic illness) and disposition (e.g. motivation). The implementation team experienced heightened needs to respond rapidly; sustain engagement; and provide training and support. Additional organizational factors included a committed fitness training and research team with skills spanning administration and logistics, participant engagement, technology training, physical therapy, and research ethics. Conclusion Fifty-five factors spanning multiple layers illustrate the complexities of online CBE with adults living with HIV. Initial implementation required a dedicated, rehabilitation-centred, multi-skilled, multi-stakeholder team to address a diverse set of factors.
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Affiliation(s)
- T. Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - A. M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- MAP Centre, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F. Ibáñez-Carrasco
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - B. Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - K. McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - D. A. Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - S. Chan Carusone
- McMasterCollaborative Centre for Health and Aging, McMaster University, Hamilton, ON, Canada
| | - A. Tang
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - M. Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Maple Leaf Medical Clinic, Toronto, ON, Canada
| | - S. Cobbing
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The Institute of Education Research, University Health Network, Toronto, ON, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - K. K. O’Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada
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O'Brien KK, Ibáñez-Carrasco F, Carusone SC, Bayoumi AM, Tang A, McDuff K, Jiancaro T, Da Silva G, Torres B, Loutfy MR, Islam S, Lindsay J, Price C, Zobeiry M, Pandovski Z, Illic I, Ahluwalia P, Brown DA, Avery L, Solomon P. Piloting an online telecoaching community-based exercise intervention with adults living with HIV: protocol for a mixed-methods implementation science study. BMJ Open 2023; 13:e067703. [PMID: 36997255 PMCID: PMC10069544 DOI: 10.1136/bmjopen-2022-067703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Our aim is to evaluate the implementation of an online telecoaching community-based exercise (CBE) intervention with the goal of reducing disability and enhancing physical activity and health among adults living with HIV. METHODS AND ANALYSIS We will conduct a prospective longitudinal mixed-methods two-phased intervention study to pilot the implementation of an online CBE intervention with ~30 adults (≥18 years) living with HIV who consider themselves safe to participate in exercise. In the intervention phase (0-6 months), participants will take part in an online CBE intervention involving thrice weekly exercise (aerobic, resistance, balance and flexibility), with supervised biweekly personal training sessions with a fitness instructor, YMCA membership providing access to online exercise classes, wireless physical activity monitor to track physical activity and monthly online educational sessions on topics related to HIV, physical activity and health. In the follow-up phase (6-12 months), participants will be encouraged to continue independent exercise thrice weekly. Quantitative assessment: Bimonthly, we will assess cardiopulmonary fitness, strength, weight, body composition and flexibility, followed by administering self-reported questionnaires to assess disability, contextual factor outcomes (mastery, engagement in care, stigma, social support), implementation factors (cost, feasibility, technology), health status and self-reported physical activity. We will conduct a segmented regression analyses to describe the change in level and trend between the intervention and follow-up phases. Qualitative assessment: We will conduct online interviews with a subsample of ~10 participants and 5 CBE stakeholders at baseline (month 0), postintervention (month 6) and end of follow-up (month 12) to explore experiences, impact and implementation factors for online CBE. Interviews will be audiorecorded and analysed using content analytical techniques. ETHICS AND DISSEMINATION Protocol approved by the University of Toronto Research Ethics Board (Protocol # 40410). Knowledge translation will occur in the form of presentations and publications in open-access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05006391.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | | | - Soo Chan Carusone
- McMaster Collaborative for Health and Aging, McMaster University, Hamilton, Ontario, Canada
| | - Ahmed M Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tizneem Jiancaro
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brittany Torres
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mona R Loutfy
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Maple Leaf Medical Clinic, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Joanne Lindsay
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Toronto, Ontario, Canada
| | - Colleen Price
- Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), Ottawa, Ontario, Canada
| | - Mehdi Zobeiry
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Zoran Pandovski
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | - Ivan Illic
- YMCA of Greater Toronto, YMCA Canada, Toronto, Ontario, Canada
| | | | - Darren A Brown
- Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Biostatistics Department, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Kitilya B, Sanga E, PrayGod G, Kavishe BB, Ditlevsen K, Peck R, Olsen MF. Perceptions, facilitators and barriers of physical activity among people living with HIV: a qualitative study. BMC Public Health 2023; 23:360. [PMID: 36803443 PMCID: PMC9938982 DOI: 10.1186/s12889-023-15052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/13/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND People living with HIV (PLWH) have low levels of physical activity. Using the social ecological model to understand perceptions, facilitators and barriers of physical activity in this population is of importance for developing contextualised interventions to improve physical activity in PLWH. METHOD This was a qualitative sub-study conducted between august and November 2019 as part of a cohort study on diabetes and associated complications in HIV infected in Mwanza, Tanzania. Sixteen in-depth interviews and three focus groups with nine participants in each were conducted. The interviews and focus groups were audio recorded, transcribed and translated into English. The social ecological model was considered during the coding and interpretation of the results. Transcripts were discussed, coded and analyzed using deductive content analysis. RESULTS Forty-three PLWH aged 23-61 years participated in this study. The findings showed that most PLWH perceived physical activity as beneficial to their health. However, their perceptions of physical activity were rooted within existing gender stereotypes and roles in the community. Running and playing football were perceived as activities for men while household chores activities were for women. Further, men were perceived to do more physical activity than women. For women, household chores and income-generating activities were perceived as sufficient physical activity. Social support and engagement of family members and friends in physical activity were reported as facilitators of physical activity. Reported barriers of physical activity were lack of time, money, availability of physical activity facilities and social support groups, and poor information on physical activity from health care providers in HIV clinics. Human-immunodeficiency virus (HIV) HIV infection was not perceived by PLWH as a barrier for doing physical activity but most family members did not support them to do physical activity, fearing that it might worsen their condition. CONCLUSION The findings demonstrated differing perceptions, facilitators and barriers of physical activity among PLWH. Interventions addressing awareness, gender stereotypes and roles related to physical activity from individual to community level are needed. Supportive environment and infrastructures are needed to improve physical activity levels in PLWH in Tanzania.
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Affiliation(s)
- Brenda Kitilya
- Mwanza Research Centre, National Institute for Medical Research, P.O BOX 1462, Mwanza, Tanzania.
| | - Erica Sanga
- Mwanza Research Centre, National Institute for Medical Research, P.O BOX 1462, Mwanza, Tanzania
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, P.O BOX 1462, Mwanza, Tanzania
| | - Bazil Baltazar Kavishe
- Mwanza Research Centre, National Institute for Medical Research, P.O BOX 1462, Mwanza, Tanzania
| | - Kia Ditlevsen
- Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark
| | - Robert Peck
- Mwanza Research Centre, National Institute for Medical Research, P.O BOX 1462, Mwanza, Tanzania
- Weill Bugando School of Medicine, Mwanza, Tanzania
- Weill Cornell Medicine, New York, USA
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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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.
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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
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Safa F, McClellan N, Bonato S, Rueda S, O’Brien KK. The Role of the Social Determinants of Health on Engagement in Physical Activity or Exercise among Adults Living with HIV: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13528. [PMID: 36294111 PMCID: PMC9602835 DOI: 10.3390/ijerph192013528] [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: 08/01/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Physical activity (PA) and exercise are an effective rehabilitation strategy to improve health outcomes among people living with HIV (PLWH). However, engagement in exercise among PLWH can vary. Our aim was to characterize the literature on the role of social determinants of health (SDOH) on engagement in PA or exercise among adults living with HIV. We conducted a scoping review using the Arksey and O'Malley Framework. We searched databases between 1996 and 2021. We included articles that examined PA or exercise among adults with HIV and addressed at least one SDOH from the Public Health Agency of Canada Framework. We extracted data from included articles onto a data extraction charting form, and collated results using content analytical techniques. Of the 11,060 citations, we included 41 articles, with 35 studies involving primary data collection 23 (66%) quantitative, 8 (23%) qualitative, and four (11%) mixed methods. Of the 14,835 participants, 6398 (43%) were women. Gender (n = 24 articles), social support (n = 15), and income and social status (n = 14) were the most commonly reported SDOH in the literature with the majority of studies addressing only one SDOH. Future research should consider the intersection between multiple SDOH to better understand their combined impact on engagement in PA or exercise among PLWH.
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Affiliation(s)
- Farhana Safa
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
| | - Natalia McClellan
- AIDS Community Care Montreal, SIDA Bénévoles Montréal, Montreal, QC H2L 2Y4, Canada
| | - Sarah Bonato
- Library Services, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
| | - Sergio Rueda
- Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON M5S 2S1, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5T 1R8, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Kelly K. O’Brien
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON M5G 1V7, Canada
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SantaBarbara NJ, Nosrat S, Arnold EM, Swendeman D, Comulada WS. Intersection of COVID-19, HIV and exercise: a commentary with home-based exercise recommendations for practice. AIDS Care 2022; 34:188-192. [PMID: 34743617 PMCID: PMC8857034 DOI: 10.1080/09540121.2021.1998312] [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: 02/03/2023]
Abstract
The worldwide spread of COVID-19 has led to closures or reduced capacity of non-essential businesses and recreational areas and stay-at-home orders to promote social distancing. Although effective to reduce transmission, these policies may negatively impact exercise behaviors. Exercise is effective at mitigating the risk of developing or exacerbating several of underlining risk factors for a more severe COVID-19 disease course and may be particularly important for people with HIV (PWH). In this commentary, we discuss the intersection of COVID-19 and exercise with a specific focus on people living with HIV. We then provide a pragmatic, home-based exercise routine that can be performed with little to no equipment or supervision. It is important for PWH (and others) to start or maintain at least some level of exercise to reduce the risk of a severe COVID-19 disease course and to improve other health outcomes in this unfamiliar climate.
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Affiliation(s)
- Nicholas J. SantaBarbara
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA 90024
| | - Sanaz Nosrat
- Department of Health Sciences, Lehman College/CUNY 250 Bedford Park Boulevard Bronx, NY 10468, USA
| | - Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd #303, Dallas, TX, 75390
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA 90024
| | - Warren Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA 90024
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Solomon P, Chan Carusone S, Davis AM, Aubry R, O'Brien KK. A Qualitative Study of Fitness Coaches' Experiences in Community Based Exercise with People Living with HIV. J Int Assoc Provid AIDS Care 2021; 20:23259582211046762. [PMID: 34668422 PMCID: PMC8532256 DOI: 10.1177/23259582211046762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fitness coaches need to understand the needs of people living with HIV engaged in community-based exercise (CBE) to be competent in developing exercises programs with this population. Our aim was to understand coaches’ experiences engaging in a CBE intervention with PLWH in an urban center in Canada. As part of a broader study, coaches supervised weekly hour-long individualized exercise sessions with PLWH over a six-month period. Using qualitative longitudinal methods, we interviewed coaches up to three times over six months. Transcribed interviews were analyzed cross-sectionally and longitudinally. Seven coaches participated in 15 interviews. Developing confidence, improving health and experiencing a sense of community were viewed as key benefits to PLWH by the coaches. Challenges included accommodating the episodic nature of HIV and ensuring they felt prepared to work with PLWH. Understanding the experiences of coaches engaged in CBE can assist in tailoring exercise programs to meet the needs of PLWH.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Soo Chan Carusone
- Casey House, Toronto, Canada.,Department of Health Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Aileen M Davis
- 7938Department of Physical Therapy, University of Toronto, Toronto, Canada.,7938Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,7938Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Rachel Aubry
- 7938Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kelly K O'Brien
- 7938Department of Physical Therapy, University of Toronto, Toronto, Canada.,7938Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Canada.,7938Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Canada
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O’Brien KK, Davis AM, Chan Carusone S, Avery L, Tang A, Solomon P, Aubry R, Zobeiry M, Ilic I, Pandovski Z, Bayoumi AM. Examining the impact of a community-based exercise intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility and physical activity among adults living with HIV: A three-phased intervention study. PLoS One 2021; 16:e0257639. [PMID: 34559851 PMCID: PMC8462727 DOI: 10.1371/journal.pone.0257639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Our aim was to examine the impact of a community-based exercise (CBE) intervention on cardiorespiratory fitness, cardiovascular health, strength, flexibility, and physical activity outcomes among adults living with HIV. METHODS We conducted a longitudinal intervention study with community-dwelling adults living with HIV in Toronto, Canada. We measured cardiopulmonary fitness (V̇O2peak (primary outcome), heart rate, blood pressure), strength (grip strength, vertical jump, back extension, push-ups, curl ups), flexibility (sit and reach test), and self-reported physical activity bimonthly across three phases. Phase 1 included baseline monitoring (8 months); Phase 2 included the CBE Intervention (6 months): participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching at a community-based fitness centre; and Phase 3 included follow-up (8 months) where participants were expected to continue with thrice weekly exercise independently. We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) among phases. Our main estimates of effect were the estimated change in slope, relative to baseline values, over the 6 month CBE intervention. RESULTS Of the 108 participants who initiated Phase 1, 80 (74%) started and 67/80 (84%) completed the intervention and 52/67 (77%) completed the study. Most participants were males (87%), with median age of 51 years (interquartile range (IQR): 45, 59). Participants reported a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25 (72%) weekly supervised sessions. Change in V̇O2peak attributed to the six-month Phase 2 CBE intervention was 0.56 ml/kg/min (95% Confidence Interval (CI): -1.27, 2.39). Significant effects of the intervention were observed for systolic blood pressure (-5.18 mmHg; 95% CI: -9.66, -0.71), push-ups (2.30 additional push-ups; 95% CI: 0.69, 3.91), curl ups (2.89 additional curl ups; 95% CI: 0.61, 5.17), and sit and reach test (1.74 cm; 95% CI: 0.21, 3.28). More participants engaged in self-reported strength (p<0.001) and flexibility (p = 0.02) physical activity at the end of intervention. During Phase 3 follow-up, there was a significant reduction in trend of benefits observed during the intervention phase for systolic blood pressure (1.52 mmHg/month; 95% CI: 0.67, 2.37) and sit and reach test (-0.42 cm/month; 95% CI: -0.68, -0.16). CONCLUSION Adults living with HIV who engaged in this six-month CBE intervention demonstrated inconclusive results in relation to V̇O2peak, and potential improvements in other outcomes of cardiovascular health, strength, flexibility and self-reported physical activity. Future research should consider features tailored to promote uptake and sustained engagement in independent exercise among adults living with HIV. CLINICALTRIALS.GOV IDENTIFIER NCT02794415. https://clinicaltrials.gov/ct2/show/record/NCT02794415.
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Affiliation(s)
- Kelly K. O’Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Aileen M. Davis
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | | | - Lisa Avery
- University Health Network, Toronto, Ontario, Canada
- Avery Information, Oshawa, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Institute of Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - Ivan Ilic
- Central Toronto YMCA, Toronto, Ontario, Canada
| | | | - Ahmed M. Bayoumi
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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11
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Vader K, Carusone SC, Aubry R, Ahluwalia P, Murray C, Baxter L, Robinson G, Ibáñez-Carrasco F, Stewart A, Solomon P, O'Brien KK. Strengths and Challenges of Implementing Physiotherapy in an HIV Community-Based Care Setting: A Qualitative Study of Perspectives of People Living with HIV and Healthcare Providers. J Int Assoc Provid AIDS Care 2021; 20:23259582211005628. [PMID: 33779374 PMCID: PMC8010811 DOI: 10.1177/23259582211005628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The needs of people living with HIV (PLWH) who have access to antiretroviral therapy have shifted from hospital to community care; however, little is known about physiotherapy within HIV community-based care. Our aim was to understand strengths and challenges of implementing physiotherapy within an interprofessional HIV day health program in Toronto, Ontario, Canada. We conducted a qualitative descriptive study using semi-structured interviews. Data were analyzed using inductive content analysis. Fifteen PLWH and 5 healthcare providers participated. Strengths included improved access to physiotherapy and fulfilling an unmet need for rehabilitation; a tailored approach to physiotherapy; co-location improved communication, coordination, and engagement in care; and improved health outcomes for PLWH (i.e. function, psychosocial outcomes, and quality of life). Challenges related to managing expectations; variable attendance at visits; and managing complex and diverse needs of PLWH. Results may be transferable to other community-based care settings that provide care for PLWH and complex multi-morbidity.
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Affiliation(s)
- Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.,Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | | | - Rachel Aubry
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Ann Stewart
- St. Michael's Academic Family Health Team, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Solomon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
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12
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Solomon P, Carusone SC, Davis AM, Aubry R, O'Brien KK. Experiences of People Living With HIV in Community Based Exercise: A Qualitative Longitudinal Study. J Int Assoc Provid AIDS Care 2021; 20:2325958221995344. [PMID: 33611978 PMCID: PMC7903824 DOI: 10.1177/2325958221995344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This qualitative longitudinal study examined the experiences of people living with HIV who engaged in a structured community-based exercise (CBE) program under the supervision of a fitness coach. Twenty people living with HIV were invited to participate in 3 semi-structured interviews over time. Participants engaged in exercise 3 times per week for 6 months with one weekly session supervised by a coach. Interviews were audio-recorded, transcribed verbatim and underwent longitudinal thematic analyses. Eleven participants were included representing a total of 30 interviews. Participants valued their experiences with the CBE program, particularly the motivation provided by the coach. Concerns about the environment, stigma and episodic health challenges affected their overall experience. To foster independence and promote self-management, health providers should consider these findings when encouraging CBE with people living with HIV. It is important to understand their goals and offer a variety of exercise options to meet their needs.
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Affiliation(s)
- Patricia Solomon
- School of Rehabilitation Science, 3710McMaster University, Hamilton, Canada
| | - Soo Chan Carusone
- 169566Casey House, Toronto, Canada.,Department of Health Research Methods, Evidence, and Impact, 3710McMaster University, Hamilton, Canada
| | - Aileen M Davis
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), 7938University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute (RSI), 7938University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
| | - Rachel Aubry
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, 7938University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), 7938University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute (RSI), 7938University of Toronto, Toronto, Canada
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13
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Homayouni TS, Ruth A, Abbott-Tate Z, Burger H, Rahim S, Murray C, Wannamaker R, Chan Carusone S, O'Brien KK. Experiences engaging in a group-based physiotherapist-led exercise programme for adults living with HIV and complex multimorbidity: a qualitative study. BMJ Open 2021; 11:e045158. [PMID: 34315789 PMCID: PMC8317082 DOI: 10.1136/bmjopen-2020-045158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To explore experiences participating in a group-based physiotherapist (PT)-led exercise programme among people living with HIV and complex multimorbidity. DESIGN We conducted a qualitative descriptive study using semistructured interviews. RECRUITMENT AND SETTING We recruited community-dwelling adults living with HIV who engaged in a group-based PT-led exercise programme within an HIV-specialty hospital in Toronto, Canada. Interviews were conducted in-person or by telephone. PARTICIPANTS Eight men and two women with a median age of 58 years and median of six concurrent conditions in addition to HIV, who had attended ≥2 classes of the exercise programme. DATA COLLECTION Interviews explored (1) reasons for engaging in the programme, (2) experiences with exercise prior to and after joining the programme, (3) facilitators and barriers to engagement and (4) perceived impacts of participation on health and disability. We administered the HIV Disability Questionnaire and a demographic questionnaire. RESULTS Experiences spanned perspectives prior to, during and after the PT-led exercise programme. Reasons for engaging in the programme included addressing health-related goals. Participants identified accessibility, the flexible schedule, interprofessional staff and the HIV-specific, group-based environment as facilitators to engagement. Participants reported high attendance rates, but identified episodic health challenges and overcrowded space as potential barriers to attending exercise classes. Perceived impacts on health and disability outcomes included improved physical, mental, social and cognitive health, and activities of daily living. Anticipated or actual experiences transitioning to independent exercise included facilitators (supportive programme leaders) and barriers (challenges motivatiing self to exercise alone). CONCLUSIONS Features of the programme that facilitated engagement included the interprofessional, group-based environment that offered tailored exercise in an HIV-specific facility, whereby participants perceived benefits in domains of health and disability. However, challenges transitioning to independent exercise remain. Group-based PT-led exercise programmes may facilitate engagement in exercise among adults living with HIV and complex multimorbidity.
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Affiliation(s)
- Tina S Homayouni
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alex Ruth
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zoe Abbott-Tate
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Helen Burger
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shaera Rahim
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Soo Chan Carusone
- Casey House, Toronto, Ontario, Canada
- Department of Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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14
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Gray L, Schuft L, Bergamaschi A, Filleul V, Colson SS, d'Arripe-Longueville F. Perceived barriers to and facilitators of physical activity in people living with HIV: A qualitative study in a French sample. Chronic Illn 2021; 17:111-128. [PMID: 30808204 DOI: 10.1177/1742395319826638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The benefits of physical activity in people living with HIV (PLHIV) are numerous and are largely reported in the literature. Understanding why PLHIV engage or not in physical activity is key to better accompanying health behaviors. Through a qualitative approach, our study sought to identify barriers to and facilitators of physical activity participation in PLHIV. METHODS PLHIV were recruited by purposive sampling. Semi-structured interviews were carried-out in Center and Southern France. The data were analyzed following the principals of thematic analysis. Physical activity level was assessed through questions related to physical activity recommendations and a physical activity questionnaire. RESULTS Fifteen semi-structured interviews (seven men and eight women; Mage = 46.6; SD = 10.3) were analyzed. Only a third of our sample was considered physically active with almost half being considered inactive according to recommendations. A multidimensional perspective of physical activity barriers and facilitators emerged. Barriers to and facilitators of physical activity were related to the physical, psychological and socio-environmental domains. DISCUSSION Our research sought to better understand the beliefs and attitudes of PLHIV towards physical activity. Physical activity was overall viewed as beneficial by both active and less active PLHIV; however, PLHIV remain insufficiently active. This is discussed through our multidimensional approach of the barriers to and facilitators of physical activity.
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Affiliation(s)
- Laura Gray
- LAMHESS, Université Côte d'Azur, Nice, France
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15
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Global and Leisure-Time Physical Activity Levels Among People Living With HIV on Antiretroviral Therapy in Burundi: A Cross-sectional Study. J Assoc Nurses AIDS Care 2021; 32:674-681. [PMID: 33908406 DOI: 10.1097/jnc.0000000000000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The latest recommendations for HIV therapeutic management emphasize the importance of regular physical activity (PA). This cross-sectional study assessed the self-reported level of PA, amount of leisure time PA (LTPA), and the predictors of PA practiced in 257 people living with HIV (PLWH) in Burundi. The World Health Organization recommends 150 min of PA per week. In our study, 80.2% of the participants met this recommendation. Participants were more engaged in PA at work (436.8 ± 682.1 min/week) compared with leisure time (231.7 ± 383.8 min/week) and transportation (235.9 ± 496.5 min/week). Multivariate analysis revealed that men (β = -101.65; p = .01) who were white-collar workers (β = 67.21; p < .03) with higher education level (β = 274.21; p < .001) reported higher levels of LTPA than other groups. Integrating PA counseling into the routine care and implementing community-based exercise programs could enhance participation in PA in PLWH.
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16
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Dnes N, Coley B, Frisby K, Keller A, Suyom J, Tsui C, Grant G, Vader K, Hunter J. "A little bit of a guidance and a little bit of group support": a qualitative study of preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain. Disabil Rehabil 2020; 43:3347-3356. [PMID: 32223460 DOI: 10.1080/09638288.2020.1742801] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose: To understand preferences, barriers, and facilitators to participating in community-based exercise opportunities among adults living with chronic pain.Materials and Methods: An interpretive description methodology based on semi-structured interviews was conducted. Adults (age>18 years) living with chronic pain (pain >3 months in duration) were recruited from a multidisciplinary chronic pain clinic in Toronto, Canada. Thematic analysis was used to conceptualize interview data.Results: Fifteen adults living with chronic pain (11/15 women) were interviewed. Four themes regarding preferences, barriers, and facilitators to participation in community-based exercise are described: (1) accessibility (e.g., cost, location, scheduling, and access to program information from healthcare providers); (2) intrinsic factors (e.g., pain, mental health, and motivation); (3) social factors (e.g., isolation, participation with people with similar capabilities, and safe environment); and (4) program factors (e.g., tailored to adults living with chronic pain, gentle exercise, group-based, and delivered by an instructor knowledgeable about chronic pain).Conclusions: Participation in community-based exercise opportunities among adults living with chronic pain may be influenced by accessibility, intrinsic factors, social factors, and program factors. Results provide a foundation of understanding to develop person-centered community-based exercise opportunities that are tailored to meet the preferences of this population.Implications for RehabilitationAlthough community-based exercise is commonly recommended as part of ongoing self-management of chronic pain, there is limited research exploring perspectives towards community-based exercise opportunities from the perspective of adults living with chronic pain.Adults living with chronic pain reported specific preferences, barriers, and facilitators to participating in community-based exercise opportunities, including accessibility, instrinsic factors, social factors, and program factors.Most adults living with chronic pain reported a preference for community-based exercise opportunities that: (1) are delivered by an instructor who is knowledgeable about chronic pain; (2) involve gentle exercise; (3) are group-based; and (4) include other individuals with similar physical capabilities.Healthcare providers, community-based organizations, and researchers should develop, implement, and evaluate person-centered community-based exercise opportunities for adults living with chronic pain that consider their unique preferences, barriers, and facilitators to participation.
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Affiliation(s)
- Natalie Dnes
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Bridget Coley
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Kaitlyn Frisby
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Anna Keller
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Jezreel Suyom
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Cindy Tsui
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - Gillian Grant
- Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Canada
| | - Kyle Vader
- Chronic Pain Clinic, Kingston Health Sciences Centre, Kingston, Canada.,School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Judith Hunter
- Department of Physical Therapy, University of Toronto, Toronto, Canada
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17
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Sundermann EE, Erlandson KM, Pope CN, Rubtsova A, Montoya J, Moore AA, Marzolini C, O'Brien KK, Pahwa S, Payne BA, Rubin LH, Walmsley S, Haughey NJ, Montano M, Karris MY, Margolick JB, Moore DJ. Current Challenges and Solutions in Research and Clinical Care of Older Persons Living with HIV: Findings Presented at the 9th International Workshop on HIV and Aging. AIDS Res Hum Retroviruses 2019; 35:985-998. [PMID: 31373216 PMCID: PMC6862962 DOI: 10.1089/aid.2019.0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In the era of effective antiretroviral therapy, the number of older people with HIV (PWH) is increasing, and those aging with HIV are experiencing an increasing burden of age-associated comorbidities. Life expectancy among older PWH is approaching that of demographically comparable HIV-uninfected (HIV-) adults. With this changing demographic of PWH come new challenges for researchers and clinicians in how to identify, address, and manage the complex interplay of treated HIV infection and aging-associated factors. In response to these challenges, the annual International Workshop on HIV and Aging was initiated in 2009 as a multidisciplinary platform for scientific discourse on the research and clinical complications arising from the aging population of PWH. The multidisciplinary nature of the workshop has resulted in a wide range of topics addressed over the past 9 years, from basic mechanisms in aging and HIV pathogenesis, to epidemiology of aging within large cohorts, interventions, and implementation of clinical programs. Herein, we summarize the key topics discussed at the 9th Annual International Workshop on HIV and Aging 2018, including "inflammaging," mitochondrial dysfunction, exercise interventions, HIV-associated neurocognitive impairment, metabolic dysfunction, menopause, and polypharmacy. In addition to recent developments in research and clinical care, we discuss open questions and future research directions required to better understand the interaction of HIV and aging.
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Affiliation(s)
- Erin E. Sundermann
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Kristine M. Erlandson
- Department of Medicine, University of Colorado-Anschutz Medical Center, Aurora, Colorado
- Department of Epidemiology, School of Public Health, University of Colorado-Anschutz Medical Center, Aurora, Colorado
| | - Caitlin N. Pope
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Anna Rubtsova
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Jessica Montoya
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Alison A. Moore
- Division of Geriatrics and Gerontology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Catia Marzolini
- Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
- The Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Kelly K. O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- The Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
| | - Savita Pahwa
- Department of Microbiology and Immunology and the Miami CFAR, University of Miami Miller School of Medicine, Miami, Florida
| | - Brendan A.I. Payne
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Leah H. Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sharon Walmsley
- Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Norman J. Haughey
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Monty Montano
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Maile Y. Karris
- Division of Infectious Diseases and Global Public Health, Department of Medicine, Unviersity of California San Diego, San Diego, California
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Environmental Health and Engineering, and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California
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18
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deBoer H, Cudd S, Andrews M, Leung E, Petrie A, Chan Carusone S, O'Brien KK. Recommendations for integrating physiotherapy into an interprofessional outpatient care setting for people living with HIV: a qualitative study. BMJ Open 2019; 9:e026827. [PMID: 31129584 PMCID: PMC6538079 DOI: 10.1136/bmjopen-2018-026827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To identify factors to consider when integrating physiotherapy (PT) into an interprofessional outpatient HIV care setting from the perspective of healthcare professionals and adults living with HIV. DESIGN We conducted a qualitative descriptive study using semi-structured interviews (healthcare professionals) and focus groups (adults living with HIV). We asked participants their perspectives on barriers, facilitators and strategies to accessing and participating in outpatient PT, important characteristics physiotherapists should possess working in outpatient HIV care, content and structure of PT delivery, and programme evaluation. RECRUITMENT AND SETTING We purposively sampled healthcare professionals based on their experiences working in interprofessional HIV care and recruited adults with HIV via word of mouth and in collaboration with an HIV-specialty hospital in Toronto, Canada. Interviews were conducted via Skype or in-person and focus groups were conducted in-person at the HIV-specialty hospital. PARTICIPANTS 12 healthcare professionals with a median of 12 years experience in HIV care, and 13 adults living with HIV (11 men and 2 women) with a median age of 50 years and living with a median of 6 concurrent health conditions in addition to HIV. RESULTS Overall impressions of PT in outpatient HIV care and factors to consider when implementing PT into an interprofessional care setting include: promoting the role of, and evidence for, PT in outpatient HIV care, structuring PT delivery to accommodate the unique needs and priorities of adults living with HIV, working collaboratively with a physiotherapist on the healthcare team and evaluating rehabilitation as a component of interprofessional care. CONCLUSIONS Multiple factors exist for consideration when implementing PT into an interprofessional outpatient HIV care setting. Results provide insight for integrating timely and appropriate access to evidence-informed rehabilitation for people living with chronic and episodic illness, such as HIV.
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Affiliation(s)
- Heather deBoer
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Cudd
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Andrews
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Ellie Leung
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Alana Petrie
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Soo Chan Carusone
- Casey House, Toronto, Ontario, Canada
- Department of Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation (IHPME); Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada
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19
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Montoya JL, Jankowski CM, O’Brien KK, Webel AR, Oursler KK, Henry BL, Moore DJ, Erlandson KM. Evidence-informed practical recommendations for increasing physical activity among persons living with HIV. AIDS 2019; 33:931-939. [PMID: 30946147 PMCID: PMC6457127 DOI: 10.1097/qad.0000000000002137] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jessica L. Montoya
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Catherine M. Jankowski
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
| | - Kelly K. O’Brien
- Department of Physical Therapy; Rehabilitation Sciences Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Krisann K. Oursler
- Geriatric Research and Education, Salem Veterans Medical Center, Salem, Virginia, USA; Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Brook L. Henry
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - David J. Moore
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Kristine M. Erlandson
- Division of Infectious Diseases; Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, USA
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20
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Bui KD, Johnson MJ. Designing robot-assisted neurorehabilitation strategies for people with both HIV and stroke. J Neuroeng Rehabil 2018; 15:75. [PMID: 30107849 PMCID: PMC6092818 DOI: 10.1186/s12984-018-0418-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/27/2018] [Indexed: 01/01/2023] Open
Abstract
There is increasing evidence that HIV is an independent risk factor for stroke, resulting in an emerging population of people living with both HIV and stroke all over the world. However, neurorehabilitation strategies for the HIV-stroke population are distinctly lacking, which poses an enormous global health challenge. In order to address this gap, a better understanding of the HIV-stroke population is needed, as well as potential approaches to design effective neurorehabilitation strategies for this population. This review goes into the mechanisms, manifestations, and treatment options of neurologic injury in stroke and HIV, the additional challenges posed by the HIV-stroke population, and rehabilitation engineering approaches for both high and low resource areas. The aim of this review is to connect the underlying neurologic properties in both HIV and stroke to rehabilitation engineering. It reviews what is currently known about the association between HIV and stroke and gaps in current treatment strategies for the HIV-stroke population. We highlight relevant current areas of research that can help advance neurorehabilitation strategies specifically for the HIV-stroke population. We then explore how robot-assisted rehabilitation combined with community-based rehabilitation could be used as a potential approach to meet the challenges posed by the HIV-stroke population. We include some of our own work exploring a community-based robotic rehabilitation exercise system. The most relevant strategies will be ones that not only take into account the individual status of the patient but also the cultural and economic considerations of their respective environment.
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Affiliation(s)
- Kevin D. Bui
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
| | - Michelle J. Johnson
- Department of Bioengineering, University of Pennsylvania, Philadelphia, USA
- Rehabilitation Robotics Lab (a GRASP Lab), University of Pennsylvania, 1800 Lombard Street, Philadelphia, 19146 USA
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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21
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Quigley A, Baxter L, Keeler L, MacKay-Lyons M. Using the Theoretical Domains Framework to identify barriers and facilitators to exercise among older adults living with HIV. AIDS Care 2018; 31:163-168. [PMID: 30021454 DOI: 10.1080/09540121.2018.1499860] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
People with HIV are living longer. However, co-morbidities are often more prevalent and severe than in the general population and have greater impacts on health status. Although compelling evidence exists about the health benefits of exercise in the HIV literature, many people living with HIV tend to be physically inactive. The purpose of this study was to use the Theoretical Domains Framework to investigate the barriers and facilitators to participation in exercise of older people living with HIV. This qualitative study involved in-depth, semi-structured interviews with 12 adults aged 45 years and older recruited from HIV organizations and health centres. Data were analyzed thematically using the Theoretical Domains Framework, and two investigators independently coded transcripts. Six prominent domains were identified from the interviews: Social influences, environmental context and resources, reinforcement, intentions, social and professional role, and knowledge. Themes emerging from the interviews fit into all 14 domains of the Theoretical Domains Framework, and 67% of themes fit into the six most prominent domains. The participants had a working knowledge of exercise and its health benefits but were unfamiliar with specific exercise parameters. The majority identified environmental or resource constraints as salient barriers for participation in exercise programmes. Co-morbidities, injuries, and the side effects of HIV disease and medication were also acknowledged as barriers. Stigma and discrimination from friends, family, people within the LGBTQ community, and health care providers were commonly discussed. Participants spoke of the importance of social support to facilitate participation in exercise programmes. Other facilitators included using technology and incorporating exercise into day-to-day activities. People aging with HIV experience many barriers to exercise. Those designing exercise interventions for people aging with HIV should incorporate strategies to address these obstacles.
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Affiliation(s)
- Adria Quigley
- a Department of Health , Dalhousie University , Halifax , Canada
| | | | - Laura Keeler
- c Department of Community Health & Epidemiology , Dalhousie University , Halifax , Canada
| | - Marilyn MacKay-Lyons
- d Department of Physiotherapy , Dalhousie University , Halifax , Canada.,e Department of Medicine , Dalhousie University , Halifax , Canada.,f Nova Scotia Health Authority , Halifax , Canada
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22
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Salbach NM, Howe JA, Baldry D, Merali S, Munce SEP. Considerations for expanding community exercise programs incorporating a healthcare-recreation partnership for people with balance and mobility limitations: a mixed methods evaluation. BMC Res Notes 2018; 11:214. [PMID: 29609662 PMCID: PMC5879753 DOI: 10.1186/s13104-018-3313-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/21/2018] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To increase access to safe and appropriate exercise for people with balance and mobility limitations, community organizations have partnered with healthcare providers to deliver an evidence-based, task-oriented group exercise program in community centers in Canada. We aimed to understand challenges and solutions to implementing this program model to inform plans for expansion. RESULTS At a 1-day meeting, 53 stakeholders (healthcare/recreation personnel, program participants/caregivers, researchers) identified challenges to program implementation that were captured by seven themes: Resources to deliver the exercise class (e.g., difficulty finding instructors with the skills to work with people with mobility limitations); Program marketing (e.g., to foster healthcare referrals); Transportation (e.g., particularly from rural areas); Program access (e.g., program full); Maintaining program integrity; Sustaining partnerships (i.e., with healthcare partners); and Funding (e.g., to deliver program or register). Stakeholders prioritized solutions to form an action plan. A survey of individuals supervising 28 programs revealed that people with stroke, acquired brain injury, multiple sclerosis, and Parkinson's disease register at 95-100% of centers. The most prevalent issues with program fidelity across centers were not requiring a minimum level of walking ability (32%), class sizes exceeding 12 (21%), and instructor-to-participant ratios exceeding 1:4 (19%). Findings provide considerations for program expansion.
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Affiliation(s)
- Nancy M Salbach
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada. .,University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
| | - Jo-Anne Howe
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.,University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Diem Baldry
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Saira Merali
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Sarah E P Munce
- University Health Network-Toronto Rehabilitation Institute, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
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Vader K, Simonik A, Ellis D, Kesbian D, Leung P, Jachyra P, Carusone SC, O'Brien KK. Perceptions of ‘physical activity’ and ‘exercise’ among people living with HIV: A qualitative study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.11.473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kyle Vader
- Department of Physical Therapy, University of Toronto, Canada
| | - Alya Simonik
- Department of Physical Therapy, University of Toronto, Canada
| | - Denine Ellis
- Department of Physical Therapy, University of Toronto, Canada
| | - Dirouhi Kesbian
- Department of Physical Therapy, University of Toronto, Canada
| | - Priscilla Leung
- Department of Physical Therapy, University of Toronto, Canada
| | - Patrick Jachyra
- Rehabilitation Sciences Institute, University of Toronto, Canada
| | | | - Kelly K O'Brien
- Department of Physical Therapy; Rehabilitation Sciences Institute; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
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