Effects of an education and home-based pedometer walking program on ischemic heart disease risk factors in people infected with HIV: a randomized trial

A systematic review and meta-analysis evaluating the effectiveness of minimally supervised home and community exercise interventions in improving physical activity, body adiposity and quality of life in adults living with HIV

People living with HIV (PLWH) are physically inactive and risk cardiometabolic dysfunction. Home and community exercise (HCE) is pragmatic, cost-effective and improves health in varied chronic conditions. This review aimed to synthesize evidence on the effectiveness of minimally supervised HCE for physical activity (PA), adiposity, quality of life (QoL), and other physical and psychological health indices for PLWH.

METHODS

Databases were searched for studies published January 2000 to April 2023. Risk of bias in experimental and quasi-experimental studies was assessed with the Cochrane Risk-of-Bias for Randomized Trials and Risk-of-Bias in Non-Randomized Studies of Interventions tools, respectively. A random-effects meta-analysis was conducted.

RESULTS

From 9648 records, 13 studies (14 HCE groups) with 857 PLWH (average ages 29-56 years) were included; 12 comparator and one single group trial. Aerobic and strength HCE significantly improved PA relative to control by 0.377 units (95 %CI = 0.097, 0.657; p = 0.008) and 1097steps/day (95 %CI = 39.27, 2156.62; p = 0.042). There was a reduction from baseline in percent body fat of 3.36 % (95 %CI = -6.10, 0.42; p = 0.025), but no change in BMI (-0.21 kg/m2; 95 %CI = -0.67, 0.24; p = 0.351) relative to control. HCE improved QoL relative to control in the physical domain by 13points (95 %CI = 6.15, 19.86; p < 0.001), but not in other domains like general health (6.6points; 95 %CI = -1.19, 14.36; p < 0.097). HCE completed at moderate intensity or higher was associated with improvement in outcomes more so than lower intensity HCE. Walking-only interventions were at least as beneficial as other activities. No adverse events were recorded.

CONCLUSION

Minimally supervised HCE can improve PA, body fat, physical QoL and other health indices in PLWH.

Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis

OBJECTIVES

This review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence.

DESIGN

Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach.

DATA SOURCES

We systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner's chronic care model.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used standardised methods to search and screen included studies. Publication bias was assessed using the Doi plot and Luis Furuya Kanamori Index. Meta-analysis was conducted using random effects models.

RESULTS

In all, we included 10 randomised controlled trials from 11 publications with 4864 participants from six SSA countries (South Africa, Kenya, Nigeria, Eswatini, Ghana and Uganda). The overall quality of evidence based on GRADE criteria was moderate. A random-effects meta-analysis of six studies involving 1754 participants shows that integrated compared with standard care conferred a moderately lower mean SBP (mean difference=-4.85 mm Hg, 95% CI -7.37 to -2.34) for people with cardiometabolic multimorbidity; Hedges' g effect size (g=-0.25, (-0.39 to -0.11). However, integrated care compared with usual care showed mixed results for glycated haemoglobin, depression, medication adherence and quality of life.

CONCLUSION

Integrated care improved SBP among patients living with cardiometabolic multimorbidity in SSA. More studies on integrated care are required to improve the evidence pool on chronic care models for multimorbidity in SSA. These include implementation studies and cost-effectiveness studies.

PROSPERO REGISTRATION NUMBER

CRD42020187756.

Home-based interventions to promote physical activity for people living with HIV - a systematic review

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.

Physical activity interventions for glycaemic control in African adults - A systematic review and meta-analysis

BACKGROUND AND AIM

Growing evidence indicates that increasing physical activity may aid in regulating altered glycaemic control, thereby mitigating the risk of diabetes. However, the evidence summarising the efficacy of physical activity on glycaemic control among African adults remains unconsolidated. Our objective was to provide an amalgamated summary of the empirical evidence that explored the effectiveness of physical activity interventions on glycaemic control among African adults.

METHODS

A systematic search of six journal databases for the studies exploring the efficacy of physical activity on glycaemic control among African adults until March 21, 2022, was administered. Two independent reviewers screened the citations based on a priori set eligibility criteria. Data were analysed using inverse variance method and a summary of findings was synthesised using the Grading of Recommendations, Assessment, Development and Evaluations approach.

RESULTS

Of the 14,624 citations retrieved, 26 articles with 1474 participants were included for final analysis. Most of the included trials had a high risk of bias (N = 20; 76.92%). Our review found a significant reduction in fasting blood glucose (FBG, -2.18 [ 95% CI -3.18, -1.18] mmol/L), insulin (-0.99 [-2.71, 0.74] μU/L), Glycosylated haemoglobin (HbA1C) (-0.53% [-0.88, -0.19]), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (-0.74% [-1.10, -0.38]) and insulin sensitivity (-0.90 μU/l/min [-1.75, -0.06]) following physical activity interventions. The review reports low certainty of evidence across all outcome measures.

DISCUSSION AND CONCLUSION

Physical activity interventions were found to improve glycaemic control among African adults. However, the optimal physical activity dose for demonstrating meaningful benefits on glucose tolerance still remains unclear due to the limited number of primary studies available.

Disability, a priority area for health research in South Africa: an analysis of the burden of disease study 2017

PURPOSE

Disabilities are increasing globally, which is attributed to the overall ageing of populations in affluent countries. This trend may differ in low and middle-income countries. This paper assesses the change over time in Years Lived with Disability (YLD) for South Africa and how this compares to regional and global trends.

MATERIALS AND METHODS

This secondary analysis of the Global Burden of Disease Study 2017 dataset describes the observed contribution of YLD to Disability-Adjusted Life Years (DALYs) per 100 000 people over the period 1990-2016, and forecast to 2030 using simple linear prediction. South African trends are compared to global and sub-Saharan African (SSA) trends to highlight the effect of HIV and policy implications.

RESULTS

Globally, the contribution of YLD to DALYs has increased from ±21.7% in 1990 to ±34% by 2016, with high socio-demographic index countries having a higher contribution (49%). HIV, mental health, musculoskeletal, neurological, and sense organ disorders are the five main contributors to YLD in South Africa (54%). Removing the effects of HIV/AIDS and sexually transmitted infections on YLD, South Africa's trend appears similar to the global trend, yet opposite to the SSA trend.

CONCLUSION

Our analysis shows there is a growing burden of disability in South Africa. Differences in trends with the regional and global patterns can be attributed to the high burden of HIV and non-communicable diseases in South Africa. Therefore, strategies are urgently needed to increase integration of disability and rehabilitation services into chronic HIV and non-communicable disease management. This calls for disability screening to identify functional limitations in routine data collection and case management.IMPLICATIONS FOR REHABILITATIONSouth Africa has experienced an increase in disability prevalence over time.This requires strengthening of services such as mental health interventions, physiotherapy, optometry, and audiology, and linking major disease clusters, such as HIV and the NCDs, to rehabilitation services.The greatest contributors towards disability adjusted life years in South Africa are currently mental disorders (13.8%), HIV and sexually transmitted infections (11.8%), musculoskeletal disorders (10.4%), neurological disorders (8.2%), and sense organ diseases (7.5%).Routine data collection and case management needs to include disability screening to identify developing functional limitations.

Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review

A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.

Systematic Review of Fitbit Charge 2 Validation Studies for Exercise Tracking

Context

There are research-grade devices that have been validated to measure either heart rate (HR) by electrocardiography (ECG) with a Polar chest strap, or step count with ACTiGraph accelerometer. However, wearable activity trackers that measure HR and steps concurrently have been tested against research-grade accelerometers and HR monitors with conflicting results. This review examines validation studies of the Fitbit Charge 2 (FBC2) for accuracy in measuring HR and step count and evaluates the device's reliability for use by researchers and clinicians.

Design

This registered review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The robvis (risk-of-bias visualization) tool was used to assess the strength of each considered article.

Eligibility Criteria

Eligible articles published between 2018 and 2019 were identified using PubMed, CINHAL, Embase, Cochran, and World of Science databases and hand-searches. All articles were HR and/or step count validation studies for the FBC2 in adult ambulatory populations.

Study Selection

Eight articles were examined in accordance with the eligibility criteria alignment and agreement among the authors and research librarian.

Main Outcome Measures

Concordance correlation coefficients (CCC) were used to measure agreement between the tracker and criterion devices. Mean absolute percent error (MAPE) was used to average the individual absolute percent errors.

Results

Studies that measured CCC found agreement between the FBC2 and criterion devices ranged between 26% and 92% for HR monitoring, decreasing in accuracy as exercise intensity increased. Inversely, CCC increased from 38% to 99% for step count when exercise intensity increased. HR error between MAPE was 9.21% to 68% and showed more error as exercise intensity increased. Step measurement error MAPE was 12% for healthy persons aged 24-72 years but was reported at 46% in an older population with heart failure.

Conclusions

Relative agreement with criterion and low-to-moderate MAPE were consistent in most studies reviewed and support validation of the FBC2 to accurately measure HR at low or moderate exercise intensities. However, more investigation controlling testing and measurement congruency is needed to validate step capabilities. The literature supports the validity of the FBC2 to accurately monitor HR, but for step count is inconclusive so the device may not be suitable for recommended use in all populations.

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

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.

Effectiveness of self-managed home and community exercise interventions in improving physical activity, body adiposity and related health indices in adults living with HIV: a protocol for a systematic review

BACKGROUND AND OBJECTIVES

Disorders of adipose tissue distribution in people living with the human immunodeficiency virus (HIV) have been associated with significant metabolic derangements that increase their risk of cardiometabolic and other chronic diseases. Systematic reviews focusing on supervised laboratory-based exercise interventions demonstrate that these interventions improve adipose tissue distribution and related health outcomes in people living with HIV (PLWH). However, there is a need to examine the effectiveness of more pragmatic home or community exercise programmes. The aim of this review will be to synthesize existing evidence on the effectiveness of self-managed home or community exercise interventions to improve physical activity levels, adipose tissue distribution and associated health indices in PLWH.

METHODS

This review will encompass interventional studies that evaluate the effect of prescribed exercise programmes performed in the home or community with minimal supervision, by adults living with HIV. The following will be searched from inception: PubMed, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.gov. Screening of studies and data extraction will be conducted by two independent reviewers. The risk of bias in included studies will be assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk of Bias In Non-Randomized Studies-of Interventions (ROBINS-I) tool for non-randomized concurrently controlled and single-arm interventional studies. A random effects meta-analysis will be used to pool effect estimates for outcomes of interest (measures of physical activity and body adiposity). However, if pooling is deemed inappropriate due to substantial differences between studies, a narrative synthesis will be performed. This protocol is written according to the Preferred Reporting Items for Systematic reviews and Meta-analysis Protocols 2015 statement (see Additional file 1).

DISCUSSION

This review shall provide evidence to support or disapprove the prescription of self-managed exercise interventions in a particularly vulnerable population. We will equally explore the potential impact of technology in improving physical activity outcomes. Our findings could help guide clinicians involved in the care of PLWH in prescribing exercise and inform the design of future trials and research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021223357 .

Effectiveness of physical activity monitors in adults: systematic review and meta-analysis

OBJECTIVE

To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity.

DESIGN

Systematic review and meta-analysis.

STUDY SELECTION

The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach.

MAIN OUTCOME MEASURES

The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time.

RESULTS

121 randomised controlled trials with 141 study comparisons, including 16 743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions.

CONCLUSIONS

The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias.

STUDY REGISTRATION

PROSPERO CRD42018102719.

Effects of a Health Promotion Intervention on Physical Activity in African American Men Living with HIV: Randomized Controlled Trial

HIV and its treatment with antiretroviral therapy increase the risk of noncommunicable diseases (NCDs) tied to physical inactivity. Older African American men are also at high risk for NCDs. We tested the efficacy of a theory-based intervention to increase adherence to federal aerobic and muscle-strengthening physical activity (PA) guidelines among African American men aged 40 years and older living with HIV. We randomized African American men aged 40 years and older living with HIV to a three-session social cognitive theory-informed health promotion intervention targeting PA or a one-session health awareness control condition. The primary outcome was PA guideline adherence assessed (self-reported) preintervention, immediate postintervention, and 3, 6, and 12 months postintervention. Secondary outcomes were the number of days on which participants reported moderate-intensity aerobic PA, vigorous-intensity aerobic PA, and muscle-strengthening PA in the past 7 days. Of 302 participants, 255 completed the 12-month postintervention measures. Generalized estimated equation logistic regression indicated that the health promotion intervention participants had higher odds of meeting PA guidelines than health awareness control participants, adjusting for baseline adherence (p = 0.011). Health promotion intervention participants also reported more muscle-strengthening PA (p = 0.001), vigorous-intensity aerobic PA (p = 0.049), and moderate-intensity aerobic PA (p = 0.010) than control participants. The rise in self-reported adherence to PA guidelines and improvements in muscle-strengthening and aerobic PA considered separately suggest that a relatively brief behavioral intervention can increase PA among African American men aged 40 years and older living with HIV and potentially curb their risk of NCDs that PA can prevent.

mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review

BACKGROUND

The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV.

OBJECTIVE

Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV.

METHODS

A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV.

RESULTS

Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV.

CONCLUSIONS

Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940.

Long-term Effectiveness of mHealth Physical Activity Interventions: Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Mobile health (mHealth) interventions can increase physical activity (PA); however, their long-term impact is not well understood.

OBJECTIVE

The primary aim of this study is to understand the immediate and long-term effects of mHealth interventions on PA. The secondary aim is to explore potential effect moderators.

METHODS

We performed this study according to the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, the Cochrane Library, SCOPUS, and PsycINFO in July 2020. Eligible studies included randomized controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate-to-vigorous physical activity (MVPA), total physical activity (TPA), and energy expenditure. Where reported, we extracted data for 3 time points (ie, end of intervention, follow-up ≤6 months, and follow-up >6 months). To explore effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration tool.

RESULTS

Of the 2828 identified studies, 117 were included. These studies reported on 21,118 participants with a mean age of 52.03 (SD 14.14) years, of whom 58.99% (n=12,459) were female. mHealth interventions significantly increased PA across all the 4 outcome measures at the end of intervention (walking standardized mean difference [SMD] 0.46, 95% CI 0.36-0.55; P<.001; MVPA SMD 0.28, 95% CI 0.21-0.35; P<.001; TPA SMD 0.34, 95% CI 0.20-0.47; P<.001; energy expenditure SMD 0.44, 95% CI 0.13-0.75; P=.01). Only 33 studies reported short-term follow-up measurements, and 8 studies reported long-term follow-up measurements in addition to end-of-intervention results. In the short term, effects were sustained for walking (SMD 0.26, 95% CI 0.09-0.42; P=.002), MVPA (SMD 0.20, 95% CI 0.05-0.35; P=.008), and TPA (SMD 0.53, 95% CI 0.13-0.93; P=.009). In the long term, effects were also sustained for walking (SMD 0.25, 95% CI 0.10-0.39; P=.001) and MVPA (SMD 0.19, 95% CI 0.11-0.27; P<.001). We found the study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and nonscalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 80.3% (94/117) of the studies. Heterogeneity was significant, resulting in low to very low quality of evidence.

CONCLUSIONS

mHealth interventions can foster small to moderate increases in PA. The effects are maintained long term; however, the effect size decreases over time. The results encourage using mHealth interventions in at-risk and sick populations and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given the low evidence quality, further methodologically rigorous studies are warranted to evaluate the long-term effects.

Effects of Aerobic and Resistance Exercise on Cardiovascular Parameters for People Living With HIV: A Meta-analysis

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.

Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC)

BACKGROUND

People living with HIV are living longer, and can experience physical, mental and social health challenges associated with aging and multimorbidity. Rehabilitation is well positioned to address disability and maximize healthy aging. An international collaborative network, called the Canada-International HIV and Rehabilitation Research Collaborative (CIHRRC), works to guide this emerging field. In this article, we report findings from CIHRRC's aim to identify emerging research priorities in HIV, aging and rehabilitation from the perspectives of people living with HIV, clinicians, researchers, representatives from community organizations and policy stakeholders.

METHODS

We conducted a multi-stakeholder multi-method international consultation with people living with HIV, researchers, clinicians and representatives of community-based organizations to identify research priorities in HIV, aging and rehabilitation. Stakeholders identified research priorities during a one-day International Forum comprised of presentations and facilitated discussion. We collated and analyzed data using content analytical techniques, resulting in a framework of research priorities.

RESULTS

Sixty-nine stakeholders from countries including Canada (n = 62; 90%), the United Kingdom (n = 5; 7%), United States (n = 1; 1%) and Australia (n = 1; 1%) attended the International Forum on HIV, Aging and Rehabilitation Research. Stakeholders represented community-based organizations (n = 20; 29%), academic institutions (n = 18; 26%), community or institutional healthcare organizations (n = 11; 16%), research or knowledge production organizations (n = 10; 14%), and organizations representing government or industry (n = 10; 14%). The Framework of Research Priorities in HIV, Aging and Rehabilitation includes seven research priorities: (1) nature, extent and impact of disability, concurrent health conditions and chronic inflammation with HIV; (2) prevalence, severity and impact of frailty; (3) community and social participation aging with HIV; (4) strategies for chronic disease management and healthy aging with HIV; (5) facilitators and barriers to access and engagement in, rehabilitation; (6) effectiveness of rehabilitation interventions for healthy aging with HIV; and (7) advancing development and use of patient reported outcome measures in HIV and aging. The Framework highlights methodological considerations to approach the priorities and the importance of knowledge translation and exchange to apply research knowledge into practice, programs and policy.

CONCLUSIONS

These priorities offer a foundation for collaboration among international and multidisciplinary teams to advance the field of HIV, aging and rehabilitation in order to promote healthy aging with HIV.

Contemporary Lifestyle Modification Interventions to Improve Metabolic Comorbidities in HIV

PURPOSE OF REVIEW

Metabolic comorbidities including diabetes, obesity, dyslipidemia, and hypertension, all of which are traditional cardiovascular disease risk factors that are highly prevalent in people with HIV (PWH). Bone disease including osteopenia, osteoporosis, and fragility fractures is also prevalent in PWH. These comorbidities may be prevented and treated in part with lifestyle modification, including changes to dietary and physical habits. The purpose of this review is to highlight recent literature that characterizes current lifestyle habits in PWH as well as the effectiveness of lifestyle strategies to improve metabolic comorbidities prevalent in PWH.

RECENT FINDINGS

Recent studies have expanded our knowledge regarding the current lifestyle habits of PWH as well as the potential for lifestyle modification to prevent or improve comorbidities prevalent in PWH. Clinical trials focusing on lifestyle modification have shown some benefit of such interventions on traditional risk factors for comorbidities; however, significant heterogeneity exists between studies and results are not consistent. Further clinical trials are needed including developing lifestyle strategies that are feasible, effective, and sustainable to prevent and decrease prevalence of comorbidities in this population.

Assessing the Measurement Properties of the Fitbit Zip® Among Adults Living With HIV

PURPOSE

To assess the criterion and construct validity of the Fitbit Zip® to measure physical activity among adults living with HIV.

METHODS

Participants were video recorded completing 2 walk tests while wearing the Fitbit Zip® and completed 3 self-reported physical activity questionnaires 1 week later. The authors calculated intraclass correlation coefficients (ICCs) to determine agreement between the number of steps taken and distance walked (Fitbit Zip®) with the visual count of number of steps taken and actual distance walked (walk tests). The authors tested 15 a priori hypotheses about predicted associations between questionnaire scores and physical activity measured by the Fitbit Zip®.

RESULTS

Among the 34 participants, there was "excellent" agreement between the number of steps taken measured by the Fitbit Zip® and visually counted number of steps taken (ICC = .99) and number of steps taken at slow (ICC = .75), moderate (ICC = .85), and fast (ICC = .78) walking speeds. There was "poor" agreement between the Fitbit Zip® recorded distance and actual determined distance walked (ICC = .20). Three (20%) construct validity hypotheses were confirmed.

CONCLUSIONS

The Fitbit Zip® demonstrated criterion validity for its ability to measure number of steps taken but not distance walked, and did not demonstrate construct validity for measuring physical activity among adults with HIV.

Physical activity among women of low socioeconomic status living with HIV in two major cities of Brazil and Mozambique: A cross-sectional comparative study

OBJECTIVES

Physical activity (PA) may reduce cardiovascular risk and preserve functional capacity of people living with human immunodeficiency virus (HIV). However, only limited research objectively measured PA in patients with low socioeconomic status (SES) in low-income countries, particularly in South America and sub-Saharan Africa. This study compared the PA assessed by accelerometers in women of low SES living with HIV under common antiretroviral therapy (cART) from two major cities in Brazil (Rio de Janeiro, n=33; 40.1±6.1 years) and Mozambique (Maputo, n=50; 38.8±8.7 years).

METHODS

Eligible women wore triaxial accelerometers during seven consecutive days, to estimate their habitual PA and daily energy expenditure.

RESULTS

The proportion of participants with overweight/obesity was greater in Rio than Maputo (57% vs. 30%; p=0.021), as well as those classified as sedentary based on steps/day (45% vs. 22%; p=0.02). Sedentary time was prevalent (Median±IQD: Rio-1236±142 vs. Maputo-1192±135 min/day; p=0.15). Time spent in PA was short, but Brazilians exhibited lower amount of light (111±56 vs. 145±51 min/day; p<0.001) and moderate-to-vigorous PA (88±3 vs. 64±36 min/day; p=0.001) vs. Mozambicans. The proportion of patients performing 60 min/day of moderate-to-vigorous PA were 58% (Rio) and 82% (Maputo), respectively. Despite of this, estimated daily energy expenditure was equivalent in both groups (1976±579 vs. 1933±492 kcal; p=0.731).

CONCLUSIONS

Women with low SES living with HIV in Maputo were more active vs. patients from Rio de Janeiro. Albeit sedentary behavior was prevalent, the proportion of patients complying with the minimum recommended PA for health was higher than values usually reported in developed countries.

The effects of exercise on lipid profile and blood glucose levels in people living with HIV: A systematic review of randomized controlled trials

Exercise is commonly prescribed to improve lipid profile and glucose levels in people living with HIV (PLWH). This systematic review was performed in order to examine the effects of exercise interventions on lipid profile and glucose levels on PLWH. Randomized controlled trials (RCTs) investigating the effects of exercise on blood glucose, triglycerides (TG), total cholesterol (TC), HDL and LDL published up to November 2017 were reviewed. Two reviewers assessed inclusion and exclusion criteria, methodological quality and extracted the data. The PEDro scale was used to assess the quality of the included studies. Nine RCTs involving 638 PLWH met inclusion criteria. The median PEDro scale score was 5 out of 10. Three combined aerobic exercise + resistance exercise studies (AE+RE) showed improvements in blood glucose levels, one study showed improvements in HDL, one showed improvements in TG, and one showed improvements in TC. The AE only study reported improvements in HDL, while the RE only study reported improvements in TG, TC, HDL and LDL. Exercise can be effective for the improvement of some metabolic parameters, especially blood glucose and HDL. However, due to methodological issues, small number of studies and differences in exercise protocols, these findings should be interpreted with caution.

Factors associated with physical function capacity in an urban cohort of people living with the human immunodeficiency virus in South Africa

Background

Effective disease management for people living with human immunodeficiency virus (PLWH) includes the encouragement of physical activity. Physical function capacity in PLWH may be influenced by a variety of factors.

Objectives

This study describes the physical function capacity as assessed with the 6-minute walk test (6MWT) of an urban cohort of PLWH and determined whether a history of pulmonary tuberculosis (PTB), anthropometric measures, age and gender predicted distance walked.

Method

Secondary data collected from 84 PLWH on antiretroviral therapy were analysed. Information included 6MWT distance, anthropometric measurements and demographic profiles. Descriptive and inferential statistics were undertaken on the data. A regression analysis determined predictive factors for 6MWT distance achieved. Significance was set at a p-value of ≤ 0.05.

Results

The study consisted of 66 (78.6%) women and 18 (21.4%) men with a mean age of 39.1 (± 9.2) years. The 6MWT distance of the cohort was 544.3 (± 64.4) m with men walking further (602.8 [± 58.6] m) than women (528.3 [± 56.4] m); however, women experienced greater effort. The majority of the sample did not report a history of PTB (n = 67; 79.8%). Age, gender and anthropometric measures were associated with 6MWT distance, but of low to moderate strength. The regression equation generated included age and gender. This model was statistically significant (p < 0.00) and accounted for 34% of the total variance observed.

Conclusion

Age and gender were predictive factors of physical function capacity and women experienced greater effort.

Clinical implications

This study provides information on the physical function capacity of PLWH and a suggested 6MWT reference equation for PLWH in South Africa.

Perspectives on ART adherence among Zambian adults living with HIV: insights raised using HIV-related disability frameworks

Anti-retroviral treatment (ART) has improved the survival of people living with HIV in Africa. Living with chronic HIV comes with new health and functional challenges and the need to manage ART adherence. The Sepo Study applied disability frameworks to better understand living with chronic HIV while using ART. The study followed 35 people (18 women, 17 men) living with HIV and on ART 6 months or longer in private and public health facilities in Lusaka, Zambia over 18-months (2012-2015). A total of 99 in-depth interviews were conducted. Conventional content analysis and NVIVOv10 were applied to analyse the data. Participants were adhering to ART at the times of the interviews and therefore less likely to report major challenges with adherence. Three main themes emerged from the data related to adherence. Firstly, ART was regarded as "giving life", which underscored adherence. Secondly, all participants described strategies for to managehealth and functional limitations, which they attributed as side-effects or chronicity. Thirdly, participants described experiences of uncertainty, including the efficacy of new regimens, potential loss of functioning, risk of new health problems, and death. Long-term ART managment in Africa needs to integrate rehabilitation approaches to address functional limitations, uncertainties, strengthen and support for adherence.

Investigation of physical and functional impairments experienced by people with active tuberculosis infection: A feasibility pilot study

Background

Tuberculosis (TB) remains a significant healthcare problem. Understanding physical and functional impairments that patients with active TB present with at the time of diagnosis and how these impairments change over time while they receive anti-TB therapy is important in developing appropriate rehabilitation programmes to optimise patients’ recovery.

Objectives

The aim of this study was to assess the acceptability, implementation and practicality of conducting a prospective, observational and longitudinal trial to describe physical and functional impairments of patients with active TB.

Method

A feasibility pilot study was performed. Patients with acute pulmonary TB admitted to an urban quaternary-level hospital were recruited. Physical (muscle architecture, mass and power, balance, and breathlessness) and functional (exercise capacity) outcomes were assessed in hospital, and at 6 weeks and 6 months post-discharge. Descriptive statistics were used to analyse the data.

Results

High dropout (n = 5; 41.7%) and mortality (n = 4; 33.3%) rates were observed. Limitations identified regarding study feasibility included participant recruitment rate, equipment availability and suitability of outcome measures. Participants’ mean age was 31.5 (9.1) years and the majority were human immunodeficiency virus (HIV) positive (n = 9; 75%). Non-significant changes in muscle architecture and power were observed over 6 months. Balance impairment was highlighted when vision was removed during testing. Some improvements in 6-minute walk test distance were observed between hospitalisation and 6 months.

Conclusion

Success of a longitudinal observational trial is dependent on securing adequate funding to address limitations observed related to equipment availability, staffing levels, participant recruitment from additional study sites and participant follow-up at community level. Participants’ physical and functional recovery during anti-TB therapy seems to be limited by neuromusculoskeletal factors.

The missing link: exploring the intersection of gender, capabilities, and depressive symptoms in the context of chronic HIV

Depressive symptoms occur frequently among people living with HIV, especially women. These symptoms are associated with human, social, financial, and physical/natural capabilities and life stressors that differ between women and men. However, the link between depressive symptoms and functional limitations/disability is seldom discussed in the context of HIV, especially for gender-specific relationships. A cross-sectional survey of 1042 people living with HIV and using long-term antiretroviral therapy (ART) in South Africa was conducted from June to August 2014 to investigate the associations of disability, human, social, physical/natural, and financial capabilities, health, and adherence to ART, including possible gender-specific factors. Socio-demographic information, capabilities, health indicators, functional limitations/disability, and depressive symptoms (CES-D 10) were measured. We applied descriptive and bivariate statistics and multiple regression. Overall, 26% of people presented with depressive symptoms. Greater functional limitations and health symptoms and lower food security were strongly associated with depressive symptoms, while associations with financial capital and body mass index were gender-specific. The results call for the improvement of comprehensive care, including gender-sensitive mental health interventions. The results further indicate that functional limitations/disability needs to be considered, along with linking rehabilitation and livelihood programs with comprehensive HIV-care, in particular for those who experience depressive symptoms.

Effects of physical exercises on inflammatory biomarkers and cardiopulmonary function in patients living with HIV: a systematic review with meta-analysis

BACKGROUND

Pro-inflammatory cytokines expressed in human immune deficiency virus (HIV) infection, may induce oxidative stress likely to compromise the patency of the airways or damage the lung tissues/cardiac function. However, physical (aerobic and/or resistance) exercise-induced release of heat shock protein, immune function alteration or reduced tissue hypoxia, have been highlighted as possible mechanisms by which increasing physical activity may reduce plasma pro-inflammatory cytokines in uninfected individuals and should be appraised in the literature for evidence of similar benefits in people living with HIV (PLWH). Therefore, we evaluated the effects of physical exercises on 1) inflammatory biomarkers and 2) cardiopulmonary function (VO2 Max) in PLWH.

METHOD

A systematic review was conducted using the Cochrane Collaboration protocol. Searching databases, up to January 2018. Only randomized control trials investigating the effects of either aerobic or 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 with random effect models using the Review Manager (RevMan) computer software.

RESULT

Twenty-three studies met inclusion criteria (n = 1073 participants at study completion) comprising male and female with age range 18-65 years. Three meta-analyses across three sub-groups comparisons were performed. The result showed no significant change in biomarkers of inflammation (IL-6 and IL-1β) unlike a significant (Z = 3.80, p < 0.0001) improvement in VO2 Max. Overall, the GRADE evidence for this review was of moderate quality.

CONCLUSION

There was evidence that engaging in either aerobic or resistance exercise, or a combination of both exercises, two to five times per week can lead to a significant improvement in cardiopulmonary function but not biomarkers of inflammation (IL-6 and IL-1β). However, this should not be interpreted as "No evidence of effect" because the individual trial studies did not attain sufficient power to detect treatment effects. 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.

Low Levels of Physical Activity Among Older Persons Living with HIV/AIDS Are Associated with Poor Physical Function

Antiretroviral therapy (ART) has prolonged lives of persons living with HIV/AIDS (PLWHA), resulting in greater incidence of aging-related diseases and disability. Physical activity (PA) is recommended for healthy aging, but little is known about PA in older PLWHA. The purpose of this study was to objectively assess PA levels in older PLWHA and the associations with physical function. Twenty-one PLWHA, ≥50 years old, on ART with undetectable HIV-1 viral loads, wore an accelerometer to assess PA, including number of steps, activity intensity, and energy expenditure over 7 days. A physical function performance battery assessing aerobic capacity, strength, and gait speed was also completed. Average age was 66, and 67% were male. An average of 3,442 (interquartile range: 4,613) steps were walked daily, with 254.9 kcals expended. Participants spent most waking hours (75%) sedentary, with minimal hours (24%) in light-intensity activity. Only 5 min per day (35 min per week), on average, were spent in moderate-to-vigorous physical activity (MVPA). Maximal gait speed and 6-min walk test significantly correlated (p < .05) with all PA outcomes. Usual gait speed significantly correlated with all PA outcomes, except for daily kcals and light-intensity activity. Greater PA was associated with better physical performance, while high sedentary time was associated with poorer performance. To our knowledge, this is the first study to objectively measure PA in older PLWHA. Our findings indicate that older PLWHA accumulate substantial sedentary time. Most (86%) do not achieve recommended MVPA levels. This activity profile was associated with poor physical function. Providers should promote PA among PLWHA.

Physical activity and HIV in sub-Saharan Africa: a systematic review of correlates and levels

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.

Nurse led home-based care for people with HIV/AIDS

BACKGROUND

Home-based care is used in many countries to increase quality of life and limit hospital stay, particularly where public health services are overburdened. Home-based care objectives for HIV/AIDS can include medical care, delivery of antiretroviral treatment and psychosocial support. This review assesses the effects of home-based nursing on morbidity in people infected with HIV/AIDS.

METHODS

The trials studied are in HIV positive adults and children, regardless of sex or setting and all randomised controlled. Home-based care provided by qualified nurses was compared with hospital or health-facility based treatment. The following electronic databases were searched from January 1980 to March 2015: AIDSearch, CINAHL, Cochrane Register of Controlled Trials, EMBASE, MEDLINE and PsycINFO/LIT, with an updated search in November 2016. Two authors independently screened titles and abstracts from the electronic search based on the study design, interventions and types of participant. For all selected abstracts, full text articles were obtained. The final study selection was determined with use of an eligibility form. Data extraction was performed independently from assessment of risk of bias. The results were analysed by narrative synthesis, in order to be able to obtain relevant effect measures plus 95% confidence intervals.

RESULTS

Seven studies met the inclusion criteria. The trial size varied from 37 to 238 participants. Only one trial was conducted in children. Five studies were conducted in the USA and two in China. Four studies looked at home-based adherence support and the rest at providing home-based psychosocial support. Reported adherence to antiretroviral drugs improved with nurse-led home-based care but did not affect viral load. Psychiatric nurse support in those with existing mental health conditions improved mental health and depressive symptoms. Home-based psychological support impacted on HIV stigma, worry and physical functioning and in certain cases depressive symptoms.

CONCLUSIONS

Nurse-led home-based interventions could help adherence to antiretroviral therapy and improve mental health. Further larger scale studies are needed, looking in more detail at improving medical care for HIV, especially related to screening and management of opportunistic infections and co-morbidities.

Effectiveness of Progressive Resistive Exercise (PRE) in the context of HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol

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.

Improving Health and Reducing Comorbidity Associated with HIV: The Development of TAVIE en santé, a Web-Based Tailored Intervention to Support the Adoption of Health Promoting Behaviors among People Living with HIV

Background. In the domain of health behavior change, the deployment and utilization of information and communications technologies as a way to deliver interventions appear to be promising. This article describes the development of a web-based tailored intervention, TAVIE en santé, to support people living with HIV in the adoption of healthy behaviors. Methods. This intervention was developed through an Intervention Mapping (IM) framework and is based on the theory of planned behavior. Results. Crucial steps of IM are the selection of key determinants of behavior and the selection of useful theory-based intervention methods to change the targeted determinants (active ingredients). The content and the sequence of the intervention are then created based on these parameters. TAVIE en santé is composed of 7 interactive web sessions hosted by a virtual nurse. It aims to develop and strengthen skills required for behavior change. Based on an algorithm using individual cognitive data (attitude, perceived behavioral control, and intention), the number of sessions, theory-based intervention methods, and messages contents are tailored to each user. Conclusion. TAVIE en santé is currently being evaluated. The use of IM allows developing intervention with a systematic approach based on theory, empirical evidence, and clinical and experiential knowledge.

Global physical activity levels among people living with HIV: a systematic review and meta-analysis

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.

A Home-Based Rehabilitation Intervention for Adults Living With HIV: A Randomized Controlled Trial

A randomized controlled trial was conducted to investigate the effects of a 16-week home-based rehabilitation (HBR) intervention on the quality of life, functional mobility, and functional capacity of adult people living with HIV (PLWH) on antiretroviral therapy in KwaZulu-Natal, South Africa. The intervention was carried out by community health care workers under the supervision of a qualified physical therapist. Participants in the control group received the standard of care as well as written health advice. While participants in the intervention group showed greater improvements across all outcome measures, between-group differences were nonsignificant. HBR for PLWH is a safe means of addressing the functional deficits experienced by PLWH and appears likely to improve quality of life. A task-shifting approach may be a feasible method of meeting the varied needs of PLWH, while at the same time potentially minimizing costs to already overburdened health care systems.

Evaluation of a physiotherapy-led group rehabilitation intervention for adults living with HIV: referrals, adherence and outcomes

HIV is characterised by episodes of disability. We report a novel, hospital outpatient rehabilitation intervention, combining physiotherapy-led group exercise and education for people living with HIV (PLWH). This observational study evaluated routine delivery of the 10-week intervention in terms of referral patterns, rehabilitation goals, intervention adherence and change in patient outcomes. Measurements at baseline & 10 weeks included locomotor performance (6 minute walk test; 6MWT), flexibility, upper and lower limb strength and health related quality of life (HRQOL). Adherence was defined as attending ≥8/20 sessions, with reasons for non-adherence identified in retrospective telephone interviews. Goal Attainment Scale measured progression to individual goals. Total 92 referrals were mostly for musculoskeletal (25.0%), oncological (19.6%) or cardio-metabolic (18.5%) reasons, and mostly male (81.5%), Caucasian (70.7%) and older (mean 51.5 years). Common themed rehabilitation goals included improving body image, participation, mobility, health/fitness and function. Adherence was achieved by 42 (46%) patients, with open access utilised by 34 patients, returning (n = 19) or restarting when non-adherent (n = 15). Post-intervention measurements collected for 37 (40%) patients demonstrated improvements in 6MWT distance (p < .001), flexibility (p < .001), strength in triceps (p < .001), biceps (p < .001), Lattisimus Dorsi (p < .001), shoulder-press (p < .001), chest-press (p < 0.001), and leg-press (p < 0.001). HRQOL improved in total score (p < .001), physical (p < .001), emotional (p < .001) and functional (p = .065) subscales. Extent of goal achievement demonstrated 83% of goals was "expected" (n = 57), "somewhat more" (n = 31) or "much more" (n = 14). Reasons for non-adherence from 21 telephone interviews identified physical health challenges, individual factors and time or location issues. This novel rehabilitation approach for PLWH improved function, HRQOL and goal attainment among those completing the intervention. Sub-optimal adherence likely relates to episodic disability.

Enhancing physical function in HIV-infected older adults: A randomized controlled clinical trial

OBJECTIVE

HIV-infected older adults (HOA) are at risk of functional decline. Interventions promoting physical activity that can attenuate functional decline and are easily translated into the HOA community are of high priority. We conducted a randomized, controlled clinical trial to evaluate whether a physical activity counseling intervention based on self-determination theory (SDT) improves physical function, autonomous motivation, depression and the quality of life (QOL) in HOA.

METHOD

In total, 67 community-dwelling HOA with mild-to-moderate functional limitations were randomized to 1 of 2 groups: a physical activity counseling group or the usual care control group. We used SDT to guide the development of the experimental intervention. Outcome measures that were collected at baseline and final study visits included a battery of physical function tests, levels of physical activity, autonomous motivation, depression, and QOL.

RESULTS

The study participants were similar in their demographic and clinical characteristics in both the treatment and control groups. Overall physical performance, gait speed, measures of endurance and strength, and levels of physical activity improved in the treatment group compared to the control group (p < .05). Measures of autonomous regulation such as identified regulation, and measures of depression and QOL improved significantly in the treatment group compared with the control group (p < .05). Across the groups, improvement in intrinsic regulation and QOL correlated with an improvement in physical function (p < .05).

CONCLUSION

Our findings suggest that a physical activity counseling program grounded in SDT can improve physical function, autonomous motivation, depression, and QOL in HOA with functional limitations. (PsycINFO Database Record

Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol

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.

Physical activity levels and perceived benefits and barriers to physical activity in HIV-infected women living in the deep south of the United States

Engaging in regular physical activity (PA) is important in maintaining health and increasing the overall quality of life of people living with HIV (PLWH). The deep south of the USA is known for its high rate of sedentary behavior although data on the activity levels and perceptions of the benefits and barriers to exercise in women living with HIV in the deep south are lacking. Understanding the perceived benefits and barriers to exercise can guide the development of PA interventions. We conducted a cross-sectional study to determine the PA levels and perceived benefits and barriers to exercise associated with both age and depression level in a group of HIV+ women living in the deep south. We recruited a total of 50 participants from a cohort site for the Women's Interagency HIV Study. Depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D) and benefits/barriers to exercise were measured using the Exercise Benefits and Barriers Scale (EBBS). We measured PA both subjectively and objectively using the International Physical Activity Questionnaire (IPAQ) and a Fitbit PA monitor, respectively. Our sample was predominantly African-American (96%) and the mean ±SD age, body mass index, and CES-D score were 42 ± 8.8 years, 36.6 ± 11.5 kg/m(2), and 15.6 ± 11.4, respectively. Both subjective and objective measures of PA indicated that our participants were sedentary. The greatest perceived benefit to exercise was physical performance and the greatest barrier to exercise was physical exertion. Higher overall perceived benefits were reported by women ≥43 years and women reporting higher levels of depression. There was no difference in overall barriers associated with age and depression level, but women with depression felt more fatigued by exercise. The results of this study can be helpful when designing and implementing PA interventions in women living with HIV in the deep south.

Are you ready? Exploring readiness to engage in exercise among people living with HIV and multimorbidity in Toronto, Canada: a qualitative study

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.

Home-based rehabilitation interventions for adults living with HIV: a scoping review

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.

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

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).

Evaluation of a Web-based tailored intervention (TAVIE en santé) to support people living with HIV in the adoption of health promoting behaviours: an online randomized controlled trial protocol

Background

Long-term use of antiretroviral therapy, normal aging, and presence of certain risk factors are associated with metabolic disorders that predispose persons living with HIV to diabetes and cardiovascular diseases. The emergence and progression of these disorders can be prevented by adopting healthy behaviours. Based on the theory of planned behaviour, the Web-based tailored intervention TAVIE en santé was developed. The aim of this study is to evaluate the effectiveness of TAVIE en santé in order to support people living with HIV in the adoption of health promoting behaviours.

Methods/Design

An online randomized controlled trial with parallel-groups will be conducted across Canada. To participate in this study, people living with HIV must be: ≥ 18 years, able to read/understand French or English, have access to the Internet. A convenience sample of 750 participants will be randomly assigned either to an experimental group (TAVIE en santé, n = 375) or to a control group (websites, n = 375) (1:1 allocation ratio). The TAVIE en santé intervention is composed of seven interactive computer sessions, lasting between 5 and 10 min. The sessions, hosted by a virtual nurse, aim to develop and strengthen skills required for behaviour change. The control group will receive a validated list of five predetermined conventional health-related Websites. The adoption of health behaviour (smoking cessation or physical activity or healthy eating) is the principal outcome. Cognitions (intention, attitude, perceived behavioral control) are the secondary outcomes. Health indicators will also be assessed. All outcomes will be measured with a self-administered online questionnaire and collected three times: at baseline, 3 and 6 months after. The principal analyses will focus on differences between the two trial groups using Intention-to-Treat analysis.

Discussion

This study will yield new results about the efficacy of Web-based tailored health behaviours change interventions in the context of chronic disease. The TAVIE en santé intervention could constitute an accessible complementary service in support of existing specialized services to support people living with HIV adopt health behaviors.

Trial registration

NCT02378766, assigned on March 3th 2015.