Effects of exercise training on bone mineral density and some health-related outcomes in HIV conditions

Abstract

Introduction: Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans. Methods and design: The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL. Discussion: The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers. Trial registration: The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number – PACTR201910562118957) on October 21, 2019. ( https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425 ).

Impact of biomechanical loading on bone mineral density explored in weight-bearing and non-weight-bearing bones of people living with HIV: An observational study

“…This also suggests physiotherapy has a key role in the routine care of PLWH. This understanding informed our recent and ongoing clinical trials in South Africa/Nigeria on the effects of physical exercises/activities on BMD in PLWH with lower limb fracture healing [58]. 28 Gender differences were observed as the median BMD T-score of the thumb was significantly lower (p = 0.005) in females (-1.00 g/cm 3 ) compared to males (-0.83 g/cm 3 ).…”

“…Also, the most effective weight-bearing exercise prescriptions that would prevent bone loss or improve BMD in PLWH, should be determined in future high-quality RCTs. Presently, one RCT is ongoing in this area with sites in South Africa and Nigeria [58], while another study located in Malawi is already completed [61]. However, more studies are required, particularly in Africa which has the greatest global HIV burden [95].…”

Impact of weight-bearing and sex-stratified differences in risk factors of bone loss on bone mineral density in HIV conditions – findings of the Nigeria HIV-BMD study: An observational study

“…Therefore, to prevent bone loss, non-weight-bearing bones must be loaded from time to time in HIV conditions which highlights a key role for physiotherapists in routine care of PLWH. This understanding informed our recent and ongoing clinical trials in South Africa/Nigeria on the effects of physical exercises/activity on BMD in PLWH during lower limb fracture healing [58].…”

“…Also, the most effective exercise prescriptions that would prevent bone loss or improve BMD in PLWH should be determined in future high-quality RCTs. Presently, one RCT is ongoing in this area in Africa with sites in South Africa and Nigeria [58], while only one is completed [61] with a site in Malawi, but more is required, particularly in Africa which has the greatest global HIV burden [95].…”

Prevalência e fatores associados à prática de atividade física em pessoas vivendo com HIV/AIDS

“…17 Furthermore, studies demonstrate that this portion of the population suffers accelerated aging in relation to the uninfected and, consequently, has an increased risk for age-dependent pathologies and, mainly, for CVD. [18][19][20] As determined by the analysis of data from the sample space, it is clear that older individuals tend to practice less physical activity, which contrasts with the benefit exposed in the literature, given that the cardiovascular risk in PLHIV increases with aging and that moderate to vigorous physical activities would be indicated to reduce mortality in adults between 50-79 years old. 21 Regarding the body changes provided by PAP for PLHIV, the literature shows that this intervention has the capacity to provide an increase in lean mass along with an increase in individuals' weight.…”