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

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.

Effects of 8-Week Circuit Exercise Training on the Cardiorespiratory Fitness and Health Status of People Living with HIV at Abakaliki, Ebonyi State, Nigeria

“…Findings from this study revealed significant improvement in the cardiorespiratory fitness/aerobic capacity (VO2max) within the intervention group, and between the groups after 8-week exercise intervention. This result is in tandem with the report of O'Brien et al [16] , that a community-based exercise intervention had a significant effect on V ̇O2peak (0.56 ml/kg/min; 95% CI: -1.27, 2.39). The result is in agreement with findings of Ibeneme et al [17] that carried out a systematic review with meta-analysis which reported a significant improvement in VO2 max following exercise intervention in people living with HIV.…”

Inflammatory and Cardiovascular Correlates of Physical Activity and Sedentary Behavior in Older Adults Living With HIV

“…The reduction in systolic blood pressure is consistent with previous literature showcasing that any PA can reduce blood pressure and reduce/prevent hypertension risk among adults 69 and PWH. 70,71 Even though the average blood pressure of the participants in the study was in the "elevated" range (according to the American College of Cardiology/American Heart Association [ACC/AHA] Guidelines), 72 our data align with the current literature suggesting that even among OPWH, engaging in PA can show improvements in cardiovascular outcomes. 68,[73][74][75][76] The findings of the present study are subject to certain limitations.…”

Considerations for developing and implementing an online community-based exercise intervention with adults living with HIV: a qualitative study

“…CBE can cultivate social interaction, encourage regular exercise and facilitate self-management strategies in PLWH to independently manage health challenges 26–29. Additionally, CBE can provide physical health benefits in PLWH such as a decrease in lipid profile, waist circumference, diastolic and systolic blood pressure, and an increase in upper and lower body muscular strength 28 30 31. Despite the benefits of CBE, PLWH may experience barriers to exercising in traditional gym environments, including, interpersonal, financial and geographical barriers, self-image issues and stigma, and difficulty initiating exercise following periods of inactivity 26 29.…”