CARDIOPULMONARY FITNESS CHANGES ACROSS A THREE-PHASED COMMUNITY-BASED EXERCISE INTERVENTION STUDY WITH ADULTS AGING WITH HIV

K.K. O'Brien1,2,3, L. Avery4, A.M. Davis1,2,3,5, A.M. Bayoumi6,2,7, A. Tang8, S. Chan Carusone9,10, P. Solomon8, R. Aubry1
1University of Toronto, Department of Physical Therapy, Toronto, Canada, 2University of Toronto, Institute of Health Policy, Management and Evaluation (IHPME), Toronto, Canada, 3University of Toronto, Rehabilitation Sciences Institute (RSI), Toronto, Canada, 4Avery Information, Toronto, Canada, 5University Health Network, Toronto, Canada, 6St. Michael's Hospital, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Toronto, Canada, 7University of Toronto, Department of Medicine, Toronto, Canada, 8McMaster University, School of Rehabilitation Science, Hamilton, Canada, 9Casey House, Toronto, Canada, 10McMaster University, Health Research Methods, Evidence, and Impact, Hamilton, Canada

Background: People  living with HIV are living longer with the potential combination of physical, mental, and social health challenges associated with HIV, multimorbidity, and aging, known as disability. Despite the role of physiotherapy for adults aging with HIV, few access formalized rehabilitation services and engage in physical activity. Exercise is a rehabilitation strategy that is safe and beneficial, and can address disability and improve health of adults aging with HIV. Community-based exercise (CBE) can help manage the health-related challenges associated with HIV and multimorbidity with a self-management framework. The impact of CBE on health outcomes when implemented in a community-based setting with adults living with HIV is unknown.

Purpose: Our aim was to examine the change in cardiopulmonary fitness among adults aging with HIV engaged in a community-based exercise intervention in a community setting.

Methods: We conducted a 22-month longitudinal intervention study with community-dwelling adults aging with HIV in Toronto, Canada. We measured cardiopulmonary fitness (VO2peak) bimonthly across three phases: 1) Baseline Monitoring (8 months); 2) CBE Intervention: participants were asked to exercise (aerobic, strength, balance and flexibility training) for 90 minutes, 3 times/week, with weekly supervised coaching (6 months) and 3) Follow-Up: participants were expected to continue with thrice weekly exercise independently (8 months). We used segmented regression (adjusted for baseline age and sex) to assess the change in trend (slope) between phases.

Results: Of the 108 participants who initiated the study, 80 (74%) started and 67/80 (84%) completed the intervention; and 52/67 (77%) completed the study. The majority were males (90%), ≥50 years of age (58%) with median age of 51 years (interquartile range (IQR): 45,60). Participants reported living with a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Participants attended a median of 18/25(72%) of weekly supervised sessions. Baseline mean (sd) VO2peak was 24.1 (7.96) ml/kg/min for males (n=88) and 16.7 (4.1) ml/kg/min for females (n=10). Median number of fitness sessions attended was 18/25(72%). During Phase 1, there was a small increase in VO2peak (0.12ml/kg/min/month; 95%CI:-0.04,0.28), followed by a larger increase in Phase 2 (0.21 ml/kg/min/month; 95%CI: 0.00,0.41) and a small decline over Phase 3 (-0.12ml/kg/min/month; 95%CI: -0.52,0.27). The rate of change in VO2peak in Phase 2 was not significantly different from Phase 1 (p=0.195) or Phase 3 (p=0.056). The overall increase in VO2peak during the intervention (Phase 2) was 1.24ml/kg/min (males) and 1.25ml/kg/min (females), with considerable variation of VO2peak within individuals over time.

Conclusion(s): Little to no change in VO2peak occurred across the three phases. Difficulty eliciting and measuring peak VO2, variable adherence to the intervention, and ensuring intervention dosage is high enough to effect a change should be explored as potential reasons for little to no change in VO2peak.

Implications: Physiotherapists should consider the role of CBE for improving health outcomes with adults living with HIV.  While VO2peak is a common outcome measure of cardiopulmonary fitness, other outcomes may better capture the impact of CBE in this population.  Results may be relevant to physiotherapists choosing outcomes to measure the impact of exercise interventions with chronic disease populations.

Funding, acknowledgements: Funded by the Canadian Institutes of Health Research (CIHR) HIV/AIDS Community-Based Research (CBR) Program.

Keywords: HIV/AIDS, exercise intervention, VO2peak

Topic: Oncology, HIV & palliative care

Did this work require ethics approval? Yes
Institution: University of Toronto
Committee: HIV Research Ethics Board
Ethics number: REB Protocol File #32910


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