IMPACT OF EXERCISE TRAINING ON SYMPTOMS OF DEPRESSION, PHYSICAL ACTIVITY LEVEL AND SOCIAL PARTICIPATION IN PEOPLE LIVING WITH HIV/AIDS

S.C. Ibeneme^1,2,3, V.C. Uwakwe¹, H. Myezwa³, F.O. Irem¹, E.F. Ezenwankwo⁴, T.A. Ajidahun³, A.D. Ezuma⁵, U.P. Okonkwo⁶, G. Fortwengel⁷, A.O. Nwosu¹

¹University of Nigeria, Enugu Campus, Department of Medical Rehabilitation, Enugu, Nigeria, ²David Umahi Federal University of Health Sciences, Department of Physiotherapy, Enugu, Nigeria, ³University of the Witwatersrand, Department of Physiotherapy, Johannesburg, South Africa, ⁴University of Cape Town/ Sports Science Institute of South Africa, Division of Exercise Science and Sports Medicine, Cape Town, South Africa, ⁵University of Nigeria Teaching Hospital, Department of Physiotherapy, Enugu, Nigeria, ⁶Nnamdi Azikiwe University, Nnewi Campus, Department of Medical Rehabilitation, Nnewi, Nigeria, ⁷Hochschule Hannover University, Faculty III, Hannover, Germany

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 interventions, usual care, or no treatment controls?

Purpose: To assess the impact of physical exercise training on symptoms of depression, PAL and social participation in PLWHA.

Methods:Data sources: Eight databases were searched up to July 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol.
Study eligibility criteria: Only randomised controlled trials involving adults who were either on HAART/HAART-naïve and reported in the English language, were included.
Data collection and analysis: 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 on 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 minutes/session, and for between 6-24 weeks, and the risk of bias varied 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%;5studies; 205participants) unlike PAL (SMD=0.98,95%CI=-0.25,2.17,p=0.11;I²=82%;2studies;62 participants) and social participation (SMD=0.04,95%CI=-0.65,0.73,p=0.91;I²=90%; 6 studies; 373 participants).

Conclusions: Physical exercise training could have an antidepressant-like effect on PLWHA but did not affect their PAL and social participation. However, the high heterogeneity in the included studies, implies that adequately powered RCTs with clinical/methodological similarity are required in future studies.

Implications: Public health policies and initiatives designed to increase participation in exercises may have the potential to improve mental health and general well-being among PLWHA. However, the paucity of RCTs on the impact of physical exercise training on PAL made it difficult to form a scientific opinion on its effect.

Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors

Keywords:
Exercise training
Mental health
HIV/AIDS

Topics:
Oncology, HIV & palliative care
Health promotion & wellbeing/healthy ageing/physical activity
Mental health

Did this work require ethics approval? No

Reason: This was a systematic review and involved evidence synthesis from secondary sources.