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O'Brien KK1,2,3, Solomon P4, Davis AM2,3, Tang A4, Bayoumi AM2,5, Chan Carusone S6, Murzin K7, King K8, Zobeiry M9, Aubry R1
1University of Toronto, Department of Physical Therapy, Toronto, Canada, 2University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada, 3University of Toronto, Rehabilitation Sciences Institute, Toronto, Canada, 4McMaster University, School of Rehabilitation Sciences, Hamilton, Canada, 5St. Michael's Hospital, Centre for Urban Health Solutions, Toronto, Canada, 6Casey House, Toronto, Canada, 7Realize, Toronto, Canada, 8Community Member, Toronto, Canada, 9YMCA of Greater Toronto, Toronto, Canada
Background: Due to advances in antiretroviral therapy, people with HIV are living longer and now aging with HIV. However, many are experiencing increased disability due to HIV, concurrent health conditions, and the potential side-effects of treatment. Physical therapy can reduce disability and improve the health of people aging with HIV, however, access to formalized physical therapy services is limited by individual and systemic barriers. Exercise is one intervention that can address and prevent disability with HIV. Community-based exercise (CBE) can help to manage health-related challenges associated with HIV, multi-morbidity and aging within a self-management framework. However, it is unknown how CBE translates into the 'real world' setting.
Purpose: Our aim was to 1) describe characteristics of adults living with HIV who engaged in a six-month CBE intervention in Toronto, Canada; and 2) describe the level of participation in the intervention.
Methods: Adults living with HIV were recruited from community-based organizations, clinics and health centres in Toronto, Canada. After an 8-month baseline monitoring phase, participants engaged in a 6-month (25 week) CBE intervention involving exercise 3 times per week, with a weekly supervised personal coaching session from a fitness trainer at the Toronto YMCA. Exercise included a combination of aerobic, resistance, neuromotor and flexibility training, performed approximately 60-90 minutes per session. Participants completed a self-reported demographic questionnaire at baseline. We documented loss to follow-up and reasons for withdrawal throughout. We described characteristics of participants using frequencies (percent) and medians (interquartile (IQR) range) for categorical and continuous data, respectively. We measured adherence to the weekly coaching sessions using a log completed by the fitness instructor.
Results: Of the 120 participants enrolled, 80 (67%) initiated the intervention. The majority were men (90%), with a median age of 51 years (IQR: 45,60 years), median year of diagnosis in 1998 (IQR: 1988,2007), and living with a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Mental health conditions (anxiety and depression) were the most commonly reported concurrent health condition (46%). Sixty-seven (84%) participants who initiated, completed the intervention. Reasons for non-completion (n=13) included loss to follow up (38%), health reasons (31%), and dissatisfaction with the study (23%). Participants (n=80) attended a median number of 17 (68%) out of 25 weekly coaching sessions (IQR: 9, 19). Twenty-nine participants (36%) extended their coaching sessions beyond 25 weeks due to coaching changes (41%), communication issues (17%), health reasons (14%), and travel (14%).
Conclusion(s): The majority (84%) of participants who initiated, completed the CBE intervention. Factors that influenced retention and adherence to the weekly coaching sessions highlight the impact of episodic disability with HIV, and implementation issues important to address in future intervention research.
Implications: Community-based exercise is a rehabilitation strategy within a self-management framework to enhance physical activity among people with HIV. Rehabilitation professionals should design interventions that are flexible and consider the episodic nature of HIV to maximize engagement in CBE. Next steps involve examining the effect of the CBE on disability and health outcomes for people with HIV and nature and extent of sustained uptake of CBE over time.
Keywords: HIV/AIDS, disabliity, exercise
Funding acknowledgements: This study is funded by the Canadian Institutes of Health Research (CIHR), HIV/AIDS Community-Based Research Initiative.
Purpose: Our aim was to 1) describe characteristics of adults living with HIV who engaged in a six-month CBE intervention in Toronto, Canada; and 2) describe the level of participation in the intervention.
Methods: Adults living with HIV were recruited from community-based organizations, clinics and health centres in Toronto, Canada. After an 8-month baseline monitoring phase, participants engaged in a 6-month (25 week) CBE intervention involving exercise 3 times per week, with a weekly supervised personal coaching session from a fitness trainer at the Toronto YMCA. Exercise included a combination of aerobic, resistance, neuromotor and flexibility training, performed approximately 60-90 minutes per session. Participants completed a self-reported demographic questionnaire at baseline. We documented loss to follow-up and reasons for withdrawal throughout. We described characteristics of participants using frequencies (percent) and medians (interquartile (IQR) range) for categorical and continuous data, respectively. We measured adherence to the weekly coaching sessions using a log completed by the fitness instructor.
Results: Of the 120 participants enrolled, 80 (67%) initiated the intervention. The majority were men (90%), with a median age of 51 years (IQR: 45,60 years), median year of diagnosis in 1998 (IQR: 1988,2007), and living with a median of 4 concurrent health conditions in addition to HIV (IQR: 2,7). Mental health conditions (anxiety and depression) were the most commonly reported concurrent health condition (46%). Sixty-seven (84%) participants who initiated, completed the intervention. Reasons for non-completion (n=13) included loss to follow up (38%), health reasons (31%), and dissatisfaction with the study (23%). Participants (n=80) attended a median number of 17 (68%) out of 25 weekly coaching sessions (IQR: 9, 19). Twenty-nine participants (36%) extended their coaching sessions beyond 25 weeks due to coaching changes (41%), communication issues (17%), health reasons (14%), and travel (14%).
Conclusion(s): The majority (84%) of participants who initiated, completed the CBE intervention. Factors that influenced retention and adherence to the weekly coaching sessions highlight the impact of episodic disability with HIV, and implementation issues important to address in future intervention research.
Implications: Community-based exercise is a rehabilitation strategy within a self-management framework to enhance physical activity among people with HIV. Rehabilitation professionals should design interventions that are flexible and consider the episodic nature of HIV to maximize engagement in CBE. Next steps involve examining the effect of the CBE on disability and health outcomes for people with HIV and nature and extent of sustained uptake of CBE over time.
Keywords: HIV/AIDS, disabliity, exercise
Funding acknowledgements: This study is funded by the Canadian Institutes of Health Research (CIHR), HIV/AIDS Community-Based Research Initiative.
Topic: Oncology, HIV & palliative care; Health promotion & wellbeing/healthy ageing; Disability & rehabilitation
Ethics approval required: Yes
Institution: University of Toronto
Ethics committee: HIV/AIDS Research Ethics Board
Ethics number: 32910
All authors, affiliations and abstracts have been published as submitted.
