Translating Exercise into the HIV Community

Evaluating A Community-Based Exercise Intervention to Improve the Health of Adults Living with HIV

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In Canada, where HIV is considered a chronic disease, people living with HIV are living longer and now aging with the health-related consequences of HIV, potential adverse effects of treatment and multi-morbidity. These health-related consequences are known as disability, and include symptoms and impairments, difficulties with day-to-day activities, challenges to social inclusion, and uncertainty or anxiety about future health.

Rehabilitation, such as physical therapy and occupational therapy, has the potential to improve the health of people with chronic illness. However, barriers to accessing formalized rehabilitation services leave many people living with HIV to employ self-management or wellness strategies to deal with their health challenges. Rehabilitation in the context of HIV is still emerging.

Exercise can address disability and improve or sustain the health of people living with HIV. Systematic reviews suggest exercise is safe and may lead to benefits in cardiopulmonary fitness, strength, weight and body composition, and psychological status (O’Brien et al, 2016; O’Brien et al, 2017). Despite the benefits, few people with HIV engage in regular physical activity.

Community Based Exercise (CBE) is an ideal approach for enhancing the health of people living with HIV within a self-management framework. However, the impact of CBE when translated into the ‘real-world’ HIV community setting, and its sustainability over the long term are unknown.

Four athletes strecting their legs, only their feet are visible

What is the Aim of the CBE Study?
1) The primary aim of this research is to evaluate a community-based exercise (CBE) intervention for adults living with HIV within the community with the goal of reducing disability and enhancing health (cardiopulmonary, strength, weight and body composition, and neurocognitive  outcomes) and contextual factor outcomes (social support, stigma, mastery, coping) for adults living with HIV.

2) The secondary aim of this research is to further assess the measurement properties of the HIV Disability Questionnaire (HDQ); specifically the interpretability and responsiveness of the HDQ with adults living with HIV.

Methods
The Community-Based Exercise (CBE) Study is a 22-month interrupted time series study consisting of an 8-month baseline phase, 6-month exercise intervention at the Central Toronto YMCA and an 8-month post-intervention phase with adults living with HIV in the community. This study was approved by the University of Toronto HIV/AIDS Research Ethics Board (REB).

Who are the CBE Study Participants?
Men and women (18 years and older) living with HIV in Toronto who considered themselves medically stable and safe to engage in exercise, and willing to participate in a 22 month study involving a 14 month CBE intervention at the YMCA.

Research Phases
Baseline (0-8 months): Participants were monitored bimonthly during the baseline (pre-intervention phase) for 32 weeks. This identified the pattern of pretest outcomes and served as the ‘control’ phase in which to compare the level and trend of outcomes during and post-intervention in the interrupted time series study.

Intervention – Exercise and Self-Management Education (8-14 months): The CBE intervention was a 6-month exercise program at the Central Toronto YMCA. Participants were asked to engage in a combination of aerobic and resistance exercise 3 times a week for ~90 minutes per session with weekly supervision with a fitness instructor. 
Participants were invited to attend monthly self-management education sessions: https://www.youtube.com/playlist?list=PLC7sbi41p__oTr7B7n7oVOYriA_CS6MpM.

Post-Intervention – Self-Monitored Exercise (14-22 months): Participants were encouraged to continue to engage in unsupervised exercise 3 times per week. Participants also were provided with a wireless activity tracker (Fitbit®) to self-monitor steps, distance and calories burned during both exercise phases (8-22 months). 

Results
Over 100 participants were involved in the study.
Data collection is complete. Analysis is in progress.

For more information contact:

CBE Study Team

Researchers
Kelly O’Brien (University of Toronto), Patty Solomon (McMaster University), Ahmed Bayoumi (St. Michael’s Hospital & University of Toronto), Aileen Davis (University Health Network & University of Toronto), Ada Tang (McMaster University).

Knowledge Users
Mehdi Zobeiry (YMCA), Ken King (Community Member), Chris Godi (Toronto PWA Foundation).

Collaborators
James Murray (Ontario Ministry of Health and Long-Term Care), Kate Murzin (Canadian Working Group on HIV and Rehabilitation), Soo Chan Carusone (Casey House).

Acknowledgements
This study was funded by a grant from the Canadian Institutes of Health Research (CIHR), HIV/AIDS Community-Based Research (CBR) Program (CBR #139685). Kelly O’Brien was supported by a CIHR New Investigator Award (2013-2017).  Kelly O’Brien is currently supported by a Canada Research Chair in Episodic Disability and Rehabilitation.

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