A pilot randomized aerobic exercise trial in older HIV-infected men: Insights into strategies for successful aging with HIV

Abstract

BackgroundHIV-infected adults have increased risk for age-related diseases and low cardiorespiratory fitness that can be prevented and improved with exercise. Yet, exercise strategies have not been well studied in older adults with HIV and may require substantial adaptation to this special population.ObjectiveTo determine the safety and efficacy of aerobic exercise in older HIV-infected men in a randomized trial comparing different levels of exercise intensity.MethodsWe conducted a pilot exercise trial in 22 HIV-infected men ≥50 years of age receiving antiretroviral therapy who were randomized 1:1 to moderate-intensity aerobic exercise (Mod-AEX) or high-intensity aerobic exercise (High-AEX) that was performed three times weekly for 16 weeks in a supervised setting. Primary outcome was cardiorespiratory fitness (VO2peak) measured by treadmill testing. Secondary outcomes were exercise endurance, six-minute walk distance (6-MWD), body composition measured by Dual-energy X-ray absorptiometry (DXA), and fasting plasma levels of lipids and glucose.ResultsVO2peak increased in the High-AEX group (3.6 ±1.2 mL/kg/min, p = 0.02) but not in the Mod-AEX group (0.4 ±1.4 mL/kg/min, p = 0.7) with a significant between group difference (p<0.01). Exercise endurance increased in both the High-AEX group (27 ±11%, p = 0.02) and the Mod-AEX group (11 ±4%, p = 0.04). The 6-MWD increased in both the High-AEX (62 ±18m, p = 0.01) and the Mod-AEX group (54 ±14m, p = 0.01). Changes in VO2peak and 6-MWD were clinically relevant. There were no serious exercise-related adverse events. Dropouts were similar between group (27% overall) and were related to joint pain.ConclusionsThis pilot exercise trial demonstrates that moderate to high-intensity aerobic exercise in older HIV-infected men increases endurance and ambulatory function. However, increased cardiorespiratory fitness was observed only with high-intensity aerobic exercise despite substantial baseline impairment. Future research is needed to determine exercise strategies in older HIV-infected adults that address advanced aging and comorbidity yet are durable and feasible.

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

“…The CBE intervention involved a combination of aerobic, resistance, balance and flexibility training, and was not specifically tailored to enhancing aerobic capacity. Oursler and colleagues found a significantly greater increase in V O 2 max of 3.6 ml/kg/min among people living with HIV who completed 16 weeks of vigorous intensity aerobic exercise compared with no change in V O 2 max among participants who completed 45 minutes of moderate-paced walking [10]. Erlandson and colleagues [62] conducted a thrice weekly 24-week aerobic and resistance exercise intervention comparing older adults living with HIV and without HIV (50-75 years) where after 12 weeks of moderate-intensity of exercise individuals were randomized to 12 additional weeks of moderate or high intensity exercise.…”

“…Exercise can reduce the risk of multimorbidity and improve health outcomes for adults living with HIV [9][10][11]. Systematic review evidence demonstrated that engaging in aerobic, resistive or combined aerobic and resistive exercise at least three times per week can improve cardiorespiratory fitness, strength and quality of life outcomes among adults living with HIV [12][13][14].…”

Factors related to functional exercise capacity amongst people with HIV in Durban, South Africa

“…The 6-min walk test (6MWT) has been used to measure functional exercise capacity in a number of studies. Casanova et al ( 2011 ) conducted a cross-sectional, international, multicentre study with normal volunteers aged 40–49 years and found that the average man walked 650 m and the average woman walked 600 m. In one older sample of PWH (Oursler et al 2018 ), the average baseline distance walked during the 6MWT was 551 m (standard deviation [SD] = 33 m). In a different HIV-infected sample with an average age of 52 years, men walked an average distance of 415 m whilst women walked an average distance of 367 m (Oliveira et al 2018 ).…”

Physical Activity and Exercise for Older People Living with HIV: A Scoping Review

“…Among women living with HIV, engaging in vigorous physical activity was associated with improved cardiorespiratory function. Oursler et al (2018) suggested, after the use of a randomized control trial, that moderate-to-high intensity aerobic exercise has the capacity to increase endurance and ambulatory function in older HIV-infected men. However, increased cardiorespiratory fitness was only observed with high intensity aerobic exercise.…”