Attitudes towards exercise among substance using older adults living with HIV and chronic pain

Abstract

Chronic pain and substance use disorders occur commonly among HIV-infected persons. Recent CDC guidelines recommend non-pharmacologic approaches over opioid medications for the management of chronic pain. This is particularly relevant for persons with substance use disorders. Structured physical activity may be an effective strategy for pain reduction. We developed a combined cognitive-behavioral therapy (CBT) + exercise intervention to reduce pain, pain-related disability and substance use and improve physical function in older HIV-infected adults with chronic pain and substance use. We employed established CBT protocols for the intervention, and sought feedback from potential end users when developing the exercise component of the intervention. A total of 27 HIV-infected adults ≥50 years of age participated in four focus group sessions. Transcripts were analyzed using thematic analysis. Participant demographics: mean age 54 years; male 81%; Hispanic 48%, Black 33%; treated for substance abuse in the past 52%. Exercise was seen as a desirable activity, but many participants expressed barriers to exercise including fear of pain exacerbation, low physical fitness, and lack of availability of perceived safe spaces for HIV-infected persons. Most participants were receptive to exercise for pain reduction, particularly modalities that provide added psychological benefits of reducing stress and anxiety. Exercise for pain management among older HIV-infected adults with chronic pain and substance use was found to be highly acceptable. However, interventions need to be tailored to the unique needs of this population to address their fears and concerns.

A qualitative focus group study of perceived barriers and benefits to exercise by self-described exercise status among older adults living with HIV

“…In our previous work among older men with HIV enrolled in an exercise intervention, participants discussed the appeal of a gym community for older PLWH 34. Here, however, we found this concept to be contentious, some citing a desire for connection with similar others (older and/or with HIV), but others relating a desire for privacy and expressing concerns about disclosure due to HIV stigma, noted as a barrier to exercise in prior studies of PLWH 29 31. Based on the data from these focus groups, the welcoming environment of a new gym or activity may be particularly important to those not currently exercising, and activities targeted for older adults may be beneficial.…”

“…Despite the medical advances in HIV management with antiretroviral therapy, older PLWH appear to experience age-associated comorbidities at a higher rate and at a younger age than the general population 2 35. The physical barriers attributed by our participants to HIV and medication, generalised fatigue, and chronic pain are consistently identified as barriers to exercise among PLWH 28 31–33 36. To engage older PLWH, exercise interventions must acknowledge and address these physical barriers.…”

“…Indeed, the SEM model has been used extensively in the exercise health- behaviour literature to investigate the many competing factors that influence physical activity 24–27. Similarly, a number of qualitative studies have explored attitudes towards exercise or physical activity among diverse populations of PLWH and have identified factors influencing exercise or routine physical activity, such as physical health and self-efficacy (personal), social support and competing priorities such as caregiver responsibilities (social), and accessibility of safe environments for exercise (community) 28–33. However, these studies did not distinguish the viewpoints of participants with and without established exercise habits.…”

Establishing the feasibility, acceptability and preliminary efficacy of a multi-component behavioral intervention to reduce pain and substance use and improve physical performance in older persons living with HIV

“…Prior to the RCT, we conducted focus groups with prospective end-users of the intervention to ascertain their preferences regarding behavioral treatments for pain (Nguyen et al, 2017); developed the integrated intervention and trained APAIT staff to deliver it; and conducted a small (N=9) pilot study, using the results to refine study materials and procedures prior to the current trial. We also obtained supplemental funding to conduct daily diary assessments (DDA) of overall health, pain, behavioral responses to pain, mood, sleep, exercise, drinking and drug use, and social contact among all study participants via their cell phones.…”

Precision Health: Use of Omics to Optimize Self-Management of Chronic Pain in Aging

“…Physical activity has been shown to alleviate infl ammatory and neuropathic pain conditions and chronic pain experienced by patients with musculoskeletal disorders (Courneya et al, 2013;Dixit, Maiya, & Shastry, 2014;Hurkmans, van der Giesen, Vliet Vlieland, Schoones, & Van den Ende, 2009;Wright & Sluka, 2001). Meta-analyses of physical activity to reduce pain can be found for several conditions (Devos-Comby, Cronan, & Roesch, 2006;Kelley, Kelley, Hootman, & Jones, 2011;Nguyen et al, 2017). Devos-Comby et al (2006) examined physical activity with and without other self-management interventions to improve osteoarthritis outcomes including pain.…”