Cardiorespiratory fitness levels and moderators in people with HIV: A systematic review and meta-analysis

Abstract

Cardiorespiratory fitness (CRF) is a modifiable risk factor for cardiovascular disease and premature mortality. CRF levels and moderators among people living with HIV (PLWH) are unknown. The aim of the current meta-analysis was to (1) determine mean CRF in PLWH and compare levels with age-and gender-matched healthy controls (HCs), (2) explore moderators of CRF,3and (4) explore moderators of CRF outcomes following physical activity (PA) interventions. Major electronic databases were searched systematically for articles reporting CRF expressed as maximum or peak oxygen uptake (ml/min/kg) in PLWH. A random effects meta-analysis calculating the pooled mean CRF including subgroup-and meta-regression analyses was undertaken. Across 21 eligible studies, the CRF level was 26.4 ml/kg/min (95%CI=24.6 to 28.1) (n=1,010; mean age =41years). There were insufficient data to compare CRF levels with HCs. A higher body mass index (β=-0.99, 95%CI=-1.93 to -0.06, P=0.04), older age (β=-0.31, 95%CI=-0.58 to -0.04, P=0.02) and the presence of lipodystrophy (β=-4.63, 95%CI=-7.88 to -1.39, P=0.005) were significant moderators of lower CRF levels. Higher CD4+ counts (β=0.004, 95%CI=0.0007 to 0.007, P=0.016), supervised interventions (P<0.001) and interventions with a lower frequency of weekly sessions (2 or 3 versus 4 times) (P<0.001) predicted a better CRFoutcome following PA. CRF levels of PLWH are among the lowest in comparison to other vulnerable populations. More research on the most optimal physical activity intervention characteristics is needed.

Relationship of HIV Status and Fatigue, Cardiorespiratory Fitness, Myokines, and Physical Activity

“…In his systematic review, Vancampfort found that among PLHIV, the average VO 2 peak was 26.4 ml/kg/min and this is among the lowest levels of those living with chronic disease. (Vancampfort et al, 2016) We found substantially lower levels among PLHIV (16.0 ml/kg/ml; IQR 13, 21.3) but that the control group (15.6 ml/kg/ml; IQR 14.1, 17.9) was equally low and the values of both groups were constant over 6 months. Several reasons for this exist.…”

“…PLHIV have reduced cardiorespiratory fitness (Vancampfort et al, 2016) and muscle strength (Schrack et al, 2016) compared with those without HIV. Cardiorespiratory fitness and muscle strength decline with age, but this decline is accelerated in PLHIV.…”

Research Article CCR5Δ32 polymorphism analysis of lipodystrophy syndrome development in HIV/AIDS patients

“…The higher incidence of lipodystrophy in men may be justified by most of the men not practicing physical activity, since 56% were not active. According to Vancampfort et al (2016), physically active people have a lower risk of developing lipodystrophy. These data support the conclusions of Segatto et al (2011) and Trevisol et al (2012), who reported an association between lipodystrophy and physical activity level, as they found that physically active individuals were 79% less likely to present lipodystrophy than sedentary patients.…”

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

“…VO 2 peak, oxygen utilization at peak exercise, is an established measure of cardiorespiratory fitness and a physiologic biomarker of aging that declines in sedentary adults 10% per decade [ 8 ] and independently predicts cardiovascular and all-cause mortality. [ 9 , 10 ] Cardiorespiratory fitness is substantially reduced in HIV-infected adults [ 11 , 12 ] and correlates with biomarkers of inflammation[ 13 ] and skeletal muscle mitochondrial function. [ 14 ] Results from exercise interventions in older adults with multimorbidity, but not HIV infection, shows that high-intensity aerobic exercise is necessary to decrease plasma levels of inflammation.…”