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

Figures & data

Figure 1 PRISMA flow diagram for the scoping review process.

Notes: PRISMA figure adapted from Moher D, Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of clinical epidemiology. 2009;62(10). Creative Commons.⁵⁸

Table 1 Study Characteristics

	Author	Title	Study Design	Study Setting	Participants	Relevant Findings
1	De Souza et al. (2008)^Citation44	Progressive resistance training in elderly HIV-positive patients: Does it work?	Case study design	Brazil (Urban)	N=11	Resistance training increased strength, improved physical fitness, reduced upper and lower limb skinfolds, and was associated with an improvement in the CD4+ and CD4+/CD8+ counts in older HIV-positive patients, without significant side effects.
2	De Souza et al. (2011)^Citation45	Effect of progressive resistance exercise on strength evolution of elderly patients living with HIV compared to healthy controls.	Prospective, non-randomized study	Brazil (Urban)	N=32 (Control=21, Intervention=11)	Resistance exercise safely increased the strength of older patients living with HIV, allowing them to achieve performance levels similar to healthy controls. Improved fasting glucose and lipid levels after the one-year training programme were also observed.
3	de Araújo et al. (2014)^Citation46	Influence of physical exercise on practice morphofunctional standards, immune function and quality of elderly with AIDS: a case study.	Case study design	Brazil (Urban)	N=4	A 16-week exercise intervention programme, consisting of aerobic and resistance training, promoted improvements in the components of morphofunctional standards, with emphasis on flexibility and muscle strength, as well as possible changes in markers of immune function and quality of life domains.
4	Fazeli et al. (2015)^Citation31	Physical activity is associated with better neurocognitive and everyday functioning among older adults with HIV disease.	Cross-sectional study	United States of America (Urban)	N=100	Higher levels of moderate PA were associated with lower chances of neurocognitive impairment (NCI). Higher levels of moderate PA were also associated with lower chances of dependence on instruments for the activities of daily living (IADL). Follow-up analysis showed those with both NCI and IADL dependence had lower moderate PA than those with neither.
5	Shah et al. (2016)^Citation47	Enhancing physical function in HIV-infected older adults - a randomized controlled clinical trial.	Randomized control trial	United States of America (Urban)	N=67 (Control=34, Intervention=33)	Overall physical performance, gait speed, measurements of endurance and strength, and levels of physical activity, improved in the treatment group compared to the control group. Measurements of autonomous regulation and measurements of depression and QoL improved significantly in the treatment group compared to the control group. Across the groups, improvement in intrinsic regulation and QoL correlated with an improvement in physical function.
6	Veeravelli et al. (2016)^Citation48	Exergaming in older people living with HIV improves balance, mobility and ameliorates some aspects of frailty.	Quasi-experimental design	United States of America (Urban)	N=10	The intervention showed improvements in balance and mobility, while requiring older people living with HIV to be more active. Exergaming can be performed at home and may have long-term as well as short-term benefits for ameliorating frailty associated with HIV infection.
7	Erlandson et al. (2018)^Citation49	Improvements in physical function, with moderate or high-intensity exercise among older adults with or without HIV infection.	Randomized control trial	United States of America (Urban)	N=69 (Control=37, Intervention=32)	PLWH had significantly poorer physical function across nearly all baseline measurements. Both groups showed significant improvements in all function measurements. An interaction between exercise intensity and HIV serostatus was significant for measurements of strength. Randomly selected PLWH participating in high-intensity exercise gained significantly more strength than those participating in moderate-intensity activity. Controls had similar gains, regardless of intensity.
8	Oursler et al. (2018)^Citation50	A randomized, pilot aerobic exercise trial in older HIV-infected men: insights into strategies for successful aging with HIV.	Randomized control trial	United States of America (Urban)	N=22 (Mod-AEX= 11; High-AEX=11)	Moderate- to high-intensity aerobic exercise in older HIV-infected men increases endurance and ambulatory function. However, increased cardiorespiratory fitness was only observed with high-intensity aerobic exercise.
9	Safeek et al. (2018)^Citation51	Low levels of physical activity among older persons living with HIV/AIDS are associated with poor physical function.	Quasi-experimental design	United States of America (Urban)	N=21	Greater physical activity was associated with better physical performance, while more sedentary time was associated with poorer performance. Older people living with HIV fall far short of public health guidelines for promoting physical activity participation.
10	Cioe et al. (2019)^Citation52	The effect of increased physical activity on symptom burden in older persons living with HIV.	Quasi-experimental design	United States of America (Urban)	N=40	Increased PA was not associated with an improvement in overall HIV symptom burden. However, bothersome symptoms were reduced, and total symptom burden was strongly correlated with PA after 12 weeks, such that participants who had higher step counts reported lower symptom burden. Significant gender differences in symptom burden were noted, with males, on average, reporting lower symptom burden.
11	De Layna Goulding et al. (2019)^Citation53	A supervised exercise intervention fails to improve depressive symptoms and quality of life among older, sedentary adults with HIV infection.	Randomized control trial	United States of America (Urban)	N=69 (PLWH=32, uninfected; control=37)	No significant improvements in most mental health outcomes over 24 weeks of supervised aerobic and resistance exercise.
12	Johs et al. (2019)^Citation54	A qualitative focus group study of perceived barriers and benefits to exercise by self-described exercise status among older adults living with HIV.	Focus group discussion	United States of America (Urban)	N = 29 exercising men (n=11), non-exercising men (n=14); women (non-exercisers and exercisers, n=4)	Exercisers emphasized positive reinforcement, positive mood change and increased energy as benefits of exercise. Non-exercisers identified lack of motivation, lack of self-efficacy and a negative perception of gym culture as barriers to exercise. Both groups identified time, cost and health-related challenges as barriers to exercise.
13	Webel et al. (2019)^Citation55	The relationship between physical activity and cardiorespiratory fitness among people living with human immunodeficiency virus throughout their life spans	Cross-sectional study	United States of America & Thailand (Urban)	N=702	Weekly physical activity of people living with HIV averaged well below the recommended level of moderate activity. Vigorous physical activity was associated with improved cardiorespiratory fitness in women, but not men.
14	Chung and Louw (2020)^Citation56	Effects of supervised exercise on physical health and quality of life among older adults living with HIV in Hong Kong.	Randomized control trial	China (Urban)	N=21 (Control=10, Intervention=11)	An eight-week, moderate-intensity, supervised exercise intervention was feasible for older Chinese PLWH. It improved physical health and aspects of health-related quality of life. The moderate-intensity training was well tolerated by participants with an inactive lifestyle. Participants in the exercise group showed excellent exercise adherence.
15	Stabell et al. (2020)^Citation57	The impact of a structured, supervised exercise programme on daily step count in older, sedentary adults with and without HIV.	Randomized control trial	United States of America (Urban)	N=38 (Control=17, Intervention=21)	Supervised exercise increased daily step counts in sedentary individuals, but at the expense of fewer steps on non-supervised exercise days.

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