Physical deficits among people living with HIV: a review of the literature and implications for rehabilitation

Abstract

Background: Life expectancy has improved significantly among people living with HIV (PLWH). However, there is evidence of an accelerated aging process among PLWH, which includes physical impairments. Relative to the other consequences of aging among PLWH, physical impairments have not received much attention in the literature. There is an emerging need to study physical deficits in this population.

Objectives: The main purposes of this review are to explore factors contributing to physical dysfunction in this population, describe common physical impairments, discuss physical performance measures, and make recommendations for rehabilitation professionals regarding exercise prescription for PLWH.

Major Findings: Factors contributing to physical impairments include HIV severity, comorbidities, inflammation, and oxidative stress. Problems with muscle strength and mass, gait, static and dynamic balance, aerobic capacity, and frailty are common among PLWH and can have a negative impact on fall risk and functional performance. Several physical performance measures can be used for screening and assessment purposes, including the Short Physical Performance Battery, Six-Minute Walk Test, 5-times sit-to-stand, Community Mobility and Balance Scale, and gait speed tests.

Conclusions: Physical impairments are prevalent among PLWH. Rehabilitation providers should identify PLWH who are at risk of developing physical impairments. Exercise interventions including aerobic, resistance, and balance training appear to benefit PLWH. More research is warranted to investigate outcome measures that should be routinely used in clinical practice and the efficacy of exercise in this population.

Keywords:

• AIDS
• balance
• postural control
• gait
• frailty

Acknowledgements

This work is supported by a Canadian Institutes of Health Research Catalyst Grant in HIV/AIDS Community Based Research.

Disclosure statement

The authors have no conflict of interest.

Additional information

Notes on contributors

Adria Quigley

Adria Quigley is in her fourth year of her PhD in Health at Dalhousie University and is supervised by Dr. Marilyn MacKay-Lyons. Her current research is looking at the impact of a yoga intervention on cognitive function and balance in older adults living with HIV. Adria is a lecturer, lab instructor, and tutorial leader for the Dalhousie Physiotherapy neurotherapeutics course, where she has worked closely with senior physiotherapy students to teach them clinical and research skills in this area of study. She provides evidence-based lectures on exercise training for individuals with stroke, spinal cord injury, and other neurological conditions.

Marilyn MacKay-Lyons

Dr. Marilyn MacKay-Lyons specializes in neurotherapeutics - the application of physiotherapy principles and techniques to improve the mobility and function of people with such neurological disorders. Dr. MacKay-Lyons runs a research laboratory at the Nova Scotia Rehabilitation Centre Site of the QEII Health Sciences Centre in Halifax, Canada, where teams of investigators conduct clinical trials involving people post-stroke.