Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol.
BACKGROUND
People with HIV are living longer with the health-related consequences of HIV, multi-morbidity, and aging. Exercise is a key strategy that may improve or sustain health for people living with HIV. Our aim was to examine the safety and effectiveness of aerobic exercise interventions on immunological, virological, cardiorespiratory, strength, weight, body composition, and psychological outcomes in adults living with HIV.


METHODS
We conducted a systematic review using the Cochrane Collaboration protocol. We searched databases up to April 2013. We included randomized controlled trials comparing aerobic exercise with no exercise or another intervention performed at least three times per week for at least four weeks among adults living with HIV. Two reviewers independently determined study eligibility. Data were extracted from studies that met inclusion criteria using standardized forms. We assessed risk of bias using the Cochrane Collaboration's tool for assessing risk of bias. Outcomes were analyzed as continuous and meta-analyses conducted using random effects models with Review Manager (RevMan) computer software.


RESULTS
Twenty-four studies met inclusion criteria (n = 936 participants at study completion); the majority of participants were men (73 %) and the majority were taking antiretroviral therapy (19/24 included studies). The exercise intervention included aerobic exercise alone (11 studies) or a combination of aerobic and resistive exercise (13 studies) ranging from 5 to 52 weeks. Fifty-eight meta-analyses were performed. Main results indicated statistically significant improvements in selected outcomes of cardiorespiratory status (maximum oxygen consumption, exercise time), strength (chest press, knee flexion), body composition (lean body mass, percent body fat, leg muscle area), depression symptoms, and quality of life (SF-36 questionnaire) among exercisers compared with non-exercisers. No significant differences in change in CD4 count and viral load were found.


CONCLUSIONS
Performing aerobic exercise or a combination of aerobic and resistive exercise at least three times per week for at least five weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, body composition and quality of life for adults with HIV. Aerobic exercise is safe and beneficial for adults living with HIV who are medically stable.
Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada. kelly.obrien@utoronto.ca.|Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada. kelly.obrien@utoronto.ca.|Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. kelly.obrien@utoronto.ca.
Kelly K
KK
O'Brien
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Anne-Marie
AM
Tynan
Department of Physical Therapy, University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada.|Rehabilitation Sciences Institute (RSI), University of Toronto, 500 University Avenue, Room 160, Toronto, ON, Canada.
Stephanie A
SA
Nixon
Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.|Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.|Institute for Clinical Evaluative Sciences, G1 06 2075 Bayview Ave, Toronto, ON, Canada.|Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada.|Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, Canada.
Richard H
RH
Glazier
D019380:Anti-HIV Agents / Q000627:therapeutic use; D001823:Body Composition; D001835:Body Weight; D018791:CD4 Lymphocyte Count; D016208:Databases, Factual; D003863:Depression / Q000150:complications; D015444:Exercise; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D010101:Oxygen Consumption; D011788:Quality of Life; D000078202:Systematic Reviews as Topic; D019562:Viral Load
D019380:Anti-HIV Agents
Aerobic; Exercise; HIV/AIDS; Systematic review