title: Effectiveness of Progressive Resistive Exercise (PRE) in the context of HIV: systematic review and meta-analysis using the Cochrane Collaboration protocol.
abstract: BACKGROUND
  HIV is increasingly considered a chronic illness. More individuals are living longer and aging with the health-related consequences associated with HIV and multi-morbidity. Exercise is a self-management approach that can promote health for people aging with HIV. We examined the safety and effectiveness of progressive resistive exercise (PRE) 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. Searching databases up to April 2013, we included randomized controlled trials that compared PRE with no exercise or another intervention performed at least three times per week for at least four weeks with adults living with HIV. Two reviewers independently determined study eligibility. We extracted data from included studies and assessed risk of bias using the Cochrane Collaboration risk of bias tool. Meta-analyses were conducted using random effects models with Review Manager (RevMan) computer software.
  
  
  RESULTS
  Twenty studies met inclusion criteria (n = 764 participants at study completion); the majority of participants were men (77%) taking antiretroviral therapy (14/20 included studies). Exercise interventions included PRE alone (8 studies) or a combination of resistive and aerobic exercise (12 studies) ranging from 6 to 52 weeks in duration. Thirty-four meta-analyses were performed. Results demonstrated statistically significant improvements in cardiorespiratory status (maximum oxygen consumption, exercise time), strength (chest press, knee flexion), weight, and body composition (arm and thigh girth, leg muscle area) among exercisers versus non-exercisers. We found no significant differences in change in CD4 count and viral load. We were unable to perform meta-analyses for psychological outcomes however results from individual studies demonstrated improvements in health-related quality of life with exercisers compared with non-exercisers.
  
  
  CONCLUSIONS
  Performing progressive resistive exercise (PRE) or a combination of resistive and aerobic exercise at least three times per week for at least six weeks is safe and can lead to improvements in cardiorespiratory fitness, strength, weight, and body composition for adults with HIV. Exercise may be considered a safe and beneficial for enhancing the health of medically stable adults aging with HIV.
authors.affiliation: 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.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: O'Brien
authors.affiliation: Centre for Urban Health Solutions (CUHS), Li Ka Shing Knowledge Institute, 30 Bond Street, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Tynan
authors.affiliation: 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.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Nixon
authors.affiliation: Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada.|Centre for Urban Health Solutions (CUHS), Li Ka Shing Knowledge Institute, 30 Bond Street, 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.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D055070:Resistance Training; D000078202:Systematic Reviews as Topic; D016896:Treatment Outcome
keywords: Exercise; HIV/AIDS; Resistive exercise; Strength training; Systematic review