Qualitative Description of Exercise Perceptions and Experiences Among People With Human Immunodeficiency Virus in the High-Intensity Exercise to Attenuate Limitations and Train Habits Study.

BACKGROUND: The benefits of physical activity (PA), specifically exercise, among older adults in general are well known. Yet globally, there is concern regarding limited engagement in PA, increased obesity, and frailty among older people with human immunodeficiency virus related to low levels of PA. METHODS: We conducted in-depth interviews among 30 older, sedentary people with human immunodeficiency virus participating in the ongoing High-Intensity Exercise to Attenuate Limitations and Train Habits (HEALTH study, NCT04550676) between February 2021 and August 2022. A semistructured interview guide, informed by two minds theory, which frames behavior change as an intention-behavior gap between 2 neurocognitive systems, was used to elicit data from participants. Interviews explored general exercise perceptions, self-efficacy for exercise, mobile health intervention tailoring, outcome expectations, and PA goals. Thirty interviews from 33 participants were recorded and transcribed verbatim, and deductive and inductive thematic analysis were used using Dedoose. RESULTS: Physical activity was defined as maintaining daily living activities and addressing health goals. Previous experiences with PA varied among participants and were influenced by chronic illnesses, including human immunodeficiency virus; motivation; work commitments; interest; and social support. Reported barriers to PA included antiretroviral adverse effects, comorbidities, aging, and the COVID-19 pandemic. Changes in health status, body changes, and relationships were identified as benefits of PA. Conversations with healthcare providers supporting exercise goals were perceived to be important but rarely received by the participants. CONCLUSION: Understanding how older people with human immunodeficiency virus perceive PA is crucial to developing tailored strategies and structuring service delivery within the healthcare setting to promote a physically active life.

Brief Report: Relationship Between Adiposity and Biomarkers of Aging and Frailty Among Adults Aging With HIV.

BACKGROUND: This study examined the relationships among adiposity, handgrip, physical function, inflammation (ie, senescence-associated secretory phenotype chemokines as biomarkers of aging and frailty), and sex hormones in aging people with HIV. METHODS: This cross-sectional exploratory study included 150 people with HIV aged ≥40 years (67.3% of participants were male). Our measures included (1) body mass index and waist circumference as measures of adiposity; (2) handgrip as a measure of muscle strength; (3) short physical performance battery as a measure of physical function; (4) interleukin-6, tumor necrosis factor alpha receptor II, high sensitivity C-reactive protein, C-X-C motif chemokine 10, and C-X3-C motif chemokine ligand 1 also known as fractalkine as senescence-associated secretory phenotype chemokines; and (5) free testosterone, estradiol, sex hormone-binding globulin, and dehydroepiandrosterone as sex hormones. Quantile regression analyses were used to identify relationships among inflammatory markers and hormones with age, adiposity, handgrip, and physical function. RESULTS: Overall, 74% (n = 111) of participants were classified as overweight or obese and 53.3% (n = 80) presented with abdominal obesity. After controlling for age and sex, body mass index was positively associated with estradiol (ß = 0.043, P < 0.01), and waist circumference was positively associated with high sensitivity C-reactive protein (ß = 2.151, P < 0.01). After controlling for sex, age was positively associated with C-X-C motif chemokine 10 (ß = 0.024, P = 0.03) and tumor necrosis factor alpha receptor II (ß = 2.205, P = 0.01). After controlling for age and sex, short physical performance battery was negatively associated with dehydroepiandrosterone (ß = -0.004, P = 0.01); no statistically significant associations were observed for handgrip. CONCLUSION: Adiposity levels and aging were associated with inflammation (ie, C-X-C motif chemokine 10, tumor necrosis factor alpha receptor II, and high sensitivity C-reactive protein) among people with HIV aged 40 years and older.

The use of non-invasive imaging modalities for the assessment of skeletal muscle quantity and quality in people with HIV: A narrative review.

BACKGROUND: People with HIV (PWH) are prone to mobility impairments and physical dysfunction, with the loss of skeletal muscle quantity and quality being a major contributor to the dysfunction. Assessment of skeletal muscle is an important component of care for this patient population for early intervention and treatment. The use of non-invasive imaging techniques to evaluate skeletal muscle, such as dual X-ray absorptiometry, computer tomography and magnetic resonance imaging, has increased in popularity in recent years. PURPOSE: This narrative review synthesizes the use of these techniques and summarizes the associations between outcomes from these imaging modalities and physical function in PWH.

Statin protects men but not women with HIV against loss of muscle mass, strength, and physical function: a pilot study.

Statins are cholesterol-lowering drugs commonly used among people with HIV, associated with an increased risk of myopathies. Considering that cardiovascular disease, statin therapy, and sarcopenia are independently prevalent in people with HIV, clarity on the potential benefits or harms of statin therapy on muscle health is useful to provide insight into ways to maximize skeletal muscle health and minimize CVD risk in this population. We aimed to study the effects of statin therapy on strength, muscle mass, and physical function parameters in people with HIV. This was a pilot cross-sectional study. People with HIV on continuous statin therapy (n = 52) were paired 1:1 according to age (people with HIV 53.9 ± 8.2 and people with HIV on statins 53.9 ± 8.4 years), sex, body mass index (Body mass index, people with HIV 28.6 ± 5.3 and people with HIV on statins 28.8 ± 6.3 kg/m2), and race with people with HIV not using statin (n = 52). Participants were evaluated for muscle strength (i.e. handgrip strength), lean and fat body mass (using bioelectric impedance analysis), and physical function (i.e. Short Physical Performance Battery-SPPB). Isokinetic strength and appendicular lean mass (using dual-energy X-ray absorptiometry), more accurate strength and body composition measures, were determined in 38% of the participants. Overall, statin usage does not exacerbated loss of muscle strength (32.2 ± 11.5 vs. 30.3 ± 9.6 kg, p > 0.05) muscle mass (7.6 ± 1.8 vs. 7.7 ± 1.1 kg/m2, p > 0.05), and impaired physical performance (10.1 ± 1.8 vs. 9.7 ± 2.1 points, p > 0.05) of PLWH. When analyzed by sex, men living with HIV on statins usage presented higher appendicular muscle mass (28.4 ± 3.1 vs. 26.2 ± 4.9 kg, p < 0.05) handgrip strength (42.1 ± 8.8 vs. 37.1 ± 8.3 kg, p < 0.05) and physical function through SPPB score (10.9 ± 1.3 vs. 9.5 ± 2.1, p < 0.05) than men living with HIV not on statins treatment. The same protection was not observed in women. This data was demonstrated when muscle mass and strength were determined clinically (i.e. handgrip strength and electrical impedance) and when more precise laboratory measurements of muscle mass and strength were conducted (i.e. isokinetic strength and DXA scans). Statin does not exacerbate muscle wasting, strength loss, or muscle dysfunction among people with HIV. Indeed, statins may protect men, but not woman with HIV against HIV and antiretroviral therapy-induced loss of muscle mass and strength.

Impact of Food Insecurity and Undernutrition on Frailty and Physical Functioning in Aging People With HIV in the United States.

ABSTRACT: We conducted an observational cross-sectional study to explore whether food insecurity or undernutrition was associated with frailty or low physical functioning in aging persons with HIV (PWH). Forty-eight PWH aged 50 years and older were enrolled. Independent samples t -tests and chi-square tests were used to examine the relationship of food insecurity or undernutrition to frailty or physical function. Participants were 58.6 (±6.3) years old, 83% male, 77% White, 21% Hispanic. In total, 44% experienced food insecurity and 71% experienced undernutrition, whereas 23% were frail and 69% were prefrail. Food insecurity was associated with impaired total short physical performance battery score ( p = .02), impaired balance ( p = .02), slower chair rise time ( p = .03), and weight loss within 12 months ( p = .05). Undernutrition was related to female gender ( p = .01), worse frailty ( p = .04), and weaker grip strength ( p = .03). In this sample of undernourished and frail PWH, strong relationships between undernutrition and frailty were observed.

Health and sociodemographic factors associated with low muscle strength, muscle mass, and physical performance among people living with HIV.

ABSTRACTThis study examined the factors associated with low muscle strength, muscle mass, and physical performance in 331 people living with HIV. Participants completed handgrip as a strength measure, appendicular skeletal muscle mass using bioimpedance analysis, and chair rise was a physical performance measure. Multivariate logistic regression was used to analyze the association between low values on these measures with sociodemographic, HIV-related factors, and comorbidities. Higher body mass index (BMI) (OR = 0.91; CI = 0.86-0.97) and higher CD4/CD8 ratio (OR = 0.38; 95% CI = 0.18-0.82) were associated with decreased likelihood of low handgrip strength. Being non-employed (OR = 2.08; 95% CI = 1.07-4.06), having hypertension (OR = 2.27; 95% CI = 1.13-4.54) and rheumatism (OR = 5.46; 95% CI = 1.68-17.74) increased the chance of low handgrip strength. Higher BMI (OR = 0.43; 95% CI = 0.34-0.56), CD4/CD8 ratio (OR = 0.29; 95% CI = 0.09-0.93), and bioimpedance phase angle (OR = 0.22; 95% CI = 0.12-0.40) were associated with decreased likelihood of low muscle mass. Lastly, having less than eight years of education (OR = 1.87; 95% CI = 1.02-3.41) and being non-employed (OR = 8.18; 95% CI = 3.09-21.61) increased the chance of low chair stand performance. In addition, higher CD4 + lymphocytes count (OR = 0.99; 95% CI = 0.99-0.99) was associated with a decreased likelihood of low chair stand performance. In conclusion, specific and non-specific HIV-related factors are associated with low handgrip strength, low muscle mass, and/or low chair stand performance.

Sarcopenia Related to Human Immunodeficiency Virus: Protective Effects of Exercise.

We discuss recent evidence supporting the hypothesis that sarcopenia is an emerging health concern among people with human immunodeficiency virus (HIV) because of increasing life expectancy and HIV- and treatment-related comorbidities. We also hypothesize that combined exercise at higher intensity has a key role in managing sarcopenia in this population because it directly (increases muscle strength and stimulates hypertrophy) and indirectly (prevents mitochondrial dysfunction, oxidative stress, and persistent inflammation) counteracts sarcopenia hallmarks.

The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH): A Research Protocol.

ABSTRACT: The High-Intensity Exercise Study to Attenuate Limitations and Train Habits in Older Adults With HIV (HEALTH), which incorporates an exercise and biobehavioral coaching intervention, has the following overall goals: (a) to determine whether high-intensity interval training (HIIT) mitigates physical function impairments, fatigue, and impairments in mitochondrial bioenergetics of older people living with HIV (PLWH) to a greater extent than continuous moderate exercise (CME); and (b) to determine whether a biobehavioral coaching and mobile health text messaging intervention after HIIT or CME can promote long-term adherence to physical activity. The HEALTH study is a randomized trial of 100 older PLWH (≥50 years of age) who self-report fatigue and have a sedentary lifestyle. Enrolled participants will be randomized to 16 weeks of supervised HIIT or CME training, followed by a 12-week maintenance phase, involving a mobile health coaching intervention. Outcomes of the HEALTH study will inform the development of scalable, effective exercise recommendations tailored to the unique needs of aging PLWH.

Low Agreement Between Initial and Revised European Consensus on Definition and Diagnosis of Sarcopenia Applied to People Living With HIV.

BACKGROUND: In 2019, the European Working Group on Sarcopenia in Older People (EWGSOP2) proposed low muscle strength as the primary outcome for sarcopenia diagnosis instead of low muscle mass, as proposed in 2010 (EWGSOP1). Therefore, the aim of this study was to compare the prevalence of sarcopenia using both EWGSOP1 and EWGSOP2 operational definitions in people living with HIV (PLHIV) and to determine the agreement and correlation between different tests proposed by EWGSOP2. SETTING: Cross-sectional study, where 302 PLHIV (151 men), 51.7 ± 9.0 years old were evaluated for the presence of sarcopenia using both EWGSOP1 and EWGSOP2 operational definitions. METHODS: Appendicular skeletal muscle was estimated using bioimpedance analysis. Handgrip strength, chair stand, gait speed, and static balance were used as muscle function measures. Agreement was determined using Cohen kappa and Pearson correlation coefficient was calculated. RESULTS: Sarcopenia prevalence was 4.3% using EWGSOP1 and 1.0% using EWGSOP2. Agreement for sarcopenia diagnosis between EWGSOP1 and EWGSOP2 was fair (k = 0.37, P < 0.01). From the 13 cases of sarcopenia diagnosed using EWGSOP1, only 3 cases (23.1%) were also diagnosed using EWGSOP2. A medium correlation (r = -0.32, P < 0.01) and poor agreement (k = 0.14, P < 0.01) between muscle strength tests (handgrip strength and chair stand) were observed. Concordance between handgrip and chair stand was observed in 11 participants only, whereas 65 participants were considered to have low muscle strength using chair stand but not using handgrip. CONCLUSIONS: Lower sarcopenia prevalence using EWGSOP2 and low agreement between EWGSOP1 and EWGSOP2 operational definitions in diagnosing sarcopenia were observed in PLHIV.

Sarcopenia in people living with the Human Immunodeficiency Virus: a systematic review and meta-analysis.

People living with HIV (PLHIV) experience greater loss of muscle mass and function than people without HIV. However, HIV is not routinely recognized as a sarcopenia risk factor outside of HIV literature. The purposes of this study were to establish the prevalence and predictors of sarcopenia among PLHIV, and to compare the prevalence of sarcopenia among PLHIV and people without HIV. A systematic literature search of the PubMed, Embase, Cinahl, and Scielo databases was performed following PRISMA and MOOSE guidelines. Identified articles were included if they evaluated sarcopenia among PLHIV using either the presence of low muscle mass only or low muscle mass in association with low muscle function. The pooled prevalence of sarcopenia among PLHIV and the odds ratio for sarcopenia in PLHIV compared with controls were calculated. From 13 studies and 2267 participants, the prevalence of sarcopenia among PLHIV was 24.1% (95% CI = 17.8-31.0%). PLHIV presented 6.1 greater odds (95% CI = 1.1-33.5) of sarcopenia compared with people without HIV, matched by age, sex, BMI, and ethnicity. Longer exposure to specific HIV drugs, tobacco and alcohol, lower education and employment rates, and greater HIV duration were associated with sarcopenia. In conclusion, PLHIV had a high prevalence of sarcopenia, related to both HIV and non-HIV risk factors. HIV should be considered a risk factor for sarcopenia in the general population. CRD42019131449.

The relationship of cardiorespiratory function, fatigue and depressive symptoms in PLHIV.

Fatigue and depressive symptoms are prevalent and associated with poor clinical outcomes, though the underlying physiological mechanisms of fatigue and depression are poorly understood. We examined the impact of cardiorespiratory fitness (CRF) on fatigue and depressive symptoms in one-hundred and nine PLHIV. CRF was examined by maximal cardiorespiratory stress test and determined by peak oxygen uptake. Patient-reported fatigue was examined utilizing the HIV-Related Fatigue Scale. Depressive symptoms were examined with the Beck Depression Inventory and PROMISE 29. Data was collected at baseline and six months. Generalized estimating equations were used to determine the effect of CRF on fatigue and depressive symptoms over time. Participants were approximately 53 years old, 86% African American (n = 93), and 65% male (n = 70). After controlling for age and sex, fatigue was inversely associated with CRF (ß = -0.163; p = .005). Depressive symptoms were not associated with CRF as measured by the BeckDepression Inventory (p = .587) nor PROMIS 29 (p = .290), but over time, depressive symptoms decreased (p = .051). Increased CRF was associated with decreased fatigue levels, but was not associated with depressive symptoms. These results should guide future research aimed at how CRF might inform interventions to improve fatigue in PLHIV.

Effects of a Combined Exercise Training Program on Health Indicators and Quality of Life of People Living with HIV: A Randomized Clinical Trial.

The aim of this study was to evaluate the effects of 16 weeks of combined exercise training (CET) on muscle strength, body composition, depression, anxiety and quality of life of people living with HIV (PLHIV). Twenty-three participants completed the study, 14 in trained group (TG) and 9 in control group (CG). TG consisted of resistance and aerobic training three times a week, while the CG was exposed to recreational activities twice a week. CET promoted increased muscle strength (25% in overall strength) and aerobic capacity (+ 20% in training speed and + 23% in VO2 during aerobic training; p < 0.05). In addition, TG had better quality of life and reduced depression rates (from 7 subjects with mild, moderate or severe depression to 1 post-training). In conclusion, this pilot data demonstrated that 16 weeks of CET increased muscle strength, and improved depression and quality of life indexes in a small sample of PLHIV.

Cardiorespiratory fitness is associated with inflammation and physical activity in HIV+ adults.

OBJECTIVE: Our objective was to examine the effect of a lifestyle diet and exercise intervention on cardiorespiratory fitness (CRF) and to examine predictors of change in CRF. DESIGN: People living with HIV (PLHIV) are at increased risk for cardiovascular disease. CRF is a better predictor of cardiovascular disease-related mortality than established risk factors yet very little is known about CRF in PLHIV. METHODS: One-hundred and seven virally suppressed PLHIV were randomized to a group-based intervention to improve lifestyle behaviors or a control condition. All PLHIV maximal cardiorespiratory stress test to determine VO2 peak, VO2 at anaerobic threshold, and ventilatory efficiency/VCO2, at baseline and 6 months later. Participants wore an accelerometer to measure physical activity, completed waist-hip circumference measures, and had a fasting lipid profile, IL-6, and high sensitivity C-reactive protein analyzed. Generalized estimating equations were used to examine the effect of the intervention on CRF and predictors of change in CRF. RESULTS: Participants were approximately 53 years old, 65% male (n = 70), and 86% African-American (n = 93). There was no effect of the intervention on markers of CRF over time (P > 0.05). After controlling for age, sex, waist-hip-ratio, the inflammatory biomarker IL-6 was inversely associated with a decline in both VO2 peak (P = 0.03) and VO2 at anaerobic threshold (P = 0.03). In addition, participants who walked an additional 10 000 steps per day had a 2.69 ml/kg per min higher VO2 peak (P = 0.02). CONCLUSION: Despite HIV viral suppression, PLHIV had remarkably poor CRF and inflammation was associated with a clinically adverse CRF profile. However, increased physical activity was associated with improved CRF.

Homocysteine-lowering exercise effect is greater in hyperhomocysteinemic people living with HIV: a randomized clinical trial.

Elevated concentration of homocysteine has been identified as an independent risk factor for the development of cardiovascular disease and is frequently associated with oxidative stress. Moreover, studies have shown that people living with human immunodeficiency virus (PLHIV) present elevated concentration of homocysteine and oxidative stress compared with people without HIV. Our purpose was to describe blood homocysteine and oxidative stress markers in PLHIV and those without HIV infection, and to examine the effects of a 16-week combined training exercise program (CTE) on oxidative stress and homocysteine concentrations of PLHIV. We included 49 PLHIV (21 men, 28 women) and 33 people without HIV infection (13 men, 20 women). After baseline evaluations, 30 PLHIV were randomized to either CTE (trained group, n = 18) or the control group (n = 12); CTE consisted of aerobic and strength exercise sessions during 16 weeks, 3 times a week. Plasma homocysteine, oxidative damage markers, folate, and vitamin B12 were assessed pre- and post-training and by hyperhomocysteinemia (homocysteine ≥ 15 µmol/L) status. At baseline, PLHIV had higher levels of homocysteine and malondialdehyde, as well as reduced circulating folate when compared with people without HIV infection. CTE resulted in a 32% reduction (p < 0.05) in homocysteine concentration and a reduction in lipid hydroperoxide in PLHIV with hyperhomocysteinemia, which was not observed in those without hyperhomocysteinemia. Hyperhomocysteinemic participants experienced a 5.6 ± 3.2 µmol/L reduction in homocysteine after CTE. In summary, 16 weeks of CTE was able to decrease elevated homocysteine concentration and enhance redox balance of PLHIV with hyperhomocysteinemia, which could improve their cardiovascular risk.

Knee extension and flexion strength asymmetry in Human Immunodeficiency Virus positive subjects: a cross-sectional study.

BACKGROUND: Human Immunodeficiency Virus positive subjects present impairment in muscle function, neural activation, balance, and gait. In other populations, all of these factors have been associated with muscle strength asymmetry. OBJECTIVE: To investigate the existence of muscle strength asymmetry between dominant and non-dominant lower limbs and to determine the hamstrings-to-quadriceps strength ratio in Human Immunodeficiency Virus positive subjects. METHODS: In this cross-sectional study, 48 subjects were included (22 men and 26 women; mean age 44.6 years), all of them under highly active antiretroviral therapy. They performed isokinetic strength efforts at speeds of 60°/s and 180°/s for knee extension and flexion in concentric-concentric mode. RESULTS: Peak torque was higher (p<0.01) at 60°/s for quadriceps (193, SD=57 vs. 173, SD=55% body mass) and hamstrings (97, SD=36 vs. 90, SD=37% body mass) in dominant compared to non-dominant. Similarly, peak torque was higher at 180°/s (quadriceps 128, SD=44 vs. 112, SD=42; hamstrings 64, SD=24 vs. 57, SD=26% body mass) in dominant. Average power was also higher for all muscle groups and speeds, comparing dominant with non-dominant. The hamstrings-to-quadriceps ratio at 60°/s was 0.50 for dominant and 0.52 for non-dominant, and at 180°/s, it was 0.51 for both limbs, with no significant difference between them. The percentage of subjects with strength asymmetry ranged from 46 to 58%, depending upon muscle group and speed analyzed. CONCLUSION: Human Immunodeficiency Virus positive subjects present muscle strength asymmetry between lower limbs, assessed through isokinetic dynamometry.