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Meta-Analysis Confirms Aerobic Exercise
Benefit on Depression With HIV
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10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City
Mark Mascolini
Meta-analysis confirmed a beneficial effect of aerobic exercise on depressive symptoms in people with HIV infection [1]. But the analysis found no link between aerobic exercise and inflammation reckoned by high-sensitivity C-reactive protein (hsCRP).
Even people with well-treated HIV infection have ongoing systemic inflammation and suffer from affective disorders such as depression. Because of the many benefits of regular exercise, interest has turned to aerobic exercise as adjunctive therapy for inflammatory outcomes and depression in antiretroviral-treated people with HIV. To provide critical analysis of data collected so far on exercise, inflammation, and depression, researchers from Obafemi Awolowo University Teaching Hospital, the University of Nigeria, and McMaster University conducted this systematic review and meta-analysis.
The researchers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. They conducted a systematic search of relevant studies in seven databases through February 2018 and reviewed reference lists of the selected articles. Studies included had to be clinical trials assessing the impact of aerobic exercise on depressive symptoms or serum levels of hsCRP. Two reviewers independently evaluated all relevant articles for eligibility and evaluated bias risk with the Cochrane Collaboration risk of bias assessment tool.
Of the 429 identified articles, 12 remained after removal of duplicate studies and after title or abstract screening. Of the 12 full-text articles screened, reviewers excluded 6 because they evaluated resistance exercise, involved people with advanced HIV/AIDS, included people who had not begun antiretroviral therapy, or were not a clinical trial. The researchers included the 6 remaining articles in a narrative synthesis and included 4 (all involving depression) in meta-analysis.
The 6 considered studies included 261 participants at least 18 years old, 41% of them women. The researchers considered only 2 of the 6 articles of high quality. The 2 studies focused on hsCRP identified no association between aerobic exercise and this inflammation marker.
Meta-analysis of the 4 depression studies linked aerobic exercise to a significant drop in depression scores (standardized mean difference -0.71, confidence interval -1.07 to -0.34, P < 0.0002). Exercise interventions involved 3 to 5 sessions per week at 55% to 75% of age-predicted maximal heart rate, 60% to 80% of VO2 max, or 50% to 80% of heart rate reserve. Exercise sessions lasted 24 to 60 minutes and involved continuous or interval exercise.
The researchers suggested this type of aerobic exercise may reduce depressive symptoms in people with HIV. They noted that "a conclusive estimate of effects" of aerobic exercise on inflammation will depend on results of further homogeneous high-quality trials. Notably, a 30-person 12-week randomized trial of resistance training did find a CRP benefit [2]. And CRP is certainly not the only inflammation marker to study.
References
1. Anieto EM, Abaraogu UO, Kalu ME. The effects of aerobic exercises on inflammatory markers and depression in people living with HIV undergoing the highly active antiretroviral therapy: A systematic review with meta-analysis. 10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City. Abstract MOPEB278.
2. Zanetti HR1, da Cruz LG, Lourenço CL, et al. Nonlinear resistance training enhances the lipid profile and reduces inflammation marker in people living with HIV: a randomized clinical trial. J Phys Act Health. 2016;13:765-770.
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