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  10th International Workshop
October 10-11, 2019
New York

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HIV+ People Who Need Exercise More Are
Less Likely to Adhere to Program

  10th International Workshop on HIV and Aging, October 10-11, 2019, New York
Mark Mascolini
Middle-aged people with HIV and those who weighed more--two groups that might benefit most from exercise--adhered worse to a 24-week moderate- or high-intensity supervised exercise program [1]. Having HIV did not affect chances of adherence in this study of 50- to 75-year-olds with or without HIV infection.
Previous work by a University of Colorado team found that supervised endurance and resistance exercise--particularly high-intensity exercise--reversed impairments in physical function in older people with or without HIV infection [2]. A new analysis presented at the Aging Workshop analyzed factors that favored good adherence to the exercise program [1].
The study enrolled 69 sedentary HIV-positive or negative people 50 to 75 years old. Everyone with HIV had an undetectable viral load for at least 2 years. All participants followed a moderate-intensity exercise program for 12 weeks then got randomized to continue moderate-intensity exercise or switch to a high-intensity program. The researchers calculated adherence as the number of attended exercise sessions divided by the number of expected sessions. They used linear regression models to determine the impact of baseline variables on exercise adherence.
Study participants averaged 57.8 years in age and 28.7 kg/m2 in body mass index (in the overweight range). Most people (91%) were men, and three quarters were white. Twenty-seven of 32 people with HIV (84%) and 29 of 37 people without HIV (78%) completed the exercise program.
Statistical analysis linked every additional 5 years of age to 6.0% better adherence (95% confidence interval [CI] 1.8% to 10.3%, P = 0.006). That association remained significant after adjustment for HIV status (6.4%, 95% CI 2.1% to 10.6%, P = 0.004) or body mass index (5.4%, 95% CI 1.5% to 9.3%, P = 0.008).
Each 1-unit higher body mass index meant 1.9% lower exercise adherence (95% CI -3.0% to -0.8%, P < 0.001), and that association remained significant after adjustment for age and HIV status (-1.7%, 95% CI -2.8% to -0.6%, P = 0.003). After adjustment for HIV and body mass index, every 10 pounds of weight gained since high school led to 2.57% worse adherence (95% CI -4.34% to -0.79%, P = 0.004).
People who took antipsychotic drugs had 20% lower exercise adherence than those who did not (95% CI -38.6% to -2.3%, P = 0.028). That difference grew after adjustment for HIV status (-25.8%, 95% CI -45.1% to -6.6%, P = 0.009), but the difference waned after adjustment for age (-15.6%, 95% CI -33.5% to 2.3%, P = 0.09).
HIV status did not affect exercise adherence (beta 3.4%, 95% CI -8.0% to 14.7%, P = 0.55). Nor did female versus male sex (beta 17.2%, 95% CI -36.8% to 2.5, P = 0.09) or exercise intensity (beta 3.1%, 95% CI -3.1% to 9.3%, P = 0.32). Other factors that did not affect exercise adherence were race/ethnicity, baseline physical function, quality of life determined by the SF-36 survey, depressive symptoms determined by the CES-D survey, use of antidepressants or antihypertensives, HIV characteristics, and comorbidity burden.
The researchers called for better strategies to promote exercise adherence in HIV-positive people "at high risk of nonadherence but likely to benefit from regular exercise," such as heavier people and those at the younger end of the study's 50-to-75 age range.
1. Abdo M, MaWhinney S, Wilson M, Jankowski C, Erlandson K. Characteristics associated with exercise adherence in the setting of a supervised intervention. 10th International Workshop on HIV and Aging, October 10-11, 2019, New York. Abstract 42.
2. Erlandson KM, MaWhinney S, Wilson M, et al. Physical function improvements with moderate or high-intensity exercise among older adults with or without HIV infection. AIDS. 2018;32:2317-2326. https://www.ncbi.nlm.nih.gov/pubmed/30134299