Exercise as it relates to Disease/Effect of Physical Activity on Older Adults with HIV

This is a critique of the journal article: “Physical Activity is Associated with Better Neurocognitive and Everyday Functioning Among Older Adults with HIV Disease”

What is the background to this research?
Since 1996, a higher amount of HIV infected individuals are living longer due to the development of effective antiretroviral therapy or ART. It is thought that over 50% of adults living with HIV in the US are over the age of 50. This number is expected to rise to 70% by the year 2020. As the affected population ages they are continually faced with medical, psychosocial and neurocognitive problems which can affect quality of life. From self-reported data, it is prevalent that older adults have a higher number of days that are physically and mentally limiting compared to younger individuals. Adults living with HIV have been shown to have poorer cognitive functioning than older people of the same age without HIV infection. Exercise can have a positive effect on quality of life for older individuals. It has been shown that exercise is an effective therapy for older people living with symptoms of HIV.

Where is the research from?
This study was carried out at the University of California San Diego (UCSD), USA. It was supported by California HIV/AIDS Research Program and received a UCSD Stein Institute for Research on Aging Grant.

What kind of research was this?
It is a cross sectional, observational study. This type of research is used to assess a specific population at one point in time.

What did the research involve?
This research analysed the association between rates of physical activity and the health of older people living with HIV. It involved 100 HIV infected participants over the age of 50. The participants completed The International Physical Activity Questionnaire (IPAQ) which allowed them to self-report physical activity over the previous 7 day period. Subjects were categorised into 3 groups delineated by activity level; low, moderate and high physical activity. The subjects then underwent neurocognitive tests assessing cognitive areas commonly affected by HIV. The collected data was normalised across all participants. Tasks associated with everyday functioning were observed. The subjects performances of daily living dependence and cognitive impairment status were then examined with respect to their activity group.

Limitations
This study used self-reported data to identify physical activity patterns. Physical activity can be highly variable over time and self-reported data for exercise has been shown not to provide accurate PA estimate. Objective measurements in conjunction with longitudinal data should be used in the future for similar studies.

What were the basic results?
It was found that a higher amount of physical activity was associated with lower neurocognitive impairment and lower chances of dependence for activities of daily living. Furthermore, it was also found that that subjects that suffered with neither dependence for activities of daily living or neurocognitive impairment had the highest level of physical activity reported. The conclusions of this study are supported by similar research which has also found a positive correlation between HIV symptoms and physical exercise in adults.

What conclusions can we take from this research?
In conclusion, it can be said that physical activity can decrease susceptibility to neurocognitive impairment and decrease dependence for activities of daily living. There is a strong association between amount of physical activity and decrease in symptoms commonly suffered by older adults with HIV.

Practical advice
From the analysis conducted during this study it is clear that higher levels of PA can have a positive effect on symptoms of HIV. A study conducted by Yahiaoui et al. has developed evidence based exercise recommendations for HIV infected individuals. These recommendations could be used a as a guide for older adults wanting to increase PA as a form of symptom management and to circumvent cognitive decline.

Further information/resources

 * Exercise and HIV
 * National Association of People with HIV Australia