# Exercise as it relates to Disease/Benefits of exercise therapy in the HIV-AIDS positive population

The following fact sheet is an analysis of journal article: “A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: A randomized controlled trial” by Fillipas et al (2006).

## Background

Human immunodeficiency virus (HIV) or acquired immune-deficiency virus (AIDS) is a chronic disease that in the past has been viewed as a death sentence. Since the development of highly active antiretroviral therapy (HAART), there has been a significant decrease in mortality rates of HIV infected individuals. HAART therapy brings with it many side effects including nausea, fatigue, pain, anxiety and depression$^,$ which may alter an individual’s motivation to continue taking it. Exercise has commonly been used as a therapy in conjunction with HAART to combat these side effects and improve patient quality of life. Exercise has shown to be both safe and beneficial for the HIV infected population and exercise program participation was found to improve health related quality of life – though this was prior to HAART therapy being ready and available.
Previous research has shown that adherence to taking medication is improved with increased self-efficacy, defined as ‘a global confidence in one’s ability across a wide range of demanding or novel situations’ – or a belief in oneself to achieve a task. Thus, in the focus study of this factsheet, the researchers wanted to determine if supervised exercise in an adult HIV-AIDS infected population would have an effect on improving self-efficacy.

## Where was the research conducted?

This research was conducted in Melbourne, Australia. It used participants from the Alfred Hospital, and researchers from Monash University and the Burnet Institute. The Alfred Hospital Ethics Committee approved the research and all participants provided signed informed consent to participate.

## Type of research

The type of research conducted was a single blind randomized controlled trial. The randomized controlled trial is used to study a number of interventions and analyse them against each other in relation to the population being tested. It is considered the gold standard of clinical trial.
The research concealed its randomization process, used a blinded assessor to collect data upon conclusion and included exclusion criteria. This study received an 8/10 score on the PEDro (Physiotherapy Evidence Database) Scale – a scale that critically appraises research and gives a number based on the dimensions present that increase research validity. A score of 8/10 indicates a high quality of reliability and validity, but does not account for the generalisability of the research.

## Aim and method of research

The aim of this research was to examine the effect of two different 6 month exercise programs for HIV infected individuals on the parameters of self-efficacy, cardiovascular fitness, health related quality of life and health status. All 40 participants were male, 18 years or older and HIV positive. Participants were randomly allocated to either a 6 month supervised aerobic and resistance based exercise program or a 6 month unsupervised walking program. Both programs were to be completed twice per week and it was predicted that those participating in the supervised exercise classes would improve in all parameters compared with the unsupervised group.

## Results

Table 1. Results of experimental intervention
| Outcome | Measured using… | Experimental (exercise program) | Control (walking group) | Between group difference |
| Adherance rate | Attendance and self-report | 81% of sessions | 85% of walking sessions 60% of forum attendance | - |
| Self efficacy | General Self Efficacy Scale | ↑ | nil change | 6.8 points |
| Cardiovascular fitness | Kasch Pulse Recovery Test | ↑ | nil change | - 20.2bpm |
| Health related quality of life | Medical Outcomes Study HIV Health Survey | ↑ | ↓ | 20.8 points (from only 2/11 dimensions) |
| Health status | CD4 T cell count | nil change | nil change | - |
| Health status | HIV RNA | nil change | nil change | - |
| Health status | Body weight | ↑ | nil change | 2.1kg |
As shown in the above table, over 6 months the experimental group improved in the general areas of self-efficacy, cardiovascular fitness, quality of life outcomes and body weight when compared with the control group counterparts. The control group did not decline in any measures except for slightly within the quality of life outcomes, and otherwise stayed ‘much the same’ as prior to the intervention.

## Conclusions

A supervised 6-month aerobic and resistance based exercise program can significantly improve self-efficacy in the male adult HIV infected population, also improving cardiovascular fitness; enhanced health related quality of life and increasing participant body weight. The control group had increased compliance to their walking program; though it was insufficient to improve self-efficacy or cardiovascular fitness.
The researchers emphasize that the relevance of the research lies in the improved self-efficacy. Prior investigations have shown a significant correlation between high self-efficacy and medication adherence, while low self-efficacy is associated with non-adherance to medications and therapy. Therefore, it is supposed that improving self-efficacy will aid in improvements in therapy adherence and outcomes. However, it is difficult to comprehend that improved self-efficacy in the experimental group will be evident in improved medication adherence as this was not the group with a higher compliance rate. The researchers are perhaps exaggerating the implications these results will have on medication compliance.

## Practical advice

The benefits of organized exercise programs for those in the HIV/AIDS population include improved self-efficacy, cardiovascular fitness, health related quality of life and weight gain. HIV/AIDS patients should have access to twice weekly structured exercise classes focusing on aerobic and resistance training with supervision by a physiotherapist or exercise physiologist to enable proper teaching of specific exercises, and allow increased education regarding exercise and HIV/AIDS. Provision of specific exercise programs may be beneficial when participants cannot attend classes.

## For further information

For any further reading regarding HIV/AIDS, medication for HIV/AIDS and the benefits of exercise on this population attached below are some useful links:
* HIV/AIDS:
** https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hiv-and-aids
* Exercise as part of HIV/AIDS therapy:
** http://www.aidsmap.com/Exercise/page/1188930/
** https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/exercise-and-physical-activity
* Pharmaceutical therapy for HIV/AIDS:
** https://www.hivtnt.org.au/treatments/#panel3

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Fillipas S, Oldmeadow LB, Bailey MJ, Cherry CL. A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: a randomised controlled trial. Australian Journal of Physiotherapy. 2006 Dec 31;52(3):185-90.
* ↑ Kress KD. HIV update: emerging clinical evidence and a review of recommendations for the use of highly active antiretroviral therapy. American journal of health-system pharmacy. 2004 Oct 2;61.
* 1 2 Ciccolo JT, Jowers EM, Bartholomew JB. The benefits of exercise training for quality of life in HIV/AIDS in the post-HAART era. Sports medicine. 2004 Jul 1;34(8):487-99.
* ↑ Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, Kebaabetswe P, Dickenson D, Mompati K, Essex M, Marlink R. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. JAIDS-HAGERSTOWN MD-. 2003 Nov 1;34(3):281-8.
* ↑ O Brien KE, Nixon S, Tynan AM, Glazier RH. Effectiveness of aerobic exercise in adults living with HIV/AIDS: systematic review. Medicine and science in sports and exercise. 2004 Oct 1;36:1659-66.
* ↑ Stringer WW, Berezovskaya M, O'Brien WA, Beck CK, Casaburi R. The effect of exercise training on aerobic fitness, immune indices, and quality of life in HIV+ patients. Medicine & Science in Sports & Exercise. 1998 Jan.
* 1 2 3 Schwarzer R. Measurement of perceived self-efficacy: psychometric scales for cross-cultural researach. Präsident d. Freien Univ.; 1993.
* ↑ Schwarzer R, Jerusalem M. The general self-efficacy scale (GSE). Anxiety, Stress, and Coping. 2010;12:329-45.
* ↑ Akobeng AK. Understanding randomised controlled trials. Archives of disease in childhood. 2005 Aug 1;90(8):840-4.
* ↑ PEDro - Search Results [Internet]. Search.pedro.org.au. 2017 [cited 24 September 2017]. Available from: https://search.pedro.org.au/search-results?calc_text=+A+six-month%2C+supervised%2C+aerobic+and+resistance+exercise+program+improves+self-efficacy+in+people+with+human+immunodeficiency+virus%3A+a+randomised+controlled+trial&-find=Search
* ↑ Frequently asked questions (FAQ, English) [Internet]. Pedro.org.au. 2017 [cited 24 September 2017]. Available from: https://www.pedro.org.au/english/faq/