H/A: Physical Activity (2009)
To examine the safety and effectiveness of aerobic exercise interventions on immunological/virological, cardiopulmonary and psychological parameters in adults living with HIV/AIDS.
- Randomized controlled trials comparing aerobic exercise interventions with no aerobic exercise interventions or another exercise or treatment modality, performed at least three times per week for at least four weeks
- Adults (age 18 or older) living with HIV/AIDS
- Studies of men only, women only or both at all stages of infection.
Excluded if not included above.
- To identify the appropriate studies, the following databases were searched: MEDLINE, EMBASE, SCIENCE CITATION INDEX, AIDSLINE, CINAHL, HEALTHSTAR, PSYCHLIT, SOCIOFILE, SCI, SSCI, ERIC and DAI
- Published and unpublished abstracts were reviewed, as well as proceedings from major international and national HIV/AIDS conferences such as the Intersciences Conference on Antimicrobial Agents and Chemotherapy, the Conference on Retroviruses and Opportunistic Infections (CROI), the Infectious Diseases Society of America Conference and the International AIDS Conference
- Reference lists from pertinent articles and books were reviewed and personal contacts with authors were used, as well as Collaborative Review Group databases
- Targeted journals were hand-searched for relevant articles
- There were no language restrictions
- Searches for the original review covered the period from 1980 to July 1999
- The first update of this review included an additional search of the literature, followed by identification of included studies that met the inclusion criteria from August 1999 to January 2001
- For the second update, a search was conducted to identify additional studies published from February 2001 to August 2003.
- Data on study design, participants, interventions, outcomes and methodological quality were abstracted from studies that met the inclusion criteria onto specifically designed data-collection forms by at least two reviewers
- Meta-analysis was done using RevMan 4.2 computer software on outcomes whenever possible
- For continuous outcomes, the weighted mean difference and 95% confidence intervals for the means were calculated
- For dichotomous/binary outcomes, the odds ratio, absolute difference in odds, relative risk, risk difference, and the number needed to treat and 95% confidence intervals were calculated
- Subgroup analyses were done whenever possible using identified outcome measures to estimate whether aerobic exercise interventions were associated with differences among groups
- Sensitivity analyses were done to determine whether particular studies skewed results.
Timing of Measurements
Studies lasted at least four weeks.
- Immunological/virological indicators: CD4 count and viral load
- Cardiopulmonary measures: Maximal oxygen consumption, oxygen pulse, maximum heart rate, maximum tidal volume, forced expiratory volume, minute ventilation, lactic acid threshold, maximum work rate, fatigue and dyspnea
- Psychological measures: General measures of psychological status and health-related quality of life
- Safety measures: Injuries, immune suppression and mortality.
- Aerobic exercise interventions compared with no aerobic exercise interventions or another exercise or treatment modality, done at least three times per week for at least four weeks
- Aerobic interventions included, but were not limited to, walking, jogging, cycling, rowing, stair-stepping and swimming.
Initial N: Searches identified 487 citations
Attrition (final N): A total of 10 studies (six from the original search, two from the first updated search and two from this second updated search) met inclusion criteria for this review
Age: Range, 18 years to 58 years
Ethnicity: Not mentioned
Anthropometrics: CD4 counts ranged from less than 100 cells per mm3 to more than 1,000 cells per mm3
Location: Worldwide studies.
Main results indicated that performing constant or interval aerobic exercise, or a combination of constant aerobic exercise and progressive resistive exercise for at least 20 minutes at least three times per week for four weeks seems to be safe and may lead to significant reductions in depressive symptoms and potentially clinically important improvements in cardiopulmonary fitness.
These findings are limited to those participants who continued to exercise and for whom there was adequate follow-up data.
Aerobic exercise seems to be safe and may be beneficial for adults living with HIV/AIDS. These findings are limited by the small sample sizes and large withdrawal rates of the included studies. Future research would benefit from increased attention to participant follow-up and intention-to-treat analysis. Further research is required to determine the optimal parameters of aerobic exercise and stage of disease in which aerobic exercise may be most beneficial for adults living with HIV.
|University/Hospital:||St. Michael's Hospital, Inner City Health Research Unit, Toronto, Canada|
Authors note that the review should be interpreted cautiously for a variety of reasons:
- Review is based on a small number of trials
- Studies included involved relatively small numbers of participants, a variety of exercise interventions and generally poor participant compliance with interventions
- The ability to perform meta-analyses was limited due to the breadth of outcome measures used in the trials
- Exercise groups had high withdrawal rates of 4% to 76%
- Vast majority of study participants were male.
Quality Criteria Checklist: Review Articles
|1.||Will the answer if true, have a direct bearing on the health of patients?||Yes|
|2.||Is the outcome or topic something that patients/clients/population groups would care about?||Yes|
|3.||Is the problem addressed in the review one that is relevant to dietetics practice?||Yes|
|4.||Will the information, if true, require a change in practice?||Yes|
|1.||Was the question for the review clearly focused and appropriate?||Yes|
|2.||Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described?||Yes|
|3.||Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased?||Yes|
|4.||Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible?||Yes|
|5.||Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined?||Yes|
|6.||Was the outcome of interest clearly indicated? Were other potential harms and benefits considered?||Yes|
|7.||Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described?||Yes|
|8.||Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included?||Yes|
|9.||Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed?||Yes|
|10.||Was bias due to the review's funding or sponsorship unlikely?||Yes|