FNCE 2023
Session 357. Providing MNT for the Pediatric Type 1 Diabetes Population: What Does the Evidence Show?
Monday, October 9, 8:30 AM - 9:30 AM

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H/A: Physical Activity (2009)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To examine the safety and effectiveness of progressive resistive exercise interventions on weight, body composition, strength, immunological/virological, cardiopulmonary and psychological parameters in adults living with HIV infection.

Inclusion Criteria:
  • Randomized controlled trials comparing progressive resistive exercise interventions with no progressive resistive exercise or another exercise or treatment modality, done at least three times per week for at least four weeks
  • Studies of adults (18 years or older) living with HIV/AIDS
  • Studies of men only, women only or both at all stages of infection were included.
Exclusion Criteria:

Excluded if not meeting inclusion criteria.

Description of Study Protocol:


  • To identify studies to be included, the following databases were searched: MEDLINE, EMBASE, CINAHL, COCHRANE, SCIENCE CITATION INDEX, PSYCHINFO, SOCIOLOGICAL ABSTRACTS, SSCI, ERIC, DAI and HEALTHSTAR
  • Published and unpublished abstracts were also reviewed, as well as proceedings from major international and national HIV/AIDS conferences such as the Interscience Conference on Antimicrobial Agents and Chemotherapy, the Conference on Retroviruses and Opportunistic Infections, the Infectious Diseases Society of America Conference, and the International AIDS Conference
  • Reference lists from pertinent articles and books were reviewed, as well as Collaborative Review Group databases
  • Targeted journals were also hand-searched for relevant articles
  • No language restriction was applied
  • The search strategy covered literature from 1980 to August 2003.


Systematic review.

Statistical Analysis

  • Data collection forms were used by reviewers to abstract data pertaining to study design, participants, interventions, outcomes and methodological quality from the studies that met inclusion criteria
  • Meta-analyses were conducted on outcomes using RevMan 4.2.2 software
  • 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 number needed to treat including 95% confidence intervals were calculated
  • Subgroup analyses were done whenever possible to estimate whether progressive resistive exercise interventions are associated with differences among groups using identified outcome measures
  • Sensitivity analyses were done to determine whether particular studies may skew results.
Data Collection Summary:

Timing of Measurements

Studies lasting at least four weeks.

Dependent Variables

  • Weight measures: Change in weight status
  • Body composition measures: Body mass index, lean body mass, girth, skinfolds and cross-sectional muscle area
  • Strength measures: Amount of weight able to resist
  • Immunological and virological indicators: CD4 count and viral load
  • Cardiopulmonary measures: Maximal oxygen consumption, maximum heart rate, dyspnea, fatigue and stamina
  • Psychological measures: Health-related quality of life, anxiety and depression 
  • Safety measures: Adverse events related to joints, muscles, tendons, ligaments, nerves, vascular or bone injuries, deterioration in immune status, progression to AIDS, hospitalization and mortality.

Independent Variables

  • Progressive resistive exercise interventions compared with no progressive resistive exercise or another exercise or treatment modality, performed at least three times per week for at least four weeks 
  • Progressive resistive exercise interventions may have included, but were not limited to, weight-training, isotonic and isometric strengthening exercises.
Description of Actual Data Sample:

Initial N

Search strategy resulted in 1,414 citations; 58 full citations were reviewed further, and 13 met inclusion criteria. Of these 13, some were identified as duplicate studies.

Attrition (final N)

Seven studies met inclusion criteria. Six included all males and one included all females.


Range: 18 to 66 years.


Not mentioned.

Other relevant data

  • CD4 counts ranged from less than 100 cells/mm3 to more than 1,000 cells/mm3
  • Two studies reported that the majority of participants were on highly active antiretroviral therapy (HAART)
  • Two studies reported that most if not all participants were taking some form of antiretroviral therapy
  • One study included participants who were taking AZT monotherapy. 


Worldwide studies.

Summary of Results:

Other Findings

Meta-analysis was limited due to the following differences among the studies: types of exercise interventions, inclusion of co-intervention groups, level of exercise supervision, baseline body composition and testosterone levels of participants, types of outcomes assessed and methodological quality of the individual studies.

Main results indicated that performing progressive resistive exercise or a combination of progressive resistive exercise and aerobic exercise at least three times per week for at least four weeks seems to be safe and may lead to statistically and possibly clinically important increases in body weight and composition.

Results also indicate that exercise interventions may lead to clinically important improvements in cardiopulmonary fitness.

Individual studies included in this review suggest that progressive resistive exercise interventions with or without aerobic exercise also contribute to improvements in strength and psychological status for adults living with HIV/AIDS.

Individual studies indicate that progressive resistive exercise or a combination of progressive resistive and aerobic exercise seems to be safe for adults living with HIV/AIDS who are medically stable, as evidenced by no change in immunological/virological status.

These results are limited to those who continued to exercise and for whom there were adequate follow-up data. 

Author Conclusion:

Progressive resistive exercise or a combination of progressive resistive exercise and aerobic exercise seem to be safe and may be beneficial for adults living with HIV/AIDS. These findings are limited by the small number of studies that could be included in meta-analyses, small sample sizes and variable participant withdrawal rates among included studies. To increase the generalizability of results, future research would benefit from including participants at various stages of HIV infection, a greater proportion of female participants and a variety of age groups. Furthermore, to better understand outcomes of participants who withdraw from exercise interventions, future research would benefit from studies with larger sample sizes that conduct an "intention-to-treat" analysis.

Funding Source:
University/Hospital: Inner City Health Research Unit, St. Michael's Hospital, Toronto, Canada
Foundation associated with industry:
Reviewer Comments:

Authors note the following limitations:

  • Review is based on a small number of studies, reducing generalizability of results
  • Ability to perform meta-analyses was limited due to the variability of characteristics of the studies pertaining to the exercise intervention
  • Methodological quality of the studies varied
  • Although the majority of studies reported on strength, weight and body composition, only two of the studies assessed health-related quality of life
  • The majority of study participants were male, thus results should be interpreted cautiously in regards to females.
Quality Criteria Checklist: Review Articles
Relevance Questions
  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
Validity Questions
  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