HIV and Aging: Low Leisure-Time Physical Activity Correlates with Diminished Physical Function in Older Persons Living with HIV Open Access

Safeek, Rachel (2017)

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Background: Current WHO guidelines promoting early initiation of antiretroviral therapy (ART) has prolonged the lives of persons living with HIV/AIDS (PLWHA). Consequently, HIV and aging is a novel and growing field. As part of the continuum of care for PLWHA, there is a need to evaluate leisure-time physical activity(PA) to reduce risk of CVD and other secondary health outcomes.

Methods: Older PLWHA on ART with undetectable HIV-1 viral loads were recruited from a larger HIV and aging study, in which the 6-minute walk test (6MWT), 30 second chair stand test (30sec-CST), and grip strength measurements were performed. Participants wore waist-mounted activity monitors (Actigraph GT3X, Pensacola, FL) for one week, determining daily steps walked and kCals expended. Pearson correlation analyses were conducted between mean number of daily steps and kCals expended versus 6MWT, age, pulse, body mass index (BMI), current/nadir CD4 count, waist circumference (WC), and diastolic blood pressure (DBP). Linear regression models, adjusted for socio-demographic and clinical status variables, were performed to determine correlates of PA and physical function as outcomes.

Results: Twenty-one subjects (14 men; mean age 66 years, range 50-78 years; 11 white; 10 black; mean BMI 30 kg/m2; mean WC 39.5 inches) participated. The mean number of daily steps was 3,995 (SD: 2,478), with 296.9 kCals expended daily. With 72% of the day spent sedentary, participants engaged in light-intensity PA 27% of the time. On average, 9 minutes were spent in daily moderate-to-vigorous PA (MVPA). Among participants, 95% had low 6MWT performance and 33% had low 30sec-CST scores and low grip strength. Daily mean number of steps(R= 0.65; p-value=0.0009) and kCals (R=0.57; p=0.0200) had significant correlations with 6MWT. Linear regression models revealed DBP was a significant, independent correlate of grip strength, and 6MWT was a significant correlate of 30sec-CST and daily mean number of steps. Significant correlates of kCals were age, pulse, CD4 nadir, and 6MWT, while significant correlates of 6MWT included 30sec-CST and kCals.

Discussion: The findings suggest that older PLWHA are remarkably inactive with diminished physical function and fail to meet public health guidelines for mobility and PA, emphasizing a need for clinicians to promote ongoing PA in PLWHA.

Table of Contents

Table of Contents

Chapter I: Introduction. 1

Context of Project 1

Problem Statement 2

Purpose of Project 3

Chapter II: Literature Review.. 4

HIV and Aging. 4

Background on Physical Activity. 5

Knowledge of PA Levels among PLWHA.. 5

Gaps in Research for Older PLWHA.. 6

Accelerometry. 6

PA Measurements from Self-Report Questionnaires. 7

Physical Function and HIV.. 8

Six Minute Walk Test (6MWT) 8

30 Second Chair Stand (30sec-CST) 9

Grip Strength. 9

Bio-Clinical Markers Associated with PA.. 9

Significance. 10

Chapter III: Manuscript 11

Introduction. 15

Methods. 17

Study Population. 17

Anthropometric and clinical data. 17

Physical Function Data. 17

Study Procedures. 18

Cutoff for At-Risk Socio-Clinical Variables. 19

Cutoff for Low Performance on Physical Function Assessments. 19

Cutoff Points for Physical Activity Levels. 20

Statistical Analysis. 20

Results. 21

Discussion. 23

References. 26

Tables and Figures. 29

Table 1. Sociodemographic and Clinical Data. 29

Table 2. Physical Function Data. 30

Table 3. Accelerometry Data. 31

Table 4. Linear Regression Models. 32

Figure 1. Correlation of Mean Number of Daily Steps with Distance Walked in Meters During the 6 Minute Walk Test 33

Figure 2. Correlations of Daily Mean kCals Expended with Distance Walked in Meters During the 6 Minute Walk Test 34

Chapter IV: Public Health Implications. 35

References. 38

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