Measuring the effect of physical activity on people living with HIV
Research type
Research Study
Full title
Cross-sectional study investigating physical activity levels in individuals with HIV in comparison to HIV negative controls and the effect on quality of life, mental wellbeing and indicators of infection
IRAS ID
230193
Contact name
Jaime Vera
Contact email
Sponsor organisation
Brighton and Sussex University Hospital NHS Trust
Duration of Study in the UK
0 years, 3 months, 29 days
Research summary
Research Summary
An estimated 36.7 million people were living with HIV worldwide at the end of 2015. As treatment for HIV has improved and become more widely accessible, HIV is now managed as a long-term condition. Many of the illnesses observed in HIV positive individuals receiving antiretroviral therapy have been shown to be reduced by regular physical exercise. This includes conditions such as heart disease, diabetes, obesity, osteoporosis, depression and anxiety. Previous studies have shown that individuals with HIV are less likely to be physically active than their HIV negative counterparts, with a subsequent impact on both physical and mental health. However, this has not yet been assessed in the HIV positive population attending clinics at Brighton and Sussex University Hospital NHS Trust.
We would like to assess physical activity levels amongst the HIV positive population in Brighton in comparison to a HIV negative population recruited from general sexual health clinics within Brighton and Sussex University Hospitals NHS Trust, and determine if any factors are associated with higher levels of activity. Additionally, we would like to investigate if levels of physical activity have any effect on general quality of life, mental wellbeing or indicators of HIV infection, such as viral load and CD4 count.
We hope to perform a cross-sectional single centre study with patient recruitment and data collection occuring in HIV and sexual health clinics between December 2017 and March 2018. The majority of data will be gathered through the use of questionnaires. This will include a basic assessment of physical activity, sociodemographic characteristics, general quality of life and mental wellbeing. Other data including CD4 counts and HIV viral loads for HIV positive patients will be gathered from existing clinical records.
Summary of Results
Study details
Study title: Cross-sectional study investigating physical activity levels in individuals with HIV in comparison to HIV negative controls and the effect on quality of life, mental wellbeing and indicators of infection
REC reference: 17/SC/0540
IRAS project ID: 230193
Sponsor: Brighton and Sussex University Hospitals NHS Trust (now University Hospitals Sussex NHS Foundation Trust)
Funder: No external funding
Researchers: Professor Jaime Vera (Consultant in HIV medicine), Dr Kevin Martin (academic foundation programme doctor at time of project)
Competing interests: Professor Jaime Vera has received honoraria and research grants, been a consultant or investigator in trials sponsored by Merck, Janssen Cilag, Piramal and Gilead sciences. He has received sponsorship to attend scientific conferences from Janssen Cilag, Gilead Sciences and AbbVie.
Public involvement: None
Lay summary
Human immunodeficiency virus (HIV) is an infection that can be effectively treated with medication called antiretroviral therapy (ART). Average life expectancy of people living with HIV (PLWH) is now similar to that of the general population. As PLWH are now living longer, we are seeing greater numbers of PLWH with diseases of ageing, such as heart disease, strokes, and cancers.
Physical activity has been shown to be effective at treating and preventing physical conditions such as obesity, diabetes, high blood pressure, as well as mental health. The World Health Organization (WHO) recommends at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity.
The main aim of this study was to assess levels of physical activity in PLWH, in comparison to individuals without HIV. In addition, we looked at factors that might be linked to higher levels of activity and if the amount of physical activity had any effect on general quality of life, mental wellbeing or indicators of HIV infection, such as viral load.
In this study, we recruited 110 people living with HIV from individuals attending the HIV department (Lawson Unit) at the Royal Sussex County Hospital in Brighton, for routine clinic appointments. We recruited 110 individuals without HIV attending sexual health clinics (Claude Nicol Centre) at the same hospital. Study recruitment took place between December 2017 and March 2018.
All participants provided information about themselves and completed three standardised questionnaires, assessing physical activity levels (rapid assessment of physical activity; RAPA), health-related quality of life (EuroQol five-level five-dimension questionnaire; EQ-5D-5L), and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Score; WEMWBS).
People living with HIV had higher numbers of other medical conditions, such as high blood pressure, high cholesterol, and lung disease. Importantly, those in the PLWH group were significantly older than those in the group without HIV and were more likely to have ever smoked.
Physical activity levels were noted to be lower in the PLWH group, with only half of PLWH meeting WHO recommended physical activity levels, in comparison to almost two-thirds of individuals without HIV. After controlling for differences between the groups with and without HIV, including age and smoking history, people living with HIV were still half as likely to meet recommended levels of physical activity. People living with HIV also reported worse health-related quality of life, and worse mental wellbeing scores. For PLWH, higher reported levels of physical activity were associated with improved self-rated quality of life scores.
There are some limitations to this study. The use of questionnaires to record physical activity levels may have introduced bias, and our sample size was relatively small. Additionally, the age difference between the two groups living with and without HIV was significant. Despite controlling for differences including age, there is likely to be significant unmeasurable differences between the groups, that we cannot control for. Furthermore, the cohort of PLWH was 95.5% male, which is reflective of the population of PLWH in Brighton. However, our findings may not apply to other areas with a higher proportion of female PLWH.
Crucially, despite the above limitations, we have shown that only half of PLWH in this cohort are meeting recommended physical activity levels. The positive effects of exercise on health and wellbeing are well documented. Overall, our study suggests that more work could be done to increase physical activity levels amongst PLWH in Brighton, such as the use of targeted exercise programmes. Further research to develop and tailor a programme to meet the needs of the local community of PLWH could be beneficial.
The full published paper can be found here:
https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbVAOorTJ2x4j9CiYByyaeqQlZ97zqpFoe5u-2Feiz0YCvJBtQ8FgSrC8h45MiKYIk0-2BCdc9pDjVhr1cdfxXBcpObfcdeDd0MgBH8X9bYzhK2PNOKQV_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YJGQ6NHAyVc6ztYWoKbFkXagOYTAmSEEVmj2r9XzbwOUjzczLhbdoQzatvBAzIvL-2Bd-2B95DcXxmcRZhM6SyAzDGOTyPYROEEbcgsa4Cogt4713BA88cTT4aO-2BaHyFbqDWJ1cWJIhTt1u3DpXmzSwyM9NnrR40EujqZPd4abJ1-2F0eWw-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7C46e7acbc919940d7633608da4ae57078%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C637904646533159011%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=tJHo7Rh1aBZuBYZACpGy6AEAtmNx1iSEt2rKmIG%2BuTI%3D&reserved=0
This lay results summary has been reviewed by the UHSussex Research Champions, including members of the public, patients and patient representatives.
REC name
South Central - Berkshire B Research Ethics Committee
REC reference
17/SC/0540
Date of REC Opinion
12 Oct 2017
REC opinion
Favourable Opinion