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Clinician encouragement, paired with greater awareness of available programs, shows potential for increasing exercise in older patients with HIV.

Clinician encouragement, paired with greater awareness of available programs, shows potential for increasing exercise in older adults with HIV.“People with HIV, especially older people with HIV, have so much to gain through exercise and attention to healthy behaviors due to their heightened risk for a greater comorbid burden,” Melissa P. Wilson, MS, notes. “While HIV-specific barriers, driven by physical symptoms and stigma-related experiences, may require more effort and support to overcome, people with HIV may ultimately realize even more benefits of exercise than the general population.”

In a secondary analysis of data from the Exercise for Healthy Aging study, Wilson and colleagues examined differences in exercise self-efficacy (ESE) between older people with HIV and seronegative controls. The findings were published in AIDS and Behavior.

The 32 virally suppressed people with HIV and 37 seronegative controls were aged 50-75, 91% were men, and 33% identified as ethnic or racial minorities.

All participants completed 12 weeks of supervised moderate-intensity cardiovascular and resistance exercise three times per week and were then randomized to 12 weeks of moderate- or high-intensity exercise.

At baseline and weeks 12 and 24, participants also completed the nine-item Self-Efficacy for Exercise Scale to rate their confidence in their ability to exercise for 20 minutes 3 times per week despite barriers such as weather, boredom, fatigue, or pain. They rated each item from 0 (not confident) to 10 (very confident) for a total possible ESE score from 0 to 90.

The researchers found that neither people with HIV nor controls significantly improved over time. Baseline total ESE scores differed significantly (61.3 in people with HIV vs 73.8 in controls; P<0.01), but at weeks 12 and 24, total ESE scores did not change significantly from baseline in either group.

Wilson spoke with Physician’s Weekly (PW) about the results and how providers can help older patients with HIV keep exercising.

PW: What are the study’s most important findings for clinicians?

Melissa P. Wilson, MS: Even after 24 weeks of in-person exercise training from a coach and improvement across a wide range of physical function measures, we found no evidence that older adults felt more equipped to overcome barriers to exercise such as fatigue, depression, or pain. This was an especially important finding in our participants with HIV, as they exhibited markedly lower confidence in this area prior to beginning the exercise intervention.

Why was it important to do this study?

Using tools like the Self-Efficacy for Exercise Scale in research can deepen our understanding of the primary findings of studies like Exercise for Healthy Aging and help us identify ways to better support older, medically complex people looking to engage in healthy behaviors. The participant experience provides incredibly valuable context and is an important reminder that the barriers people face form a complex reflection of their unique social, physical, and psychological experiences.

Did the results surprise you?

This did surprise me! These previously sedentary participants showed up to the gym 3 days a week for 24 weeks, with impressive attendance rates. However, despite their incredible dedication to this exercise regimen, presumably while experiencing some of the measured barriers to exercise, their confidence in exercising in the presence of challenges did not change.

How could an exercise intervention for patients with HIV be improved?

Incorporating more positive reinforcement aspects such as peer-to-peer social support, motivational interviewing, and text messaging could increase participant adherence and effort in this type of intervention, ultimately leading to increased health-related benefits commonly seen with exercise. By adding these components to supported exercise interventions like this one, we hope to create a positive set of experiences and outcomes that will ultimately translate into sustained, independent physical activity practices out in the community.

What other strategies could increase exercise for older people with HIV? 

Ask and encourage them! Many participants in exercise studies comment that clinicians have never asked them about or encouraged them to exercise. Creating an open dialogue about physical activity may also reveal unexpected barriers and fears that the medical community can help to reduce or resolve.

Encouragement from physicians is a positive factor in motivating patients to initiate physical activity, and physician guidance about individual safety and risk would be invaluable in this population. This type of discussion, paired with efforts to increase awareness of low- and no-cost exercise programs offered to older adults, could help people with HIV identify approachable ways to increase their physical activity and manage symptoms likely to be barriers to exercise.