Evidence-Informed Practical Recommendations for Increasing Physical Activity Among Persons Living With HIV

Jessica L. Montoya; Catherine M. Jankowski; Kelly K. O'Brien; Allison R. Webel; Krisann K. Oursler; Brook L. Henry; David J. Moore; Kristine M. Erlandsong


AIDS. 2019;33(6):931-939. 

In This Article

Abstract and Introduction


With the advent of effective antiretroviral therapy (ART), the care of persons living with HIV (PLWH) is shifting focus to the management of age-related chronic health conditions (e.g. metabolic syndrome and cardiovascular disease), syndromes of ageing (e.g. dementia and frailty) and side effects related to ART. Non-ART polypharmacy is common among PLWH and associated with an increasing risk of hospitalization and mortality;[1] thus, nonpharmacologic management of comorbidities is critical for PLWH who may experience an earlier onset and a greater burden of comorbidities. Routine engagement in health-enhancing behaviours, including physical activity, may help prevent and manage comorbid health conditions and syndromes of ageing common among PLWH.[2] Physical activity refers to any bodily movement produced by muscle contraction that causes energy expenditure, whereas exercise is a subset of physical activity that involves planned, repetitive body movement with the intent to increase well being and energy level to allow for independent participation in physical activities.[3] The goal of this narrative review is to summarize key literature from the past 10 years examining the benefits of physical activity and to outline recommendations to prescribe and support physical activity engagement among PLWH.

The second edition of Physical Activity Guidelines for Americans issued by the Department of Health and Human Services (HHS)[4] proposes that adults – even those with chronic conditions and disability – engage in at least 150–300 min of moderate-intensity or 75–150 min of vigorous-intensity aerobic physical activity per week, as well as muscle strengthening activities on two or more days a week. Balance training is additionally recommended as part of older adults' weekly physical activity to reduce fall risk. Importantly, HHS emphasizes that moving more and sitting less will benefit nearly everyone, with the most sedentary and least active individuals experiencing the greatest benefit from small physical activity increases.[5] Although some PLWH may have unique physical limitations that must be accommodated in order for them to safely engage in physical activity, the take-home recommendation is that physical activity participation is key to maximizing health and function. For additional information regarding physical activity recommendations and safety precautions for patients with combinations of cardiovascular disease risk factors (i.e. obesity, arterial hypertension, diabetes mellitus and dyslipidaemia), we refer the reader to an expert consensus statement on physical activity prescription.[6]

Despite the well established health benefits of physical activity (summarized in Table 1),[7–41] rates among PLWH remain low. A meta-analysis of 24 studies involving nearly 4000 PLWH found that only half of the individuals engaged in 150 min of moderate-intensity physical activity.[42] Among middle-aged PLWH, 26% reported no moderate, vigorous, or muscle strengthening physical activity, similar to rates in the U.S. general population.[43] These physical activity trends are consistent across settings: 32% of Vietnamese adults with HIV reported low or no physical activity,[44,45] with similar rates in the Swiss HIV Cohort study (41%),[46] Germany (39%)[47] and Brazil (44%).[7] Despite limited engagement in physical activity, results of a qualitative study found that PLWH understood the health promotion benefits of physical activity and thought physical activity should be a greater priority in their life.[48]