The Impact of Structured Exercise on Brain Health in HIV Positive Individuals

McGill University30 enrolled

Overview

Exercise programs that combine resistance exercise with aerobic training yield optimal health benefits for people with HIV. The global aim of this study is to contribute evidence for the impact potential of a comprehensive exercise program on brain health in people with HIV. This study is part of a larger project based upon a cohort multiple randomized controlled design. Within a fully characterized cohort which is followed over time, people meeting the specific criteria for an exercise intervention will be identified. The sample will be randomly selected to receive the intervention; the remaining eligible persons will serve as controls. The intervention group will receive a 45 minute structured exercise program 3 times a week consisting of aerobic exercise and resistance training for a total of 12 weeks.

Exercise is an inexpensive intervention with widespread benefits to vascular and musculoskeletal health and few harms. Showing an additional benefit to brain health and cognition in particular is likely to encourage adoption and help elucidate mechanisms underpinning brain health in HIV. The primary objective of the study is to estimate, in comparison to individuals not offered the exercise intervention, the extent to which a comprehensive exercise program impacts on indicators of brain health, where these indicators are the primary outcome of cognitive ability (B-CAM) and the related brain health outcomes of depression, anxiety, fatigue, motivation, and speed of motor performance. A secondary objective is to estimate the extent to which changes in brain health are mediated through exercise induced changes in brain network function as measured by EEG and/or by exercise induced changes in muscle power, aerobic capacity, physical function, and body composition.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Interventions

Exercise groupOTHER

Interval training will be performed for 21 minutes including a 3 minute warm-up and cool-down period. The interval program will be 15 minutes at 65-75% of maximal heart rate with 30 sec. bursts of exercise to 80-85%; intervals. Resistance training will be done as a circuit and will make use of weight machines and functional exercises. Resistance will be done in 2 sets of 15 repetitions and will last 24 minutes. The work load of the program is calibrated and is conducted at a specified rhythm. All exercise sessions will be supervised.

Eligibility

Sex: MALEMin age: 35 YearsMax age: 80 Years

Medical Language ↔ Plain English

The exercise intervention will target individuals recruited from two Montreal clinics who identified at cohort entry they were interested in being approached for different trials if they eligible. Inclusion Criteria: * men and women aged ≥ 35 years, HIV+ for at least 1 year, able to communicate adequately in either French or English, and able to give written informed consent. Also, participants must identify that they are mostly sedentary by reporting that they perform moderate level physical activity of 30 minutes duration less than twice a week or have limitations in performing vigorous activities, walking a kilometer, or climbing stairs. Individuals answering yes to any of the Physical Activities Readiness Questionnaire (PAR-Q) (Thomas et al., 1992) items except taking medication (Item 6) will require clearance from their physician to be included. Exclusion Criteria: * people with dementia (MOCA \< 18) or treating physician's concern about capacity to consent, life expectancy of \< 3 years or other personal factors limiting the ability to participate in follow-up, non-HIV-related neurological disorder likely to affect cognition, known active CNS opportunistic infection or hepatitis C requiring interferon (IFN) treatment during the follow-up period, psychiatric disorder on the psychotic axis, current substance use disorder or severe substance use disorder within the past 12 months. Also excluded will be people with a contraindication for exercise from cardiovascular or musculoskeletal co-morbidity as gathered from the medical history and from the PAR-Q (Thomas et al., 1992).

Outcomes

Primary Outcomes

Change in Cognitive Ability

The primary outcome is cognitive ability as measured by B-CAM. This is part of the measurement platform for all and the value taken at the regular assessment prior to the exercise intervention will serve as the baseline value and the subsequent evaluation 9 months following will serve as the follow-up value. The strategy ensures that the intervention cohort does not have additional measurements of cognitive ability than the control cohort. The items on the B-CAM fit the Rasch Model and as such have linearized units on a logit scale.

Time frame: 0 and 39 weeks

Secondary Outcomes

Change in depression

Measured by Hospital Anxiety and Depression Scale (HADS)

Time frame: 0 and 39 weeks

Change in depression

Measured by RAND -36 Mental Health Inventory (MHI)

Time frame: 0 and 39 weeks

Change in stress levels

Measured by Trier Inventory for Chronic Stress (TICS)

Time frame: 0 and 39 weeks

Change in anxiety

Measured by Hospital Anxiety and Depression Scale (HADS)

Time frame: 0 and 39 weeks

Change in fatigue

Measured by RAND-36 Vitality

Time frame: 0 and 39 weeks

Change in motivation

Measured by Motivation Ladder

Time frame: 0 and 39 weeks

Change in global quality of life (QOL)

Measured by Person Generated Index (PGI)

Time frame: 0 and 39 weeks

Change in health related quality of life (HRQoL)

Measured by RAND-36

Time frame: 0 and 39 weeks

Change in health related quality of life (HRQoL)

Measured by WHOQOL-HIV

Time frame: 0 and 39 weeks

Change in measures of brain network function

The measures of brain network function are derived from event related potential (ERPs) which are electric potentials produced by the brain in response to auditory or visual stimulation, respectively. These brain responses are easily recorded noninvasively with scalp electrodes (EEG). ERPs allow insights into the neural mechanisms underlying specific cognitive processes. The potentials of interest here include the N1, N2, P2 and P3 ERPs.

Time frame: 0 and 12 weeks

Change in skeletal muscle mass

A total body Dual energy X-ray absorptiometry (DEXA) scan will be done to compute skeletal muscle mass (whole body, spine and thigh) (Lee \& Gallagher, 2009).

Time frame: 0 and 12 weeks

Change in muscle quality

Peripheral quantitative computed tomography (pQCT) will be used to measure the muscle quality in lower extremity (MacIntyre \& Lorbergs, 2012).

Time frame: 0 and 12 weeks

Change in exercise capacity

Measured by step test

Time frame: 0 and 12 weeks

Change in functional walking capacity

Measured by Six Minute Walk Test (6MWT)

Time frame: 0 and 12 weeks

Change in quadriceps power

Measured using leg press and jump test

Time frame: 0 and 12 weeks

Change in core strength

Measured using curl ups/push ups

Time frame: 0 and 12 weeks

Change in grip strength

Measured using hand dynamometer

Time frame: 0 and 12 weeks

Change in gait speed

Comfortable gait speed: GAITRite; Fast gait speed: GAITRite; Dual task gait speed: GAITRite and naming the fruits

Time frame: 0 and 12 weeks

Change in exercise enjoyment

Exercise enjoyment will be measured by Physical Activity Enjoyment Scale (PACES) (Mullen et al., 2011).

Time frame: 0 and 12 weeks

Change in physical activity

The data from the accelerometer will be used to estimate the extent to which the structured exercise program carries over into everyday life. Participants will be asked to wear an ActivPal accelerometer for 5-7 days prior to the start of the intervention, at 6 weeks, and after 12 weeks, to objectively measure habitual physical activity.

Time frame: 0, 6 and 12 weeks

Change in semantic fluency

Following question will be asked: Name as many animals as you can in 1 minute (in sitting).

Time frame: 0 and 12 weeks

The Impact of Structured Exercise on Brain Health in HIV Positive Individuals

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts