The goal of this R21 application is to conduct a feasibility study of a home-based physical activity program designed to reduce cardiovascular disease risk associated with HIV infection and anti- retroviral therapy (ART). In the last 15 years, ART has resulted in an increase of over 10 years in the life expectancy of HIV-infected individuals. Along with increased life expectancy is an increased risk of cardiovascular disease and diabetes. The risk of these comorbidities results, at least in part, from the viral infection, lifestyle choices, and specific ART regimens. Observational studies and randomized trials demonstrate the efficacy of physical activity/exercise in decreasing the risk of metabolic and cardiovascular pathologies in a range of clinical populations. Laboratory-based, tightly controlled clinical trials from our research group and others indicate that physical activity is an appropriate intervention for reducing many modifiable risk factors for cardiovascular morbidity/mortality in PLWHA. These studies indicate that even relatively modest increases in physical activity increase cardiorespiratory fitness, reduce visceral fat and increase muscle mass, reduce serum total and LDL/VLDL cholesterol, reduce triglycerides, and increase serum HDL cholesterol. However, no studies have demonstrated the effectiveness, in terms of either program adherence or risk factor reduction, of a home-based physical activity program when prescribed for those living with HIV. This gap in knowledge regarding home based training for community-dwelling patients is of special concern due to the disproportionate prevalence of HIV infection in poor, rural, and minority populations who have limited access to exercise training facilities and professional support. We will obtain data for power calculations, test the feasibility of a telephone-based intervention, and perform process evaluations to enable refining a breakthrough full-scale study. The physical activity program will be designed around activity recommendations that are appropriate for home use in a clinical population.
SPECIFIC AIMS will include 1) Testing the feasibility of recruiting study participants from community-based HIV support centers, and achieving a high level of program adherence to a physical activity program designed to help individuals achieve the consensus public health recommendation for physical activity;2) Obtaining data for power calculations on changes in risk factors for CVD, psychological factors, and quality of life;3) Providing an exploratory assessment of activity-induced changes to emerging risk factors for cardiovascular disease, such as serum CRP and interleukin 6 (IL-6), in order to perform power calculations for future studies;and 4) Using process evaluations to refine interventions and to prepare and submit a grant application for a large randomized controlled trial to test the effectiveness of the physical activity program.
Because of advances in drug treatment, people living with HIV/AIDS (PLWHA) are living longer, but are also at greater risk for cardiovascular disease (CVD) and diabetes. Exercise and increased physical activity can reduce the risk factors for these diseases in PLWHA, but no studies have tested an at-home exercise program that would benefit low income people and others who do not have access to exercise facilities. This study will test the feasibility of an at-home exercise program for PLWHA and prepare for a full-scale intervention study, which may lead to a reduction in CVD risk among PLWHA.
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|Jaggers, Jason R; Prasad, Vivek K; Dudgeon, Wesley D et al. (2014) Associations between physical activity and sedentary time on components of metabolic syndrome among adults with HIV. AIDS Care 26:1387-92|
|Jaggers, Jason R; Dudgeon, Wesley; Blair, Steven N et al. (2013) A home-based exercise intervention to increase physical activity among people living with HIV: study design of a randomized clinical trial. BMC Public Health 13:502|
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