Research proposal

The effect of a 12 weeks’ aerobic exercise on immunological measures of HIV positive clients on ART.

A study in Uganda examined the impact of aerobic exercise on HIV-positive individuals receiving Antiretroviral therapy (ART). Participants were divided into a control group receiving no treatment and an experimental group undergoing twelve weeks of moderate-intensity aerobic exercise. Both groups were assessed using a physical activity readiness questionnaire. The study measured immunological measures, functional work capacity, and psychological markers before and after the intervention. The results showed that aerobic exercise significantly decreased CD4 count, improved functional work capacity, and reduced psychological markers in HIV-positive individuals on ART. The study suggests that incorporating aerobic exercise into the care of these individuals could enhance their quality of life and reduce mortality rates.

Chapter one

Background

Human Immunodeficiency Virus (HIV), a retrovirus belonging to the Lentivirus genus, is the cause of the sickness. The virus slowly affects a human body and deprives it of its immunity by seeking to destroy CD4 cells gradually – a type of T-lymphocytes (T-cells) that is critical to the immune system.

In 2020, UNAIDS highlighted HIV as a major global health concern, with around 37.9 million people living with HIV/AIDS worldwide. The majority were adults, but a significant portion were children under 15 years old. About 1.7 million individuals contracted the virus in 2018, primarily adults. Africa bore the brunt, hosting 25.7 million cases and accounting for the majority of new infections. By 2021, there were 1.5 million new infections globally, with Africa still experiencing the highest numbers. A 2022 UNAIDS report noted over 2.5 million AIDS-related deaths globally, with Uganda hosting over 1.5 million people living with HIV.

Aerobic exercise may be a helpful treatment for a variety of ART side effects and symptoms, according to studies from both healthy individuals and those with various chronic illnesses (O’Brien et al., 2016).

workouts also contribute to the body’s overall red blood cell count, which facilitates oxygen delivery, lowers stress levels, decreases the risk of depression, and improves cognitive function (Bopp et al., 2003). O’Brien et al. (2016) in a study on the benefits of aerobic exercise for persons living with HIV/AIDS showed improvements in their health, mood, life satisfaction, and quality of life in addition to symptoms of anxiety and sadness.

Problem Statement

Despite the lack of cure for HIV/AIDS, the present ART makes it possible for an individual’s immune system to fortify. They can combat other illnesses better as a result. Nonetheless, advanced HIV illnesses continue to be a challenge in the HIV response, a sign of subpar clinical results that worsen sickness and mortality in certain HIV-positive individuals, (Tugume et al., 2023). Studies have indicated that the use of antiretroviral therapy (ART) is strongly linked to adverse alterations, specifically morphologic and metabolic abnormalities. These changes are further compounded by obesity brought on by lipodystrophy, nutritional imbalances, and a sedentary lifestyle, (Thet & Siritientong, 2020). Aerobic exercise therapy has the potential to lower the total cost of HIV treatment by prolonging the asymptomatic phase of the illness. This may also lessen the need for additional medications and the burden of those pills, as well as enhance the patients’ overall health, rate of health care utilization, and quality of life (Bopp et al., 2003), the MoH HIV Prevention and Treatment Guidelines (2018), recommend the inclusion of exercise in improving psychosocial state in adults and adolescents who are HIV positive. However, it does not also sufficiently guide on the kind, level of intensity, and length of physical activity to be performed. To date, there is no published study on the roles of exercise in enhancing clinical results of HIV positive clients on ART in Uganda. This study therefore, aimed at providing knowledge and skills required when applying aerobic exercise to HIV positive clients, This may also help remove the myth where many HIV positive clients were found to believe that engaging in physical activities would worsen the disease (Frantz and Murenzi, 2013).

1.3 Specific Objectives

The following objectives served as the study’s guidelines:

To assess the effect of a 12 weeks aerobic exercise on immunological measures of HIV positive clients on ART at GMH-Bombo.
To evaluate the impact of a 12 weeks aerobic exercise on functional work capacity of HIV positive clients on ART at GMH-Bombo.
To determine the effects of a 12 weeks aerobic exercise on psychological markers of HIV positive clients on ART at GMH-Bombo.

CHAPTER TWO

Literature review

Antiretroviral Therapy (ART), particularly Highly Active Antiretroviral Therapy (HAART), significantly improves the quality of life and reduces hospitalization and mortality rates among People Living with HIV (PLHIV). However, it is associated with various negative side effects such as fatigue, nausea, depression, and neuropsychiatric issues. Aerobic exercises have been identified as a beneficial alternative therapy for HIV-infected individuals, improving physical and mental health without the severe side effects of ART. Studies have shown that aerobic exercises can positively impact CD4 counts, psychological measures, general health, mood, life satisfaction, and quality of life. However, there is a lack of emphasis on exercise therapy in managing HIV-positive clients in Uganda, despite its potential benefits.

In addition to exercise, nutritional interventions play a crucial role in reducing the incidence of Opportunistic Infections (OIs) among adults living with HIV. Poor nutrition can lead to faster development of OIs, impacting the well-being of HIV-positive individuals. High viral load due to noncompliance with ART is another concern, requiring enhanced adherence counseling and monitoring.

While exercise has numerous benefits for HIV-positive individuals, some studies have not shown significant improvements in immunological variables with exercise interventions. Nevertheless, regular physical activity is known to boost mitochondrial function, improve energy metabolism, and positively impact mental health and weight management, ultimately enhancing the quality of life for HIV-positive clients.

Implications

Aerobic exercise is highly recommended for managing HIV symptoms, especially for clients with mild symptoms or no severe infections. Starting aerobic exercise early after HIV diagnosis can delay symptom onset, reduce their severity, and possibly slow down disease progression and related comorbidities from antiretroviral medications. This approach can also lower overall healthcare costs. Customized aerobic exercise plans based on individual symptoms and abilities are advised, focusing on moderate-intensity activities like walking, cycling, or rowing. Progressive resistance training can be added later. Activities with a metabolic equivalent (MET) level of 3-6 are recommended, including jogging, walking, dancing, water aerobics, cycling, and low-intensity sports. These exercises help maintain functional capacity even for HIV-positive individuals without symptoms.

A 12-week aerobic exercise program increased the lipid profile and CD4 cell counts, two immunological indicators of HIV infection (Maduagwu et al 2015). However, by stressing appropriate nutrition and adherence to antiretroviral medication, health care providers and/or exercise experts may improve immune function in the HIV community (Maduagwu et al, 2015). In apparently healthy individuals free of HIV infection, acute, moderate-intensity exercise causes neutrophil proliferation, the release of adrenaline and cortisol, a temporary decrease in lymphocyte counts, an increase in natural killer cells, and higher levels of cytokines (IL-I, TNF-a, and IL-6). After just one exercise session, this reaction is diminished in HIV-positive people ((Bopp et. al. 2003). Exercises with greater intensity reduce immune system function, increasing the risk of opportunistic infections in people without HIV (Bopp et. al. 2003).

Effects of Exercise on Functional Work Capacity

In healthy persons without HIV infection, VO₂max rises in tandem with physical fitness. A healthy male with no training typically has a V̇O₂ max of 35–40 mL/(kg. min). According to Scribbans et al. (2016), the average untrained healthy female has a V̇O₂ max of about 27–31 mL/(kg. min). Teens living with HIV had average VO₂max values in the upper 20s, placing them in the “well below average” group when compared to age-matched, HIV-negative controls (Keyser et al., 2000). Webel et al. (2019) discovered that HIV-positive patients had lower VO₂max values than an uninfected control group, both at the anaerobic threshold and throughout maximal exercise. This means they needed to aerobic exercise in order to improve their VO₂max values significantly increased in functional capacity following 12 weeks of exercise Bopp et al. (2003) and 24 weeks of aerobic endurance activity.

Methodology

Chapter three details the methodology used in the study, including the research design (quasi-experimental), study area (General Military Hospital Bombo in Luwero District, Uganda), research variables, target population (HIV-positive patients receiving care), sampling technique (purposive sampling), data collection instruments (Physical Activity Readiness Questionnaire, Point of care CD4 analyser, Rate of Perceived Exhaustion scale, Duke Activity Status Index, Psychosocial assessment tool), data quality control measures (validity and reliability tests), data analysis techniques (two-sample t-test), inclusion and exclusion criteria, ethical considerations (informed consent, confidentiality, voluntary participation), and data collection procedure (exercise sessions, blood samples, psychosocial assessments).

The study used a quasi-experimental design due to practical and ethical constraints in assigning participants randomly. The target population included HIV-positive patients aged 20 and above who had been on treatment for at least 12 months. Purposive sampling was used to select participants based on specific criteria. Various data collection instruments were used to assess physical activity readiness, immunological measures, functional work capacity, and psychosocial markers. Validity and reliability tests were conducted on these instruments to ensure data accuracy. Data analysis was performed using SPSS, and ethical considerations such as informed consent and participant confidentiality were strictly observed throughout the study.

Chapter Four

The findings in the study included; Last Engagement in Physical Exercises: Most participants not regularly exercising had not done so for over a year. Fatigue was a significant issue during physical activity. Fatigue was the most common problem, especially in the control group. Pressure over the heart was least reported. Avoiding cardiovascular diseases and weight loss were top reasons for exercising.

Participants preferred exercising three days a week, with some indicating one day. Both male and female trainers were preferred by most participants. Gyms were favored, followed by playing fields.

Few participants reported restrictions, suggesting doctors recognize exercise’s benefits for HIV patients.

The study found participants were physically prepared for aerobic exercise, leading to improved CD4 cell counts, especially in the experimental group. Aerobic exercise significantly improved CD4 counts in HIV-positive individuals on ART, supporting previous research. Aerobic exercise reduced perceived exertion rates and improved physical fitness post-exercise.

The experimental group was -1.574, falling within the 95% confidence interval of -1.803 to -1.345. Similarly, the control group mean of -0.450 was within its interval of -0.730 to -0.170. Both t-tests were statistically significant, with p-values <0.001 for the experimental group and 0.002 for the control group. These results rejected the null hypothesis, indicating that aerobic exercises reduce anxiety in HIV-positive clients on ART.

The study’s conclusions align with previous research, showing that aerobic exercises can alleviate anxiety symptoms. Additional studies by Jayakody et al. (2014), Heidarya et al. (2011), and Antoni et al. (2002) also support exercise’s positive effects on anxiety reduction in various populations. High-intensity exercise, according to Askari et al. (2020), may be particularly effective in reducing anxiety sensitivity.

Moreover, the study’s findings are important given the higher prevalence of depression and anxiety among people living with HIV/AIDS (PLWH), as noted by Heissel et al. (2019). They emphasize the significance of exercise interventions in managing mental health issues in this population, highlighting the role of professional supervision, exercise type, and frequency in symptom reduction.

CHAPTER FIVE

Effect on Immunological Measures (CD4 Cell Count):

Aerobic exercises led to an increase in CD4 cell count in the experimental group compared to a slight drop in the control group.

Supervised aerobic exercises positively impacted the immune system of HIV-positive clients on ART.

Effect on Functional Work Capacity

Participants in the experimental group showed a significant improvement in functional work capacity after aerobic exercise intervention.

This improvement was indicated by reduced perceived exertion and increased VO2max, suggesting better cardiovascular fitness.

Effect on Psychological Markers

Aerobic exercises had positive effects on psychological markers such as paranoid ideation, depression, neuroticism, anxiety, and phobia.

Participants reported improvements in these psychological aspects after engaging in aerobic exercises.

Conclusions

Well-structured aerobic exercises, conducted under supervision, can improve CD4 cell count, functional work capacity, and psychological well-being in HIV-positive clients on ART.

The study recommends incorporating aerobic exercises into the care and treatment of HIV-positive clients, training clinicians in exercise prescription, and promoting exercise adherence among this population.

Further research is needed to explore the effects of aerobic exercise on viral load, body composition, adherence to drugs, and optimal diet-exercise combinations for immune system optimization in ART clients.

This study focused on examining the impact of a 12-week aerobic exercise program on HIV-positive clients receiving antiretroviral therapy (ART) at General Military Hospital-Bombo in Uganda. The research aimed to evaluate changes in immunological measures, functional work capacity, and psychological markers among these clients.

The study addressed the growing concern of HIV/AIDS as a global health issue, particularly in Africa, and highlighted the challenges faced by HIV-positive individuals, such as opportunistic infections, psychological disorders, and treatment side effects. It emphasized the need for comprehensive approaches to improve the quality of life for HIV-positive clients, including exploring alternative therapies like aerobic exercise.

Using a socio-ecological model, the study considered various environmental influences at different levels to enhance participation in aerobic exercises among HIV-positive clients. The conceptual framework illustrated how the 12-week aerobic exercise intervention influenced clinical outcomes, including CD4 cell count, functional work capacity (measured by VO2max), and psychological well-being.

The geographical scope of the study was limited to General Military Hospital-Bombo in Uganda, focusing on clients aged 20-49 who had been on ART for more than 12 months. The study period spanned from 2019 to 2023, with a delay due to interruptions caused by the COVID-19 pandemic.

The study’s significance lies in providing insights into the potential benefits of aerobic exercise for HIV-positive clients in Uganda, contributing to policy refinement, guiding healthcare providers, and inspiring further research in this area. It aimed to bridge the gap in knowledge regarding the specific impacts of aerobic exercise on clinical outcomes for HIV-positive clients undergoing ART.

The impact of a 12 weeks aerobic exercise on functional work capacity of HIV positive clients on ART.

THE EFFECTS OF A 12 WEEKS AEROBIC EXERCISE ON ANXIETY AND DEPRESSION OF HIV POSITIVE CLIENTS ON ART

Abstract

The advent of Highly Active Antiretroviral Therapy (HAART) has significantly improved the health outcomes and life expectancy of People Living with HIV (PLHIV). However, challenges persist, including mental health issues and adverse effects associated with treatment. Uganda, grappling with a substantial HIV burden, seeks innovative approaches to enhance the overall well-being of PLHIV. Aerobic exercise, despite its proven benefits, is underutilized in HIV management in Uganda. This study explores the potential of a 12-week aerobic exercise program as an adjunct therapy to improve the quality of life for PLHIV and potentially reduce the overall cost of HIV treatment.

Existing research underscores the positive impact of aerobic exercise on physical, mental, and immunological aspects of HIV management. Aerobic exercise has been associated with improvements in CD4 cell counts, functional work capacity, and mental health outcomes. The evidence supports the hypothesis that a structured aerobic exercise program can alleviate anxiety and depression in PLHIV on ART, offering a complementary approach to conventional treatment.

The study, conducted at the General Military Hospital in Uganda, employed a quasi-experimental design. A sample of 135 PLHIV on ART engaged in a 12-week supervised aerobic exercise program. Quantitative data were analyzed using t-tests, revealing significant reductions in depression and anxiety symptoms among participants.

The findings demonstrated a 58.5% reduction in depression symptoms and a significant decrease in anxiety symptoms among participants engaged in aerobic exercises. Both groups exhibited improvements, with the experimental group showing greater reductions. The results support the potential of aerobic exercise as a valuable adjunct therapy for PLHIV on ART.

The study concludes that supervised aerobic exercises contribute to improvements in CD4 cell counts, functional work capacity, and mental health outcomes for PLHIV on ART. Recommendations include integrating exercise counseling into HIV care guidelines, providing training for clinicians, and involving exercise scientists in care teams. Advocacy efforts by health and education authorities are essential to promote the benefits of aerobic exercise for PLHIV, potentially revolutionizing HIV care in Uganda.

Background

Since the onset of Acquired Immune Deficiency Syndrome (AIDS) in 1981, triggered by the Human Immunodeficiency Virus (HIV), substantial progress has been made in handling the disease. Antiretroviral Therapy (ART), particularly the Highly Active Antiretroviral Therapy (HAART), has significantly enhanced the well-being and life expectancy of individuals living with HIV. Nevertheless, persistent challenges persist, notably mental health issues such as anxiety and depression among those on ART (Prabhu & Van wagoner, 2023). Uganda, akin to numerous African nations, grapples with a substantial HIV burden. According to UNAIDS, Uganda has witnessed over 2.5 million AIDS-related deaths, with more than 1.5 million people currently living with HIV (Wallis, O’Garr, Sher, & Wack, 2023). Thirty-five years (1986–2021) of HIV/AIDS in Nigeria: bibliometric and scoping analysis. AIDS Research and Therapy, 19(1), 1-15.). Mental disorders, often undetected and untreated, are prevalent among people living with HIV (PLHIV), a situation further compounded by disruptions caused by the COVID-19 pandemic (Liu, Chen, Cheng, Ye, & Pan, 2023), While ART has notably improved the health outcomes of PLHIV, it is not without its drawbacks. Adverse side effects like exhaustion, nausea, pain, anxiety, and sadness are associated with ART, Additionally, the financial strain and the necessity for regular hospital visits pose challenges, particularly for those in remote areas (Barin, 2022).

Aerobic exercise has emerged as a potential adjunct treatment to alleviate symptoms, complications, and unwanted side effects linked with chronic HIV (Nkweke, 2021).

Research indicates that aerobic exercise can enhance the health, mood, life satisfaction, and overall quality of life for individuals with HIV/AIDS (Suleman, et al., 2023). However, despite these recommendations, the utilization of aerobic exercise in managing HIV in Uganda has not been widely underscored by clinicians (Abdul-Rahman, et al., 2023). Despite strides in HIV management, there remains no cure, and certain HIV-positive individuals continue to experience suboptimal clinical outcomes. Adverse alterations associated with ART, combined with issues like obesity, nutritional imbalances, and sedentary lifestyles, contribute to challenges in the HIV response (Thomas, Kenfield, Yanagisawa, & Newton, 2021).The study also indicates that it is imperative for future research to delve into the specific types, frequencies, and approaches of aerobic exercises most effective for PLHIV. Additionally, integrating this knowledge into clinical practice is essential, equipping healthcare professionals with the tools and understanding to prescribe exercise as a potent means of enhancing the clinical outcomes and mental health of HIV-positive clients on ART (Zhang, et al., 2021). The exploration of aerobic exercise as a complementary treatment for PLHIV in Uganda holds promise in enhancing their overall well-being. By addressing the physical, psychological, and immunological aspects, a holistic approach to HIV management can be achieved, potentially revolutionizing the landscape of HIV care in the country.

Literature review of the study

Human Immunodeficiency Virus (HIV) remains a global health concern, with Antiretroviral Therapy (ART) playing a pivotal role in managing the condition. While ART, such as Highly Active Antiretroviral Therapy (HAART), has proven benefits, including improved quality of life and reduced mortality, it is not without its drawbacks, such as potential negative side effects (Wallis, O’Garr, Sher, & Wack, 2023).

ART, despite its undeniable benefits, comes with a set of side effects, ranging from fatigue and nausea to neuropsychiatric issues like peripheral neuropathy and insomnia. These challenges can impact the overall well-being of People Living with HIV (PLHIV) and may contribute to psychological distress. Recognizing these issues, researchers have turned their attention to the potential benefits of exercise as a complementary therapy for individuals on ART.

Several studies have highlighted the positive impact of aerobic exercises, particularly those of low intensity and long duration, on the physical and mental health of HIV-infected clients. Aerobic exercise has been shown to match the signs and consequences of long-term HIV infection without the side effects associated with ART. In addition, studies examining the effectiveness of aerobic exercise in adults on ART have reported improvements in general health, mood, life satisfaction, and a decrease in anxiety and depression (Guerra, Mesquita, Soares, Morgan, & Knackfuss, 2015). The use of aerobic exercises as part of the management of HIV symptoms is highly recommended. Implementing aerobic exercise therapy early in the diagnosis can potentially postpone the onset and severity of symptoms, slow disease progression, and reduce the overall cost of treating HIV-positive patients. Customized aerobic exercise regimens, starting with moderate-intensity exercises like walking, cycling, and rowing, can be beneficial for HIV-positive clients based on their unique symptomology and functional capabilities (Garcia, et al., 2014). Aerobic exercise has been linked to positive changes in immunological measures, including an increase in CD4 counts, essential for determining immunity in HIV-positive individuals. While some studies have reported no significant changes in viral load or CD4 count after exercise, others have demonstrated improvements in CD4 cell counts, suggesting the potential benefits of exercise on immune function (O’Brien, Nixon, Tynan, & Glazier, 2020). Functional work capacity, often measured by VO2max, is crucial for daily activities and overall quality of life. Studies have shown that aerobic exercise can lead to improvements in functional work capacity, with potential benefits for individuals with HIV infection. The use of the Duke Activity Status Index (DASI) and Rating of Perceived Exertion (RPE) as measurement tools further supports the positive impact of exercise on functional work capacity (Calitz, 2018). Anxiety and depression are prevalent psychological issues among HIV-positive individuals on ART. Exercise, particularly aerobic activities, has demonstrated positive effects on psychological well-being, including reductions in anxiety and depressive symptoms, the combination of exercise and standard care has shown promise in improving mental health outcomes for PLHIV (Patil, 2017). The evidence presented in various studies supports the hypothesis that a 12-week aerobic exercise program can have positive effects on anxiety and depression in HIV-positive clients on ART. While acknowledging the challenges and side effects associated with ART, this article emphasizes the potential of exercise as a complementary therapy. However, it is essential for clinicians to consider personalized exercise regimens, taking into account the unique needs and capabilities of each HIV-positive individual (Ibeneme, et al., 2019). HIV infection, once considered a life-threatening condition, has become a chronic illness with the advent of Highly Active Antiretroviral Therapy (HAART). While HAART has significantly increased the life expectancy of HIV-positive individuals, it is also associated with various comorbidities, disability issues, and a decline in exercise capacity. Exercise has emerged as a crucial management strategy for promoting the rehabilitation and overall health of HIV/AIDS clients (Ciccolo, Jowers, & Bartholomew, 2014). Research suggests that exercise plays a vital role in mitigating HIV-related side effects and addressing the cardiometabolic and morphological challenges associated with HAART, including inflammation, oxidative stress, and mitochondrial dysfunction exercise can slow down the progression of the disease, improve quality of life, enhance aerobic capacity, increase functional ability, and reduce the cardiovascular disease risk in HIV-positive individuals (Dianatinasab, Ghahri, Amanat, & Fararouei, 2020). Supervision by qualified health professionals, particularly clinical exercise physiologists, is essential during exercise sessions with HIV-positive clients, ensuring their ability to handle the recommended workload. Factors such as the client’s drug regimen, symptoms, functional ability, and disease stage should be considered when designing exercise programs. The gradual progression approach, involving an increase in the frequency and duration of exercise sessions, is recommended until clients can comfortably endure three to five sessions per week (Abdul-Rahman, et al., 2021), Aerobic exercise, ranging from moderate intensity to high intensity, is generally considered safe for both symptomatic and asymptomatic HIV/AIDS patients. The American College of Sports Medicine recommends a combination of aerobic exercise (AE) and progressive resistive exercise (CARE) to enhance various health indices more effectively than either strategy alone (Calitz, 2018).

Resistance training, focusing on large muscular groups, is advised after completing four to six weeks of aerobic training to reduce the risk of immunological problems and enhance overall fitness. Caution is advised against using free weights due to the higher risk of injury (Garcia, et al., 2014).

Clients with HIV/AIDS should obtain medical clearance from their doctors before initiating exercise programs. An exercise stress test under physician supervision is also recommended, considering potential limiting factors that may be present. Dehydration and electrolyte abnormalities, common among HIV clients, can lead to muscle cramping and irregular heartbeats, emphasizing the importance of monitoring these conditions during exercise (Jaggers & Hand, 2016). As HIV-positive individuals continue to live longer, maintaining their overall health and well-being becomes increasingly important. This article highlights the positive impact of a 12-week aerobic exercise program on anxiety and depression among HIV-positive clients on ART. By incorporating safe and supervised exercise regimens, individuals living with HIV can experience improved physical and mental health, contributing to a better quality of life in the era of advanced medical interventions for HIV/AIDS (Guerra, Mesquita, Soares, Morgan, & Knackfuss, 2015).

Methodology

Research Design

A quasi-experimental research design was selected for this study.

Location of the Study

The study was conducted at the General Military Hospital (GMH) Bombo in Luwero District, central Uganda.

Target Population

The target demographic comprised HIV-positive patients receiving care at General Military Hospital-Bombo, specifically those on ART for 12 months or more and aged 20 years and above. This group constituted the majority of the 4150 clients receiving ART treatment at GMH.

Inclusion and Exclusion Criteria

Inclusion criteria encompassed clients meeting specific conditions such as being asymptomatic, on ART for 12 months and more, and volunteering for aerobic exercise sessions. Exclusion criteria considered limitations to exercise, opportunistic infections, signs and symptoms of HIV disease, and the age category of children, adolescents, and clients on ART for less than 12 months.

Sampling Procedure and Sample Size

After extensive health education sessions, 135 volunteers meeting the inclusion criteria were enrolled in the study out of the 3300 eligible clients. The sample size determination utilized Yemen’s formula, resulting in a study sample of 99 participants.

Quantitative data were analyzed using two-sample t-tests, with a significance level set at p ≤ 0.05. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for all analyses.

Results

The study investigated the impact of aerobic exercises on depression and anxiety symptoms in HIV-positive individuals receiving antiretroviral therapy (ART). The results revealed a significant improvement in depression symptoms, with a 58.5% reduction and 86.0% of participants reporting no depression post-exercise. The experimental group demonstrated a greater decrease in mean depression scores compared to the control group. The calculated means fell within the confidence intervals, and t-tests confirmed statistical significance for both groups.

Similarly, the study found a significant reduction in anxiety symptoms among participants engaging in aerobic exercises. The calculated means for the experimental and control groups fell within their respective confidence intervals, and t-tests confirmed statistical significance. These results led to the rejection of the null hypothesis, indicating that aerobic exercises have a positive effect on reducing anxiety in HIV-positive individuals on ART.

The findings align with previous research suggesting that aerobic exercise contributes to psychological well-being and can alleviate symptoms of depression and anxiety in individuals with HIV. The study emphasizes the importance of exercise interventions in improving mental health outcomes for HIV-positive individuals, considering the elevated prevalence of depression and anxiety in this population compared to those without HIV/AIDS.

Conclusions and Recommendations

In the conclusion section, the study findings on the impact of aerobic exercise on various aspects of HIV-positive clients on antiretroviral therapy (ART) are summarized; CD4 Cell Improvement: Supervised 12 weeks of moderate-intensity aerobic exercises at a heart rate of 120-150 beats per minute led to an improvement in CD4 cell counts in HIV-positive clients on ART, Well-structured and supervised aerobic exercises were identified as crucial for enhancing the clinical outcomes of People Living with HIV (PLHIV) on ART.

After an exercise intervention, HIV-positive clients on ART demonstrated a notable enhancement in functional work capacity, making them more productive and less fatigued.

Both the Rating of Perceived Exertion (RPE) and Duke Activity Status Index (DASI) showed consistent results in measuring oxygen consumption. Notably, DASI indicated a substantial improvement in functional work capacity. Exercise interventions resulted in significant improvements in all psychological markers studied among HIV-positive clients on ART. Given the positive impact on depression, it is suggested that aerobic exercise may contribute to reducing mortality rates in this population.

Ministry of Health (MoH) in Uganda is recommended to authorize the use of aerobic exercise as an additional therapy for HIV-positive clients on ART to enhance their quality of life. MoH should provide training for clinicians in the prescription of exercise for HIV-positive clients on ART. MoH should include details of recommended exercises in the HIV prevention and treatment guidelines in Uganda. HIV-positive clients are advised to regularly participate in aerobic exercises for improved weight management and overall quality of life.

Ministry of Education and Sports should include exercise physiology in the training of clinicians and counselors. Implementing partners, exercise scientists, and mental health experts are encouraged to support advocacy for the benefits of aerobic exercise for PLHIV. MoH should include exercise scientists in the care and management teams for HIV-positive clients. Academic institutions should include exercise counseling as a course unit to promote exercise adherence. Mental health experts should advocate for the integration of aerobic exercise training into healthcare services for HIV-positive clients to improve mental health.

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The effects of a 12 weeks aerobic exercise on anxiety and depression of HIV positive clients on ART

THE IMPACT OF A 12 WEEKS AEROBIC EXERCISE ON FUNCTIONAL WORK CAPACITY OF HIV POSITIVE CLIENTS ON ART.

Abstract

Sub-Saharan Africa, notably Uganda, faces a substantial HIV/AIDS prevalence, compounded by prevalent mental health issues among People Living with HIV (PLHIV), further exacerbated by the challenges posed by the COVID-19 pandemic. This study explores the implications of integrating aerobic exercise into the treatment regimen for HIV-positive clients on Antiretroviral Therapy (ART) in Uganda, with a specific focus on its impact on functional work capacity.

Existing literature underscores the potential benefits of aerobic exercise in managing symptoms and side effects of chronic HIV infection, including improved mood, quality of life, and CD4 cell count. Despite recommendations, there is a dearth of emphasis on aerobic exercise for PLHIV in Uganda. This article aims to bridge this gap by investigating the impact of a 12-week aerobic exercise program on clinical outcomes for HIV-positive clients.

The study employed a quasi-experimental research design at the General Military Hospital (GMH) Bombo in Luwero District, central Uganda. The target population comprised HIV-positive patients on ART for over 12 months, aged 20 and above. Inclusion and exclusion criteria were established, resulting in a sample size of 99 participants. Quantitative data analysis utilized two-sample t-tests with a significance level set at p ≤ 0.05.

The study demonstrated a significant positive impact of a 10-minute aerobic exercise on perceived exertion and functional work capacity in the experimental group, with results falling within the 95% confidence interval. Statistical analysis rejected the null hypothesis, suggesting a substantial effect of aerobic exercise on functional work capacity in HIV-positive clients on ART. The findings support existing research on the efficacy of aerobic exercise for adults living with HIV.

The study recommends the incorporation of aerobic exercises into HIV care protocols, educational initiatives for clinicians on exercise prescription, and collaboration with exercise scientists in patient management. The positive effects observed in physical and psychological well-being suggest that such interventions can contribute to improved quality of life, reduced mortality rates, and better overall health outcomes for HIV-positive individuals on ART.

Background of the study

Significant advancements have been made in understanding and managing Human Immunodeficiency Virus (HIV) Since the declaration of Acquired Immune Deficiency Syndrome (AIDS) in 1981. The global prevalence of HIV/AIDS remains a critical public health concern, particularly in sub-Saharan Africa, where a substantial number of individuals are living with the virus. In Uganda, the Ministry of Health acknowledges the high prevalence of mental disorders among People Living with HIV (PLHIV), aggravated by the challenges posed by the COVID-19 pandemic. This article explores the implications of incorporating aerobic exercise into the treatment regimen for HIV-positive clients on Antiretroviral Therapy (ART) in Uganda, focusing on its impact on functional work capacity (Waheed & Waheed, 2017)

As of 2021, over 1.5 million new HIV infections were reported globally, with Africa being the most affected region. In Uganda, more than 2.5 million people have died due to AIDS, and 1.5 million individuals continue to live with HIV. Ment al health issues among PLHIV in Uganda are common but often go unrecognized, a situation further exacerbated by the disruptions caused by the COVID-19 pandemic (Dirlikov, et al., 2023). Scientific breakthroughs, particularly in the form of Antiretroviral Therapy (ART), have significantly improved the quality of life and life expectancy of those infected with HIV. However, these treatments come with negative side effects, including exhaustion, nausea, pain, anxiety, and a decrease in functional work capacity. Multi-sectoral approaches are needed to mitigate these side effects and enhance adherence to ART (Ting & Koo, 2016).

Recent studies highlight the potential benefits of aerobic exercise in managing symptoms, complications, and side effects associated with chronic HIV infection. Aerobic exercise is recommended as a means to address various ART side effects, improve mood, enhance life satisfaction, and ultimately boost the quality of life for PLHIV. Studies have shown that exercise therapy should begin soon after an HIV diagnosis to delay the onset and severity of symptoms, potentially slowing disease progression. Despite these recommendations, there is a lack of emphasis on the use of aerobic exercise for PLHIV in Uganda. The article underscores the need for more comprehensive and specific guidelines on the incorporation of exercise into HIV management protocols. It addresses the existing gap in literature by investigating the implications of a 12-week aerobic exercise program on clinical outcomes for HIV-positive clients in various regions of Uganda (Hanson, Chu, Farizo, & Ward, 2015). As Uganda grapples with the challenges posed by the HIV/AIDS epidemic, this study seeks to contribute valuable insights into the role of aerobic exercise in enhancing clinical outcomes for PLHIV on ART, By understanding the impact on functional work capacity, the study aims to provide a foundation for tailored exercise prescriptions that can be integrated into the existing HIV management guidelines, ultimately improving the quality of life for those living with HIV in Uganda (Ranganathan & Umadevi, 2019).

LITERATURE

This article explores the impact of a 12-week aerobic exercise regimen on the functional work capacity of HIV-positive clients undergoing Antiretroviral Therapy (ART). The focus is on the human immunodeficiency virus (HIV) and the potential benefits and side effects associated with ART. The article delves into the role of aerobic exercises in enhancing the physical and mental health of HIV-infected clients and their potential to alleviate the side effects of ART. Additionally, the study aims to address the scarcity of information on the utilization of exercise therapy among HIV-positive clients in Uganda (Malta, Strathdee, Magnanini, & Bastos, 2018). Antiretroviral Therapy (ART) has become a cornerstone in managing HIV, offering improved quality of life but presenting potential side effects. This article examines the negative impacts of ART, including fatigue, nausea, and reduced functional work capacity, emphasizing the need for alternative therapies such as aerobic exercise (Sharp, et al., 2021).There are positive effects of aerobic exercise on HIV-positive individuals, drawing on studies that demonstrate improvements in general health, mood, and quality of life. Notably, increased CD4 counts suggest potential benefits for those on ART who engage in regular exercise (Huang, Zhu, Wiener, Kourtis, & Hoover, 2022). Incorporating aerobic exercises into the management of HIV symptoms, particularly for clients not experiencing severe infections. Customized aerobic exercise regimens involving moderate-intensity activities such as walking, cycling, and rowing are suggested, with progressive resistance training introduced after an initial period of aerobic exercise (Zhang, et al., 2021). The insights into the recommended exercise intensity levels, with MET levels used to gauge oxygen consumption intensities. Activities like low-intensity jogging, walking, dancing, and cycling are endorsed for HIV-positive individuals to enhance their functional capacity (Ho, et al., 2021). There is positive correlation between aerobic exercise and increased CD4 cell counts, highlighting the potential benefits for individuals on ART. In enhancing the immune system key immunological factors such as viral load and CD4 cell count, emphasizing the importance of exercise in enhancing immune function and reducing the risk of opportunistic infections (Geretti, et al., 2021). The concept of functional work capacity and its estimation through maximal oxygen consumption or VO2max. Studies are cited, demonstrating the improvement in functional capacity following aerobic exercise in HIV-positive individuals, the use of RPE and DASI to measure perceived exertion and functional capacity, respectively. The DASI score is associated with improved functional work capacity, providing valuable insights for clinicians.

This study delves into the psychological benefits of exercise, specifically its positive effects on anxiety, depression, and overall mental well-being in HIV-positive individuals. Various studies are referenced, emphasizing exercise as a supplementary treatment for psychological conditions.

This article further suggests incorporating exercise therapy to address psychological symptoms in HIV-positive individuals, advocating for a holistic approach that combines exercise with other therapeutic interventions. This comprehensive review underscores the potential of a 12-week aerobic exercise program to positively impact the functional work capacity of HIV-positive clients on ART. The evidence presented supports the integration of tailored aerobic exercises into the management of HIV, emphasizing the need for further research and the development of exercise protocols specific to the Ugandan context. There is need for increased awareness among clinicians regarding the benefits of exercise in enhancing the overall well-being of HIV-positive individuals (Berzow, et al., 2021).

CHAPTER THREE

Research Design

A quasi-experimental research design was selected for this study.

Location of the Study

The study was conducted at the General Military Hospital (GMH) Bombo in Luwero District, central Uganda.

Target Population

Inclusion and Exclusion Criteria

Sampling Procedure and Sample Size

Quantitative data were analyzed using two-sample t-tests, with a significance level set at p ≤ 0.05. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for all analyses.

The study utilized the Pima point-of-care CD4 analyzer for assessing immunity, accredited by WHO, with quality assurance conducted weekly and during data collection. Alere PIMA demonstrated reliability compared to other machines, with specific sensitivity and specificity values. The RPE scale was employed for predicting VO2max and cardiorespiratory endurance, showing consistency and correlation with other laboratory tests. Functional work capacity was triangulated using the Duke Activity Status Index (DASI), assessing daily living activities. A psychosocial assessment tool from MoH Uganda, validated by experts, was used, and research assistants were trained for participant selection. The study employed the Five A’s psychological counseling framework and a risk mitigation plan for COVID-19. Informed consent and a self-administered PAR-Q were obtained. Exercise sessions, including brisk walking, jogging, and aerobic dance, followed ACSM guidelines. Blood samples were taken using K3 EDTA vacutainers, and CD4 counts were determined by Alere PIMA and reference methods. The Borg RPE scale and DASI were used for analysis. Sub-groups were formed based on exercise days and times, with music tempo progression. Data analysis included predictive analytics for PAR-Q, t-test for comparing experimental and control groups, and SPSS version 20.0 was used for all analyses.

RESULTS

This study aimed to investigate the impact of aerobic exercise on immunological measures (CD4 count) and functional work capacity in HIV-positive clients on antiretroviral therapy (ART) for at least 12 months. The test group engaged in aerobic exercise, while the control group did not. CD4 cell counts were assessed before and after the intervention. Additionally, functional work capacity was measured using the Borg Rate of Perceived Exertion (RPE) scale and Duke Activity Status Index (DASI).

The results indicated that after a 10-minute aerobic exercise at 150bpm, the experimental group showed a shift in perceived exertion from ‘hard to very hard’ to ‘very light to fairly light,’ suggesting improved physical fitness. Pre-test and post-test functional work capacity results were not correlated, and the calculated mean for both groups fell within the 95% confidence interval.

Statistical analysis revealed that the t-test for the experimental group was significant (p < 0.001), rejecting the null hypothesis and suggesting a significant effect of aerobic exercise on functional work capacity in HIV-positive clients on ART. However, the t-test for the control group was not statistically significant.

The findings imply that aerobic exercises improve the functional work capacity of HIV-positive clients on ART. This aligns with existing research supporting the efficacy of aerobic exercise for adults living with HIV. The study provides valuable insights into the potential benefits of aerobic exercise for this population, contributing to the broader understanding of HIV management and well-being.

Recommendations and conclusion

In this study, researchers examined the impact of 12 weeks of moderate-intensity aerobic exercise on HIV positive clients on antiretroviral therapy (ART). The experimental group showed significant improvements in perceived exertion, functional work capacity, VO2max, heart rate, anxiety relief, and phobia reduction compared to the control group. The findings suggest that well-organized aerobic exercises positively influence the physical and psychological well-being of HIV positive individuals on ART. Conclusions include the improvement of CD4 cell counts, the importance of supervised aerobic exercises for clinical outcomes, and the positive effects on psychological markers. Recommendations include incorporating aerobic exercises into HIV care, educating clinicians on exercise prescription, and involving exercise scientists in patient management. The study suggests that such interventions can contribute to improved quality of life, reduced mortality rates, and better overall health outcomes for HIV positive individuals on ART.

REFERENCES

Berzow, D., Descamps, D., Obermeier, M., Charpentier, C., Kaiser, R., Guertler, L., & Camacho, R. (2021). Human immunodeficiency virus–2 (HIV-2): a summary of the present standard of care and treatment options for individuals living with HIV-2 in Western Europe. Clinical infectious diseases,, 72(3), 503-509.

Dirlikov, E., Kamoga, J., Talisuna, S., Namusobya, J., Kasozi, D., Akao, J., & Odeloba, B. (2023). Scale-up of HIV antiretroviral therapy and estimation of averted infections and HIV-related deaths—Uganda, 2004–2022. Morbidity and Mortality Weekly Report,, 72(4), 90.

Geretti, A., Stockdale, A., Kelly, S., Cevick, M., Collins, S., & Waters, L. (2021). Outcomes of coronavirus disease 2019 (COVID-19) related hospitalization among people with human immunodeficiency virus (HIV) in the ISARIC World Health Organization (WHO) clinical characterization protocol (UK):. Clinical Infectious Diseases, , 73(7), e2095-e2106.

Hanson, D., Chu, S., Farizo, K., & Ward, J. (2015). Distribution of CD4+ T Lymphocytes at Diagnosis of Acquired Immunodeficiency Syndrome Defining and Other Human Immunodeficiency Virus Related Illnesses. Archives of Internal Medicine,, 155(14), 1537-1542.

Ho, H., Peluso, M., Margus, C., Matias , L., He, C., Gaisa, M., & Mullen, M. (2021). Clinical outcomes and immunologic characteristics of coronavirus disease 2019 in people with human immunodeficiency virus. The Journal of infectious diseases,, 223(3), 403-408.

Huang, Y., Zhu, W., Wiener, J., Kourtis, A., & Hoover, K. (2022). Impact of coronavirus disease 2019 (COVID-19) on human immunodeficiency virus (HIV) pre-exposure prophylaxis prescriptions in the United States—a time-series analysis. Clinical Infectious Diseases,, 75(1), e1020-e1027.

Malta, M., Strathdee, S., Magnanini, M., & Bastos, F. (2018). Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users:. a systematic review. Addiction,, 103(8), 1242-1257.

Ranganathan, K., & Umadevi, K. (2019). Common oral opportunistic infections in Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome: Changing epidemiology; diagnostic criteria and methods; management protocols. Periodontology 2000,, 80(1), 177-188.

Sharp, P., Bailes, E., Chaudhuri, R., Rodenburg, C., Santiago, M., & Hahn, B. (2021). The origins of acquired immune deficiency syndrome viruses: where and when?. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences,, 356(1410), 867-876.

Ting, P., & Koo, J. (2016). Use of etanercept in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients. International journal of dermatology,, 45(6), 689-692.

Waheed, Y., & Waheed, H. (2017). Pakistan needs to speed up its human immunodeficiency virus control strategy to achieve targets in fast-track acquired immune deficiency syndrome response. World Journal of Virology, , 6(2), 46.

Zhang, X., Krebs, E., Chen, S., Piske, M., Armstrong, W., & Behrends, C. (2021). The potential epidemiological impact of coronavirus disease 2019 (COVID-19) on the human immunodeficiency virus (HIV) epidemic and the cost-effectiveness of linked, opt-out HIV testing: a modeling study in 6 US cities. Clinical Infectious Diseases,, 72(11).

The effects of a 12 weeks aerobic exercise on paranoid ideation, phobia and neuroticism of HIV positive clients on ART

THE EFFECT OF A 12 WEEKS AER OBIC EXERCISE ON IMMUNOLOGICAL MEASURES OF HIV POSITIVE CLIENTS ON ART.

Abstract

Since the identification of Acquired Immune Deficiency Syndrome (AIDS) in 1981, Uganda has grappled with significant challenges due to Human Immunodeficiency Virus (HIV), affecting over 1.5 million individuals. The United Nations Programme on HIV & AIDS (UNAIDS) highlighted Africa’s, particularly Uganda’s, substantial contribution to global HIV infections. People living with HIV (PLHIV) in Uganda face mental health issues, worsened by disruptions caused by the COVID-19 pandemic and Anti-retroviral Therapy (ART) side effects.

The financial burden of HIV treatment, exacerbated by long-distance travel for care, necessitates innovative interventions. Aerobic exercise, with its potential to address symptoms and complications, is underemphasized in Ugandan clinical settings. This study investigates the impact of a 12-week aerobic exercise program on immunological, functional, and psychosocial outcomes in PLHIV on ART.

Literature review reveals a dearth of emphasis on aerobic exercises in managing HIV in Uganda. Existing research supports aerobic exercise’s positive effects on CD4 counts, functional work capacity, and mental well-being. The study’s research design employs a quasi-experimental approach at the General Military Hospital (GMH) Bombo in central Uganda, targeting PLHIV on ART for 12 months or more.

Results indicate a significant increase in CD4 counts and improved functional work capacity in the experimental group compared to the control. The Borg RPE scale shows reduced perceived exertion after exercise. Recommendations include integrating aerobic exercise into HIV care, tailored exercise regimens, and stakeholder involvement to optimize outcomes.

In conclusion, this study demonstrates the potential of structured aerobic exercise to enhance the quality of life for PLHIV on ART, addressing immunological, functional, and psychological aspects. The findings advocate for the integration of exercise interventions into comprehensive care strategies for improved HIV management in Uganda and beyond.

Chapter one

Introduction

Since the identification of Acquired Immune Deficiency Syndrome (AIDS) in humans in 1981, Uganda has undergone noteworthy transformations in the standard of living. Human Immunodeficiency Virus (HIV), the culprit behind AIDS, gradually undermines the immune system, giving rise to various complications. With a population of over 1.5 million individuals grappling with HIV in Uganda, addressing the accompanying challenges is imperative (Marquez et al., 2024).

In 2020, the United Nations Programme on HIV & AIDS (UNAIDS) underscored the global impact of HIV, underscoring its status as a substantial public health concern. Africa, specifically Uganda, shoulders a significant burden, contributing to about two-thirds of new infections worldwide in 2018 (Harris et al., 2022).

People living with HIV (PLHIV) in Uganda often confront mental health disorders, exacerbated by the disruption of mental health services due to the COVID-19 pandemic. Furthermore, the side effects of Anti-retroviral Therapy (ART), while enhancing life expectancy, present challenges such as fatigue, nausea, pain, and diminished functional work capacity.

The financial strain of HIV treatment is considerable, with estimated monthly costs ranging from 254,000/= to 524,000/= for adults. Many PLHIV also grapple with the hardship of covering long distances for treatment, further elevating the cost of care.

Aerobic exercise is emerging as a promising intervention to mitigate the symptoms, complications, and side effects linked with chronic HIV infection. Research suggests that aerobic exercise can enhance overall health, mood, life satisfaction, and quality of life for PLHIV. Despite these advantages, there is a noticeable lack of emphasis on the integration of aerobic exercise in clinical settings in Uganda (Ozemek, Erlandson, & Jankowski, 2020).

Aerobic exercise, characterized by low to moderate-intensity physical activity utilizing oxygen in metabolic processes, offers numerous health benefits. These encompass strengthening muscles, improving circulation efficiency, reducing blood pressure, and enhancing overall well-being. Studies indicate improvements in CD4 counts, a crucial immunological marker, with appropriate exercise (Grace, Semple, & Combrink, 2015).

The present study aims to bridge the knowledge gap by exploring the implications of a 12-week aerobic exercise program on the clinical outcomes of PLHIV on ART across various regions of Uganda. Focusing on immunological measures, functional work capacity, and psychosocial markers, the study endeavors to provide valuable insights into the potential benefits of aerobic exercise in the Ugandan context. While ART has undeniably enhanced the lives of PLHIV, challenges persist in advanced HIV illnesses, indicating suboptimal clinical outcomes. Adverse alterations linked to ART, compounded by factors like obesity and a sedentary lifestyle, underscore the necessity for adjunct therapies. Aerobic exercise therapy has the potential to augment the quality of life, reduce the overall cost of HIV treatment, and address psychological effects and non-communicable diseases (Grace, Semple, & Combrink, 2015).

The Ministry of Health’s guidelines advocate for aerobic exercise as an intervention for PLHIV, but the lack of specific details on the exercises and their benefits presents a challenge. This study endeavors to fill this void by scrutinizing the impact of aerobic exercise on clinical outcomes in Uganda.

The implications of aerobic exercise on the clinical outcomes of HIV-positive clients in Uganda are profound and merit attention. Tackling the challenges faced by PLHIV through interventions like aerobic exercise can contribute to improving the overall health, well-being, and quality of life of individuals living with HIV. This study aspires to offer valuable insights that can shape healthcare practices and policies for enhanced HIV management in Uganda, aligning with the topic.

Literature review

The management of Human Immunodeficiency Virus (HIV) through Antiretroviral Therapy (ART) has improved the quality of life for People Living with HIV (PLHIV). Despite the benefits, ART is associated with potential side effects impacting overall well-being. This article investigates the potential benefits of a 12-week aerobic exercise program on immunological measures in HIV-positive clients on ART (Somarriba, Neri, Schaefer, & Miller, 2010).

Antiretroviral Therapy, particularly Highly Active Antiretroviral Therapy (HAART), has improved the quality of life for PLHIV. However, side effects such as fatigue, nausea, and psychological issues affect patients. Aerobic exercises, particularly low-intensity and long-duration ones, have shown positive impacts on physical and mental health, providing an alternative therapy. Research indicates improvements in general health, mood, and life satisfaction among HIV-positive individuals engaging in aerobic exercises (Ceccarelli, et al., 2014).

Studies have observed significant increases in CD4 counts among HIV-positive individuals on ART engaging in regular aerobic exercise, suggesting potential benefits in immunological measures. Despite global research on exercise benefits, there is limited emphasis on aerobic exercises in managing HIV-positive clients in Uganda, emphasizing the need for more studies (Maharaj, & Yakasai, 2018).

Aerobic exercise is consistently listed as one of the most popular self-care therapies for managing HIV and AIDS-related symptoms. Integrating aerobic exercises into the treatment regimen is recommended to extend the asymptomatic phase, reduce drug use, lower healthcare costs, and enhance overall treatment outcomes (Sundermann et al., 2019).

The measurement of immune activation and cellular concentration of HIV illness is crucial. Studies show that a 12-week aerobic exercise program can positively impact lipid profiles and CD4 cell counts, indicating improvements in immune function. However, the correlation between viral load, CD4 count, and exercise regimen compliance requires further exploration (Daniels, & Van Niekerk, 2018).

Functional work capacity, often estimated through VO2max, is crucial for individuals with HIV infection. Research suggests that aerobic exercise can significantly improve VO2max and functional work capacity in HIV-positive individuals. Utilizing the Duke Activity Status Index (DASI) and Rating of Perceived Exertion (RPE) can provide insights into the effectiveness of exercise interventions on functional capacity (Pedersen, & Saltin, 2015).

Psychological markers, including anxiety, depression, and overall mental well-being, play a significant role in the overall health of PLHIV. Various studies indicate that aerobic exercise has antidepressant and anxiolytic properties, positively influencing mental health outcomes.

A 12-week aerobic exercise program holds promising potential for positively influencing immunological measures, functional work capacity, and psychological markers in HIV-positive clients on ART. Further research and clinical emphasis on tailored aerobic exercise regimens are essential to optimize the overall health and well-being of individuals living with HIV. As Uganda and other regions continue to address the challenges of HIV/AIDS, incorporating evidence-based exercise interventions into comprehensive care strategies may contribute to improved outcomes for PLHIV (Del Fabbro, 2019).

Living with HIV poses not only physical challenges but also significant psychological burdens for individuals on ART. According to Seid et al. (2020) revealed a two-fold increased risk of poor treatment outcomes and mortality from AIDS among individuals with chronic depressive symptoms. Depression, anxiety, and neuroticism are prevalent in those living with HIV, often leading to insomnia and further exacerbating their mental health struggles. However, interventions such as stress management, aerobic exercise, and a combination of massage and exercise have shown promise in alleviating psychological symptoms and improving overall mental health (Ahmadi, H., & Daneshmand, 2014).

Numerous studies highlight the positive impact of aerobic exercise on psychological markers. Exercise has been shown to reduce symptoms of anxiety and depression, with high-intensity workouts proving more effective in some cases. The combination of exercise and antidepressants has demonstrated improved clinical outcomes, emphasizing the potential of structured exercise programs in enhancing the quality of life for individuals with anxiety disorders (Abd El-Kader, et al., 2015).

As HIV infection transitions into a chronic condition due to advances in ART, the importance of managing comorbidities and promoting overall health becomes paramount. Studies emphasize the role of aerobic exercise in slowing disease progression, enhancing immune function, and improving various health indices in HIV-positive clients. Exercise has shown to mitigate side effects of ART, such as inflammation, oxidative stress, and mitochondrial dysfunction. While existing studies provide valuable insights, there is a gap in research specific to Uganda and a lack of clarity on the types and intensity of exercises undertaken by participants. This article underscores the need for tailored exercise programs, specifying intensity, duration, and types of exercises to maximize the benefits for HIV-positive individuals on ART (Baute et al., 2019).

The multifaceted impact of aerobic exercise on both psychological well-being and immunological measures in HIV-positive clients on ART is explored. Structured exercise programs have the potential to address not only the psychological challenges associated with living with HIV but also contribute to immune modulation and overall health improvement (Chetty, Cobbing, & Chetty, 2021). Further research, particularly in the context of Uganda, is needed to guide clinicians in designing effective and culturally relevant exercise interventions for this population. As the evidence suggests, integrating aerobic exercise into the comprehensive care of HIV-positive individuals can significantly enhance their quality of life and contribute to long-term well-being.

CHAPTER THREE

Research Design

A quasi-experimental research design was selected for this study.

Location of the Study

The study was conducted at the General Military Hospital (GMH) Bombo in Luwero District, central Uganda.

Target Population

Inclusion and Exclusion Criteria

Sampling Procedure and Sample Size

Quantitative data were analyzed using two-sample t-tests, with a significance level set at p ≤ 0.05. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for all analyses.

RESULTS

This study aimed to investigate the impact of aerobic exercise on immunological measures (CD4 count) and functional work capacity in HIV+ clients on ART for at least 12 months. The experimental group engaged in aerobic exercise, while the control group did not. CD4 cell counts were measured before and after the intervention. The experimental group showed a significant increase in CD4 count, with a mean of 167.776, falling within a 95% confidence interval. The control group’s CD4 count mean was -35.583, not significant.

The p-value for the experimental group was <0.001, rejecting the null hypothesis that aerobic exercise has no effect on immunological measures. The findings suggest that moderate-intensity aerobic exercises positively impact CD4 levels, improving the quality of life for HIV+ clients on ART. Results align with previous studies showing increased CD4 counts with aerobic exercise, supporting the idea that individuals on ART benefit more from exercise.

The study used the Borg Rate of Perceived Exertion (RPE) scale to assess perceived exertion before and after a 10-minute aerobic exercise at 150bpm. The post-test RPE scores for the experimental group indicated lower perceived exertion, suggesting improved physical fitness.

The study’s outcomes are consistent with previous research, supporting the hypothesis that aerobic exercise positively affects the functional work capacity of HIV+ clients on ART. However, the results contrast with some studies, emphasizing the importance of well-organized and scheduled exercise. Overall, the findings highlight the potential benefits of aerobic exercise for individuals living with HIV on ART, not only in immunological measures but also in functional work capacity.

Recommendations and conclusions

The study evaluated the impact of 12 weeks of well-structured, supervised aerobic exercises on the CD4 cell count of HIV-positive individuals on antiretroviral therapy (ART). The experimental group showed a significant increase in mean CD4 count, while the control group experienced a slight decline. The results suggest that aerobic exercises positively affect the immunity of participants, with a notable difference between the experimental and control groups in post-test to pre-test mean CD4 counts. The t-test confirmed the statistical significance of the experimental group’s results.

The findings imply that organized aerobic exercises play a crucial role in improving clinical outcomes for HIV-positive individuals on ART by raising CD4 cell counts, providing protection against opportunistic infections. The study recommends the incorporation of aerobic exercise as an additional therapy in the care and treatment of HIV-positive clients, with specific actions suggested for various stakeholders, including the Ministry of Health (MoH), clinicians, education institutions, exercise scientists, and mental health experts. Additionally, the study proposes the inclusion of exercise physiology in the training of clinicians and counselors and advocates for the integration of physiotherapists in the management of PLHIV for appropriate exercise prescription and education. Overall, the study underscores the potential of aerobic exercise to enhance the quality of life for HIV-positive individuals on ART.

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