Research proposal
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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