Although the human body is designed to be physically active for both survival and optimal physiological functioning, in the current era of sedentary jobs, poor public transportation and urban walkability, unpredictable climate events, digital social networking, and even (ahem) binge watching Netflix, we are less active today than we were 20 years ago. And, in those past 2 decades, the trajectory of HIV disease has dramatically changed, with persons living with HIV (PLWH) surviving into their eighth, ninth, and even their 10th decade of life. This month's issue of the JANAC strengthens the growing evidence that physical activity is second only to adhering to antiretroviral therapy for improving quality and quantity of life.
Many of us have advised our patients to stay active as a way of improving brain health and aging well. Yet until recently, few studies had confirmed the health-promoting effects of physical activity in HIV-infected populations. In their integrative review of physical activity and cognitive health, Winston et al. found that physical activity was associated with improved cognitive health among adults living with HIV (Winston et al., 2020). Among the seven studies they reviewed, there was a consistent, significant, moderate-to-high relationship between self-reported physical activity and various domains of cognitive health. Although most of the studies reviewed were cross sectional, one longitudinal study indicated that higher levels of physical activity may slow cognitive decline in PLWH. Also, in this issue of JANAC, Rubtsova et al. found that frailty exerted a negative influence on health-related quality of life in PLWH. Frailty was found to be elevated in PLWH compared with demographically similar, HIV-uninfected adults, and a subset of PLWH experienced frailty at earlier ages (Rubtsova et al., 2020). Yet, although there are few interventions to reduce frailty, increasing physical activity throughout the lifespan is a key prevention and treatment strategy (Beaudart et al., 2017).
Our patients want and need evidence-based recommendations regarding the duration, frequency, and types of physical activity that will maintain and/or improve their health. Currently, PLWH are encouraged to follow the Department of Health and Human Services' guidelines that all adults, even those with chronic health conditions, engage in 150–300 min of moderate intensity or 75–150 min of vigorous intensity physical activity per week. In addition, they should engage in muscle strengthening activities at least 2 days per week (Montoya et al., 2019). Like so many in the general population, few PLWH achieve these goals. The current study by de Oliveira et al. offers insights into how PLWH can tailor their physical activity and muscle strengthening regimens to meet the recommended targets. They found that PLWH were less active on the weekends and thus recommended that providers encourage them to increase their activity throughout the week to compensate (Oliveira et al., 2020).
There are several clinical tools that can inform our development of precision-based plans to help our patients meet their personal goals and recommended targets. One is the two-item exercise vital sign. This tool asks patients how many days per week they engage in moderate to vigorous exercise (like a brisk walk) and, on average, how many minutes they exercise at this level. The results allow providers to offer informed recommendations regarding physical activity levels needed to meet recommended targets. For example, if an individual has not engaged in any physical activity, starting with 2–3 short, brisk walks per week may be a manageable starting place. This brings us to a second helpful and underused clinical tool—the exercise prescription. An exercise prescription succinctly and clearly communicates physical activity parameters, including frequency, intensity, duration, and type. Exercise prescriptions have demonstrated effectiveness and are gaining traction in primary care settings across the country. For some examples of exercise prescription formats, we encourage you to review the Exercise is Medicine® website hosted by the American College of Sports Medicine.
All nurses in HIV care have an opportunity to help PLWH increase their physical activity, which, as this month's JANAC makes clear, is important to their health and well-being across their lifespan. The message is simple, whether your patients move to Oliva Newton-John or Dua Lipa, indoors or outdoors, the important thing is to get out there, get moving, break a sweat, and do it again and again.
The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.
Beaudart C., Dawson A., Shaw S. C., Harvey N. C., Kanis J. A., Binkley N., Reginster J. Y., Chapurlat R., Chan D. C., Bruyère O., Rizzoli R., Cooper C., Dennison E. M., & IOF-ESCEO Sarcopenia Working Group. (2017). Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporosis International, 28(6), 1817–1833.
Montoya J. L., Jankowski C. M., O'Brien K. K., Webel A. R., Oursler K. K., Henry B. L., Moore D. J., Erlandson K. M. (2019). Evidence-informed practical recommendations for increasing physical activity among persons living with HIV. AIDS, 33(6), 931–939.
Oliveira V. H. F., Currie J., Horvat D. C., Josephson R. A., Silva D. R. P. D., Deminice R., Webel A. R. (2020). Weekday and weekend physical activity and stationary behavior patterns of people living with HIV. The Journal of the Association of Nurses in AIDS Care: JANAC, 31(3), XXX.
Rubtsova A. A., Sabbag S., Sundermann E., Nguyen A. L., Ellis R. J., Moore D. J., Letendre S., Jeste D. V., Marquine M. J. (2020). Frailty and neurocognitive impairment: Impacts on quality of life in HIV. Journal of the Association of Nurses in AIDS Care, 31(3), XXX.
Winston N., Swanson B., Capuano A. W., Fogg L. F., Barnes L. L. (2020). Physical activity and cognitive health among people living with HIV: An integrative review. The Journal of the Association of Nurses in AIDS Care: JANAC, 31(3), XXX.