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Table 1 Study characteristics

From: Effects of physical exercises on inflammatory biomarkers and cardiopulmonary function in patients living with HIV: a systematic review with meta-analysis

Study (Country), Design, Attrition Participants Interventions Outcomes Conclusion
Aweto et al. [66] (Nigeria), RCT, 17.5% People living with HIV on HAART (n = 40). Intervention: Aerobic exercise training three times a week for 6 weeks and counseling. Control: Control group received Counseling. Cardiopulmonary function: FEV1 assessed at baseline and at 6th week. FEV1 significantly improved in the study group compared with the control group
Bonato et al. [59] (New Zealand), Pilot clinical trial, 28.6% Sedentary HIV-infected persons (cART-treated) with metabolic complications (n = 49). Intervention: 12-week exercise training, consisting of three sessions per week of 60 min brisk walking with (strength-walk group) or without (walk group) 30 min circuit-training. Control: Pre-test- post-test walk-strength group. Inflammatory biomarkers: High sensitivity CRP, Interleukin-6, 18, D-dimer, soluble CD14. Outcome assessed at baseline and at 12 weeks. Brisk walking, with or without strength exercise, could improve lipid profile and inflammatory markers in chronic HIV infection.
Dolan et al. [36] (USA), RCT, 5% HIV-infected women with increased waist-hip ratio and self-reported fat redistribution (n = 34). Intervention: Home based aerobic exercise (60–75% of MaxHR, 20–30 min) and progressive resistant exercise with equipments (60–80% of 1-RM, 3–4 sets of 8–10 RM). Control: Maintained normal activities. Cardiopulmonary function: VO2max. Outcome assessed at baseline and at 16th week. There was a significant improvement in VO2max after 16 weeks of aerobic training relative to the control group.
Dudgeon et al. [61] (Columbia), RCT, 21.63% HIV infected men (n = 37). Intervention: For MOD group, 30 mins of aerobic exercise at 60–65% of age-predicted max HR and upper-body/lower-body resistant exercise (60% of 1-RM). For LOW group, 60 min of low intensity exercise (50% of age predicted max HR). Control: Did not receive any activity. Inflammatory biomarkers: interleukin-6, soluble TNfrereceptor II. Outcome assessed at baseline 30, 30-mins post exercise, 60-mins post exercise. There was an increase in Il-6 from baseline to post 30 (31%) and post 60 (23%) in the MOD group while the LOW group had a 3.5% decrease in sTNFrII (p < 0.05) at 30-mins post exercise compared with baseline.
Dudgeon et al. [60] (Columbia), RCT, 31.54% HIV infected men (n = 111). Intervention: 30 mins of moderate intensity aerobic exercise training on a treadmill or stationary cycle (60–75% of age-predicted max HR) and lower-body/upper-body resistant exercise (12-RM). Control: Did not receive any activity Inflammatory biomarkers: Interleukin-6, 1β. Outcome accessed at baseline and 6th week Although, there was no detectable change in the level of IL-6, IL-1β was significantly elevated.
Ezema et al. [67] (Nigeria), RCT, 9.1% People Living with HIV who are receiving ART (n = 30). Intervention: Moderate intensity continuous aerobic exercise training (60–79% of the maxHR, 40–60 min, 3 times/week) on a treadmill. Control: Conventional therapy involving ART and counseling. Cardiopulmonary function: VO2max. Outcome assessed at baseline and at 8th week. Moderate intensity continuous exercise program had a significant effect on VO2max.
Farinatti et al. [68] (Brazil), RCT, nil Seropositive patient treated with HAART. Intervention: Aerobic exercise on cycle ergometer (30 mins); strengthening exercises (3 sets of 12 reps; Flexibility exercise (10 mins). Control: Participants did not receive any exercise. Cardiopulmonary function: VO2max. Outcome assessed at baseline and at 12th week. Overall training can improve aerobic fitness of HIV-infected patients with no negative effect on their immunological function.
Hand et al. [69] (Columbia), RCT, 34.88% HIV-infected men and women (n = 43). Intervention: Aerobic exercise training on threadmill (30 mins, 50–70% of age predicted MHR) and upper-body/lower body resistance training (20 mins, 12-RM). Control: wait-list Cardiopulmonary function: VO2 max. Outcome assessed at baseline and at 6thweek. There was a significant increase in estimated VO2 max (p = 0.001) using moderate exercise training
Mangona et al. [70] (Mozambique), RCT, 15% HIV+ African Women taking ART (n = 53). FEG: 20 mins of cycling at 60–85% of V2 peak and muscular endurance; circuit training consisting of 6 free weight exercises (15-RM); stretching exercises (n = 19) PEG: recreational activities Control: No exercise Cardiopulmonary function: VO2 max. Outcome assessed at baseline and at 12th week. Cardiopulmonary fitness increases significantly in VO2 peak (FEG: 14.8%; PEG: 11.1%) with no significant difference in the CG
McDermott et al. [65] (Ireland), RCT, 15.4% HIV+ patients without any known cognitive function (n = 13). Supervised session of exercise training (ergometer, treadmill, cross trainer); 40–75% of HRreserve and unsupervised session (jogging, brisk walking, cycling) 3 times per week. Control: Advised to continue with normal routine. Cardiopulmonary function: VO2max. Outcome assessed at baseline and at 16th week. Aerobic exercise had no effect on aerobic fitness or cognitive function.
Mutimura et al. [77] (Rwanda), RCT, 4% HIV+ patients with moderate to severe Body fat redistribution (n = 150). Supervised training program (stretching, aerobic and strengthening exercises) 45–75% of age predicted Max HR. Control: Participants did not perform any exercise training. Cardiopulmonary function: VO2peak. Outcome assessed at baseline and at 6th month. Exercise training positively improved cardiorespiratory fitness in HAART-treated HIV+ Africans.
Patil et al. [73] (India), RCT, 40% HIV-positive females (n = 40). Aerobic exercise (brisk walking, 50–70% of VO2max) and resistance exercise via free weight. Control: Advised to continue their routine level of daily tasks and activities. Cardiopulmonary function: VO2peak. Outcome assessed at baseline and at 8th week. Moderate intensity improved aerobic capacity in experimental HIIV group.
Perna et al. [72] (South Florida), RCT, 34.88% Symptomatic HIV-1 seropositive men and women (n = 43). An interval cycling exercise program (3 times per week) for 3 months; 45 mins, 70–80% of mHR. Control: Continued with usual activity (wait-list). Cardiopulmonary function: VO2peak, O2 pulse, Tidal volume. Outcome assessed at baseline and at 12th week. Functional aerobic limitations common in HIV-infected individuals can be reversible through exercise adherence.
Pedro et al. [76] (Brazil), RCT, 43.1% Adults living with HIV (n = 58). Intervention: Concurrent training (15–20 min of aerobic exercise; 50–70% of HRrest plus 40 mins of resistant exercise; 2–3 sets of 8–12 RM) 3 times per week The resistant exercise involves free weights & machine. Control: Optional Recreational activities (once/twice per week). Cardiopulmonary function: VO2peak, VO2sub, peak speed. Outcome assessed at baseline and at 16th week. Concurrent training was effective in improving cardiopulmonary fitness and endurance.
Pedro et al. [62] (Brazil), RCT, 42.86% Adults living with HIV (n = 49). Concurrent training consisting of 20-min aerobic exercise training on a treadmill (50–70% of HR) and resistant training (8 exercises via free weights or machine, 2–3 sets of 8–12 RM). Control: 60 min of recreational activities comprising of dancing, walking, stretching. Inflammatory biomarkers: Intrleukin-4, 5, 6, 8, 10, Tumor Necrosis Factor-alpha, IFN-ϒ. Outcome accessed at baseline and 16th week. Concurrent training decreased the pro-inflammatory effects of IL-5, IL-5, 8, 10 in HIV infected people undergoing ART.
Smith et al. [71] (USA), RCT, 18% HIV-1 Infected adults (n = 60). Intervention: Supervised aerobic exercise training program (3x per wk) for 30 mins, 60–80% of VO2 max. Control: Continued with usual activity (wait-list) Cardiopulmonary function: FEV1, Vo2 max. Outcome assessed at baseline and at 12th week. There was a beneficial increase in VO2max by 2.6 mL/kg.
Stringer et al. [75] (California), RCT, 23% HIV positive subjects (n = 34). Intervention: For MOD, aerobic exercise (80% of LAT work rate, 3 times per week). For HEAVY: aerobic exercise (50% of difference between their LAT and their VO2 max) for 30–40 min on cycle ergometer. Control: Maintained current level of activity without change. Cardiopulmonary function: FEV1, VO2max. Outcome assessed at baseline and at 6th week. Aerobic fitness increased was significantly in both the EX groups relative to the control group.
Roos et al. [63] (South Africa), RCT, 39.2% HIV-infected individuals with the risk factor of Ischemic Heart Diseases (n = 84). Intervention: Education and home-based pedometer walking program to improve participants’ activity.30 min walking program 3 or 5 times a week over a 12-week period. Control: continued with standard clinic management High Sensitivity CRP. Outcome assessed at baseline and at 12 weeks. Intervention had no effect on CRP.
Terry et al. [74] (Brazil), RCT, 28.57% Carriers of HIV-1 virus who had hyperlipidemia (n = 42). Intervention: Aerobic exercise training (30 mins of the target intensity) using treadmill and stretching exercises. Control: 45 mins of soft stretching and relaxation routine without significant elevation of HR Cardiopulmonary function: VO2max. Outcome assessed at baseline and at 12th week. Intervention resulted in a significant improvement in VO2max for the Diet/EX group compared to the Diet-only group.
Vingren et al. [64] (USA), RCT, nil Men infected with HIV and recently admitted to an inpatient substance facility (n = 30). Intervention: Progressive overload Resistance training program comprising of free weight and cable controlled exercise (3x per week, 3–5 sets of 5–12 reps). Control: Maintained usual daily activities. Inflammatory biomarkers: IL-10, 6, 4, 2, 1β, IFN-ϒ Outcome assessed at baseline and at 6th week. Intervention had no effect on basal concentration of circulating cytokines for men living with HIV and undergoing treatment for substance abuse.
Zanetti et al. [80] (Brazil), RCT, nil Previously sedentary people infected with HIV (n = 30). Intervention: Non-linear Resistance intervention with free weight exercises on 3 alternate days. Control: Maintained daily habits. Inflammatory biomarkers: Interlleukin-6, 8, 10, 1β. Outcome assessed at baseline and at 12th week. There was an increase in IL-10, and a decrease in IL-1β, IL-6, IL-8, TNF-α.
Zanetti et al. [44] (Brazil), RCT, nil People living with HIV that are on HAART (n = 30). Intervention: Supervised nonlinear Resistance training program 3times per week on nonconsecutive days via free weight. Control: Maintained usual daily activities High Sensitivity CRP. Outcome assessed at baseline and at 12th week. There was a significant reduction in CRP levels in inflammatory markers in PLHIV.