Background: HIV infection and use of highly active antiretroviral therapy are associated with increased expression of pro-inflammatory biomarkers and major affective disorder. There is a growing research interest in aerobic exercise as an adjunct therapy on inflammatory outcomes and depression in people living with HIV (PLHIV) who are undergoing antiretroviral therapy. Synthesizing and appraising available evidence may be essential to guide practice and future research on exercise intervention to this population. This review evaluated the effects of aerobic exercises on serum levels of high-sensitivity C-reactive protein (hs-CRP) and depressive symptoms in PLHIV.
Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in conducting this review. A systematic search was conducted in seven relevant databases until February 2018. In addition, the reference lists of identified studies were also searched. We included clinical trials that investigated the effects of aerobic exercises on hs-CRP and/or depression in PLHIV. Two reviewers independently screened all the articles for eligibility (kappa= 0.89) and also evaluated the risk of bias using the Cochrane Collaboration risk of bias assessment tool (α=0.84). Data were extracted and meta-analyses conducted using Review Manager (RevMan 5.3) software.
Results: Six studies comprising of 261 participants (41% females) within the age of 18 years and above met the inclusion criteria and were included in the review. Only two out of the six included clinical trials were appraised as high quality, culminating to low-GRADE evidence. A meta-analysis of four homogenous studies that reported depression outcome was conducted. The result showed a significant decrease in depression scores (p< 0.0002, standardized mean difference= -0.71, CI: -1.07 to -0.34) following aerobic exercise interventions. The two studies that reported on hs-CRP outcome, found no significant effect of aerobic exercise on hs-CRP.
Conclusions: Aerobic exercise interventions of frequency: 3-5 sessions/week; Intensity: 55-75% of age-predicted maximal heart rate, 60-80% of VO2 max, 50-80% of heart rate reserve; Time: 24-60 minutes and Type: continuous or interval, appear beneficial in reducing depressive symptoms in PLHIV. There was no observed significant effect on hs-CRP. However, further homogeneous, high-quality trials with enough “power” are necessary for a conclusive estimate of effects.