Effectiveness of Exercise Training on Mental Health, Physical Activity Level and Social Participation in People Living with HIV/AIDS: A Systematic Review and Meta-Analysis

Abstract Background: Exercise training may increase physical activity(PA) level, improve social participation and mental health in people living with HIV/AIDS(PLWHA). Thus, a systematic review was conducted to answer the review question: what is the effectiveness of physical exercise training on mental health, physical activity level and social participation in PLWHA? Method: Eight databases namely: PubMed, Emcare, Cochrane Library, Embase, CINAHL, AMED, PsycoINFO and MEDLINE – were systematically searched from 1990 till August 2019. This review includes only studies published in English language, on adults (>18years) and are either on HAART/HAART-naïve; only RCTs that gave exercise intervention and assessed mental health, physical activity level and social participation on HIV/AIDS patients. The primary outcomes were mental health, PA level and social participation, while the secondary outcomes included psychological disorders. Results: Meta-analysis of the five (out of seven) included studies for depression that met the inclusion criteria (n=346 participants) comprising males/females aged≥18 years, show a significant overall effect (SMD=-0.89,[95%CI:-1.77,-0.01],Z=1.97,p=0.05) of exercise compared to the control group at post-intervention. However, statistical heterogeneity was high (I2=91%,X2=53.14,df=5,p<0.00001). The removal of two papers during sensitivity analysis for missing data/baseline differences showed a large significant effect (SMD=-1.01,[95%CI:-1.45,-0.57],Z=4.48,p=<0.00001). The statistical heterogeneity was low (I2=39%,X2=4.94,df=3,p=0.18). The results demonstrate a significant trend towards a decrease in depressive symptoms for participants in the exercise compared to no exercise group; aerobic exercise compared to normal routine activity group; aerobic and resistance exercise compared to other control groups. Narrative synthesis demonstrates the beneficial effects of exercise training on outcome measures: anxiety and cognitive function, apart from other psychological benefits. There was limited and no RCTs on the effects of exercise on physical activity level and social participation, respectively.Conclusion: Combined exercise (Aerobic exercise+Strength training; 80mins/session; 3X/week for 12weeks.) + routine counselling OR Aerobic exercise training+counselling 40mins per session; 3X/week for 6weeks OR Combined exercise: Aerobic and Resistance exercise training 50mins/session; 2X/week for 6weeks OR Combined exercise: Aerobic and Resistance exercise training 60mins/session; 3X/week for 24weeks OR Aerobic exercise training 60mins per session; 3X per week for 12weeks may improve mood disorders while therapeutic exercise(2X per week for 6weeks) may improve psychological wellbeing.