Michael Carter October 2, 2019
Exercise reduces symptoms of depression and anxiety in people living with HIV, according to the results of a meta-analysis published in the Journal of Psychosomatic Research . The research also showed that aerobic exercise, training at least three times a week, and exercise under professional supervision had the greatest benefits.
"The meta-analysis results for depression revealed a large and significant effect on depressive symptoms," the authors commented. "A large and significant effect was also found for anxiety after treatment."
The researchers believe their findings have immediate clinical relevance and that exercise can be recommended for people with HIV. However, they do not consider their results definitive and believe that large studies are needed to fully determine the type and intensity of exercise that is most beneficial for people with HIV and anxiety or depression.
It is estimated that the prevalence of anxiety and depression is two to four times higher among HIV-positive adults than among their HIV-negative peers of the same age and sex. The beneficial effects of exercise in relieving the symptoms of anxiety and depression in the general population are well recognized. A similar effect has been observed in small studies with people living with HIV.
Dr. Andreas Heissel of the University of Potsdam and his colleagues wanted to expand upon these studies. Therefore, they conducted a meta-analysis to synthesize the results of research exploring the benefits of exercise for depression and anxiety in adults with HIV. They limited their analysis to randomized controlled trials comparing individuals who exercised with those who did not. To be included, studies had to include a post-intervention assessment of depression or anxiety symptoms.
A literature review identified ten eligible studies. These were published between 1990 and 2018 and involved a total of 479 people. Slightly less than half of the participants were women. At the start of the study, participants did not necessarily have mental health symptoms or a diagnosis. The studies were conducted in a wide range of geographic settings, including sub-Saharan Africa, India, the United States, Iran, and Germany.
Eight of the studies examined the impact of traditional types of aerobic and resistance training, and two evaluated yoga. The exercise intervention lasted between four and 12 weeks. The training frequency ranged from two to six sessions per week, with sessions lasting between 45 and 75 minutes. In five of the studies, the exercise was supervised by a professional such as a personal trainer, physical therapist, or yoga instructor.
The use of antiretroviral therapy was reported in six studies, and data on antidepressant use were provided for two. The studies had a high retention rate, and overall, 90% of participants completed follow-up.
Nine of the studies reported on depression and five analyzed anxiety. The methodology of five of the studies was assessed as high quality, while the others were assessed as low quality with a high risk of bias in their findings.
Of the nine studies that analyzed depression, five were rated as high quality. Overall, the results showed that exercise had a highly significant effect on depressive symptoms compared to the control group (p = 0.002).
Only two of the five anxiety studies were rated as having high-quality methodology. Again, the pooled results showed a positive effect, with anxiety symptoms significantly reduced in the intervention group compared to the controls (p = 0.004).
Subgroup analyses were only possible for studies that examined depression. These secondary analyses showed that aerobic exercise, training at least three times per week, and supervised exercise had the greatest impact on depressive symptoms.
The authors believe their findings can help guide care for people with HIV and comment: "This meta-analysis showed the benefits of exercise in reducing symptoms of depression and anxiety far beyond the well-researched benefits for overall health in people living with HIV."
Heissel and colleagues also note that their findings have highlighted several gaps in the research. These include the impact of exercise based on gender and age, as well as the competence and empathy of those supervising the training. Overall, they call for larger studies with robust methodologies. References
Heissel A et al. Effects of exercise on depression and anxiety in people living with HIV: a meta-analysis . Journal of Psychosomatic Research, 126, 2019. https://doi.org/10.1016/j.psychores.2019.109823