Physical activity interventions for cardiometabolic and psychosocial outcomes in people living with HIV in sub Saharan Africa: A systematic review.

Abstract

Antiretroviral therapy (ART) has extended the lifespan of people living with HIV (PWH), resulting in a growing burden of cardiometabolic disease (CMD) associated with chronic HIV infection and the effects of ART. Physical activity (PA) may reduce CMD risk while improving psychosocial health among PWH. We systematically reviewed the efficacy of PA interventions for improving cardiometabolic and psychosocial outcomes among PWH in sub-Saharan Africa (sSA). Web of Science, PubMed, African Index Medicus, Embase, and CINAHL were searched from inception to 10 August 2023 for randomised controlled trials and quasi-experimental studies published from 2000 onwards involving adults with HIV in sSA. Methodological quality was assessed using the PEDro scale and Downs and Black checklist, and findings were synthesised narratively. Seventeen studies involving 1,130 participants met the inclusion criteria and generally demonstrated good methodological quality. Most participants were female (51%), and all studies included PWH receiving ART. Interventions included aerobic exercise (n = 8), resistance exercise (n = 3), combined aerobic and resistance exercise (n = 5), while one study did not report exercise modality. Intervention durations ranged from 6 weeks to 12 months. Nearly all studies reported improvements in cardiometabolic outcomes, including blood pressure, lipids, body mass index, body fat percentage, and waist circumference, and/or psychosocial outcomes, including depression, anxiety, self-efficacy and quality of life. Two studies assessing PA outcomes reported significant improvements in step count and metabolic equivalents per week. Limitations included small sample sizes and generally short post-intervention follow-up, limiting assessment of sustained benefits and cardiovascular events. PA interventions may therefore be a valuable addition to standard HIV care in sSA. Future research should identify optimal exercise modalities, duration, and intensity and develop feasible, context-sensitive, scalable interventions, particularly for resource-constrained and underserved populations.

Systematic review registration: PROSPERO registration ID: CRD42021271937.