2020 Theses Doctoral

Physical Activity among Adults Living with HIV/AIDS: Interventions, Predictors, and Measurement

Voigt, Natalie

The purpose of this dissertation was to investigate the physical activity (PA) patterns of adults living with HIV (ALWH). To achieve this purpose, the aims of this dissertation were to assess the impact of supervised PA interventions on the functional capacity of ALWH (ages 18 and over), assess potential environmental factors that acted as barriers or facilitators to regular PA participation in older ALWH (ages 50 and over), and attempt to validate a PA instrument that measured routine PA in older ALWH (ages 50 and over) that classified these individuals as low, moderately, or vigorously physically active.

The first study, Supervised Physical Activity and Improved Functional Capacity among Adults Living with HIV: A Systematic Review, aimed to investigate whether PA interventions supervised by clinical or allied health professionals improved functional capacity in ALWH aged 18 and over. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Of the 8,267 articles that resulted from the database search, 15 articles were included after screening. We found that supervised PA interventions improved functional capacity outcomes (i.e., strength, cardiovascular fitness, and flexibility) in ALWH and that the presence of clinical or allied health professionals during PA may motivate them to regularly participate in PA. This study was published in the September/October issue of the Journal of the Association of Nurses in AIDS Care in 2018. The second study, The Role of Environment on Physical Activity Patterns of Older Adults Living with HIV, aimed to investigate the PA patterns of older ALWH and the relationship between environmental factors and PA in this population. This study was a secondary analysis of data from 100 adults, aged 50 and over, living with HIV in New York City (NYC). Descriptive statistics assessed PA patterns. Linear regression assessed the association between environmental factors and the time spent in PA. Participants were 50% female, ranged from 50-71 years, and had HIV for an average of 23 years. Participants performed below their functional capacity and males walked farther than females on the Six Minute Walk Test. In this sample, the presence of traffic hazards was the sole environmental predictor of PA participation. The third and final study, Validation of the Modified Baecke Questionnaire in Older Adults Living with HIV, aimed to assess the known groups validity, predictive validity, and internal consistency reliability of the modified Baecke Questionnaire (mBQ) in a sample of U.S. ALWH, aged 50 and older. The mBQ measures routine PA over the past 12 months and classifies participant activity as low, moderately, or vigorously physically active. This study was a secondary analysis of data from 100 adults with HIV in NYC. T-tests assessed known groups validity, comparing the physical health of older (> 50 years) to younger (< 50 years) ALWH; correlations and linear regression assessed predictive validity; and Cronbach’s alpha coefficient measured internal consistency reliability. The mBQ demonstrated adequate predictive validity but limited known groups validity. Internal consistency reliability was not established. Subsequently, factor analyses were performed and three items were removed from the mBQ. In this revised version of the mBQ, internal consistency reliability and construct validity were established.

This dissertation contributes three important additions to the current HIV literature. First, the dissertation adds evidence to support the expanded role of nurses as clinical professionals to motivate ALWH to regularly participate in PA. Second, it adds two studies conducted exclusively on older ALWH, a subset underrepresented in the current HIV literature. Finally, this dissertation adds a PA instrument that demonstrated validity to predict physical health in older ALWH, an important feature needed for PA prescriptions as adjunct treatment to support healthy aging for these adults. Future studies are needed with more robust designs and larger samples of older ALWH that are geographically and demographically diverse.