Hearts and Minds in HIV

By 2015 more than half of persons living with HIV (PLWH) in the U.S. will be older than 50
years of age. Two factors contribute to the "graying" of the HIV epidemic. The overwhelming
success of antiretroviral therapy (ART) has improved life expectancy and dramatically
changed the trajectory of HIV; it is now a complex chronic condition, often associated with
multiple comorbidities such as cardiovascular disease (CVD) and cognitive impairment (CI).
Second, increasing numbers of middle-aged and older adults are becoming infected with HIV.
Clinicians, patients, and society are currently ill-prepared to deal with the biomedical
complexities and unique medical and psychosocial challenges associated with the growing
aging HIV population.

Aerobic exercise or exercise that speeds up the heart rate lowers CVD risk, and is known to
improve physical and mental function with aging, but few well designed studies have reported
use of aerobic exercise interventions in PLWH, and no studies have reported whether exercise
improves cognitive function in this high risk for CI population. Regular aerobic exercise
performed 5 times per week for 150 minutes has also been shown to improve aspects of
cognitive function in community-dwelling older adults. Only one exercise study however, has
examined the effect of exercise on cognition in PLWH and was limited by a self-reported,
unreliable indicator of cognitive status; no studies have reported whether exercise improves
cognition in this population using objective assessments, or examined the potential
mechanisms involved.

The home-based, 5 day per week moderate intensity walking intervention, the 'Let's Move
Program,' has been tested and is effective for lowering CVD risk older caregivers and adults
with advanced CVD. The proposed pre-post test pilot study will examine the feasibility of
implementing the Lets Move Program among 40 PLWH over 6-months. Participants enrolled in the
study will be ≥ 50 years of age, sedentary, have 2 CVD risk factors such as high blood
pressure and obesity and demonstrate mild to moderate CI using standardized tests.
Motivational Interviewing (MI) will be used to promote exercise confidence and optimize
adherence to the intervention.

Inclusion Criteria:

- men and women aged 50 and over with 2 CVD risk factors (i.e., obesity, hypertension,
hyperlipidemia) who are diagnosed with HIV/AIDS and willing to participate

- English speaking

- live independently and within a 30 mile radius of Atlanta

- not involved in any structured exercise program or exercising 3 or more times per
week for a minimum of 30 minutes

- not involved in any weight loss program

- not hospitalized within the last 60-days

- clinically stable (absence of viral load and no active opportunistic infection), on
ART 6 months before enrollment and a screening MOCA score ≤ 24 indicating mild
cognitive impairment

Exclusion Criteria:

- non sedentary (defined as engaging in > 30 minutes of moderately strenuous exercise 3
times or more a week)

- medical or physical condition that would preclude participation in the exercise
component of the study (e.g., severe arthritis or mobility problems, uncontrolled
hypertension or diabetes, renal failure, or a history of angina with activity

- ischemic changes or inappropriate BP changes on BL exercise (modified Balke)
treadmill test

- on corticosteroids, experiencing acute inflammation at time of baseline or follow-up
testing (this will result in rescheduling of testing if no other exclusion criteria
apply)

- presence of current opportunistic infection

- any terminal illness

- regular use of anti-inflammatory medications such as non-steroidal anti-inflammatory
agents

- women who are pregnant

- severe learning disabilities, intellectual disabilities, psychotic disorders to
minimize confounding effects on neurocognitive data

- confounding neuro-medical conditions (e.g., active CNS opportunistic infections,
seizure disorders, head injury with loss of consciousness greater than 30 minutes,
intracranial neoplasms, stroke with neurological or neuropsychiatric sequelae, and
non-HIV-associated dementias)

- active substance abuse and major depression