Annals of Behavioral Medicine

, Volume 46, Issue 2, pp 149–156 | Cite as

Physical Activity and Health Outcomes Among HIV-Infected Men Who Have Sex with Men: A Longitudinal Mediational Analysis

  • Aaron J. Blashill
  • Kenneth H. Mayer
  • Heidi Crane
  • Jessica F. Magidson
  • Chris Grasso
  • W. Christopher Mathews
  • Michael S. Saag
  • Steven A. Safren
Original Article

Abstract

Background

Low physical activity is associated with depression, which may, in turn, negatively impact antiretroviral therapy (ART) adherence among HIV-infected individuals; however, prior studies have not investigated the relationships between physical inactivity and ART non-adherence.

Purpose

The purpose of this study was to examine the association of physical inactivity, depression, ART non-adherence, and viral load in HIV-infected men who have sex with men.

Methods

The sample (N = 860) was from a large, multicenter cohort of HIV-infected patients engaged in clinical care.

Results

Across time, depression mediated the relationship between physical inactivity and ART non-adherence (γ = 0.075) and the relationship between physical inactivity and viral load (γ = 0.05). ART non-adherence mediated the relationship between depression and viral load (γ = 0.002) and the relationship between physical inactivity and viral load (γ = 0.009).

Conclusions

Low levels of physical activity predicted increased depression and poor ART adherence over time, which subsequently predicted higher viral load.

Keywords

HIV/AIDS Physical activity Depression Adherence Viral load 

References

  1. 1.
    Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: A statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107:3109-3116.PubMedCrossRefGoogle Scholar
  2. 2.
    Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med. 2005;352:48-62.PubMedCrossRefGoogle Scholar
  3. 3.
    Samaras K. Prevalence and pathogenesis of diabetes mellitus in HIV-1 infection treated with combined antiretroviral therapy. J Acquir Immune Defic Syndr. 2009;50:499-505.PubMedCrossRefGoogle Scholar
  4. 4.
    Brown TT, McComsey GA, King MS, Qaqish RB, Bernstein BM, da Silva BA. Loss of bone mineral density after antiretroviral therapy initiation, independent of antiretroviral regimen. J Acquir Immune Defic Syndr. 2009;51:554-561.PubMedCrossRefGoogle Scholar
  5. 5.
    Patel P, Hanson DL, Sullivan PS, et al. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med. 2008;148:728-736.PubMedCrossRefGoogle Scholar
  6. 6.
    Ciccolo JT, Jowers EM, Bartholomew JB. The benefits of exercise training for quality of life in HIV/AIDS in the post-HAART era. Sports Med. 2004;34:487-499.PubMedCrossRefGoogle Scholar
  7. 7.
    Dudgeon WD, Phillips KD, Bopp CM, Hand GA. Physiological and psychological effects of exercise interventions in HIV disease. AIDS Patient Care STDS. 2004;18:81-98.PubMedCrossRefGoogle Scholar
  8. 8.
    Neidig JL, Smith BA, Brashers DE. Aerobic exercise training for depressive symptom management in adults living with HIV infection. J Assoc Nurses AIDS Care. 2003;14:30-40.PubMedCrossRefGoogle Scholar
  9. 9.
    Wagner G, Rabkin J, Rabkin R. Exercise as a mediator of psychological and nutritional effects of testosterone therapy in HIV+ men. Med Sci Sports Exerc. 1998;30:811-817.PubMedCrossRefGoogle Scholar
  10. 10.
    Rigsby LW, Dishman RK, Jackson AW, Maclean GS, Raven PB. Effects of exercise training on men seropositive for the human immunodeficiency virus-1. Med Sci Sports Exerc. 1992;24:6-12.PubMedGoogle Scholar
  11. 11.
    Smit E, Crespo CJ, Semba RD, et al. Physical activity in a cohort of HIV-positive and HIV-negative injection drug users. AIDS Care. 2006;18:1040-1045.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith BA, Neidig JL, Nickel JT, Mitchell GL, Para MF, Fass RJ. Aerobic exercise: Effects on parameters related to fatigue, dyspnea, weight and body composition in HIV-infected adults. AIDS. 2001;15:693-701.PubMedCrossRefGoogle Scholar
  13. 13.
    Stringer WW, Berezovskaya M, O’Brien WA, Beck CK, Casaburi R. The effect of exercise training on aerobic fitness, immune indices, and quality of life in HIV+ patients. Med Sci Sports Exerc. 1998;30:11-16.PubMedGoogle Scholar
  14. 14.
    Bopp CM, Phillips KD, Fulk LJ, Dudgeon WD, Sowell R, Hand GA. Physical activity and immunity in HIV-infected individuals. AIDS Care. 2004;16:387-393.PubMedCrossRefGoogle Scholar
  15. 15.
    LaPerriere AR, Antoni MH, Schneiderman N, et al. Exercise intervention attenuates emotional distress and natural killer cell decrements following notification of positive serologic status for HIV-1. Appl Psychophysiol Biofeedback. 1990;15:229-224.Google Scholar
  16. 16.
    Antoni MH, Carrico AW, Durán RE, et al. Reductions in depressed mood and denial coping during cognitive behavioral stress management with HIV-positive gay men treated with HAART. Ann Behav Med. 2006;31:155-164.PubMedCrossRefGoogle Scholar
  17. 17.
    Carrico AW, Antoni MH. Effects of psychological interventions on neuroendocrine hormone regulation and immune status in HIV-positive persons: A review of randomized controlled trials. Psychosom Med. 2008; 70:557–584.Google Scholar
  18. 18.
    CDC (Centers for Disease Control and Prevention). CDC analysis provides new look at disproportionate impact of HIV and syphilis among U.S. gay and bisexual men. Available at http://www.cdc.gov/nchhstp/Newsroom/msmpressrelease.html. Accessed 20 August 2012.
  19. 19.
    Ledergerber B, Egger M, Opravil M, et al. Clinical progression and virological failure on highly active antiretroviral therapy in HIV-1 patients: A prospective cohort study. Swiss HIV Cohort Study. Lancet. 1999;353:863-868.PubMedCrossRefGoogle Scholar
  20. 20.
    Ambrosioni J, Calmy A, Hirschel B. HIV treatment for prevention. J Int AIDS Soc. 2011;14:28.PubMedCrossRefGoogle Scholar
  21. 21.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493-505.PubMedCrossRefGoogle Scholar
  22. 22.
    Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70:539-545.PubMedCrossRefGoogle Scholar
  23. 23.
    Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: A review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58:181-187.PubMedGoogle Scholar
  24. 24.
    Carrico AW, Bangsberg DR, Weiser SD, Chartier M, Dilworth SE, Riley ED. Psychiatric correlates of HAART utilization and viral load among HIV-positive impoverished persons. AIDS. 2011;25:1113-1118.PubMedCrossRefGoogle Scholar
  25. 25.
    Cook JA, Cohen MH, Grey D, et al. Use of highly active antiretroviral therapy in a cohort of HIV-seropositive women. Am J Public Health. 2002;92:82-87.PubMedCrossRefGoogle Scholar
  26. 26.
    Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: Longitudinal analysis from the HIV Epidemiology Research Study. JAMA. 2001;285:1466-1474.PubMedCrossRefGoogle Scholar
  27. 27.
    Ironson G, O’Cleirigh C, Fletcher MA, et al. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med. 2005;67:1013-1021.PubMedCrossRefGoogle Scholar
  28. 28.
    Li X, Margolick JB, Conover CS, et al. Interruption and discontinuation of highly active antiretroviral therapy in the multicenter AIDS cohort study. J Acquir Immune Defic Syndr. 2005;38:320-328.PubMedGoogle Scholar
  29. 29.
    Patterson T, Shaw W, Semple S, Cherner M. Relationship of psychosocial factors to HIV disease progression. Ann Behav Med. 1996;18:30-39.CrossRefGoogle Scholar
  30. 30.
    Pence BW, Miller WC, Gaynes BN, Eron JJ Jr. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007;44:159-166.PubMedCrossRefGoogle Scholar
  31. 31.
    Kitahata MM, Rodriguez B, Haubrich R, et al. Cohort profile: The Centers for AIDS Research Network of Integrated Clinical Systems. Int J Epidemiol. 2008;37:948-955.PubMedCrossRefGoogle Scholar
  32. 32.
    Crane HM, Lober W, Webster E, et al. Routine collection of patient-reported outcomes in an HIV clinic setting: The first 100 patients. Curr HIV Res. 2007;5:109-118.PubMedCrossRefGoogle Scholar
  33. 33.
    Fredericksen R, Crane PK, Tufano J, et al. Integrating a web-based, patient-administered assessment into primary care for HIV-infected adults. J Acquir Immune Defic Syndr. 2012;4:47-55.Google Scholar
  34. 34.
    Lawrence ST, Willig JH, Crane HM, et al. Routine, self-administered, touch-screen, computer-based suicidal ideation assessment linked to automated response team notification in an HIV primary care setting. Clin Infect Dis. 2010;50:1165-1173.PubMedCrossRefGoogle Scholar
  35. 35.
    Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737-1744.PubMedCrossRefGoogle Scholar
  36. 36.
    Ainsworth BE, Jacobs DR Jr, Leon AS. Validity and reliability of self-reported physical activity status: The Lipid Research Clinics questionnaire. Med Sci Sports Exerc. 1993;25:92-98.PubMedCrossRefGoogle Scholar
  37. 37.
    Lu M, Safren SA, Skolnik PR, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12:86-94.PubMedCrossRefGoogle Scholar
  38. 38.
    Feldman BJ, Fredericksen RJ, Crane PK, et al. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav. 2013;17:307–318.Google Scholar
  39. 39.
    Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA. Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10:227-245.PubMedCrossRefGoogle Scholar
  40. 40.
    West BT. Analyzing longitudinal data with the linear mixed models procedure in SPSS. Eval Health Prof. 2009;32:207-228.PubMedCrossRefGoogle Scholar
  41. 41.
    Bauer DJ, Preacher KJ, Gil KM. Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: New procedures and recommendations. Psychol Methods. 2006;11:142-163.PubMedCrossRefGoogle Scholar
  42. 42.
    Mackinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivar Behav Res. 2004;39:99-128.CrossRefGoogle Scholar
  43. 43.
    Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychol Methods. 2002;7:422-445.PubMedCrossRefGoogle Scholar
  44. 44.
    Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51:1173-1182.PubMedCrossRefGoogle Scholar
  45. 45.
    Hayes A. Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Commun Monogr. 2009;76:408-420.CrossRefGoogle Scholar
  46. 46.
    Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. In: Leinhardt S, ed. Sociological Methodology. Washington, DC: American Sociological Association; 1982:290-312.Google Scholar
  47. 47.
    Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40:879-891.PubMedCrossRefGoogle Scholar
  48. 48.
    Selig JP, Preacher KJ. Monte Carlo method for assessing mediation: An interactive tool for creating confidence intervals for indirect effects. Available at http://www.quantpsy.org/medmc/medmc.htm. Accessed 20 August 2012.
  49. 49.
    Preacher KJ, Kelley K. Effect size measures for mediation models: Quantitative strategies for communication indirect effects. Psychol Methods. 2011;16:93-115.PubMedCrossRefGoogle Scholar
  50. 50.
    Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum; 1988.Google Scholar
  51. 51.
    Kelley K. Confidence intervals for standardized effect sizes: Theory, application, and implementation. J Stat Softw. 2007;20:1-24.Google Scholar
  52. 52.
    Kelley K. Methods for the behavioral, educational, and social sciences: An R package. Behav Res Methods. 2007;39:979-984.PubMedCrossRefGoogle Scholar
  53. 53.
    Kelley K, Lai K. MBESS (version 3.2.0) Computer Software and Manual. Available at http://www.cran.r-project.org/.
  54. 54.
    Ogalha C, Luz E, Sampaio E, et al. A randomized, clinical trial to evaluate the impact of regular physical activity on the quality of life, body morphology and metabolic parameters of patients with AIDS in Salvador, Brazil. J Acquir Immune Defic Syndr. 2011;57:S179-S185.PubMedCrossRefGoogle Scholar
  55. 55.
    Bova CA, Fennie KP, Knafl GJ, Dieckhaus KD, Watrous E, Williams AB. Use of electronic monitoring devices to measure antiretroviral adherence: Practical considerations. AIDS Behav. 2005;9:103-110.PubMedCrossRefGoogle Scholar
  56. 56.
    Santos-Lozano A, Garatachea N. Physical activity measurements using accelerometers and pedometers in HIV-infected people. J AIDS Clinic Res. 2011;2:126.Google Scholar
  57. 57.
    Spencer SJ, Zanna MP, Fong GT. Establishing a causal chain: Why experiments are often more effective than mediational analyses in examining psychological processes. J Pers Soc Psychol. 2005;89(6):845-851.PubMedCrossRefGoogle Scholar
  58. 58.
    Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1423-1434.PubMedCrossRefGoogle Scholar
  59. 59.
    Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: The evidence. CMAJ. 2006;174:801-809.PubMedGoogle Scholar
  60. 60.
    Safren SA, O’Cleirigh C, Tan JY, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol. 2009;28:1-10.PubMedCrossRefGoogle Scholar
  61. 61.
    Safren SA, O’Cleirigh CM, Bullis JR, Otto MW, Stein MD, Pollack MH. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: A randomized controlled trial. J Consult Clin Psychol. 2012;80:404-415.PubMedCrossRefGoogle Scholar
  62. 62.
    Antoni MH, Baggett L, Ironson G, et al. Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notifications of HIV-1 seropositivity. J Consult Clin Psychol. 1991;59:906-915.PubMedCrossRefGoogle Scholar
  63. 63.
    Penedo FJ, Dahn JR. Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatry. 2005;18:189-193.PubMedCrossRefGoogle Scholar
  64. 64.
    Jacobson NS, Martell CR, Dimidjian S. Behavioral activation treatment for depression: Returning to contextual roots. Clin Psychol. 2001;8:255-270.Google Scholar
  65. 65.
    Lejuez CW, Hopko DR, LePage J, Hopko S, McNeil D. A brief behavioral activation treatment for depression. Cogn Behav Pract. 2001;8:164-175.CrossRefGoogle Scholar
  66. 66.
    Lejuez CW, Hopko DR, Acierno R, Daughters SB, Pagoto SL. Ten year revision of the Brief Behavioral Activation Treatment for Depression: Revised treatment manual. Behav Modif. 2011;35:111-161.PubMedCrossRefGoogle Scholar
  67. 67.
    Mazzuchelli T, Kare R, Rees C. Behavioral activation treatments for depression in adults: A meta-analysis and review. Clin Psychol. 2009;16:383-411.Google Scholar
  68. 68.
    Sturmey P. Behavioral activation is an evidence-based treatment for depression. Behav Modif. 2009;33:818-829.PubMedCrossRefGoogle Scholar
  69. 69.
    Pagoto S, Bodenlos JS, Schneider KL, Olendzki B, Spates CR, Ma Y. Initial investigation of behavioral activation therapy for comorbid major depressive disorder and obesity. Psychotherapy. 2008;45:410-415.PubMedCrossRefGoogle Scholar
  70. 70.
    Daughters SB, Magidson JF, Schuster RM, Safren SA. Act Healthy: A combined cognitive-behavioral depression and medication adherence treatment for HIV-infected substance users. Cogn Behav Pract. 2010;17:309-321.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2013

Authors and Affiliations

  • Aaron J. Blashill
    • 1
    • 2
    • 3
    • 8
  • Kenneth H. Mayer
    • 2
    • 3
    • 4
  • Heidi Crane
    • 5
  • Jessica F. Magidson
    • 1
    • 2
  • Chris Grasso
    • 3
  • W. Christopher Mathews
    • 6
  • Michael S. Saag
    • 7
  • Steven A. Safren
    • 1
    • 2
    • 3
  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.The Fenway InstituteBostonUSA
  4. 4.Beth Israel Deaconess Medical CenterBostonUSA
  5. 5.University of WashingtonSeattleUSA
  6. 6.University of California San Diego Medical CenterSan DiegoUSA
  7. 7.University of Alabama BirminghamBirminghamUSA
  8. 8.BostonUSA

Personalised recommendations