Physical exercise is associated with less neurocognitive impairment among HIV-infected adults
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Neurocognitive impairment (NCI) remains prevalent in HIV infection. Randomized trials have shown that physical exercise improves NCI in non-HIV-infected adults, but data on HIV-infected populations are limited. Community-dwelling HIV-infected participants (n = 335) completed a comprehensive neurocognitive battery that was utilized to define both global and domain-specific NCI. Participants were divided into “exercise” (n = 83) and “no exercise” (n = 252) groups based on whether they self-reported engaging in any activity that increased heart rate in the last 72 h or not. We also measured and evaluated a series of potential confounding factors, including demographics, HIV disease characteristics, substance use and psychiatric comorbidities, and physical functioning. Lower rates of global NCI were observed among the exercise group (15.7 %) as compared to those in the no exercise group (31.0 %; p < 0.01). A multivariable logistic regression controlling for potential confounds (i.e., education, AIDS status, current CD4+ lymphocyte count, self-reported physical function, current depression) showed that being in the exercise group remained significantly associated with lower global NCI (odds ratio = 2.63, p < 0.05). Similar models of domain-specific NCI showed that exercise was associated with reduced impairment in working memory (p < 0.05) and speed of information processing (p < 0.05). The present findings suggest that HIV-infected adults who exercise are approximately half as likely to show NCI as compared to those who do not. Future longitudinal studies might be best suited to address causality, and intervention trials in HIV-infected individuals will determine whether exercise can prevent or ameliorate NCI in this population.
KeywordsHIV/AIDS Mild neurocognitive impairment Physical exercise Cognition Lifestyle Neuropsychology
The HIV Neurobehavioral Research Center (HNRC) is supported by Center award P30MH062512 from NIMH.
The San Diego HIV Neurobehavioral Research Program group is affiliated with the University of California, San Diego; the Naval Hospital, San Diego; and the Veterans Affairs San Diego Healthcare System, and includes: Director: Robert K. Heaton, Ph.D.; Co-Director: Igor Grant, M.D.; Associate Directors: J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., and Scott Letendre, M.D.; Center Manager: Thomas D. Marcotte, Ph.D., Jennifer Marquie-Beck, M.P.H., Melanie Sherman; Neuromedical Component: Ronald J. Ellis, M.D., Ph.D. (P.I.), Scott Letendre, M.D., J. Allen McCutchan, M.D., Brookie Best, Pharm.D., Rachel Schrier, Ph.D., Terry Alexander, R.N., Debra Rosario, M.P.H.; Neurobehavioral Component: Robert K. Heaton, Ph.D. (P.I.), J. Hampton Atkinson, M.D., Steven Paul Woods, Psy.D., Thomas D. Marcotte, Ph.D., Mariana Cherner, Ph.D., David J. Moore, Ph.D., Matthew Dawson; Neuroimaging Component: Christine Fennema-Notestine, Ph.D. (P.I.), Terry Jernigan, Ph.D., Monte S. Buchsbaum, M.D., John Hesselink, M.D., Sarah L. Archibald, M.A., Gregory Brown, Ph.D., Richard Buxton, Ph.D., Anders Dale, Ph.D., Thomas Liu, Ph.D.; Neurobiology Component: Eliezer Masliah, M.D. (P.I.), Cristian Achim, M.D., Ph.D., Ian Everall, FRCPsych., FRCPath., Ph.D.; Neurovirology Component: David M. Smith, M.D. (P.I.), Douglas Richman, M.D.; International Component: J. Allen McCutchan, M.D., (P.I.), Mariana Cherner, Ph.D.; Developmental Component: Cristian Achim, M.D., Ph.D.; (P.I.), Stuart Lipton, M.D., Ph.D.; Participant Accrual and Retention Unit: J. Hampton Atkinson, M.D. (P.I.), Jennifer Marquie-Beck, M.P.H.; Data Management and Information Systems Unit: Anthony C. Gamst, Ph.D. (P.I.), Clint Cushman; Statistics Unit: Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D. (Co-PI), Reena Deutsch, Ph.D., Anya Umlauf, M.S., Christi Kao, M.S.
Conflict of interest
Nothing to disclose.
The views expressed herein are those of the authors and do not reflect the official policy or position of the US government.
- Antinori A, Arendt G, Becker JT, Brew BJ, Byrd DA, Cherner M, Clifford DB, Cinque P, Epstein LG, Goodkin K, Gisslen M, Grant I, Heaton RK, Joseph J, Marder K, Marra CM, McArthur JC, Nunn M, Price RW, Pulliam L, Robertson KR, Sacktor N, Valcour V, Wojna VE (2007) Updated research nosology for HIV-associated neurocognitive disorders. Neurology 69:1789–1799PubMedCrossRefGoogle Scholar
- Artiola L, Hermosillo D, Heaton R, Pardee R (1999) Manual De Normas Y Procedimientos Para La Bateria Neuropsicologica En Espanol. m Press, TucsonGoogle Scholar
- Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II. Psychological Corporation, San AntonioGoogle Scholar
- Benedict R (1997) Brief visuospatial memory test—revised. Psychological Assessment Resources, OdessaGoogle Scholar
- Blackstone K, Moore DJ, Heaton RK, Franklin DR Jr, Woods SP, Clifford DB, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, Rivera-Mindt M, Deutsch R, Ellis RJ, Hampton Atkinson J, Grant I (2012) Diagnosing symptomatic HIV-associated neurocognitive disorders: self-report versus performance-based assessment of everyday functioning. J Int Neuropsychol Soc 18:79–88PubMedCrossRefGoogle Scholar
- Castro KG, Ward JW, Slutsker L, Buehler JW, Jaffe HW, Berkelman RL (1992) 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. US Department of Health and Human Services.Google Scholar
- DeCarli C, Murphy DG, Tranh M, Grady CL, Haxby JV, Gillette JA, Salerno JA, Gonzales-Aviles A, Horwitz B, Rapoport SI et al (1995) The effect of white matter hyperintensity volume on brain structure, cognitive performance, and cerebral metabolism of glucose in 51 healthy adults. Neurology 45:2077–2084PubMedCrossRefGoogle Scholar
- Fabbiani M, Ciccarelli N, Tana M, Farina S, Baldonero E, Di Cristo V, Colafigli M, Tamburrini E, Cauda R, Silveri M, Grima P, Di Giambenedetto S (2012) Cardiovascular risk factors and carotid intima-media thickness are associated with lower cognitive performance in HIV-infected patients. HIV Med 14:136–144PubMedCrossRefGoogle Scholar
- Golden CJ (1978) The Stroop color and word test. Stoetling Company, ChicagoGoogle Scholar
- Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, Petersen RC, Schneider JA, Tzourio C, Arnett DK, Bennett DA, Chui HC, Higashida RT, Lindquist R, Nilsson PM, Roman GC, Sellke FW, Seshadri S (2011) Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:2672–2713PubMedCrossRefGoogle Scholar
- Heaton RK, Clifford DB, Franklin DR Jr, Woods SP, Ake C, Vaida F, Ellis RJ, Letendre SL, Marcotte TD, Atkinson JH, Rivera-Mindt M, Vigil OR, Taylor MJ, Collier AC, Marra CM, Gelman BB, McArthur JC, Morgello S, Simpson DM, McCutchan JA, Abramson I, Gamst A, Fennema-Notestine C, Jernigan TL, Wong J, Grant I (2010) HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: charter study. Neurology 75:2087–2096PubMedCrossRefGoogle Scholar
- Heaton RK, Grant I, Matthews CG (1991) Comprehensive norms for an expanded Halstead-Reitan battery: demographic corrections, research findings, and clinical applications. Psychological Assessment Resources, OdessaGoogle Scholar
- Heaton RK, Taylor MJ, Manly J (2003) WMS-III. Clinical interpretation of the WAIS-III and WMS-III: 181Google Scholar
- Hurling R, Catt M, Boni MD, Fairley BW, Hurst T, Murray P, Richardson A, Sodhi JS (2007) Using internet and mobile phone technology to deliver an automated physical activity program: randomized controlled trial. J of Med Int Res 9:e7Google Scholar
- Kang M, Marshall SJ, Barreira TV, Lee JO (2009) Effect of pedometer-based physical activity interventions: a meta-analysis. Res Quarterly for Exercise Sport 80:648–655Google Scholar
- Kongs SK, Thompson LL, Iverson GL, Heaton RK (2000) Wisconsin card sorting test: 64-card version (Wcst‚Äì64). Psychological Assessment Resources, OdessaGoogle Scholar
- O'Brien K, Nixon S, Tynan AM and Glazier R (2010) Aerobic exercise interventions for adults living with HIV/AIDS. Cochrane Database Syst Rev: CD001796Google Scholar
- Rosenberg DE, Kerr J, Sallis JF, Norman GJ, Calfas K, Patrick K (2012) Promoting walking among older adults living in retirement communities. J of Aging and Physical Activity 20:379–394Google Scholar
- Wechsler D (1997) Wechsler adult intelligence scale‚ third edition and Wechsler memory scale‚ third edition technical manual. The Psychological Corporation, San AntonioGoogle Scholar
- Wright EJ, Grund B, Robertson K, Brew BJ, Roediger M, Bain MP, Drummond F, Vjecha MJ, Hoy J, Miller C, Penalva de Oliveira AC, Pumpradit W, Shlay JC, El-Sadr W, Price RW (2010) Cardiovascular risk factors associated with lower baseline cognitive performance in HIV-positive persons. Neurology 75:864–873PubMedCrossRefGoogle Scholar