Presenter Disclosure Presenter: Melanie Bisnauth Relationships with - PowerPoint PPT Presentation

Presenter Disclosure Presenter: Melanie Bisnauth Relationships with commercial interests • Grants/Research support: • Pilot Study funded by a Connaught New Researcher Award (University of Toronto); Full CBE Implementation Study funded by the CIHR Community‐ Based Research Initiative • Kelly O’Brien is supported by a CIHR New Investigator Award • Speakers Honoraria: Waved • Other: Employee of Kelly O’Brien, University of Toronto, Physical Therapy Department, Canada‐UK HIV Rehabilitation Research Collaborative Research Coordinator We have no conflicts of interest.

Implementing a Community‐Based Exercise Intervention to Improve the Health of Adults Living with HIV: A Pilot Study Melanie Bisnauth Department of Physical Therapy, University of Toronto OHTN Conference: HIV Endgame I Tuesday October 25 th , 2016

YMCA‐CBE Pilot Study Team KNOWLEDGE USERS & RESEARCH TEAM COLLABORATORS Kelly O’Brien Mehdi Zobeiry University of Toronto Principal Knowledge User, Toronto YMCA Patty Solomon Ken King McMaster University Knowledge User, Community Member Ahmed Bayoumi Chris Godi St. Michael’s Hospital Knowledge User, Toronto PWA Foundation Aileen Davis James Murray University Health Network Collaborator, Ontario Ministry of Health and Ada Tang Long‐Term Care, AIDS Bureau McMaster University Kate Murzin Sean Rourke Collaborator, realize St. Michael’s Hospital/ Soo Chan Carusone OHTN Collaborator, Casey House RESEARCH COORDINATOR YMCA Staff Melanie Bisnauth Community Advisory Committee University of Toronto Katie Lowe, Ivan Ilic

Background • People with HIV are living longer; more individuals may encounter physical, social and psychological health‐related challenges of HIV, the consequences of treatment, and multi‐morbidity associated with aging. • Disability: Any symptoms and impairments, difficulties with day‐to‐day activities, challenges to social inclusion and uncertainty or worrying about the future experienced by an individual. • Rehabilitation can assist in managing the health challenges (or disability) associated with HIV, and complex comorbidities. • Community‐based exercise programs exist for people chronic illness and are an ideal approach for enhancing health for people with HIV using a self‐ management framework. • However, no known HIV‐specific CBE programs exist in Canada; and the impact of CBE when translated in the ‘real‐world’ community setting is unknown.

Purpose To pilot test a community‐based exercise (CBE) intervention with adults living with HIV to reduce disability experienced by adults living with HIV and to determine optimal implementation.

Methods Study Design: Prospective 4 month pilot intervention study May‐September 2015 (involving 2 waves of participants). Inclusion Criteria : Adults (18 years or older), living with HIV in Toronto who considered themselves medically stable and safe to engage in exercise, willing to participate in CBE program. Recruitment : Recruited through 4 organizations and health centres in Toronto (YMCA, Casey House, Toronto PWA, realize ) via posters, brochures, recruitment cards, and word of mouth.

CBE Intervention – 4 months Pre CBE Intervention • YMCA Fitness Instructors (n=7 instructors) • Realize (CWGHR) Interprofessional Learning Modules CBE Intervention • 4 months (16 weeks) • Combination of aerobic, resistance, neuro‐motor and flexibility exercise • 3X per week for ~1.5 hours per session • Supervised (and progressed as tolerated) weekly by YMCA Fitness Coach • Individual and/or group‐based exercise (classes) • Monthly self‐management educational sessions (4 sessions) • Participants asked to keep an exercise log throughout.

CBE Assessments

Results

Recruitment and Retention

Characteristics of Participants at Baseline Characteristics Baseline (n=28) N (%) Median Age (years, IQR) 49 (44, 59) Age Range 36 to 64 years >50 years 13 (46%) Gender Men 20 (74%) Women 5 (18%) Other (two‐spirited; gender spectrum) 2 (4%) Median Year of Diagnosis (IQR) 2000 (1989, 2006) Range 1984‐2014 Currently Taking Antiretrovirals (ARVs) 27 (96%) Viral Load Undetectable 21 (75%) Employment Status‐Currently Working for Pay (FT/PT) 11 (39%) Receiving Care from HIV Doc or HIV Clinic 26 (93%) Overall General Perceived Health Very Good 12 (43%) Good 11 (39%) Fair 5 (18%) Common Comorbidities (>30%) included: mental health condition (e.g. anxiety, depression) (57%) high cholesterol (43%) • Median # of comorbidities (IQR) 4 (2,7) muscle pain (36%) • 82% (23 participants) were living with 2 or more bone and Joint disorder (osteopenia, comorbidities osteoporosis, osteoarthritis’ or osteonecrosis) (36%), joint pain (30%)

Goals of Participants at Baseline

Participant Activity Level Activity Level At Baseline At Completion (n=28) (n=19) N (%) Exercise Activity Currently exercise, but not regularly 10 (36%) 7 (37%) Currently exercise regularly and have done so >6 months 7 (25%) 4 (21%) 0 (0%) Currently do not exercise, but thinking about starting 5 (18%) 0 (0%) Exercised regularly in the past, but not currently 4 (14%) Currently exercise regularly, but only within last 6 months 2 (7%) 8 (42%) Approximately over half of sample had experience with current exercise

CBE Implementation Process Large variation in the CBE prescribed among participants. Majority included a CBE Prescription combination of aerobic and resistance exercise. Activity Monitoring 9/28 (32%) participants completed the exercise log. Weekly Coaching 15/28 (54%) participants attended >40% of weekly supervised sessions. Session Adherence Exercised 17 /28 (61%) participants exercised on their own outside the YMCA during the study (e.g. walking, swimming, fitness classes at work, office gym, home exercise) independently outside YMCA Health Status 12/28 (43%) participants experienced changes in health status during the study. 21/28 (75%) participants changed their fitness program during the study (majority Progression of increased frequency and intensity of exercise; whereas some decreased with episode of Program illness). Fitness and Median time to complete fitness assessments = 75 min; questionnaire assessments = 85 min. Questionnaire Assessments

Self‐management education sessions Self‐Management Education Speaker Participants Attended Session Topic N/# still enrolled at the time of the session(%) 1) Welcome / Introduction to the Physical Therapist 19/30 (63%) Study & HIV and Exercise YMCA Volunteer 2) Steps to a Healthy Weight Dietician 16/26 (62%) 3) Role of Occupational Therapy Occupational Therapist 12/25 (48%) in HIV 4) Complementary and Naturopathic Doctor 8/24 (33%) Alternative Therapy and HIV Feedback • Positively received‐ provided them with an opportunity to learn, ask questions as well as socialize with other participants. • Opportunity to provide feedback to the study team.

Reasons for not attending • Challenges with Scheduling • Hard to juggle (or conflicts) with social schedule / work schedule / medical appointments / family matters • Away / out of town / work travel / Busy • Fluctuations in Health • Feeling unwell, not physically able to attend • Fatigue, Pain, surgery, migraines, back spasms, stomach issues, injuries • 20‐30% experienced episodes of illness • Lack of motivation

Pilot Study Results Feedback Study Completion N (%) Felt the CBE Intervention was Beneficial 19 (100%) • I am not afraid of the gym anymore • Opportunity to work with a trainer one on one; opportunity to use machines I was not aware of; someone to push me and show me another way of exercising • Better sleep habits, strength, less stress, less stiffness Felt Initial Meeting with Fitness Instructor was Helpful 19 (100%) • Spoke about medical issues and were able to plan exercises accordingly • Set the framework for my exercise plan; Helped me set goals Level of Fitness Instruction ‐ Very good or excellent 14 (74%) Felt they Achieved their Goals set at the Beginning of the Study 13 (72%) • Achieved some (energy level increase, body fat reduced, but weight no change) • Some achieved, others are ‘work in progress’ • Improved stamina, flexibility, enjoy going to gym Experienced a Negative Event While Participating in the CBE Intervention 7 (39%) Logistics – Difficulty scheduling with the instructor; administrative/logistics around membership Health – Overdoing it; Health issues interfered sometimes Strengths of the Study (quotes): Practical and important intervention, Central Toronto YMCA is a great setting in the community, felt better overall, access to Fitness Coaches.