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 25th, 2016

YMCA‐CBE Pilot Study Team

RESEARCH TEAM Kelly O’Brien University of Toronto Patty Solomon McMaster University Ahmed Bayoumi

• St. Michael’s Hospital

Aileen Davis University Health Network Ada Tang McMaster University Sean Rourke

• St. Michael’s Hospital/

OHTN RESEARCH COORDINATOR Melanie Bisnauth University of Toronto KNOWLEDGE USERS & COLLABORATORS Mehdi Zobeiry Principal Knowledge User, Toronto YMCA Ken King Knowledge User, Community Member Chris Godi Knowledge User, Toronto PWA Foundation James Murray Collaborator, Ontario Ministry of Health and Long‐Term Care, AIDS Bureau Kate Murzin Collaborator, realize Soo Chan Carusone Collaborator, Casey House YMCA Staff Community Advisory Committee 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
• f 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) Age Range >50 years 49 (44, 59) 36 to 64 years 13 (46%) Gender Men Women Other (two‐spirited; gender spectrum) 20 (74%) 5 (18%) 2 (4%) Median Year of Diagnosis (IQR) Range 2000 (1989, 2006) 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 Good Fair 12 (43%) 11 (39%) 5 (18%) Common Comorbidities (>30%) included: mental health condition (e.g. anxiety,

depression) (57%) high cholesterol (43%) muscle pain (36%) bone and Joint disorder (osteopenia,

• steoporosis, osteoarthritis’ or
• steonecrosis) (36%),

joint pain (30%)

• Median # of comorbidities (IQR) 4 (2,7)
• 82% (23 participants) were living with 2 or more

comorbidities

Goals of Participants at Baseline

Participant Activity Level

Approximately over half of sample had experience with current exercise

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

CBE Implementation Process

CBE Prescription

Large variation in the CBE prescribed among participants. Majority included a combination of aerobic and resistance exercise.

Activity Monitoring

9/28 (32%) participants completed the exercise log.

Weekly Coaching Session Adherence

15/28 (54%) participants attended >40% of weekly supervised sessions.

Exercised independently

• utside YMCA

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)

Health Status

12/28 (43%) participants experienced changes in health status during the study.

Progression of Program

21/28 (75%) participants changed their fitness program during the study (majority increased frequency and intensity of exercise; whereas some decreased with episode of illness).

Fitness and Questionnaire Assessments

Median time to complete fitness assessments = 75 min; questionnaire assessments = 85 min.

Self‐management education sessions

Self‐Management Education Session Topic Speaker Participants Attended N/# still enrolled at the time of the session(%) 1) Welcome / Introduction to the Study & HIV and Exercise Physical Therapist YMCA Volunteer 19/30 (63%) 2) Steps to a Healthy Weight Dietician 16/26 (62%) 3) Role of Occupational Therapy in HIV Occupational Therapist 12/25 (48%) 4) Complementary and Alternative Therapy and HIV Naturopathic Doctor 8/24 (33%) 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

• 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

19 (100%) Felt Initial Meeting with Fitness Instructor was Helpful

• Spoke about medical issues and were able to plan exercises accordingly
• Set the framework for my exercise plan; Helped me set goals

19 (100%) Level of Fitness Instruction ‐ Very good or excellent 14 (74%) Felt they Achieved their Goals set at the Beginning of the Study

• 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

13 (72%) Experienced a Negative Event While Participating in the CBE Intervention Logistics – Difficulty scheduling with the instructor; administrative/logistics around membership Health – Overdoing it; Health issues interfered sometimes 7 (39%) 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.

Discussion

Over 60% of participants completed the 4 month intervention. Factors contributing to the success of the CBE pilot included:

• Extensive interest from the community in the study – recruited sample

within 8 weeks.

• Partnership with the YMCA & Meetings with Research Team and YMCA Staff

were critical to debrief on process throughout.

• Coaches were knowledgeable, dedicated, and supportive.

Considerations for Full CBE Implementation Study include:

• Strategies to mitigate last minute cancellations or ‘no shows’ to the fitness

assessments and coaching sessions (episodic nature of HIV); streamline communication between participants, coordinator and coaches.

• Few (32%) completed the exercise log – tedious, did not fit diversity of

exercise programs.

• Respondent burden ‐ questionnaire and assessments.

Conclusions

• CBE intervention was positively received by participants

who completed the pilot study

• Need to identify strategies to maximize adherence to

exercise, enhance measurement of physical activity, and reduce the burden of assessments for future phases of CBE implementation

Next (Current) Steps ‐ Full CBE Implementation Study

Purpose: To evaluate the translation of a community‐based exercise (CBE) intervention for adults living with HIV within the community. Study Design: Interrupted Time Series Study Inclusion Criteria:

• Adults (18 years of age and older)
• Living in Toronto
• Able to safely engage in exercise
• Commit to 22 month study

Funded by: Canadian Institutes of Health Research (CIHR), Community‐ Based Research Initiative

Study Timeline (22 months)

As of October 2016 – 80/120 participants enrolled to date

For more information:

Melanie Bisnauth Research Coordinator & CUHRRC Coordinator melanie.bisnauth@utoronto.ca Acknowledgements: Connaught New Researcher Award (UofT) Canadian Institutes of Health Research (CIHR)

Thank You

Extra slides

Multi-morbidity

At Baseline (n=28) N (%) Median # of Concurrent Health Conditions (IQR) 4 (2, 7) Living with >1 concurrent health condition (living with at least 1) 26 (93%) Living with >2 concurrent health condition (multi‐morbidity) 23 (82%) Common Concurrent Conditions (>10%) Mental Health Condition (e.g. depression, anxiety) High Cholesterol Muscle pain ‘Bone and Joint’, ‘Osteopenia or Osteoporosis’, ‘Osteoarthritis’ or ‘Osteonecrosis’ Joint Pain (arthritis) 16 (57%) 12 (43%) 10 (36%) 10 (36%) 8 (30%) High Blood Pressure Addiction Elevated Lipid Level Neurocognitive Decline (e.g. memory loss, confusion, trouble thinking clearly..) 7 (25%) 5 (18%) 5 (18%) 4 (15%) Peripheral Neuropathy Obesity Diabetes Fibromyalgia Asthma 4 (14%) 4 (14%) 4 (14%) 3 (11%) 3 (11%) Dementia Hepatitis C 3 (11%) 3 (11%)