Aerobic exercise in HIV-associated neurocognitive disorders : protocol for a randomized controlled trial

BACKGROUND : Since the introduction of antiretroviral therapy (ART), the incidence of HIV-associated dementia has drastically fallen. Despite using ART, people living with HIV continue to experience less severe but limiting forms of HIV-associated neurocognitive disorder (HAND). People living with HIV who are on ART and experiencing symptoms of HAND may benefit from aerobic exercise. OBJECTIVE : This protocol describes a randomized controlled trial designed to determine the effects of a 12-week aerobic exercise program on HAND in Southeastern Nigeria. METHODS : At least 68 patients diagnosed with HAND will be randomly placed into either an aerobic exercise group or control group. Patients in the aerobic exercise group will perform a moderate intensity workout on a stationary bicycle ergometer, 3 times a week for 12 weeks. We will measure the primary outcomes including neurocognitive performance, prevalence of HAND, viral load, and CD4 count. We will evaluate postexercise neurocognitive performance using reliable neuropsychological tests relevant to people living with HIV, in line with the Frascati criteria. We will assess secondary outcomes such as quality of life, activity limitation, and social participation using the World Health Organization Quality of Life (WHOQOL)-Brief, and the Oxford Participation and Activities questionnaire. We will use exploratory statistics to test the data for normality and homogeneity. We will analyze the effect of the exercise program on HAND using relative risk (RR) and absolute risk reduction (number needed to treat). Analysis of covariance will be run to estimate the effect of exercise on quality of life and activity and participation level. RESULTS : This funded trial was approved by the Institutional Review Board in May 2020. The protocol was approved on June 15, 2020. Enrollment commenced in January 2021 and was completed in May 2021. Over 60% of the participants were recruited at the time of first submission to JMIR Mental Health. Data curation is still ongoing; hence, data analysis is yet to be executed. Study outcomes are expected to be published in March 2022. CONCLUSIONS : This is a protocol for a randomized controlled trial that aims to evaluate the effect of a 12-week aerobic exercise program on HAND in Southeastern Nigeria.SUPPLEMENTARY MATERIALS : APPENDIX 1. Beck Depression Inventory.APPENDIX 2. Alcohol Use Disorder Identification Test (AUDIT).APPENDIX 3. Drug Abuse Screening Test.APPENDIX 4. International HIV Dementia Scale.APPENDIX 5. Controlled Oral Word Association Test (COWAT) (Verbal Fluency Test).APPENDIX 6. Hopkin Verbal Learning Test-Revised.APPENDIX 7. Trail Making Test A & B.APPENDIX 8. Digit span test.APPENDIX 9. Lawton Instrumental Activities of Daily Living (IADL) scale.APPENDIX 10. The World Health Organization Quality of Life (WHOQoL) Bref.APPENDIX 11. Oxford Participation and Activities Questionnaire (Ox-PAQ).APPENDIX 12. Physical Activity Readiness Questionnaire.APPENDIX 13. Adverse events form.The National Student Financial Aid Scheme (NSFAS) via the University Pretoria Doctoral Research Bursary.http://www.researchprotocols.orgPhysiotherap