Feasibility and Impact of a Yoga Intervention on Cognition, Physical Function, Physical Activity, and Affective Outcomes among People Living with HIV: A Randomized Controlled Pilot Trial

Adria Quigley, Marie-Josée Brouillette, Jacqueline Gahagan, Kelly Kathleen O'Brien, Marilyn MacKay-Lyons, Adria Quigley, Marie-Josée Brouillette, Jacqueline Gahagan, Kelly Kathleen O'Brien, Marilyn MacKay-Lyons

Abstract

The purpose of this pilot randomized controlled trial is to assess the feasibility and impact of a triweekly 12-week yoga intervention among people living with HIV (PLWH). Additional objectives included evaluating cognition, physical function, medication adherence, health-related quality of life (HRQoL), and mental health among yoga participants versus controls using blinded assessors. We recruited 22 medically stable PLWH aged ≥35 years. A priori feasibility criteria were ≥70% yoga session attendance and ≥70% of participants satisfied with the intervention using a postparticipation questionnaire. Two participants withdrew from the yoga group. Mean yoga class attendance was 82%, with 100% satisfaction. Intention-to-treat analyses (yoga n = 11, control n = 11) showed no within- or between-group differences in cognitive and physical function. The yoga group improved over time in HRQoL cognition (P = .047) with trends toward improvements in HRQoL health transition (P =.063) and depression (P = .055). This pilot study provides preliminary evidence of feasibility and benefits of yoga for PLWH.

Trial registration: ClinicalTrials.gov NCT03071562.

Keywords: AIDS; HIV; balance; cognition; yoga.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
CONSORT flow diagram.
Figure 2.
Figure 2.
Pre- and postintervention scores of B-CAM, C3Q, and CB&M. B-CAM indicates Brief Cognitive Ability Measure; C3Q, Communicating Cognitive Concerns Questionnaire; CB&M, Community Balance and Mobility Scale.

References

    1. Joint United Nations Programme on HIV/AIDS. AIDS by the Numbers. Joint United Nations Programme on HIV/AIDS.
    1. Joint United Nations Programme on HIV/AIDS. UNAIDS data 2019. Retrieved June 15, 2020, from
    1. Joint United Nations Programme on HIV/AIDS. Women and HIV. Retrieved August 13, 2019, from
    1. Heaton RK, Clifford DB, Franklin DR, et al. HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology. 2010;75(23):2087 doi:10.1212/WNL.0b013e318200d727
    1. Simioni S, Cavassini M, Annoni JM, et al. Cognitive dysfunction in HIV patients despite long-standing suppression of viremia. AIDS. 2010;24(9):1243–1250. doi:10.1097/QAD.0b013e3283354a7b
    1. Sacktor N. Changing clinical phenotypes of HIV-associated neurocognitive disorders. J Neurovirol. 2018;24(2):141–145.
    1. Bonnet F, Amieva H, Marquant F, et al. Cognitive disorders in HIV-infected patients. AIDS. 2013;27(3):391–400. doi:10.1097/qad.0b013e32835b1019
    1. Goodkin K. Psychiatric aspects of HIV spectrum disease. Focus (Madison). 2009;7(3):303–310.
    1. Grant I, Heaton RK, Marcotte TD, et al. Neurocognitive disturbances in HIV. Int Rev Psychiatry. 2008;20(1):33–47. doi:10.1080/09540260701877894
    1. Maki PM, Rubin LH, Springer G, et al. Differences in cognitive function between women and men with HIV. J Acquir Immune Defic Syndr. 2018;79(1):101–107. doi:10.1097/QAI.0000000000001764
    1. Bauer LO, Wu Z, Wolfson LI. An obese body mass increases the adverse effects of HIV/AIDS on balance and gait. Phys Ther. 2011;91(7):1063 doi:10.2522/ptj.20100292
    1. Richert L, Brault M, Mercié P, et al. Decline in locomotor functions over time in HIV-infected patients. AIDS. 2014;28(10):1441–1449. doi:10.1097/QAD.0000000000000246
    1. Robertson K, Parsons T, Sidtis J, et al. Timed gait test: normative data for the assessment of the AIDS dementia complex. J Clin Exp Neuropsychol. 2006;28(7):1053–1064. doi:10.1080/13803390500205684
    1. Wu C, Yi Q, Zheng X, et al. Effects of mind-body exercises on cognitive function in older adults: a meta-analysis. J Am Geriatr Soc. 2018;67(4):749–758. doi:10.1111/jgs.15714
    1. Zhang Y, Li C, Zou L, Liu X, Song W. The effects of mind-body exercise on cognitive performance in elderly: a systematic review and meta-analysis. Int J Environ Res Public Health. 2018;15(12):2791 doi:10.3390/ijerph15122791
    1. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Med. 2005;18(6):491–519. doi:10.3122/jabfm.18.6.491
    1. Ross A, Thomas S. The health benefits of yoga and exercise: a review of comparison studies. J Altern Complement Med. 2010;16(1):3 doi:10.1089/acm.2009.0044
    1. Ramirez-Garcia MP, Gagnon MP, Colson S, et al. Mind-body practices for people living with HIV: a systematic scoping review. BMC Complement Altern Med. 2019;19(1):125 doi:10.1186/s12906-019-2502-z
    1. Lorenc A, Robinson N. A review of the use of complementary and alternative medicine and HIV: issues for patient care. AIDS Patient Care STDS. 2013;27(9):503 doi:10.1089/apc.2013.0175
    1. Braun LA, Forrester CA, Rawlins MDM, et al. Complementary medicine use by people living with HIV in Australia—a national survey. Int J STD AIDS. 2016;27(1):33–38. doi:10.1177/0956462415573122
    1. Robins JLW, McCain NL, Gray DP, et al. Research on psychoneuroimmunology: tai chi as a stress management approach for individuals with HIV disease. Appl Nurs Res. 2006;19(1):2–9
    1. Galantino M, Lou Shepard K, Krafft L, et al. The effect of group aerobic exercise and T’ai chi on functional outcomes and quality of life for persons living with acquired immunodeficiency syndrome. J Altern Complement Med. 2005;11(6):1085–1092. doi:10.1089/acm.2005.11.1085
    1. Kuloor A, Kumari S, Metri K. Impact of yoga on psychopathologies and quality of life in persons with HIV: a randomized controlled study. J Bodyw Mov Ther. 2019;23(2):278–283. doi:10.1016/j.jbmt.2018.10.005
    1. Mawar N, Katendra T, Bagul R, et al. Sudarshan Kriya yoga improves quality of life in healthy people living with HIV (PLHIV): results from an open label randomized clinical trial. Indian J Med Res. 2015;141(1):90–99. doi:10.4103/0971-5916.154509
    1. Naoroibam R, Metri KG, Bhargav H, Nagaratna R, Nagendra HR. Effect of Integrated Yoga (IY) on psychological states and CD4 counts of HIV-1 infected patients: a randomized controlled pilot study. Int J Yoga. 2016;9(1):57 doi:10.4103/0973-6131.171723
    1. Dunne EM, Balletto BL, Donahue ML, et al. The benefits of yoga for people living with HIV/AIDS: a systematic review and meta-analysis. Complement Ther Clin Pract. 2019;34:157–164. doi:10.1016/j.ctcp.2018.11.009
    1. Kietrys DM, Galantino M, Lou Cohen ET, et al. Yoga for persons with HIV-related distal sensory polyneuropathy: a case series. Rehabil Oncol. 2018;36(2):123–131. doi:10.1097/01.REO.0000000000000089
    1. Curno MJ, Rossi S, Hodges-Mameletzis I, et al. A systematic review of the inclusion (or exclusion) of women in HIV research: from clinical studies of antiretrovirals and vaccines to cure strategies. J Acquir Immune Defic Syndr. 2016;71(2):181–188. doi:10.1097/QAI.0000000000000842
    1. Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and Gender Equity in Research: rationale for the SAGER guidelines and recommended use. Heidari S, ed. Res Integr Peer Rev. 2016;1(1):2 doi:10.1186/s41073-016-0007-6
    1. Eldridge SM, Chan CL, Campbell MJ, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016;2(1):64 doi:10.1186/s40814-016-0105-8
    1. Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010:343 doi:10.1016/j.ijsu.2011.10.001
    1. Askari S, Fellows L, Brouillette MJ, et al. Development of an item pool reflecting cognitive concerns expressed by people with HIV. Am J Occup Ther. 2018;72(2):1–9. doi:10.5014/ajot.2018.023945
    1. Bredin SSD, Gledhill N, Jamnik VK, Warburton DER. PAR-Q+ and ePARmed-X+: new risk stratification and physical activity clearance strategy for physicians and patients alike. Can Fam Physician. 2013;59(3):273–277.
    1. Quigley A, O’Brien KK, Brouillette MJ, MacKay-Lyons M. evaluating the feasibility and impact of a yoga intervention on cognition, physical function, physical activity, and affective outcomes in people living with HIV: protocol for a randomized pilot trial. JMIR Res Protoc. 2019;8(5):e7 doi:10.2196/13818
    1. Uebelacker LA, Epstein-Lubow G, Gaudiano BA, et al. Hatha yoga for depression: critical review of the evidence for efficacy, plausible mechanisms of action, and directions for future research. J Psychiatr Pract. 2010;16(1):22–33. doi:10.1097/01.pra.0000367775.88388.96
    1. Cohen ET, Kietrys D, Fogerite SG, et al. Feasibility and impact of an 8-week integrative yoga program in people with moderate multiple sclerosis-related disability: a pilot study. Int J MS Care. 2017;19(1):30–39. doi:10.7224/1537-2073.2015-046
    1. Brems C, Colgan D, Freeman H, et al. Elements of yogic practice: perceptions of students in healthcare programs. Int J Yoga. 2016;9(2):121–129. doi:10.4103/0973-6131.183710
    1. Morgan R, Freeman L. The healing of our people: substance abuse and historical trauma. Subst Use Misuse. 2009;44(1):84–98. doi:10.1080/10826080802525678
    1. Roos R, Myezwa H, van Aswegen H. “Not easy at all but I am trying”: barriers and facilitators to physical activity in a South African cohort of people living with HIV participating in a home-based pedometer walking programme. AIDS Care. 2015;27(2):235 doi:10.1080/09540121.2014.951309
    1. Mayo NE, Brouillette M-J, Fellows LK. Understanding and optimizing brain health in HIV now: protocol for a longitudinal cohort study with multiple randomized controlled trials. BMC Neurol. 2016;16(1):8 doi:10.1186/s12883-016-0527 -1
    1. Koski L, Brouillette M, Lalonde R, et al. Computerized testing augments pencil-and-paper tasks in measuring HIV-associated mild cognitive impairment. HIV Med. 2011;12(8):472–480. doi:10.1111/j.1468-1293.2010.00910.x
    1. Knorr S, Brouwer B, Garland SJ. Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke. Arch Phys Med Rehabil. 2010;91(6):890–896. doi:10.1016/j.apmr.2010.02.010
    1. Studenski SA, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–58. doi:10.1001/jama.2010.1923
    1. Topolski TD, LoGerfo J, Patrick DL, et al. The Rapid Assessment of Physical Activity (RAPA) among older adults. Prev Chronic Dis. 2006;3(4):A118.
    1. Fitbit. Fitbit Flex 2TM Fitness Wristband. Published 2018. Accessed November 29, 2018
    1. Knobel H, Alonso J, Casado JL, et al. Validation of a Simplified Medication Adherence Questionnaire in a large cohort of HIV-infected patients: the GEEMA study. AIDS. 2002;16(4):605–613.
    1. Skevington SM, O’Connell KA. Measuring quality of life in HIV and AIDS: a review of the recent literature. Psychol Health. 2003;18(3):331–350. doi:10.1080/0887044031000084030
    1. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi:10.1111/j.1600-0447.1983.tb09716.x
    1. Vanderbilt. Software—REDCap. REDCap—Research Electronic Data Capture. Published 2017. Accessed August 18, 2018
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. doi:10.1191/1478088706qp063oa
    1. Akoglu H. User’s guide to correlation coefficients. Turkish J Emerg Med. 2018;18(3):91–93. doi:10.1016/j.tjem.2018.08.001
    1. Henderson AR. The bootstrap: a technique for data-driven statistics. Using computer-intensive analyses to explore experimental data. Clin Chim Acta. 2005;359(1):1–26. doi:10.1016/j.cccn.2005.04.002
    1. Walters SJ, Campbell MJ. The use of bootstrap methods for analysing health-related quality of life outcomes (particularly the SF-36). Health Qual Life Outcomes. 2004;2:70 doi:10.1186/1477-7525-2-70
    1. IBM. SPSS statistics. Published 2017. Accessed August 9, 2019
    1. Field A. Discovering Statistics Using IBM SPSS Statistics. 3rd ed Sage Publications; 2013.
    1. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates (2nd ed.). Lawrence Erlbaum Associates.
    1. Richardson JTE. Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev. 2011;6(2):135–147. doi:10.1016/j.edurev.2010.12.001
    1. Walters KL, Horwath PF, Simoni JM. Sexual orientation bias experiences and service needs of gay, lesbian, bisexual, transgendered, and two-spirited American Indians. J Gay Lesbian Soc Serv. 2001;13(1-2):133–149. doi:10.1300/J041v13n01_10
    1. O’brien K, Tynan AM, Nixon S, Glazier R. Effectiveness of progressive resistive exercise (PRE) in the context of HIV: systematic review and meta-analysis using the Cochrane Collaboration Protocol. BMC Infect Dis. 2017;17(1):268 doi:10.1186/s12879-017-2342-8
    1. O’Brien K, Tynan A-M, Nixon SA, Glazier RH. Effectiveness of aerobic exercise for adults living with HIV: systematic review and meta-analysis using the Cochrane Collaboration Protocol. BMC Infect Dis. 2016;16(1):182 doi:10.1186/s12879-016-1478-2
    1. Vancampfort D, Mugisha J, Richards J, et al. Dropout from physical activity interventions in people living with HIV: a systematic review and meta-analysis. AIDS Care. 2017;29(5):636–643. doi:10.1080/09540121.2016.1248347
    1. Agarwal RP, Kumar A, Lewis JE. A pilot feasibility and acceptability study of yoga/meditation on the quality of life and markers of stress in persons living with HIV who also use crack cocaine. J Altern Complement Med. 2015;21(3):152–158 7p. doi:10.1089/acm.2014.0112
    1. Mcdermott A, Zaporojan L, Mcnamara P, et al. The effects of a 16-week aerobic exercise programme on cognitive function in people living with HIV. AIDS Care. 2017;29(6):667–674.
    1. Fazeli P, Woods SP, Heaton RK, et al. An active lifestyle is associated with better neurocognitive functioning in adults living with HIV infection. J Neurovirol. 2014;20(3):233–242. doi:10.1007/s13365-014-0240-z
    1. Dufour C, Marquine MJ, Fazeli PL, et al. A longitudinal analysis of the impact of physical activity on neurocognitive functioning among HIV-infected adults. AIDS Behav. 2016;22(5):1–11. doi:10.1007/s10461-016-1643-z
    1. Fazeli P, Marquine M, Dufour C, et al. Physical activity is associated with better neurocognitive and everyday functioning among older adults with HIV disease. AIDS Behav. 2015;19(8):1470–1477. doi:10.1007/s10461-015-1024-z
    1. Dufour C, Marquine MJ, Fazeli PL, et al. Physical exercise is associated with less neurocognitive impairment among HIV-infected adults. J Neurovirol. 2013;19(5):410–417. doi:10.1007/s13365-013-0184-8
    1. Mapstone M, Hilton TN, Yang H, et al. Poor aerobic fitness may contribute to cognitive decline in HIV infected older adults. J Am Geriatr Soc. 2013;61(6): S30 doi:10.14336/AD.2013.0400311
    1. Monroe A, Zhang L, Jacobson L, et al. The association between physical activity and cognition in men with and without HIV infection. HIV Med. 2017;18(8):555–563. doi:10.1111/hiv.12490
    1. Ortega M, Baker LM, Vaida F, et al. Physical activity affects brain integrity in HIV+ individuals. J Int Neuropsychol Soc. 2015;21(10):880–889. doi:10.1017/S1355617715000879
    1. Honn VJ, Para MF, Whitacre CC, Bornstein RA. Effect of exercise on neuropsychological performance in asymptomatic HIV infection. AIDS Behav. 1999;3(1):67–74.
    1. Northey JM, Cherbuin N, Pumpa KL, Smee DJ, Rattray B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Br J Sports Med. 2018;46(1):71–85. doi:10.1136/bjsports-2016-096587
    1. Gomes-Osman J, Cabral DF, Morris TP, et al. Exercise for cognitive brain health in aging: a systematic review for an evaluation of dose. Neurol Clin Pract. 2018;8(3):257–265. doi:10.1212/cpj.0000000000000460
    1. Gupta S. Intention-to-treat concept: a review. Perspect Clin Res. 2011;2(3):109–112. doi:10.4103/2229-3485.83221
    1. Brazier A, Mulkins A, Verhoef M. Evaluating a yogic breathing and meditation intervention for individuals living with HIV/AIDS. Am J Health Promot. 2006;20(3):192–195.
    1. Galantino ML, Krafft L, Shepard K, et al. Blending traditional and alternative strategies for rehabilitation: measuring functional outcomes and quality of life issues in an AIDS population. Rehabil Oncol. 1998;16(3):23–25 3p.
    1. Chhatre S, Metzger DS, Frank I, et al. Effects of behavioral stress reduction transcendental meditation intervention in persons with HIV. AIDS Care. 2013;25(10):1291–1297. doi:10.1080/09540121.2013.764396
    1. Schmid AA, Van Puymbroeck M, Altenburger PA, et al. Poststroke balance improves with yoga: a pilot study. Stroke. 2012;43(9):2402 doi:10.1161/STROKEAHA.112.658211
    1. Guner S, Inanici F. Yoga therapy and ambulatory multiple sclerosis assessment of gait analysis parameters, fatigue and balance. J Bodyw Mov Ther. 2015;19(1):72–81. doi:10.1016/j.jbmt.2014.04.004
    1. Schmid A, Van Puymbroeck M, Miller K, Schalk N. P02.166. Group yoga intervention leads to improved balance and balance self-efficacy after stroke. BMC Complement Altern Med. 2012;12(suppl 1):P222 doi:10.1186/1472-6882-12-S1-P222
    1. Schmid AA, Van Puymbroeck M, Altenburger PA, et al. Balance and balance self-efficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke. Arch Phys Med Rehabil. 2012;93(6):1101–1107. doi:10.1016/j.apmr.2012.01.020
    1. Ni M, Mooney K, Richards L, et al. Comparative impacts of Tai Chi, balance training, and a specially-designed yoga program on balance in older fallers. Arch Phys Med Rehabil. 2014;95(9):1620–1628. doi:10.1016/j.apmr.2014.04.022
    1. Zbarsky K, Parsley D, Clegg H, et al. Community Balance & Mobility Scale (CB&M): age-related reference values. Physiother Canada. 2010;62(suppl):e8.
    1. Ramnath U, Rauch L, Lambert EV, Kolbe-Alexander TL. The relationship between functional status, physical fitness and cognitive performance in physically active older adults: a pilot study. PLoS One. 2018;13(4):1–17. doi:10.1371/journal.pone.0194918
    1. Won H, Singh DKA, Din NC, et al. Relationship between physical performance and cognitive performance measures among community-dwelling older adults. Clin Epidemiol. 2014;6:343–350. doi:10.2147/CLEP.S62392
    1. McGough EL, Kelly VE, Logsdon RG, et al. Associations between physical performance and executive function in older adults with mild cognitive impairment: gait speed and the timed “up & go” test. Phys Ther. 2011;91(8):1198–1207. doi:10.2522/ptj.20100372
    1. Cummings JL, Benson DF. Subcortical dementia: review of an emerging concept. Arch Neurol. 1984;41(8):874–879. doi:10.1001/archneur.1984.04050190080019
    1. Elicer M., I, Byrd D, Clark US, et al. Motor function declines over time in human immunodeficiency virus and is associated with cerebrovascular disease, while HIV-associated neurocognitive disorder remains stable. J Neurovirol. 2018;24(4):514–522. doi:10.1007/s13365-018-0640-6
    1. Foley J, Ettenhofer M, Wright MJ, et al. Neurocognitive functioning in HIV-1 infection: effects of cerebrovascular risk factors and age. Clin Neuropsychol. 2010;24(2):265–285. doi:10.1080/13854040903482830
    1. Suresh K. An overview of randomization techniques: an unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011;4(1):8–11. doi:10.4103/0974-1208.82352

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