The High-Intensity Exercise to Attenuate Limitations and Train Habits (HEALTH) in Older Adults with HIV

项目摘要 随着治疗和护理的进步，更长的预期寿命正在改变艾滋病毒的人口结构 在美国，艾滋病毒携带者中近一半的人年龄在50岁或以上。艾滋病毒携带者， 即使在接受有效的艾滋病毒药物治疗的同时，与艾滋病毒相比，他们的发病率和死亡率也更高- 未受感染的人群。不断增长的年龄、并存的负担和生活方式因素导致的 老年人日常功能主要组成部分的预期损害和高疲劳负担 艾滋病毒携带者。需要有效的、可扩展的、非药理学的策略来改善 这些脆弱的人群。 该提案的总体目标是确定高强度间歇训练(HIIT)是否可以 克服1)身体功能损伤和疲劳增加以及2)线粒体损伤 老年HIV(PWH)患者的生物能量学比持续中等强度运动更大程度上 (芝加哥商品交易所)。我们进一步试图确定HIIT或HIIT后的生物行为训练干预 继续医学教育可以促进长期坚持体力活动，这是 干预。我们之前表现出了比预期更大的身体功能损害和 携带艾滋病毒的老年人普遍存在疲劳感。我们发现继续医学教育和阻力训练可以改善 较老的PWH的身体功能，通过更高强度的有氧和 抵抗力训练计划。此外，只有我们的高强度持续有氧运动干预 减少了PWH的疲劳感。最后，只有不到一半的参与者持续锻炼至少一次 在监督干预后的一周，这表明即使锻炼是有益的，它也可以是 威尔斯亲王医院难以维持。总而言之，我们的发现表明，一种创新的锻炼方法是 需要改善身体机能，减少疲劳，并保持长期锻炼的习惯 旧威尔斯亲王医院。 为了解决这一关键需求，我们建议的研究将利用两个不同参与者的资源 科罗拉多大学和凯斯西储大学的人群将HIIT与CME进行比较 在身体机能和疲劳方面，2)比较HIIT和CME对骨骼肌和外周血的影响 单核细胞线粒体生物能量学，以及3)在体能方面测试教练干预与对照 活动坚持，使用混合方法评估对这些方法的看法。这项研究将产生 关于身体机能和运动疲劳反应的严格数据，相关的线粒体适应， 并研究灌输持续的、自我指导的锻炼行为的策略。总体而言，我们的发现将为 开发可扩展的、有效的运动建议，以满足日益老化的威斯康星医院的独特需求。

PROJECT ABSTRACT With advances in treatment and care,a longer life expectancy is changing the demographics of the HIV epidemic, and nearly half of those living with HIV in the U.S. are now 50 years or older. People living with HIV, even while receiving effective HIV medications, have excess morbidity and mortality compared to HIV- uninfected populations. Increasing age, comorbid burden, and lifestyle factors, contribute to greater than expected impairments in key components of daily function and a high burden of fatigue among older adults living with HIV. Effective, scalable, non-pharmacological strategies are needed to improve the healthspan of this vulnerable population. The overall goals of this proposal are to determine whether high-intensity interval training (HIIT) can overcome 1) physical function impairments and increased fatigue and 2) impairments in mitochondrial bioenergetics of older people with HIV (PWH) to a greater extent than continuous moderate-intensity exercise (CME). We further seek to determine whether a biobehavioral coaching intervention following either HIIT or CME can promote long-term adherence to physical activity, a crucial component of the sustainability of the intervention. We have previously demonstrated greater than expected impairments in physical function and a high prevalence of fatigue among older adults with HIV. We found that CME and resistance exercise improves physical function in older PWH, with additional improvements from a higher-intensity aerobic and resistance exercise program. Additionally, only our higher-intensity continuous aerobic exercise intervention reduced fatigue among PWH. Lastly, less than half of our participants continued to exercise at least once a week following the supervised intervention, which suggests that even when exercise is beneficial it can be difficult for PWH to maintain. Together, our findings suggest that an innovative approach to exercise is needed to improve physical function, reduce fatigue, and to maintain a long-term exercise habit among older PWH. To address this critical need, our proposed study will leverage the resources of two diverse participant populations at the University of Colorado and Case Western Reserve University to 1) Compare HIIT vs CME on physical function and fatigue, 2) Compare HIIT vs CME on skeletal muscle and peripheral blood mononuclear cell mitochondrial bioenergetics, and 3) Test a coaching intervention vs control on physical activity adherence, assessing perceptions of these approaches using mixed methods. This study will generate rigorous data on physical function and fatigue responses to exercise, the associated mitochondrial adaptations, and investigate strategies to instill sustained, self-directed exercise behavior. Overall, our findings will inform the development of scalable, effective exercise recommendations tailored to the unique needs of aging PWH.