EVIDENCE ON PHYSICAL ACTIVITY FOR ADULTS (NO UPPER AGE LIMIT) LIVING WITH CHRONIC CONDITIONS

E1EVIDENCE ON PHYSICAL ACTIVITY FOR ADULTS (NO UPPER AGE LIMIT) LIVING WITH CHRONIC CONDITIONS

Publication Details

Guiding Questions

E1.

What is the association between physical activity and health-related outcomes?

Is there a dose response association (volume, duration, frequency, intensity)?
Does the association vary by type or domain of physical activity?

Inclusion Criteria

Population: People living with any of the following conditions:

Cancer
Hypertension
Type 2 diabetes
HIV

Exposure: Greater volume, duration, frequency or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Table

Evidence identified

Thirty-six reviews were initially identified (published from 2016 to 2019) that examined the association between physical activity and health-related outcomes among people with chronic conditions (1–36). However, 14 reviews were excluded from further evaluation given populations, exposures, or outcomes that were out-of-scope or given redundancy with another more comprehensive and credible review. Table E1.1a presents the reviews that were excluded and their reason for exclusion.

Table E1.1.a

Excluded Systematic Reviews, with Reasons for Exclusion for chronic conditions including cancer, hypertension and Type 2 diabetes.

For the commissioned umbrella review on physical activity and health outcomes in persons living with HIV, searches were conducted in three reference databases including: Pubmed, CINAHL and Web of Science. Where available, search strings were based on those used in the Physical Activity Guidelines for Americans 2018, with the following distinctions: publications were limited to systematic reviews, meta-analyses, pooled analyses; with no restrictions on publication year; English language only. The searches were completed between the 12–16 October, 2019.

Initial screening of titles and abstracts was done by two independent reviewers, and where consensus was not reached, a third reviewer was consulted. Records were subsequently excluded where duplicates were found, and also if the articles did not specifically address the PICOS. Finally, 24 full-text articles were also excluded, for example, if they did not include PLWHA, or there was no comparator, or the study was not a systematic review (Table E1.1.b).

Table E1.1.b

Excluded Systematic Reviews, for persons living with HIV.

Included Evidence

In general, these reviews had many limitations in their design, execution, and reporting. None of the systematic reviews were rated as having high credibility based on the AMSTAR 2 instrument. Eleven were rated as having moderate credibility, 5 were rated as having low credibility, and the remaining 6 were rated as having critically low credibility. Given concerns regarding the comprehensiveness and the validity of the results presented in reviews rated as having critically low credibility, they were not incorporated into the final Evidence Profiles. Table E1.2.a presents the ratings for each review according to all the AMSTAR 2 main domains.

For the HIV umbrella review, there were 24 studies that were found to be eligible for inclusion in the qualitative synthesis and underwent quality scoring. An independent team of nine reviewers used the AMSTAR2 tool to rate the quality of the final included systematic reviews. Of these 24 reviews, 5 scored critically low on the AMSTAR score, and were excluded from further consideration. Of the remaining 19 reviews, 12 were rated as having high quality, 2 as moderate and 5 as low quality. Table E1.2.b. presents the ratings for each review according to all the AMSTAR 2 main domains

After appropriate exclusions, 1 review was included among persons with cancer (12), 2 reviews were included among persons with hypertension (4, 7), and 13 reviews were included among those with diabetes (5, 8, 13, 15, 19, 20, 25, 27, 29, 31, 33, 34, 36) (Table E1.3.a). None of the reviews included evidence published in 2019; in fact, very few reviews included evidence published in 2017 or 2018. The included bodies of evidence for each review was relatively small ranging from 5 to 39 included studies; one review among persons with a history of cancer included 136 studies. The evidence profiles for these studies are presented in Table 1.4. Extracted data for each included review is presented in Appendix A. A summary of the U.S. Physical Activity Guidelines evidence relevant to these subgroups is provided in the Evidence Profiles.

For HIV, after appropriate exclusions, 19 reviews were included, representing between 5 and 28 studies. Of these, 13 scored a high AMSTAR2 rating, 2 moderate and 4 low (Table 1.3.b). The evidence profiles for these reviews are presented in Table 1.4 and extracted data for each included review are presented in Appendix A.

Table E1.2.a

Credibility Ratings (AMSTAR 2) for systematic reviews on physical activity in persons living with cancer, hypertension and Type 2 diabetes.

Table E1.2.b

Credibility Ratings (AMSTAR 2) for systematic reviews on physical activity in persons living with HIV.

Table E1.3.a

Systematic Reviews Assessed, by chronic condition for cancer, hypertension and Type 2 diabetes.

Table E1.3.b

Systematic Reviews Assessed, by health outcomes for persons living with HIV.

E.1.4. Physical Activity in adults living with chronic conditions

Table E.1.4.a. People who have been diagnosed with cancer, relationship between physical activity and health-related outcomes (PDF, 99K)

Questions: What is the association between physical activity and health-related outcomes? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: People who have been diagnosed with cancer

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: All-cause mortality, cancer-specific mortality, risk of cancer recurrence or second primary cancer

Table E.1.4.b. People with hypertension, relationship between physical activity and health-related outcomes (PDF, 92K)

Population: People with hypertension

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Risk of co-morbid conditions, physical function, health-related QOL, cardiovascular disease progression, cardiovascular mortality

Table E.1.4.c. People with Type 2 Diabetes, relationship between physical activity and health-related outcomes (PDF, 124K)

Population: People with Type 2 Diabetes

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Risk of co-morbid conditions, physical function, health-related QOL, disease progression

Table E.1.4.d

People with HIV, relationship between physical activity and health-related outcomes.

Appendix A. Data Extractions of Included Reviews

Cancer (PDF, 62K)

Hypertension (PDF, 55K)

Diabetes (PDF, 121K)

Human Immunodeficiency Virus (HIV) (PDF, 173K)

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88.: Gomes-Neto M, Rodriguez I, Ledo AP, et al. Muscle strength and aerobic capacity in HIV-infected patients: a systematic review and meta-analysis. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2018 Dec 1;79(4):491–500. [PubMed: 30371532]

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NLM Citation

WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. E1, EVIDENCE ON PHYSICAL ACTIVITY FOR ADULTS (NO UPPER AGE LIMIT) LIVING WITH CHRONIC CONDITIONS.

Condition	Outcomes	Importance
Cancer	All-cause mortality	Critical
	Cancer-specific mortality	Critical
	Risk of cancer recurrence or second primary cancer	Critical
Hypertension	Risk of co-morbid conditions	Critical
	Physical function	Critical
	Health-related quality of life	Critical
	Cardiovascular disease progression	Critical
Diabetes	Risk of co-morbid conditions	Critical
	Physical function	Critical
	Health-related quality of life	Critical
	Disease progression	Critical
HIV	Risk of co-morbid conditions	Critical
	Physical function	Critical
	Health-related quality of life	Critical
	Disease progression	Critical
	Adiposity	Critical

Table E1.1.aExcluded Systematic Reviews, with Reasons for Exclusion for chronic conditions including cancer, hypertension and Type 2 diabetes

Author, Year	Reason for Exclusion	Rationale
People living with cancer
Blond, 2019 (3)	Population	Review is among a general unselected adult population, not among those with a history of cancer
Dinu, 2019 (11)	Population	Review is among a general unselected adult population, not among those with a history of cancer
Lee, 2019 (16)	Population	Review is among a general unselected adult population, not among those with a history of cancer
Liu, 2018 (37)	Population	Review is among a general unselected adult population, not among those with a history of cancer
Qui, 2019 (26)	Redundancy	Review by Friedenreich 2019 (12) includes same evidence base, is more comprehensive, and better quality
Spei, 2019 (30)	Redundancy	Review by Friedenreich 2019 (12) includes same evidence base, is more comprehensive, and better quality
People with hypertension
Chen, 2017 (6)	Population	Review among adults with coronary artery disease, not among those with hypertension
Wang, 2017 (32)	Population	Review among a general unselected adult population, not among those with hypertension
Zhang, 2018 (35)	Population	Results not presented separately for those with hypertension
People with type 2 Diabetes
Anand 2018 (1)	Outcome	Primary outcome is diastolic dysfunction
Bhati 2018 (2)	Outcome	Outcomes are measures of cardiac autonomic function (heart rate reserve, heart rate variability, baroreflex sensitivity)
Delevatti 2019 (10)	Exposure	Comparison of progressive aerobic training vs. non-progressive aerobic training
Jayawardena 2018 (14)	Exposure	Direct comparison between yoga and other forms of exercise
Mosalman Haghighi 2018 (22)	Outcome	Primary outcome is measures of physical activity

Table E1.1.bExcluded Systematic Reviews, for persons living with HIV

Author, Year	Reason for Exclusion	Rationale
People living with HIV
Bjerk, 2017 (40)	Population	Review is among a general unselected adult population, not among those with HIV
Cobbing, 2016 (41)	Design	Review is a scoping review
Falco, 2012 (42)	Exposure	Review is on nutritional interventions
Field, 2016 (43)	Design	Review is a narrative review
Forbes, 2019 (44)	Population	Review targets men with a history of prostate cancer, not among those with HIV
Gonçalves, 2017 (45)	Population	Review is among a general unselected adult population, not among those with HIV
Ivanyi, 2015 (46)	Population/Exposure	Review is on the effects of orthoses, footwear, and walking aids on the walking ability of children and adolescents with spina bifida
Kamitani, 2017 (47)	Design	Review is an umbrella review
Kietrys, 2018 (48)	Design	The study design is a case series
Koepke, 2018 (49)	Population	Review is among people with multiple sclerosis
Kong, 2002 (50)	Exposure	Review is on testosterone therapy in HIV wasting syndrome
Larsen, 2019 (51)	Population	Review is among a general unselected adult population, not among those with HIV
Lee, 2013 (52)	Population	Review is among a general unselected adult population at risk of or with diagnosed cardiovascular diseases, not among those with HIV
Maddocks, 2013 (53)	Exposure	Review is on neuromuscular electrical stimulation for muscle weakness in adults with advanced disease
McKay, 2018 (54)	Exposure	Review evaluates mobile phone applications for health behaviour change
Moraes, 2018 (55)	Exposure	Review evaluates psychoneuroimmunology-based interventions
Nelson, 2014 (56)	Population	Review is on the management of osteoarthritis
Omura, 2012 (57)	Exposure	Review is on patient experience of haemophilia and HIV
Roeh, 2019 (58)	Population	Review is on the effects of exercise training on depressive symptoms in somatically ill patients
Roll, 2018 (59)	Population/Design	The study is a concept analysis on the health promotion for people with intellectual disabilities
Russell, 2014 (60)	Exposure	Review examines the efficacy of nutritional interventions on soccer skills
Tian, 2013 (61)	Population/Exposure	Review is among overweight or obese adults and examines the effects of chromium picolinate supplementation
Vancampfort, 2018 (62)	Exposure	Review examines physical activity correlates in people living with HIV/AIDS
Yahiaoui, 2012 (63)	Design	Not a systematic review

Table E1.2.aCredibility Ratings (AMSTAR 2) for systematic reviews on physical activity in persons living with cancer, hypertension and Type 2 diabetes

Author, Year	PICO¹	A priori Methods²	Study Design Selection³	Lit Search Strategy⁴	Study Selection⁵	Data Extraction⁶	Excluded Studies⁷	Included Studies⁸	RoB Assessment⁹	Funding Sources¹⁰	Statistical Methods¹¹	Impact of RoB¹²	RoB Results¹³	Heterogeneity¹⁴	Publication Bias¹⁵	COI¹⁶	Overall Rating¹⁷
People living with cancer
Friedenreich, 2019 (12)	Y	PY	N	PY	Y	N	PY	PY	PY	N	Y	Y	Y	Y	Y	Y	Moderate
People living with hypertension
Cao, 2019 (4)	Y	N	N	PY	Y	Y	PY	PY	Y	N	Y	N	Y	Y	Y	Y	Moderate
Costa, 2018 (7)	Y	PY	N	PY	Y	Y	PY	Y	PY	N	Y	N	Y	N	N	Y	Low
de Sousa, 2017 (9)	Y	N	N	PY	Y	Y	N	PY	N	N	N	N	N	N	N	Y	Critically Low
People living with Type 2 diabetes
Chao 2018 (5)	Y	N	N	PY	Y	Y	PY	PY	PY	N	Y	N	Y	Y	Y	Y	Moderate
De Nardi 2018 (8)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	Y	N	Y	Y	N	Y	Moderate
Jang 2019 (13)	Y	N	N	PY	Y	N	PY	PY	Y	N	Y	N	Y	Y	N	Y	Low
Lauche 2018 (15)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	Y	Y	Y	Y	N	Y	Moderate
Lee 2017 (17)	Y	N	N	PY	Y	Y	PY	PY	Y	N	Y	N	N	Y	N	Y	Critically Low
Liao 2019 (18)	Y	N	N	PY	Y	N	PY	PY	PY	N	Y	N	N	N	Y	Y	Critically Low
Liu, Zhu, et al. 2019 (19)	Y	N	N	PY	Y	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Liu, Ye, et al. 2019 (20)	Y	N	N	PY	Y	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Meng 2018 (21)	Y	N	N	PY	Y	Y	N	PY	N	N	Y	N	Y	Y	Y	Y	Critically Low
Pan 2018 (23)	Y	PY	N	PY	Y	Y	PY	PY	Y	N	N	N	N	N	N	Y	Critically Low
Qui 2017 (25)	Y	PY	N	PY	N	Y	PY	PY	Y	N	Y	N	N	Y	Y	Y	Moderate
Rees 2017 (27)	Y	N	N	PY	Y	N	PY	PY	Y	N	Y	N	N	Y	Y	Y	Low
Sampath Kumar 2019 (28)	Y	PY	N	PY	N	Y	N	PY	N	N	N	N	Y	Y	N	Y	Critically Low
Song 2018 (29)	Y	Y	N	PY	Y	Y	PY	PY	Y	N	Y	Y	Y	Y	Y	Y	Moderate
Thind 2017 (31)	Y	PY	N	PY	N	Y	PY	PY	N	N	Y	N	Y	Y	Y	Y	Low
Xia 2019 (33)	Y	N	N	PY	Y	Y	PY	Y	Y	N	Y	N	Y	Y	Y	Y	Low
Yu 2018 (34)	Y	N	N	PY	Y	Y	PY	PY	PY	N	Y	Y	Y	N	Y	N	Moderate
Zhou 2019 (36)	Y	N	N	PY	Y	Y	PY	PY	PY	N	Y	Y	Y	Y	Y	Y	Moderate

: Abbreviations: COI = conflict of interest; N = no; N/A = not applicable; PICO = population, intervention, comparator, outcome; PY = partial yes; RoB = risk of bias; Y = yes

1: Did the research questions and inclusion criteria for the review include the components of PICO?

2: Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?

3: Did the review authors explain their selection of the study designs for inclusion in the review?

4: Did the review authors use a comprehensive literature search strategy?

5: Did the review authors perform study selection in duplicate?

6: Did the review authors perform data extraction in duplicate?

7: Did the review authors provide a list of excluded studies and justify the exclusions?

8: Did the review authors describe the included studies in adequate detail?

9: Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?

10: Did the review authors report on the sources of funding for the studies included in the review?

11: If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?

12: If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?

13: Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?

14: Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?

15: If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?

16: Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?

17: Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.

Table E1.2.bCredibility Ratings (AMSTAR 2) for systematic reviews on physical activity in persons living with HIV

Author, Year	PICO¹	A priori Methods²	Study Design Selection³	Lit Search Strategy⁴	Study Selection⁵	Data Extraction⁶	Excluded Studies⁷	Included Studies⁸	RoB Assessment⁹	Funding Sources¹⁰	Statistical Methods¹¹	Impact of RoB¹²	RoB Results¹³	Heterogeneity¹⁴	Publication Bias¹⁵	COI¹⁶	Overall Rating¹⁷
People living with HIV
Ibeneme, 2019a (64)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	Y	High
Ibeneme, 2019b (65)	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	N	Y	N	Y	Y	High
O’Brien, 2017 (66)	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	NmAc	NmAc	Y	NmAc	NmAc	Y	High
O’Brien, 2016 (67)	Y	Y	N	Y	Y	Y	Y	PY	Y	Y	Y	Y	Y	Y	Y	Y	High
Gomes Neto, 2015 (68)	Y	Y	Y	Y	Y	Y	PY	Y	Y	N	Y	Y	Y	Y	Y	Y	High
O’Brien, 2010 (69)	Y	Y	N	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	High
Nixon, 2005 (70)	Y	Y	Y	Y	Y	Y	Y	PY	Y	N	Y	Y	Y	Y	Y	Y	High
Bhatta, 2017 (71)	Y	Y	Y	PY	Y	Y	PY	Y	Y	N	Y	Y	Y	Y	Y	Y	High
Pedro, 2017 (72)	Y	Y	N	PY	Y	Y	Y	Y	Y	N	NmAc	NmAc	Y	NmAc	NmAc	N	High
O’Brien, 2004 (73)	Y	Y	N	Y	Y	Y	Y	Y	PY	N	Y	N	Y	N	Y	N	High
O’Brien, 2008 (74)	Y	Y	Y	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	N	High
Zech, 2019 (75)	Y	Y	N	Y	Y	Y	PY	Y	Y	N	Y	Y	Y	Y	Y	Y	High
Chaparro, 2018 (76)	Y	Y	N	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	High
Voigt, 2018 (77)	Y	PY	N	PY	N	Y	PY	Y	Y	N	NmAc	NmAc	Y	NmAc	NmAc	Y	moderate
Poton, 2017 (78)	Y	PY	Y	Y	Y	Y	PY	Y	Y	Y	Y	Y	Y	Y	Y	Y	moderate
Gomes Neto, 2013b (79)	Y	Y	N	Y	Y	Y	N	Y	Y	N	NmAc	NmAc	Y	NmAc	NmAc	N	Low
Fillipas, 2010 (80)	Y	Y	Y	PY	Y	Y	PY	Y	Y	N	Y	Y	Y	Y	N	N	Low
Heissel, 2019 (81)	Y	Y	Y	Y	Y	Y	N	Y	Y	Y	Y	Y	Y	Y	Y	Y	Low
Quiles, 2019 (82)	Y	N	Y	PY	Y	Y	Y	Y	Y	N	NmAc	NmAc	Y	NmAC	NmAC	Y	Low
Nosrat, 2017 (83)	Y	PY	Y	Y	N	N	N	Y	N	N	NmAc	NmAc	N	NmAc	NmAc	Y	critically low
Gomes Neto, 2013a (84)	Y	PY	Y	Y	Y	Y	N	Y	N	N	NmAc	NmAc	N	NmAc	NmAc	Y	critically low
Lopez, 2015 (85)	Y	Y	N	PY	Y	N	PY	PY	N	N	NmAc	NmAc	N	NmAc	NmAc	Y	critically low
Lofgren, 2018 (86)	Y	N	N	N	N	N	PY	Y	N	N	NmAc	NmAc	N	NmAc	NmAc	N	critically low
Leyes, 2008 (87)	Y	N	Y	N	N	Y	Y	PY	N	N	NmAc	NmAc	N	NmAc	NmAc	Y	critically low

: Abbreviations: COI = conflict of interest; N = no; NmAC = No meta-analysis conducted; PICO = population, intervention, comparator, outcome; PY = partial yes; RoB = risk of bias; Y = yes

1: Did the research questions and inclusion criteria for the review include the components of PICO?

2: Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol?

3: Did the review authors explain their selection of the study designs for inclusion in the review?

4: Did the review authors use a comprehensive literature search strategy?

5: Did the review authors perform study selection in duplicate?

6: Did the review authors perform data extraction in duplicate?

7: Did the review authors provide a list of excluded studies and justify the exclusions?

8: Did the review authors describe the included studies in adequate detail?

9: Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?

10: Did the review authors report on the sources of funding for the studies included in the review?

11: If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results?

12: If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis?

13: Did the review authors account for RoB in individual studies when interpreting/ discussing the results of the review?

14: Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review?

15: If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review?

16: Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?

17: Shea et al. 2017. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both.

Table E1.3.aSystematic Reviews Assessed, by chronic condition for cancer, hypertension and Type 2 diabetes

Author, Year	Outcomes							Last Search Date	# of Included Studies	AMSTAR 2 (38)
Author, Year	All-causer mortality	Cancer-specific mortality	Risk of cancer reoccurrence	Risk of comorbid conditions	Physical function	Quality of life	Disease progression	Last Search Date	# of Included Studies	AMSTAR 2 (38)
People living with cancer
Friedenreich, 2019 (12)	✕	✕						Jul-2018	136	Moderate
People with hypertension
Cao, 2019 (4)						✕	✕	Jul-2018	14	Moderate
Costa, 2018 (7)					✕		✕	Apr-2017	9	Low
de Sousa, 2017 (9)							✕	Nov-2016	5	Critically Low
People with type 2 diabetes
Chao 2018 (5)							✕	Jun-2016	14	Moderate
De Nardi 2018 (8)							✕	Jul-2017	7	Moderate
Jang 2019 (13)							✕	Aug-2017	23	Low
Lauche 2018 (15)				✕			✕	Jan-2017	6	Moderate
Lee 2017 (17)					✕		✕	Nov-2016	10	Critically Low
Liao 2019 (18)							✕	Jan-2018	20	Critically Low
Liu, Zhu, et al. 2019 (19)							✕	Apr-2018	13	Moderate
Liu, Ye, et al. 2019 (20)							✕	Sep-2018	24	Moderate
Meng 2018 (21)							✕	Jun-2016	21	Critically Low
Pan 2018 (23)							✕	Apr-2017	37	Critically Low
Qui 2017 (25)							✕	Oct-2017	9	Moderate
Rees 2017 (27)						✕	✕	Feb-2017	9	Low
Sampath Kumar 2019 (28)							✕	Jun-2017	11	Critically Low
Song 2018 (29)							✕	Sep-2017	39	Moderate
Thind 2017 (31)							✕	Feb-2016	23	Low
Xia 2019 (33)							✕	Apr-2018	17	Low
Yu 2018 (34)						✕	✕	Dec-2016	20	Moderate
Zhou 2019 (36)					✕	✕	✕	Mar-2018	23	Moderate

Table E1.3.bSystematic Reviews Assessed, by health outcomes for persons living with HIV

Author, Year	Outcomes							Last search date	# of included studies	AMSTAR 2
	HRQOL	Body Composition	Anxiety/Depression	Fitness and Functional Capacity	Cardio-Metabolic Markers	Viral Load/CD4 +	Cognition	Last search date	# of included studies	AMSTAR 2
Ibeneme, 2019a (64)				✕				Jan 2018	23	high
Ibeneme, 2019b (65)	✕					✕		June 2017	19	high
O’Brien, 2017 (66)	✕	✕		✕		✕		April 2013	20	high
O’Brien, 2016 (67)	✕	✕	✕	✕		✕		April 2013	24	high
Gomes Neto, 2015 (68)	✕			✕				Aug 2014	7	High
O’Brien, 2010 (69)	✕	✕	✕	✕		✕		June 2009	14	high
Nixon, 2005 (70)	✕		✕	✕		✕		Aug 2003	10	high
Bhatta, 2017 (71)	✕							Dec 2015	28	high
Pedro, 2017 (72)	✕	✕		✕	✕	✕		July 2016	5	High
O’Brien, 2004 (73)	✕		✕	✕		✕		NMR2002	10	high
O’Brien, 2008 (74)	✕	✕		✕		✕		Nov 2008	10	high
Zech, 2019 (75)				✕				Aug 2017	27	high
Chaparro, 2018 (76)				✕				Dec 2017	13	high
Voigt, 2018 (77)				✕				Not reported	15	moderate
Poton, 2017 (78)		✕		✕		✕		June 2016	13	moderate
Gomes Neto, 2013b (79)	✕			✕				Aug 2012	8	low
Fillipas, 2006 (80)		✕			✕			Nov 2009	9	low
Heissel, 2019 (81)			✕					Feb 2019	10	low
Quiles, 2019 (82)					✕			Nov 2017	9	low
Nosrat, 2017 (83)	✕		✕					Nov 2016	24	critically low
Gomes Neto, 2013a (84)	✕	✕		✕				Aug 2012	29	critically low
Lopez, 2015 (85)	✕		✕	✕		✕		Nov 2015	18	critically low
Lofgren, 2018 (86)			✕					Feb2017	18	critically low
Leyes, 2008 (87)	✕	✕		✕		✕		1996–2008	25	critically low

Table E.1.4.dPeople with HIV, relationship between physical activity and health-related outcomes

Table E.1.4.d.1. Effects of physical activity on health-related quality of life among people living with HIV (PDF, 108K)

Questions: What is the association between physical activity and heath related quality of life (HRQOL? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: People living with HIV

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcomes: Health-related quality of life (HRQOL)

Table E.1.4.d.2. Effects of physical activity on body composition among people living with HIV (PDF, 127K)

Questions: What is the association between physical activity and body composition? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: People living with HIV

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcomes: Body mass index, waist and hip circumference, body fat percentage, lean body mass, fat mass, skeletal muscle mass

Table E.1.4.d.3. Effects of physical activity on anxiety/depression among people living with HIV (PDF, 88K)

Questions: What is the association between physical activity and anxiety and depression? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: People living with HIV

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Symptoms of anxiety or depression

Table E.1.4.d.4. Effects of physical activity on fitness and functional capacity among people living with HIV (PDF, 143K)

Questions: What is the association between physical activity, functional capacity and fitness? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: People living with HIV

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Measures of fitness and functional capacity (VO₂max, Exercise time, strength)

Table E.1.4.d.5. Effects of physical activity on cardio metabolic markers among people living with HIV (PDF, 80K)

Questions: What is the association between physical activity and markers of cardiometabolic risk? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: People living with HIV

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Markers of cardiometabolic risk (blood lipids, glucose and insulin, blood pressure)

Table E.1.4.d.6. Effects of physical activity on viral load and CD4+ cell count among people living with HIV (PDF, 99K)

Questions: What is the association between physical activity and disease progression? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: People living with HIV

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Markers of disease progression (CD4 count, CD4 percentage, viral load)

Table E.1.4.d.6. Effects of physical activity on cognition among people living with HIV (PDF, 66K)

Questions: What is the association between physical activity and cognition? Is there a dose response association (volume, duration, frequency, intensity)? Does the association vary by type or domain of PA?

Population: People living with HIV

Exposure: Greater volume, duration, frequency, or intensity of physical activity

Comparison: No physical activity or lesser volume, duration, frequency, or intensity of physical activity

Outcome: Cognition, measures of cognitive function