A systematic review and meta-analysis evaluating the effectiveness of minimally supervised home and community exercise interventions in improving physical activity, body adiposity and quality of life in adults living with HIV

People living with HIV (PLWH) are physically inactive and risk cardiometabolic dysfunction. Home and community exercise (HCE) is pragmatic, cost-effective and improves health in varied chronic conditions. This review aimed to synthesize evidence on the effectiveness of minimally supervised HCE for physical activity (PA), adiposity, quality of life (QoL), and other physical and psychological health indices for PLWH. Methods: Databases were searched for studies published January 2000 to April 2023. Risk of bias in experimental and quasi-experimental studies was assessed with the Cochrane Risk-of-Bias for Randomized Trials and Risk-of-Bias in Non-Randomized Studies of Interventions tools, respectively. A random-effects meta-analysis was conducted. Results: From 9648 records, 13 studies (14 HCE groups) with 857 PLWH (average ages 29-56 years) were included; 12 comparator and one single group trial. Aerobic and strength HCE significantly improved PA relative to control by 0.377 units (95 %CI = 0.097, 0.657; p = 0.008) and 1097steps/day (95 %CI = 39.27, 2156.62; p = 0.042). There was a reduction from baseline in percent body fat of 3.36 % (95 %CI = -6.10, 0.42; p = 0.025), but no change in BMI (-0.21 kg/m2; 95 %CI = -0.67, 0.24; p = 0.351) relative to control. HCE improved QoL relative to control in the physical domain by 13points (95 %CI = 6.15, 19.86; p < 0.001), but not in other domains like general health (6.6points; 95 %CI = -1.19, 14.36; p < 0.097). HCE completed at moderate intensity or higher was associated with improvement in outcomes more so than lower intensity HCE. Walking-only interventions were at least as beneficial as other activities. No adverse events were recorded. Conclusion: Minimally supervised HCE can improve PA, body fat, physical QoL and other health indices in PLWH.