JMIR Publications

ABSTRACT

Background:

More individuals with HIV are living longer and aging with disability associated with multimorbidity. Community-based exercise (CBE) can prevent and mitigate disability, and improve health outcomes aging with HIV. However, engagement in exercise can vary.

Objective:

To describe the fidelity of implementation (FOI) of a six-month online tele-coaching community-based exercise intervention with adults living with HIV from the perspectives of adults with HIV and personal trainers.

Methods:

We conducted an observational longitudinal study involving a six-month online CBE intervention that included thrice-weekly 60-minute exercise sessions; online biweekly supervised one-on-one exercise sessions with a personal trainer (13 sessions); and online monthly group educational sessions at the YMCA. We assessed fidelity using 1) online structured interviews with participants living with HIV at months 2 and 6 comprised of 20 fidelity items on trainer performance, participant engagement, and exercise experiences; and 2) coaching logs completed by personal trainers after biweekly training sessions (frequency, intensity, time, and type of physical activity during biweekly supervised sessions and self-reported physical activity in the prior week). We considered FOI criteria to be met if ≥80% of the participants living with HIV: 1) attended at least 80% of training sessions (11 of 13 sessions); 2) engaged in thrice weekly exercise the week of the personal training session ≥80% of the time over the six-month intervention as reported on the coaching logs, 3) reported “complete criteria met” for ≥80% of the fidelity items (≥16 of 20 items) at month 2 and month 6, as reported from the interviews; and 4) engaged in a combination of aerobic, strength, balance, flexibility ≥80% of the time over the six-month intervention as reported in the coaching logs.

Results:

Twenty-nine of 32 participants (69% male) participated in at least one fidelity interview. FOI was met for one of our four criteria among the 18 participants who completed the intervention and FOI assessment at month 6, specifically Criterion 1 whereby 83% (95% confidence interval (CI):66, 100) of participants (15/18) attended ≥80% of the 13 coaching sessions. For Criterion 2: 50% (95%CI:27,73) of participants (9/18) engaged in thrice weekly exercise in the week of the personal training session at least 80% of the time over the six-month intervention; Criterion 3: At least 80% of participants reported criteria as ‘completely met’ for 14 of 20 items (70%; 95%CI:50,89) at month 2 (n=27 participants), and 6 of 20 items (30%; 95%CI:10,50) at month 6 (n=18 participants); and Criterion 4: 22% (95%CI:3,41) of participants engaged in a combination of all four exercise types ≥80% of the time. Barriers to engagement included scheduling issues, lack of interest, technology problems, and episodic disability.

Conclusions:

Fidelity of implementation was achieved for supervised components of the CBE intervention, and less with independent exercise. Health and rehabilitation providers should tailor exercise interventions to personal preferences and abilities to improve engagement among adults living with HIV.