JMIR Publications

ABSTRACT

Background:

Frailty is prevalent and dynamic among older people living with HIV (PLWH), and it is associated with adverse outcomes. Lifestyle interventions (diet and physical activity) are recommended, but implementation is limited by resources and patient-level barriers. Digital, self-access education may help scale lifestyle support, yet its effectiveness and limitations in older, multimorbid populations remain uncertain.

Objective:

To evaluate 6-month changes in frailty phenotype status and related clinical, behavioral, and psychosocial outcomes after a QR code–enabled, self-access lifestyle education program (Mediterranean diet and exercise routines) delivered to PLWH aged ≥60 years.

Methods:

We conducted a prospective, quasi-experimental, uncontrolled before-and-after study (single-group pre–post design) with a 6-month follow-up in the HIV outpatient clinic of Universitary Hospital Costa del Sol (Marbella, Spain). Participants received a tri-fold leaflet containing QR codes linking to curated YouTube videos with guidance on Mediterranean diet and aerobic/resistance exercise (basic and advanced levels), as an adjunct to usual clinical care. Frailty was assessed using Fried’s Frailty Phenotype (robust, prefrail, frail). Secondary outcomes included changes in individual frailty criteria and patient-reported measures (insomnia severity [ISI], resilience [CD-RISC-10], loneliness [UCLA], anxiety/depression [HADS]), physical activity (IPAQ), Mediterranean diet adherence (The Andalusian Regional Government Mediterranean Diet Adherence Questionnaire), and inflammatory/immunologic markers (eg, IL-6, hsCRP, D-dimer, CD4/CD8 ratio). We described transitions between frailty states and compared baseline vs 6-month values using paired tests: McNemar’s test was used for categorical variables and the paired Student’s t test was used for continuous variables (Wilcoxon signed-rank test in case of non-normal distribution).

Results:

Of 52 enrolled participants at baseline, 50 were included in the 6-month analysis (available-case). Frailty status showed frequent transitions between adjacent states with no direct robust↔frail transitions. Half of frail participants improved to prefrail (2/4), while 20% of prefrail participants improved to robust (5/25). Conversely, 47.6% of robust participants transitioned to prefrail (10/21), and 24% of prefrail participants transitioned to frail (6/25). No statistically significant changes were observed in inflammatory/immunologic markers or physical activity/diet adherence. Insomnia severity improved (ISI median 6.5 to 4; P=.001) and resilience increased (CD-RISC-10 median 32 to 37; P<.001), while loneliness worsened (UCLA median 34.5 to 38; P=.001). Grip strength did not improve among those impaired at baseline.

Conclusions:

In older PLWH, a QR code–enabled, self-access lifestyle education program was associated with meaningful improvements in insomnia and resilience but did not produce detectable short-term changes in inflammation, physical activity, diet adherence, or grip strength, and loneliness worsened. Frailty remained highly dynamic with bidirectional transitions, supporting the need for multi-component programs that combine scalable digital education with strategies to enhance engagement, resistance training uptake, and social connectedness. Clinical Trial: Not applicable.