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[Preprint]. 2023 Nov 10:2023.11.10.23298367.
doi: 10.1101/2023.11.10.23298367.

Chronotropic Incompetence among People with HIV Improves with Exercise Training in the Exercise for Healthy Aging Study

Matthew S Durstenfeld  1 , Melissa P Wilson  2 , Catherine M Jankowski  3 , Grace L Ditzenberger  2 , Chris T Longenecker  4 , Kristine M Erlandson  2
Affiliations

Chronotropic Incompetence among People with HIV Improves with Exercise Training in the Exercise for Healthy Aging Study

Matthew S Durstenfeld et al. medRxiv. .

Update in

Abstract

Background: People with HIV (PWH) have lower exercise capacity compared to HIV-uninfected peers, which may be explained by chronotropic incompetence (CI), the inability to increase heart rate during exercise.

Methods: The Exercise for Healthy Aging Study included adults ages 50-75 with and without HIV. Participants completed 12 weeks of moderate intensity exercise, before randomization to moderate or high intensity for 12 additional weeks. We compared adjusted heart rate reserve (AHRR; CI <80%) on cardiopulmonary exercise testing by HIV serostatus, and change from baseline to 12 and 24 weeks using mixed effects models.

Results: Among 32 PWH and 37 controls (median age 56, 7% female, mean BMI 28 kg/m2), 28% of PWH compared to 11% of controls had CI at baseline (p=0.067). AHRR was lower among PWH (91 vs 102%; difference 11%, 95% CI 2.5-19.7; p=0.01). At week 12, AHRR normalized among PWH (+8%, 95% CI 4-11; p<0.001) and was sustained at week 24 (+5, 95%CI 1-9; p=0.008) compared to no change among controls (95%CI -4 to 4; p=0.95; pinteraction=0.004). After 24 weeks of exercise, only 15% PWH and 10% of controls had CI (p=0.70).

Conclusions: Chronotropic incompetence contributes to reduced exercise capacity among PWH and improves with exercise training.

Keywords: HIV; VO2; adjusted heart rate reserve/chronotropic index; cardiorespiratory fitness; chronotropic incompetence; exercise training.

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Figures

Figure 1.
Figure 1.. Chronotropy by HIV Status and Time
Boxplots (median, interquartile range) for adjusted heart rate reserve among those with and without HIV at baseline, after 12 weeks, and after 24 weeks of exercise. Dashed line represented the definition for chronotropic incompetence among people not on chronotropic medications (<80%).
Figure 2.
Figure 2.. Association between Chronotropy and Cardiorespiratory Fitness
Scatter plots and linear fit of the association between adjusted heart rate reserve (x-axis) and peak VO2 in ml/kg/min at baseline. Adjusted for age, sex, and body mass index, each 10% increase in AHRR was associated with a 1.4 ml/kg/min higher peak VO2.
See this image and copyright information in PMC

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