Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Oct 16;230(4):919-927.
doi: 10.1093/infdis/jiae284.

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
Randomized Controlled Trial

Chronotropic Incompetence Among People With HIV Improves With Exercise Training in the Exercise for Healthy Aging Study

Matthew S Durstenfeld et al. J Infect Dis. .

Abstract

Background: People with HIV (PWH) have lower exercise capacity than peers without HIV, which may be explained by chronotropic incompetence, the inability to increase heart rate during exercise.

Methods: The Exercise for Healthy Aging Study included adults aged 50 to 75 years 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; chronotropic incompetence <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 years; 7% female), 28% of PWH vs 11% of controls had chronotropic incompetence at baseline (P = .067). AHRR was lower among PWH (91% vs 101%; difference, 10%; 95% CI, 1.9%-18.9%; P = .02). At week 12, AHRR normalized among PWH (+8%; 95% CI, 4%-11%; P < .001) and was sustained at week 24 (+5%; 95% CI, 1%-9%; P = .008) versus no change among controls (95% CI, -4% to 4%; P = .95; interaction P = .004). After 24 weeks of exercise, 15% of PWH and 10% of controls had chronotropic incompetence (P = .70).

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

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

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Chronotropy and peak VO2 by HIV status and exercise training duration. Adjusted heart rate reserve (AHRR; top) and peak VO2 (bottom) among adults with and without HIV at baseline, after 12 weeks of exercise, and after 24 weeks of exercise. Data are presented as median (line), IQR (box), upper and lower adjacent values, which are 1.5 times the interquartile range further from the first and third quartiles (whiskers), and outliers (circles). Dashed line represents the definition for chronotropic incompetence among people not taking chronotropic medications (AHRR <80%). There is a greater increase in AHRR among people with HIV from baseline to week 12 as compared with people without HIV, which is sustained at week 24. Similarly, from baseline to week 12, there is a greater increase in peak VO2 among people with HIV vs people without HIV, with a similar trend from week 12 to 24.
Figure 2.
Figure 2.
Association between chronotropy and cardiorespiratory fitness. Scatter plots and linear fit of the association between adjusted heart rate reserve (AHRR; x-axis) and peak VO2 (y-axis) 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

Update of

References

    1. Feinstein MJ, Hsue PY, Benjamin LA, et al. Characteristics, prevention, and management of cardiovascular disease in people living with HIV: a scientific statement from the American Heart Association. Circulation 2019; 140:e98–124. - PMC - PubMed
    1. Pothoff G, Wassermann K, Ostmann H. Impairment of exercise capacity in various groups of HIV-infected patients. Respiration 1994; 61:80–5. - PubMed
    1. Oursler KK, Sorkin JD, Smith BA, Katzel LI. Reduced aerobic capacity and physical functioning in older HIV-infected men. AIDS Res Hum Retroviruses 2006; 22:1113–21. - PubMed
    1. Duong M, Dumas JP, Buisson M, et al. Limitation of exercise capacity in nucleoside-treated HIV-infected patients with hyperlactataemia. HIV Med 2007; 8:105–11. - PubMed
    1. Gomes Neto M, Conceicao CS, Ogalha C, Brites C. Aerobic capacity and health-related quality of life in adults HIV-infected patients with and without lipodystrophy. Braz J Infect Dis 2016; 20:76–80. - PMC - PubMed

Publication types