Strength exercise for balance and gait in HIV-associated distal symmetrical polyneuropathy: A randomised controlled trial.

Abdulsalam M Yakasai,Sonill Maharaj,Musa S Danazumi

doi:10.4102/sajhivmed.v22i1.1268

Abstract

BackgroundHIV-associated peripheral neuropathy (PN) is a common neurological complication associated with HIV infection. Distal symmetrical polyneuropathy (DSPN) is the most commonly occurring type, which is associated with symptoms such as numbness, unsteady gait and, in some cases, muscle atrophy and weakness when myelinated nerve fibres are affected. If unmyelinated nerve fibres are affected, a painful neuropathy and autonomic symptoms may occur.ObjectivesThis research study assessed the effects of a strength exercise intervention on balance impairment and gait disturbance amongst individuals living with HIV-associated DSPN.MethodThe study was a single-blinded, randomised controlled trial (RCT) with participants sourced from four HIV centres in Kano metropolis, Nigeria. The intervention was supervised and included progressive resistance exercise (PRE) (three 40-min sessions per week for 12 weeks) using a quadriceps bench (n = 44). The control group (CG) included the non-exercise group (n = 47). The two groups continued to receive routine care. Data were summarised and analysed using inferential statistics (SPSS version 20 program) with the alpha level set at < 0.05.ResultsAt 12 weeks, the results revealed significant improvement with regard to balance performance (p = 0.001) and walking ability (p = 0.001) in the training group. In contrast, no significant differences in balance (P = 0.677) or gait (P = 0.578) were observed in the CG.ConclusionThe findings suggest that PRE is beneficial for balance impairment and gait disturbance caused by neuropathy in persons living with HIV and receiving antiretroviral drugs.

Highlights

Peripheral neuropathy (PN) is a neurological condition affecting the sensory, motor or autonomic peripheral nerves
This study investigated the effect of progressive resistance exercise (PRE) on balance impairment and the walking ability of HIV-positive individuals on ART and living with neuropathy
Seven (6.9%) of the 51 participants randomised to the PRE group dropped out, whilst four (3.9%) of the 51 randomised to the control group (CG) dropped out (Figure 1)

Summary

Introduction

Peripheral neuropathy (PN) is a neurological condition affecting the sensory, motor or autonomic peripheral nerves. The classification of PN is generally based on the cause or pathological features of the nerve fibres affected. It can be subdivided based on primary myelin or axonal damage into demyelinating or axonal PN.[1] The global estimate of HIV-associated neuropathy varies widely from 1.73% to 69.4% in different HIV-infected populations.[2] Sadly, PN was shown to be associated with HIV infection itself but in many cases triggered by treatment with antiretroviral agents.[3] Growing evidence of unwanted adverse effects of the early antiretrovirals (ARVs) led to the use of safer, later generation ART in many countries. If unmyelinated nerve fibres are affected, a painful neuropathy and autonomic symptoms may occur

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