***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The HIV-infected older adult ( HOA ) community is particularly vulnerable to cognitive impairment . Previous studies in the general older adult population have reported that lower scores on tests of cognitive function often correlate negatively with aerobic fitness [ 5 - 7 ] . HIV-infected individuals have significantly reduced aerobic fitness and physical function compared to HIV-uninfected individuals . Determining important correlates of cognitive ability may be beneficial in not only detecting precursors to future cognitive impairments , but also target areas for interventions . The purpose of this study was to investigate the relationship between cognitive ability and aerobic fitness in HIV-infected older adults . We conducted a cross-sectional study of HOA on antiretroviral therapy ( ART ) > 50 years of age . Domain specific cognitive function was assessed by means of a neuropsychological battery . Aerobic fitness ( VO2peak ) was assessed using a grade d , progressive treadmill test .  Thirty-seven HOA on ART ( mean±SD : age 59±6 years , BMI 28±5 , CD4 663±337 cells/ml , duration since HIV diagnosis 17±7 years ; 81 % males ) completed the cognitive tests . Several domains of cognition were significantly associated with VO2peak by Spearman correlation analysis ( p<0.05 ) . By step-wise adjusted regression VO2peak was most frequently and significantly related to many cognitive domains such as verbal and visual memory , visual perception , and language ( p<0.05 ) . We found that participants with higher Vo2peak were less likely to have more severe forms of HIV-associated neurocognitive disorders ( H AND ) such as mild neurocognitive disorder ( OR=0.65 ; p=0.01 ) and HIV-associated dementia ( OR=0.64 ; p=0.0006 ) . In HOA and in conclusion , aerobic fitness is related to cognitive performance on various tasks . The likelihood of cognitive impairment increased with lower fitness levels . Therefore , increased fitness may serve an important factor in maintenance of cognition and neural integrity for aging HIV-infected individuals . Future prospect i ve and large scale studies are needed to evaluate the effect of fitness and vascular stiffness and function on cognition and brain structure among HOA Psychoneuroimmunology is a framework for mind-body practice and research that combines cutting-edge scientific exploration with holistic philosophy to appreciate and underst and stress responses . The rapidly growing research literature provides a foundation for building an integrative stress management model with the potential to positively influence the stress-disease relationship and , ultimately , health outcomes . This article introduces a novel tai chi intervention and provides quantitative and qualitative data from a r and omized clinical trial indicating its effects on psychosocial variables in individuals living with various stages of HIV disease Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life The aim of this study was to evaluate and compare the effect of two types of exercises interventions on the regularity and health-related physical fitness in HIV-infected individuals who use antiretroviral therapy ( ART ) . A total of 53 HIV+ African women ( mean age=39.5±8.4 years ) on ART participated in the study . Subjects were r and omly divided into 3 groups , namely , formal exercise ( FEG ) , playful exercise ( PEG ) and control ( CG ) . During 12 weeks , the exercise groups underwent a program of 1-hour duration with a frequency of 3 times a week . The FEG performed a protocol that included 20 minutes of exercise , cycling at 60 % of V̇O2peak , increasing to 75 % and 85 % in the 4th and 8th weeks , respectively , and a muscular endurance circuit consisted of 6 exercises at 15 repetitions per minute ( RM ) . The PEG followed a program consisting of active games . Before and after the intervention the participants were su bmi tted to a clinical evaluation including immunological parameters ( CD4 + ) , cardiovascular risk factors , physical fitness and anthropometry . Comparison of somatic variables before and after the program showed no exercise effect . Immunological and cardiovascular variables were also independent of the exercise group . The main effect was found in cardiorespiratory fitness : exercise groups increased significantly in V̇O2peak ( FEG=14.7 % ; PEG=11.1 % ) with no significant differences in CG . The percentage of high attendance was identical between the two groups . It was concluded that there is no contraindication for exercise in this type of population and the beneficial effect was mainly in cardiorespiratory fitness , regardless of the type of exercise performed The prevalence and incidence of insulin resistance and type 2 diabetes mellitus ( DM ) are higher in people treated for human immunodeficiency virus-1 ( HIV ) infection than in the general population . Identifying safe and effective interventions is a high priority . We evaluated whether the peroxisome proliferator-activated receptor-γ agonist pioglitazone with exercise training improves central and peripheral insulin sensitivity more than pioglitazone alone in HIV-infected adults with insulin resistance and central adiposity . Forty-four HIV-infected adults with baseline insulin resistance and central adiposity were r and omly assigned to 4 mo of pioglitazone ( 30 mg/day ) with or without supervised , progressive aerobic , and resistance exercise training ( 1.5 - 2 h/day , 3 days/wk ) . The hyperinsulinemic euglycemic clamp was used to evaluate alterations in central and peripheral insulin sensitivity . Thirty-nine participants completed the study . Hepatic insulin sensitivity improved similarly in both groups . Exercise training augmented the beneficial effects of pioglitazone on peripheral insulin sensitivity . Greater improvements in peripheral insulin sensitivity were associated with reductions in total body and limb adipose content rather than increases in limb adiposity or pioglitazone-induced increases in adiponectin concentration . We conclude that supplementing pioglitazone with increased physical activity improved insulin sensitivity more effectively than pioglitazone alone in HIV-infected adults with insulin resistance and central adiposity . Pioglitazone alone did not significantly increase limb adipose content . Potential cardiovascular benefits of these interventions in HIV need investigation In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Neurocognitive impairment ( NCI ) remains prevalent in HIV infection . R and omized trials have shown that physical exercise improves NCI in non-HIV-infected adults , but data on HIV-infected population s are limited . Community-dwelling HIV-infected participants ( n = 335 ) completed a comprehensive neurocognitive battery that was utilized to define both global and domain-specific NCI . Participants were divided into “ exercise ” ( n = 83 ) and “ no exercise ” ( n = 252 ) groups based on whether they self-reported engaging in any activity that increased heart rate in the last 72 h or not . We also measured and evaluated a series of potential confounding factors , including demographics , HIV disease characteristics , substance use and psychiatric comorbidities , and physical functioning . Lower rates of global NCI were observed among the exercise group ( 15.7 % ) as compared to those in the no exercise group ( 31.0 % ; p < 0.01 ) . A multivariable logistic regression controlling for potential confounds ( i.e. , education , AIDS status , current CD4 + lymphocyte count , self-reported physical function , current depression ) showed that being in the exercise group remained significantly associated with lower global NCI ( odds ratio = 2.63 , p < 0.05 ) . Similar models of domain-specific NCI showed that exercise was associated with reduced impairment in working memory ( p < 0.05 ) and speed of information processing ( p < 0.05 ) . The present findings suggest that HIV-infected adults who exercise are approximately half as likely to show NCI as compared to those who do not . Future longitudinal studies might be best suited to address causality , and intervention trials in HIV-infected individuals will determine whether exercise can prevent or ameliorate NCI in this population Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Sport and exercise can have several health benefits for people living with HIV . These benefits can be achieved through different types of physical activity , adapting to disease progression , motivation and social-ecological options . However , physical activity levels and adherence to exercise are generally low in people living with HIV . At the same time , high drop-out rates in intervention studies are prevalent ; even though they often entail more favourable conditions than interventions in the natural setting s. Thus , in the framework of an intervention study , the present study aims to explore social-ecological , motivational and volitional correlates of South African women living with HIV with regard to physical activity and participation in a sport and exercise health promotion programme . The qualitative data was produced in the framework of a non-r and omised pre-post intervention study that evaluated structure , processes and outcomes of a 10-week sport and exercise programme .  All 25 participants of the programme were included in this analysis , independent of compliance . Data was produced through question naires , participatory group discussion s , body image pictures , research diaries and individual semi-structured interviews . All participants lived in a low socioeconomic , disadvantaged setting . Hence , the psychological correlates are context ualised and social-ecological influences on perception and behaviour are discussed . The results show the importance of considering social-cultural and environmental influences on individual motives , perceptions and expectancies , the fear of disclosure and stigmatisation , sport and exercise-specific group dynamics and self-supporting processes . Opportunities and strategies to augment physical activity and participation in sport and exercise programmes in the context of HIV are discussed Background Progressive resistance exercise training ( PRT ) improves physical functioning in patients with HIV infection .  Creatine supplementation can augment the benefits derived from training in athletes and improve muscle function in patients with muscle wasting . The objective of this study was to determine whether creatine supplementation augments the effects of PRT on muscle strength , energetics , and body composition in HIV-infected patients . Methodology /Principal Findings This is a r and omized , double blind , placebo-controlled , clinical research center-based , outpatient study in San Francisco . 40 HIV – positive men ( 20 creatine , 20 placebo ) enrolled in a 14-week study . Subjects were r and omly assigned to receive creatine monohydrate or placebo for 14 weeks . Treatment began with a loading dose of 20 g/day or an equivalent number of placebo capsules for 5 days , followed by maintenance dosing of 4.8 g/day or placebo . Beginning at week 2 and continuing to week 14 , all subjects underwent thrice-weekly supervised resistance exercise while continuing on the assigned study medication ( with repeated 6-week cycles of loading and maintenance ) . The main outcome measurements included muscle strength ( one repetition maximum ) , energetics ( 31P 
    Output:
    
Results demonstrated statistically significant improvements in cardiorespiratory status ( maximum oxygen consumption , exercise time ) , strength ( chest press , knee flexion ) , weight , and body composition ( arm and thigh girth , leg muscle area ) among exercisers versus non-exercisers .
We found no significant differences in change in CD4 count and viral load .
We were unable to perform meta-analyses for psychological outcomes however results from individual studies demonstrated improvements in health-related quality of life with exercisers compared with non-exercisers .
Conclusions Performing progressive resistive exercise ( PRE ) or a combination of resistive and aerobic exercise at least three times per week for at least six weeks is safe and can lead to improvements in cardiorespiratory fitness , strength , weight , and body composition for adults with HIV .
Exercise may be considered a safe and beneficial for enhancing the health of medically stable adults aging with HIV