Women living with HIV (WLWH) are at greater risk of advanced cellular aging, comorbidities,
and early mortality than men living with HIV or women in the general population. WLWH face
significant social and economic disadvantages which serve as barriers to accessing HIV
therapy or other programming that could support their health and wellbeing. It is thus
critical to identify amenable healthy aging factors to ameliorate the burden of HIV for WLWH.
Aerobic training has consistently been shown to reduce disease risk and early mortality in
the general population and in people living with HIV. Immune system function partly underlies
many of the cardiovascular, lung, muscular, and neural benefits of aerobic exercise. While
sporadic immune activation is typical during innate and adaptive immune responses, the
development and pathogenesis of non-communicable diseases are now understood to result from
chronic, low-grade, systemic inflammation in the body, known as inflamm-aging as seen among
people living with HIV even when their viremia is controlled by therapy. Systemic
inflammation results from multiple sources, including, but not limited to, accumulation of
fat and immunosenescent cells, the latter of which no longer divide but secrete damaging
inflammatory cytokines. Immunosenescent cells are marked by several biomarkers, though most
attention has been directed towards average telomere lengths of immune cells. Telomeres are
genepoor regions located at the ends of chromosomes and are formed by hexameric 5'(TTAGGG)
n3' repeats and shortened telomeres portend earlier replicative senescence - when cells no
longer replicate but live on in a pro-inflammatory state - or programmed cellular death. 24
weeks of physical activity is associated with apparent reversal of the aging process of
immune cells with increases in average leukocyte (i.e. immune cells) telomere lengths (LTL).
While aerobic exercise benefits people living with HIV, a recent review emphasizes that WLWH
and adults from minority groups are less likely to engage in or are more likely to withdraw
from standard exercise programs. Consultations with The Canadian HIV Sexual and Reproductive
Health Cohort Study (CHIWOS) Advisory Board of WLWH identified and prioritized the need for
interventional research to mitigate the effects of accelerated aging and decrease the risk of
disease, and identified dance as a particularly exciting program to study, if made free and
easily accessible.
This study will be a 12-week randomized dance pilot program. The dance classes will be led by
trained peer dance instructors who are also WLHIV.
Prior to consent, participants will be screened for inclusion/exclusion criteria. Next,
participants will be invited to an in-person, paid orientation session to review study
objectives and discuss the pros/cons to participating in the pilot program and randomization
to either a waitlist control or active study arm. After consent, participants will then be
asked to complete blood draws and a pre-intervention survey.
Each dance instructor (PRA) will lead 1-2 classes (50-min/class) per week (depending on
availability) for 12 weeks, with an expectation that women in the pilot's active arm have
access to 2 classes per week during the first 12 weeks of active data collection. Classes
will be offered in person at a local dance studio. Attendance will be taken at each dance
class by throughout the 12 weeks. Participants will also have the opportunity to socialize
during breaks after dance classes for as long as they wish for up to half an hour.
Following the 12 weeks of active data collection for the pilot program, all participating
women will be asked to return to complete blood draws and a repeat survey to collect
post-intervention data on physical activity levels, mental and physical health, and social
integration. We will also conduct semi-structured interviews with all women in the active arm
to learn more about their experiences in and impressions of the program.
Our 12-week program will be followed by 12 more weeks of dance classes where waitlist women
are invited to join the classes. Attendance of all women will be tracked.