Assessing the fidelity of implementation of an online tele-coaching community-based exercise intervention among adults living with HIV in Toronto, Ontario Canada (Preprint)

BACKGROUND Community-based exercise (CBE) can prevent and mitigate disability and improve health outcomes in people aging with HIV; however, engagement in exercise can vary. OBJECTIVE This study aims to describe the fidelity of implementation (FOI) of an online telecoaching CBE intervention with adults living with HIV. METHODS We conducted an observational longitudinal study involving a 6-month online CBE intervention involving thrice-weekly 60-minute exercise sessions; online biweekly supervised one-on-one exercise sessions with a personal trainer (13 sessions); and online monthly group educational sessions. We assessed fidelity using (1) online structured interviews with participants living with HIV at months 2 and 6, comprising 20 fidelity items on trainer performance, participant engagement, and exercise experiences; and (2) coaching logs completed by personal trainers after biweekly training sessions (frequency, intensity, time, and type of physical activity during supervised sessions and self-reported physical activity in the prior week). We considered FOI criteria to be met if ≥80% of the participants living with HIV: (1) attended ≥80% of training sessions (11 of 13 sessions); (2) engaged in thrice-weekly exercise the week of the personal training session ≥80% of the time over the 6-month intervention, as reported on the coaching logs; (3) reported “complete criteria met” for ≥80% of the fidelity items (≥16 of 20 items) at month 2 and month 6, as reported from the interviews; and (4) engaged in a combination of aerobic, strength, balance, and flexibility exercise ≥80% of the time over the 6-month intervention, as reported in the coaching logs. RESULTS A total of 29 of 32 participants completed at least 1 fidelity interview; 69% (22/32) were male. FOI was met for 1 of our 4 criteria among the 18 participants who completed the intervention and FOI assessment at month 6, specifically criterion 1, whereby 83% (15/18; 95% CI 66%-100%) of participants attended ≥80% of the 13 coaching sessions. For criterion 2, 50% (9/18; 95% CI 27%-73%) of participants engaged in thrice-weekly exercise in the week of the personal training session ≥80% of the time over the 6-month intervention; criterion 3: ≥80% of participants reported criteria as “completely met” for 70% (14/20 items; 95% CI 50%-89%) of items at month 2 (n=27 participants) and 30% (6/20 items; 95% CI 10%-50%) of items at month 6 (n=18 participants); and criterion 4: 22% (4/18; 95% CI 3%-41%) of participants engaged in a combination of all 4 exercise types ≥80% of the time. Barriers to engagement included scheduling issues, lack of interest, technology problems, and episodic disability. CONCLUSIONS FOI was achieved for supervised components of the CBE intervention and less so with independent exercise. Health and rehabilitation providers should tailor exercise interventions to personal preferences and abilities to improve engagement among adults living with HIV.

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