Impact of Physical Activity Routines and Dietary Intake on the Longitudinal Symptom Experience of People Living with HIV (PROSPER-HIV)

Years: 2018-2023

Background

People living with HIV (PWH) experience a disproportionately high symptom burden (e.g. fatigue, insomnia, pain) with few treatment options. Non-pharmacological treatment options are highly desirable for symptom management among PLHIV who already experience high pill burden from multiple comorbid diseases. Building on our previous work, the PROSPER-HIV study is examining the effect of physical activity and dietary intake as effective symptom management strategies in 706 PWH.

Specifically, we are:

Identifying and characterizing longitudinal, objectively-measured, physical activity and dietary patterns among PWH;
Determining which aspects of physical activity patterns and diet quality are associated with decreased symptom burden and intensity in PWH, and if this relationship is moderated by age and sex; and
Exploring the potential mediating effect of anthropomorphic and physical fitness variables on the relationships between physical activity, dietary patterns, and symptom burden and intensity in PWH.

Research Design

We are conducting a four-year, prospective, observational study of 706 Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) participants who complete an enhanced PRO assessment to measure physical activity and diet once a year for three years. We will integrate these measures in an enhanced annual assessment of PRO plus objective measures of physical activity, diet intake and anthropomorphic factors at four CNICS sites: University of Washington, Case Western Reserve University, University of Alabama at Birmingham, and Fenway Health. This study was registered at ClinicalTrials.gov #NCT03790501.

Research Team

Principal Co-Investigators

Allison Webel, PhD, RN, FAAN, University of Washington School of Nursing
Amanda L. Willig, PhD, RD, University of Alabama at Birmingham

Co-Investigators

Heidi Crane, MD, School of Medicine, University of Washington
Michael Saag, MD, School of Medicine, University of Alabama at Birmingham
Julia Fleming, MD, Fenway Health
Dustin Long, PhD, University of Alabama at Birmingham
Tom Buford, PhD, University of Alabama at Birmingham

Results

Enrollment is complete at all study sites and following up and data analysis are ongoing. The following are a few of our recent publications:

dos Santos AP, Oliveira VHF, Willig AL, Ruderman SA, Horvat Davey C, Buford TW, Long DM, Gripshover B, Katundu M, Crane HM, Fleming J, Burkholder G, Saag MS, Webel AR. Influence of the Low-Frequency Extension Filter on Accelerometer-Based Activity Measurements in People with HIV: A Comparative Analysis. AIDS. Accepted for publication on 9/26/2025.
Horvat Davey, C., Willig, A. L., Ruderman, S. A., Dos Santos, A. P., Oliveira, V., Gripshover, B. M., Long, D. M., Cleveland, J. D., Crane, H. M., Fleming, J., Buford, T. W., Burkholder, G., Saag, M. S., & Webel, A. R. (2026). Exploring the Relationship Between Insomnia and Biological Factors, Substance Use, and Physical Activity in People With HIV in the United States: Insights From the PROSPER Study. The Journal of the Association of Nurses in AIDS Care : JANAC, 37(1), 52–62. https://doi.org/10.1097/JNC.0000000000000589
Webel, A. R., Dos Santos, A. P., Davey, C. H., Oliveira, V., Cleveland, D., Buford, T. W., … & Willig, A. L. (2026). Differences in Physical Activity, Physical Function, and Diet Intake, in Men and Women Living With HIV in the United States: A Cross-Sectional Study. Journal of the Association of Nurses in AIDS Care, 37(1), 63-74.
Oliveira, V. H. F., Willig, A. L., Horvat Davey, C., Buford, T. W., Long, D. M., Cleveland, J. D., Menezes, P., Cachay, E., Crane, H. M., Burkholder, G. A., Gripshover, B. M., Fleming, J. G., Katundu, M., Saag, M. S., & Webel, A. R. (2025). Abdominal adiposity is negatively associated with physical function among people with HIV. AIDS (London, England), 39(8), 986–994. https://doi.org/10.1097/QAD.0000000000004168
Dos Santos, A. P., Willig, A. L., Ruderman, S. A., Oliveira, V. H. F., Davey, C. H., Buford, T. W., Long, D. M., Gripshover, B., Katundu, M., Cleveland, J. D., Crane, H. M., Fleming, J., Burkholder, G., Saag, M. S., & Webel, A. R. (2025). The lipid research clinics physical activity questionnaire does not accurately measure physical activity in people with HIV. AIDS (London, England), 39(10), 1392–1396. https://doi.org/10.1097/QAD.0000000000004226
Oliveira, V. H. F., Willig, A. L., Horvat Davey, C., Buford, T. W., Menezes, P., Cachay, E., Crane, H. M., Burkholder, G. A., Gripshover, B. M., Fleming, J. G., Cleveland, J. D., & Webel, A. R. (2024). Brief Report: Relationship Between Adiposity and Biomarkers of Aging and Frailty Among Adults Aging With HIV. Journal of acquired immune deficiency syndromes (1999), 95(4), 377–382. https://doi.org/10.1097/QAI.0000000000003362
Dos Santos, A. P., Willig, A. L., Ruderman, S. A., Oliveira, V. H. F., Horvat Davey, C., Buford, T. W., Long, D. M., Gripshover, B., Katundu, M., Cleveland, J. D., Crane, H. M., Fleming, J., Burkholder, G., Saag, M. S., & Webel, A. R. (2025). Hazardous alcohol consumption is associated with an increased occurrence of falls among people with HIV in the PROSPER-HIV Study. AIDS (London, England), 39(3), 298–305. https://doi.org/10.1097/QAD.0000000000004061
Fazeli, P. L., Davey, C. H., Webel, A. R., Oliveira, V., Buford, T. W., Vance, D. E., Burkholder, G., Crane, H. M., Fleming, J., & Willig, A. L. (2024). Select Dietary Components Are Associated With Better Global Cognition in U.S. Adults With HIV: A Pilot Study. The Journal of the Association of Nurses in AIDS Care : JANAC, 35(5), 388–396. https://doi.org/10.1097/JNC.0000000000000479
Ruderman, S. A., Webel, A. R., Willig, A. L., Drumright, L. N., Fitzpatrick, A. L., Odden, M. C., Cleveland, J. D., Burkholder, G., Davey, C. H., Fleming, J., Buford, T. W., Jones, R., Nance, R. M., Whitney, B. M., Mixson, L. S., Hahn, A. W., Mayer, K. H., Greene, M., Saag, M. S., Kamen, C., … Delaney, J. A. C. (2023). Validity Properties of a Self-reported Modified Frailty Phenotype Among People With HIV in Clinical Care in the United States. The Journal of the Association of Nurses in AIDS Care : JANAC, 34(2), 158–170. https://doi.org/10.1097/JNC.0000000000000389
Webel, A. R., Long, D., Rodriguez, B., Davey, C. H., Buford, T. W., Crane, H. M., Mayer, K., Saag, M. S., & Willig, A. L. (2020). The PROSPER-HIV Study: A Research Protocol to Examine Relationships Among Physical Activity, Diet Intake, and Symptoms in Adults Living With HIV. The Journal of the Association of Nurses in AIDS Care : JANAC, 31(3), 346–352. https://doi.org/10.1097/JNC.0000000000000145
Willig, A. L., Webel, A. R., Westfall, A. O., Levitan, E. B., Crane, H. M., Buford, T. W., Burkholder, G. A., Willig, J. H., Blashill, A. J., Moore, R. D., Mathews, W. C., Zinski, A., Muhammad, J., Geng, E. H., Napravnik, S., Eron, J. J., Rodriguez, B., Bamman, M. M., & Overton, E. T. (2020). Physical activity trends and metabolic health outcomes in people living with HIV in the US, 2008-2015. Progress in cardiovascular diseases, 63(2), 170–177. https://doi.org/10.1016/j.pcad.2020.02.005
Webel, A. R., Schexnayder, J., Cioe, P. A., & Zuñiga, J. A. (2021). A Review of Chronic Comorbidities in Adults Living With HIV: State of the Science. The Journal of the Association of Nurses in AIDS Care : JANAC, 32(3), 322–346. https://doi.org/10.1097/JNC.0000000000000240
Fazeli, P. L., Willig, A. L., Oliveira, V., Buford, T. W., Vance, D. E., Burkholder, G., Crane, H. M., Horvat Davey, C., Fleming, J., & Webel, A. R. (2023). The Association Between Objectively-Measured Physical Activity and Cognitive Functioning in Middle-Aged and Older People Living with HIV. AIDS and behavior, 27(4), 1199–1210. https://doi.org/10.1007/s10461-022-03857-5
Lee D. (2023). The importance of exercise and physical activity in older adults with HIV. AIDS (London, England), 37(12), 1905–1907. https://doi.org/10.1097/QAD.0000000000003664
Webel, A. R., Davey, C. H., Oliveira, V., Cleveland, D., Crane, H. M., Gripshover, B. M., Long, D. M., Fleming, J. G., Buford, T. W., & Willig, A. L. (2023). Physical activity is associated with adiposity in older adults with HIV in the modern HIV era. AIDS (London, England), 37(12), 1819–1826. https://doi.org/10.1097/QAD.0000000000003635

Media

Cleveland.com
- Which diets, exercises ease symptoms of HIV?
Birmingham Business Journal
- UAB awarded $3.25 million grant for HIV research

Support

This project is supported by the National Institutes of Health, National Institute of Nursing Research (R01NR018391).

PROSPER-HIV Study