Exercise tops list for quality of life with HIV

With antiretroviral therapy, HIV has become a manageable chronic condition, which shifts the goal of care from survival towards living well. Health-related quality of life — spanning physical, psychological, social and other domains — is now a central outcome, and non-pharmacological interventions offer distinct advantages for optimising long-term health. But many candidate approaches exist, from exercise to mindfulness to cognitive behavioural therapy, and they are rarely compared directly. This review asked which non-drug intervention is most effective for improving overall quality of life and its individual domains in people living with HIV.

The authors searched ten databases — including Embase, MEDLINE, Web of Science, CINAHL, PsycINFO and CENTRAL — from inception to August 2025 for randomised controlled trials of non-pharmacological interventions in people living with HIV. Thirty-seven articles were included. Bayesian network meta-analyses combined direct and indirect comparisons, allowing interventions to be ranked against each other even where head-to-head trials were absent. Risk of bias was assessed with the Cochrane RoB-2 tool and certainty of evidence with CINeMA.

Exercise came out on top for overall health-related quality of life, with a standardised mean difference of 1.00 (95% CI 0.43 to 1.58), and also led the physical (SMD 0.69), psychological (SMD 0.93) and social (SMD 0.57) domains. Mindfulness-based interventions ranked second for overall quality of life (SMD 0.82), and cognitive behavioural therapy ranked second in the psychological domain (SMD 0.73). Notably, there was insufficient data to run network meta-analyses for the environmental, independence and spiritual domains at all. The confidence intervals around these estimates were wide.

This analysis extends a broader pattern in chronic-disease research: structured exercise tends to deliver benefits across multiple quality-of-life domains at once, not just physical function. Ranking exercise above psychological interventions even for psychological and social domains is a striking result, though the wide intervals mean the ordering is not definitive. The authors call for large head-to-head randomised trials to confirm the rankings, and for research into how different exercise types affect specific domains. Methodological improvements — blinded outcome assessment, intention-to-treat analysis and standardised measures — are also flagged as needed.

For readers living with HIV, or interested in how lifestyle interventions perform in chronic conditions, this is a reason to think that exercise is among the best-supported non-drug tools for feeling and functioning better across several life domains. It is also a reminder that psychological approaches such as mindfulness and CBT showed meaningful effects too, particularly for mental wellbeing. Because the rankings rest partly on indirect comparisons and imprecise estimates, they indicate where the evidence currently points rather than settling the question.