Jan. 12, 2000 (Atlanta) -- Aerobic exercise can bring a multitude of benefits to those who are HIV positive, enhancing mood and overall quality of life -- and possibly improving immunity -- according to an article in a recent issue of Sports Medicine.
"Aerobic exercise is clearly important," author William W. Stringer, MD, an HIV researcher at Harbor-UCLA Medical Center in Torrance, Calif., tells WebMD. "It helps maintain lean body mass when wasting is a problem. It can have effects not only on aerobic capacity and the amount of exercise you can do, but also ... on the immune system and quality of life."
Stringer adds, "There are such excellent HIV drugs now that are boosting the immune system, we can recommend a much more aggressive exercise program than before."
In his paper, Stringer reviews six recent studies that provide the basis for his recommendations to exercise trainers. He cites evidence confirming that regular, moderate-intensity "breathless" aerobic exercise is at the very least not detrimental to the HIV patient's immune system. Some patients may be able to work up to "heavy exercise" -- that which produces heavy sweating.
For previously sedentary HIV patients, "We recommend six to 12 weeks of moderate exercise, three times a week for about an hour," says Stringer. Exercising daily is less beneficial, he says: "A day or so [of recovery time] allows the immune system to get back to a baseline."
While aerobic exercise has been thought to boost the immune system and slow disease progression, "Immune function is not the best reason to recommend aerobic activity," says Stringer. "It's pretty clear it doesn't have large negative effects. Whether it has small positive effects is going to be difficult to determine. Certainly, there is anecdotal evidence that it does, and that's encouraging. It may be the placebo effect, plus the fact that it's a non-drug therapy that helps them feel better."
"I think this study gives us a new perspective on aerobic exercise and HIV," Alberto Avendano, MD, director of the University of Miami's HIV/AIDS Services program, tells WebMD. "For many years, like we do for other patients for other conditions, we have recommended exercise to patients. In the beginning, it was because we wanted to maintain lean body mass. This study shows that it [has many additional benefits]. Oxygen is a great healer."
In his paper, Stringer cites some evidence that exercise increases CD4 counts. Says Avendano, "From my research and the material I've read, people who start treatment on time and do exercise will maintain 50 CD4s higher than people who don't exercise. That's very significant. It represents an important adjuvant to therapy." CD4 is a kind of white blood cell targeted by HIV. The higher the CD4 count in the blood, the better patients are able to resist infections.
Patients must be careful about physical limitations, especially with new medications that cause high triglycerides and cholesterol levels. If they have a hereditary condition -- such as heart disease -- they need to start very slowly, Avendano advises.
Andrew Zopola, MD, director of Stanford University's Positive Care program, tells WebMD, "We recommend that our patients work with a personal trainer as part of their comprehensive care. We also advise that they talk with their health care provider first before beginning an exercise program."
Exercise appears to lessen some side effects of HIV medications, says Zopola. "Patients who are vigorous exercisers seem to have less problem with the body changes -- what we call peripheral lipodystrophy -- the redistribution of fat that can make patients look sick even when they are not sick," he says. "It also helps with cholesterol problems. It does appear to help control some of the metabolic sequences of [HIV] therapy. We don't have good studies on this, but it's a strong anecdotal experience for many providers."
"The main benefit is that people feel better, they feel healthier, they're more energetic," says Zopola. "It's good for their sense of well being, but specifically with the HIV treatments it does seem to lessen those side effects."
- Moderate aerobic exercise can be beneficial to HIV-positive patients because it enhances mood and quality of life, helps maintain lean body mass when wasting is a problem, and can lessen some side effects of HIV medications.
- There is also evidence that exercise can help improve immunity, as patients who exercise maintain a CD4 count that is significantly higher than that of patients who do not.
- Patients should be aware of their physical limitations, especially high triglyceride and cholesterol levels that can be caused by some of the new medications.