Benefits of Exercise

Exercise has been proven to provide many health benefits, ranging from increased aerobic fitness to improved mood for the general population. Although healthcare professionals previously recommended that persons with HIV/AIDS refrain from exercise due to concerns of symptom exacerbation or increased risk of infection, current research implies that persons with HIV/AIDS can reap some of the same benefits of exercise as the general population. Today, therapeutic exercise is becoming a more commonly prescribed alternative therapy for persons with HIV/AIDS, although many physicians refrain from prescribing exercise. Much more research is needed to categorize all the benefits of exercise for persons with HIV/AIDS. Some existing studies show conflicting results or inconclusive findings, often due to small sample sizes because of dropouts. However, much of the research does show definitive results of several exercise benefits.

The overall immunological safety of exercise for persons with HIV/AIDS has been widely researched. Previous concerns revolved around the belief that exercise could result in decreased effectiveness of the immune system, and possible decrease in CD4 cell count. However, several studies have shown that CD4 cell count does not change significantly with exercise, thus concluding that exercise is likely to be safe for persons with HIV/AIDS.

A study conducted by Stringer et al. (1998) considered the changes of aerobic function with exercise training. In addition to a control group, participants were divided into moderate- and high-intensity exercise groups, and participants engaged in respective aerobic exercise plans. The study revealed statistically significant increases in VO2 max changes as well as lactic acidosis threshold (LAT) in the moderate- and high-intensity groups. Studies conducted by Thoni et al. (2002), and Perna et al. (1999) yield similar results, thus supporting the aerobic benefits of exercise to persons with HIV/AIDS.

Studies regarding the effects of exercise on lipodystrophy have also been conducted. A pilot study conducted by Roubenoff et al. (1999) indicated that exercise has the potential to improve body composition in HIV/AIDS associated lipodystrophy. Participants in the study engaged in 20 minutes of aerobic activity followed by 1 hour of resistance training three times per week. Results yielded a significant decline in total body fat of participants, most of which occurred in the trunk. Smith et al. (2001) found similar results in their study in which participants reduced weight, body mass index (BMI), subcutaneous fat, and central fat. Based on current research, it appears that exercise can aid in reducing fat deposits caused by lipodystrophy. Persons who experience lipodystrophy also often experience elevated cholesterol and triglyceride levels. Studies have been performed to determine if exercise can decrease these levels, but have yielded conflicting results. Jones, Doran, Leat, Maher, and Piromhamed (2001) conducted a study in which six participants engaged in aerobic exercise and resistance training program approximately 90 minutes per week for 10 weeks. The results yielded a significant decrease in total cholesterol and triglyceride concentrations upon completion of the program. Conversely, Birk, MacArthur, Lipton, and Levine (2002) conducted a study in which five participants engaged in aerobic exercise 40 minutes three times per week for 12 months. The results yielded no significant change in total cholesterol, but an increase in triglycerides. The small sample sizes and variation in length of the studies cannot provide a definitive determination; thus more research on this topic needs to be implemented.

Although muscle wasting is not as prevalent in the U.S. as it was a decade ago, persons with HIV/AIDS are still at risk. Exercise can be used to prevent wasting as well as to combat wasting. Roubenoff, Abad, and Lundgren (2001) reported findings from a study indicating that the ability to respond to exercise with protein synthesis is maintained in HIV wasting. Zinna and Yarasheski (2003) further established that regular exercise can mitigate muscle protein wasting. Progressive resistance training (PRT) can be used to increase muscle mass and strength in non-wasting persons, and to preserve existing muscle in patients who have muscle wasting.

Participating in exercise can also result in psychological benefits. In a study conducted by Stringer et al. (1998), participants completed a Quality of Life (QOL) questionnaire at entry and after completion of the study. The participants who engaged in exercise during the study improved in all questions on the QOL. Some of the benefits of exercise, such as decreased lipodystrophy, could also result in psychological benefits.

Current exercise guidelines for persons with HIV/AIDS vary, depending on the stage of the person's HIV/AIDS, medications, functional capacity, and symptoms. It is recommended to consult with the person's physician before implementing a program. Most exercise prescriptions consist of endurance or resistance exercises, or a combination. It is important to have the client warm-up at a low intensity, followed by static stretching. Aerobic exercise should be moderate in intensity, as high-intensity exercise is thought to depress immune function. Ideally, start with 15 minutes and gradually increase to 40 minutes, three times per week. Resistance exercise should be performed three days per week, if possible, waiting a full day between sessions. Exercises should target all major muscle groups, and should range in intensity, based on the client's ability. Clients should begin slowly with low weight, repetitions, and sets and gradually increase over time. After aerobic or resistance exercise is completed, the client should engage in cool-down exercise followed by static stretching (Brewi, 2001). Throughout exercise, it is important to make sure the client stays properly hydrated.

Alternatively, Bopp et al. (2003) recommend the number of weekly sessions start low and be increased until the patient can tolerate three to five sessions per week. If the patient is debilitated, a 40-minute session, for example, can be broken up into four 10-minute sessions until the client can work up to a continuous 40-minute session. In addition, Bopp et al. recommend the client complete 4 to 6 weeks of aerobic training before starting a resistance training program in order to improve conditioning and prevent overtraining.

There are several contraindications to exercise in individuals with HIV/AIDS. Workouts should be cancelled if the client is experiencing swollen joints, vomiting, diarrhea, severe dizziness, profuse night sweating, open sores or oozing lesions, bleeding gums, pain on bottoms of feet or in hands, or blood in urine or stool (Youssouf, date unknown). In addition, some persons with HIV/AIDS have peripheral neuropathy. Exercise is believed to be helpful for neuropathy because it promotes circulation. However, if the neuropathy causes severe pain, refrain from exercising the affected area.

Despite evidence that exercise does not negatively affect immune measures and can impact many of the associated conditions of HIV/AIDS, some physicians still caution persons with HIV/AIDS against participating in structured physical activity (Bopp et al., 2003). Although many studies have been conducted pertaining to the effects of exercise on HIV/AIDS, many more need to be carried out to fill gaps in the research. The effects of HAART on the body and the long-term effects of HIV/AIDS and their correlation with exercise are new topics for research. In addition, existing studies focusing on such matters as the effect of exercise on lipodystrophy, cholesterol, and psychological well-being need to be further developed. Research for this paper included a large number of studies, several of which exhibited inconsistent or questionable results. The leading reason behind inconsistencies was due to small sample sizes or dropouts, which often skewed results. Researchers need to focus on gathering large sample sizes when designing future studies.

It is imperative that the benefits of exercise for people with HIV/AIDS be made known to persons with the disease as well as the healthcare professionals who treat them. Although many existing studies provide a foundation, more significant research needs to be completed to provide sound evidence of the importance and benefits of exercise. Future research should include large sample sizes and should differentiate studies between genders and stages of disease. Aside from the physical and emotional benefits, implementing exercise into the treatment of persons with HIV/AIDS is cost-effective and may provide alternative treatments to medication for certain symptoms. Today, persons with HIV/AIDS are living much longer lives; engaging in physical activity and exercise can only better these individuals' lives.




Credits:
http://www.health24.com/medical/Condition_centres/777-792-814-1760,22161.asp
www.ncpad.org/disability/fact_sheet.php?sheet=190&section=1388