Top 6 Fitness Tips for People With HIV

A Practical Guide to Aerobic and Resistance Training

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According to research from Case Western Reserve University, people with HIV generally do far less exercise than is needed to ensure optimal health and to mitigate the associative impact of long-term HIV infection. This appears to be especially true for those who need it most.

According to the report, women generally exercised an average of 2.4 hours per week, while men did slightly more at around 3.5 hours per week.

However, when walking was excluded from the routines, the rates fell sharply. On average, women did barely more than an hour's exercise per week, and while men generally did more, they did so far less vigorously.

Fitness Goals Differ in People with HIV

The consequences of reduced physical activity for people living with HIV can often be profound, particularly since long-term infection can, in and of itself, result in the premature development of such non-HIV-related conditions as heart disease and osteoporosis—often 10-15 years before that of the general population.

Moreover, people with HIV over the age of 50 who have had little physical activity—defined by a so-called short physical performance battery (SPPB) rating of 10 or less—have an astonishing six-fold increase in the likelihood of death compared to HIV-negative adults with the same SPPB rating.

By contrast, the benefits of an informed fitness program, even for those with reduced immune function, are clear, including

  • Improvement in lipid (fat) levels
  • Improvement in markers for insulin resistance (which measures the risk of diabetes)
  • Improvements in muscle size and strength, mitigating the effects of wasting or weight loss
  • Improvement in cardiovascular function, lessening risk of heart attacks and strokes

A review of 12 different studies into the impact of exercise on people with HIV was conducted by researchers at the University of Washington in Seattle in 2011.

It aimed to quantify not only the effects of aerobic and resistance training on the study population, but to afford recommendations by which to design programs specific to both younger and older groups.

These recommendations were largely supported by the American College of Sport Medicine (ACSM), which in 2011 also published training goals for people living with HIV, with an aim of increasing aerobic capacity; improving lean muscle mass and strength; ensuring progressive growth in fitness levels; and maintaining limberness and joint strength.

TIP #1: Ensure a Proper Balance of Aerobic and Resistance Exercises

It doesn't matter if you are young and healthy, or if you're older and frail. It doesn't even matter how high or low CD4 count may be. An informed exercise program for all people living with HIV includes both aerobic and resistance training, focusing on attainable goals with a steady progression in both the time and intensity of the programs.

Do not limit yourself to all-aerobics, all-yoga, or all-weight lifting routine.

Mix it up to provide an ideal balance between lean muscle growth and increased lung/cardiovascular capacity. To launch an effective fitness program, aim for the following goals:

  • Adults 18 years and over: Between 30-60 minutes of aerobic exercise 3 days per week combined with resistance/strength training involving each of the five muscle groups for 2-3 days per week (starting at three sets of 10 repetitions).
  • Older adults with metabolic syndrome (i.e., abdominal obesity, high blood pressure, high cholesterol, etc.):  45 minutes of aerobic exercise in tandem with resistance training (starting at two sets of 10-15 repetitions) for 3-5 days per week.
  • Older, frail adults: Between five and 60 minutes of aerobic activity, as tolerated, for 3-5 days per week combined with resistance training 3 days per week (15-20 minute sessions).

TIP #2: Seek Expert Advice

Before beginning any fitness training, consult with the appropriate professional to ensure that you are embarking on a program that is safe and appropriate for you.  This is particularly true for persons with metabolic syndrome or anyone in poorer health. Prior to initiating a program, it is strongly recommended that you meet with a doctor to discuss your goals and to ensure there are no health barriers that may put you at needless risk.

Even for younger, healthy individuals, consider meeting with a sports medicine professional or licensed trainer before beginning a program (even a home-based one). Not only will this ensure proper form and preparation, it can greatly reduce the risk of exercise-related injuries.

For older, frail adults, seek input from your doctor, ideally to perform a treadmill test and to ascertain your so-called VO2max, which measures your lung capacity. Subsequent visits can determine the improvement on these baseline markers and ensure that your training goals are both appropriate and on target.

TIP #3: Choose the Exercises and Levels That Are Right for You

It is not uncommon for people, with HIV or without, to jump head-first into an ambitious, "get fit" routine only to burn out within months or even weeks. In people with HIV, program failure was most often associated with the following, three factors:

  • Minimal exercise sessions of 20 minutes or less
  • Lack of progression in exercise intensity or duration
  • Missed sessions

To overcome this, ensure that you start with a realistic program that challenges you but still affords you some assurance of marked progression. Begin first by choosing the activity appropriate to your lifestyle and current training capacity.

Younger adults, for example, may want to start with a mixed routine of chest press, leg extensions, leg curls, shoulder press, lat pulldowns, bicep curls, and tricep dips. Aerobic options appropriate to this group can include jogging, cycling, stair climbing, treadmill or a group aerobics class.

By contrast, larger or older adults may want to focus on isokinetic machines, weight machines or ball machines that provide greater control, while kicking off an aerobics program with lower-impact walking or stationary cycling.

TIP #4: Start Reasonably, but Progress Steadily

Once a fitness routine is established, gradually increase intensity over the course of the first six weeks, aiming for the following intensity goals:

  • Younger adults: Aim to raise heart rate by 50-85% from resting baseline during aerobic exercises, while increasing resistance training from three to four sets with higher weights but lower repetitions (between 4-8 reps).
  • Adults with metabolic syndrome: Aim to increase heart rate by 60-90% from resting baseline during aerobic exercises, while increasing resistance training from 10 repetitions per set to 15 and, later, two sets to three.
  • Older, frail adults: Aim to increase the intensity of aerobic activities (as measured by your VO2max) by gradually increasing duration, while moving from an exercise program without weights to one with weights.

TIP #5: Stretch... and Then Stretch Some More

Whether young or old, always ensure that you provide yourself ample time to stretch before and after each session, ideally 10-15 minutes. This not only helps prevent injury but ensures that the long-term loss of flexibility often associated with heavy training (e.g. shoulders curling forward, hamstrings tightening) can be prevented.

Gentle yoga—as well as yin yoga, growing in popularity in recent years—may be an ideal adjunct to an informed fitness program, both of which concentrate on flexibility and the gradual release of tight muscles, joints, and connective tissues. This is particularly true for older adults who may be unable to engage in more robust forms of resistance training, at least at the onset.

TIP #6: Never Overtrain

Prolonged, strenuous activity for over 90 minutes is not advised and may, in fact, be counterproductive to your training goals.

Oftentimes people will assume that bigger muscles or a more robust program of aerobics and resistance training will translate to greater immune function. This is simply not the case. While exercise is safe for everyone with HIV, regardless of age group or stage of infection, exercise itself has absolutely no impact on either a person's CD4 count or viral load.

In fact, excessive training can potentially add to the chronic inflammation that is at the heart of many the premature comorbidities associated with long-term HIV infection. Loss of flexibility, joint damage, increases in insulin resistance (due to increased cortisol levels) and decreased testosterone levels are just some of the consequences of excessive training. Steroid use only compounds these concerns.

Always embark on an exercise program that fit within your lifestyle with an eye toward maintaining your goals over the long run.

Sources:

Yahioauoi, A.; McGough, B.; and Voss, J. "Development of Evidence-Based Recommendations for Older HIV-Infected Patients." Journal of the Association of Nurses in AIDS Care. May-June 2012; 23(3):204-219.

Greene, M.; Covinsky, K.; Astemorski, J.; et al. "The relationship of physical performance with HIV disease and mortality: a cohort study." AIDS. November 28, 2014; 28(18):2711-2719.

Cannon, J. "Keeping Fit with HIV – ACSM Guidelines Make Exercise Possible for Patients." Today’s Dietician. October 2011; 13(10):86.

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