Exercise for People Living with HIV: Difference between revisions

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== Introduction ==
== Introduction ==
Since the introduction of [[Antiviral Drugs|antiviral therapy]], the prognosis of people living with [[Human Immunodeficiency Virus (HIV)|HIV]] (PLWH) has greatly improved<ref name=":2" />. This has however led to new challenges relating to the chronicity of HIV and the long term effects of the disease and the side-effects of [[Antiretrovirals and HIV|ART]] (Antiretroviral therapy).  
Since the introduction of [[Antiviral Drugs|antiviral therapy]], the prognosis of people living with [[Human Immunodeficiency Virus (HIV)|HIV]] (PLWH) has greatly improved<ref name=":2">Jaggers JR, Hand GA. Health Benefits of Exercise for People Living With HIV: A Review of the Literature. ''Am J Lifestyle Med''. 2014;10(3):184-192. Published 2014 Jun 16. doi:10.1177/1559827614538750</ref>. This has however led to new challenges relating to the chronicity of HIV and the long term effects of the disease and the side-effects of [[Antiretrovirals and HIV|ART]] (Antiretroviral therapy).  


Regular [[Physical Activity|physical activity]] and [[Exercise -Therapeutic|exercise]] are part of a healthy lifestyle for everyone, including PLWH<ref name=":0">https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/exercise-and-physical-activity</ref>. In 2020, the World Health Organisation (WHO) released revised [[Physical Activity|physical activity]] recommendations, with additional considerations for people with chronic conditions, including HIV <ref name=":3">Dempsey, P. C., Friedenreich, C. M., Leitzmann, M. F., Buman, M. P., Lambert, E., Willumsen, J., & Bull, F. (2021). Global public health guidelines on physical activity and sedentary behavior for people living with chronic conditions: A call to action. ''Journal of Physical Activity and Health'', ''18''(1), 76–85. <nowiki>https://doi.org/10.1123/JPAH.2020-0525</nowiki></ref>. These recommendations made it clear that exercise is safe and beneficial for PLWH.  
Regular [[Physical Activity|physical activity]] and [[Exercise -Therapeutic|exercise]] are part of a healthy lifestyle for everyone, including PLWH<ref name=":0">https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/exercise-and-physical-activity</ref>. In 2020, the World Health Organisation (WHO) released revised [[Physical Activity|physical activity]] recommendations, with additional considerations for people with chronic conditions, including HIV <ref name=":3">Dempsey, P. C., Friedenreich, C. M., Leitzmann, M. F., Buman, M. P., Lambert, E., Willumsen, J., & Bull, F. (2021). Global public health guidelines on physical activity and sedentary behavior for people living with chronic conditions: A call to action. ''Journal of Physical Activity and Health'', ''18''(1), 76–85. <nowiki>https://doi.org/10.1123/JPAH.2020-0525</nowiki></ref>. These recommendations made it clear that exercise is safe and beneficial for PLWH.  
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PLWH may have a variety of psychological and physiological symptoms associated with the [[Viral Infections|virus]] itself, the related medications, or a combination of both.<ref name=":2" /> Due to these factors, there is need for special considerations when it comes to physical activity and exercise. PLWH often present with significant reductions in general well-being and overall [[Quality of Life|quality of life]], with an interplay of various complex factors contributing to this.   
PLWH may have a variety of psychological and physiological symptoms associated with the [[Viral Infections|virus]] itself, the related medications, or a combination of both.<ref name=":2" /> Due to these factors, there is need for special considerations when it comes to physical activity and exercise. PLWH often present with significant reductions in general well-being and overall [[Quality of Life|quality of life]], with an interplay of various complex factors contributing to this.   


=== WHO guidelines ===
==== WHO guidelines ====
The WHO guidelines recommends that PLWH should engage in regular physical activity, because:
People living with HIV can do the same types of physical activity and exercise as individuals who do not have HIV. The WHO guidelines recommends that PLWH should engage in regular physical activity, because:


* It can improve physical fitness and mental health
* It can improve physical fitness and mental health
* It does not have any negative effects on CD-4 counts or body composition <ref name=":3" />   
* It does not have any negative effects on CD-4 counts or body composition <ref name=":3" />   


It is recommended that PLWH should:
It is recommended that PLWH should:
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[https://apps.who.int/iris/bitstream/handle/10665/337001/9789240014886-eng.pdf WHO guidelines booklet]
[https://apps.who.int/iris/bitstream/handle/10665/337001/9789240014886-eng.pdf WHO guidelines booklet]


=== Health considerations ===
==== Health considerations ====
 
People living with HIV may exhibit metabolic changes with negative health implications. Some of these changes include increased [[Blood Physiology|blood]] lipids, [[Body Composition|central fat accumulation]], lipodystrophy, and decreased aerobic capacity.<ref name=":2" />
=== ART side-effects ===
People living with HIV may have a variety of psychological and physiological symptoms associated with the [[Viral Infections|virus]] itself, the related medications, or a combination of both.<ref name=":2" /> Due to these factors, their general well-being and overall [[Quality of Life|quality of life]] are often reduced.


People living with HIV may exhibit metabolic changes with negative health implications. Some of these changes include increased [[Blood Physiology|blood]] lipids, [[Body Composition|central fat accumulation]], lipodystrophy, and decreased aerobic capacity.<ref name=":2">Jaggers JR, Hand GA. Health Benefits of Exercise for People Living With HIV: A Review of the Literature. ''Am J Lifestyle Med''. 2014;10(3):184-192. Published 2014 Jun 16. doi:10.1177/1559827614538750</ref>
==== Barriers to Exercise ====


==== ART side-effects ====
Symptoms of HIV and treatment-related toxicities may include:<ref name=":2" />
Symptoms of HIV and treatment-related toxicities may include:<ref name=":2" />


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== Benefits of Physical Activity  ==
== Benefits of Physical Activity  ==
Physical activity has numerous benefits, including:<ref name=":0" /><ref name=":1">https://www.hiv.va.gov/patient/daily/exercise/index.asp</ref>


==== 1. Psychological benefits ====
===== Mental Health =====
===== Quality of Life =====
===== Improved self-efficacy<ref>Fillipas S, Oldmeadow LB, Bailey MJ, Cherry CL. A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: a randomised controlled trial. Aust J Physiother. 2006;52(3):185-90. </ref> =====
===== Social Engagement =====
==== 2. Cardiorespiratory benefits ====
==== 3. Haemodynamic effects ====
Regular exercise can also reduce the risk of [[Cardiovascular Disease|cardiovascular disease]], [[Hypertension|high blood pressure]], [[Diabetes|type 2 diabetes]], and cancer and may help reduce symptoms associated with the virus and negative treatment-related side effects. <ref name=":0" />
==== 4. Immunological effects ====
===== CD4 count =====
===== Inflammation =====
==== 5. Physical benefits ====
* Maintains or builds muscle mass
* Maintains or builds muscle mass
* Reduces cholesterol and triglyceride levels (less risk of heart disease)
* Increases energy throughout the day
* Improved self-efficacy<ref>Fillipas S, Oldmeadow LB, Bailey MJ, Cherry CL. A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: a randomised controlled trial. Aust J Physiother. 2006;52(3):185-90. </ref>
* Reduced risk of [[obesity]]
* Regulates bowel function
* Strengthens bones (less risk of [[osteoporosis]])
* Improves blood circulation
* Increases lung capacity
* Helps with sound, restful [[Sleep: Regulation and Assessment|sleep]]
* Lowers [[Stress and Health|stress]]
* Improves appetite
* Improves mood
Regular exercise can also reduce the risk of [[Cardiovascular Disease|cardiovascular disease]], [[Hypertension|high blood pressure]], [[Diabetes|type 2 diabetes]], and cancer and may help reduce symptoms associated with the virus and negative treatment-related side effects. <ref name=":0" /> It is important to note that, although there is a lack of strong evidence suggesting a beneficial effect of exercise on immune function in people living with HIV,  short-term exercise performed at low, moderate, or even high intensities does not have any effect on disease progression or immune function in this population.<ref name=":2" />


== Frequency of Physical Activity  ==
== Types of Exercise ==
People living with HIV can do the same types of physical activity and exercise as individuals who do not have HIV.  
1. Aerobic
 
2. Strengthening and resistance training
 
3. Balance and functional strengthening


The Physical Activity Guidelines advise at least 150-300 minutes per week of moderate-intensity aerobic activity that increase the heart rate such as brisk walking, cycling, or jogging. The Guidelines also recommend some sort of muscle-strengthening activity, such as lifting weights or body-weight exercise, twice per week for adults. <ref>https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines/top-10-things-know</ref>
== Frequency of Exercise ==


Before starting an exercise program, it is important to talk to your health care providers. Your health care team will consider your current health status and and co-existing medical conditions that may affect the type of exercise you can do.<ref name=":1" />
== References  ==
== References  ==


Revision as of 20:23, 14 April 2023

Original Editor - Audrey Brown

Top Contributors - Melissa Coetsee, Kim Jackson, Audrey Brown and Lucinda hampton  

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (14/04/2023)

Introduction[edit | edit source]

Since the introduction of antiviral therapy, the prognosis of people living with HIV (PLWH) has greatly improved[1]. This has however led to new challenges relating to the chronicity of HIV and the long term effects of the disease and the side-effects of ART (Antiretroviral therapy).

Regular physical activity and exercise are part of a healthy lifestyle for everyone, including PLWH[2]. In 2020, the World Health Organisation (WHO) released revised physical activity recommendations, with additional considerations for people with chronic conditions, including HIV [3]. These recommendations made it clear that exercise is safe and beneficial for PLWH.

Considerations for People Living with HIV[edit | edit source]

PLWH may have a variety of psychological and physiological symptoms associated with the virus itself, the related medications, or a combination of both.[1] Due to these factors, there is need for special considerations when it comes to physical activity and exercise. PLWH often present with significant reductions in general well-being and overall quality of life, with an interplay of various complex factors contributing to this.

WHO guidelines[edit | edit source]

People living with HIV can do the same types of physical activity and exercise as individuals who do not have HIV. The WHO guidelines recommends that PLWH should engage in regular physical activity, because:

  • It can improve physical fitness and mental health
  • It does not have any negative effects on CD-4 counts or body composition [3]

It is recommended that PLWH should:

  • Do at least 150-300min of moderate-intensity aerobic physical activity OR 75-150min of vigorous-intensity aerobic physical activity per week [3]
  • Also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups, 2 or more days per week [3]
  • When not contra-indicated, increase moderate-intensity aerobic physical activity to more than 300min, or vigorous physical activity to more than 150min[3]
  • Older adults should also engage with weekly functional balance and strength training 3 days per week, to prevent falls and improved functional capacity[3]
  • When these guidelines can't be met, PLWH should aim to engage with physical activity to the best of their abilities and follow a process of gradual introduction as health status and capacity allow [3]
  • The WHO also emphasises that the above guidelines are not applicable when undergoing acute treatment, if any contra-indications are present or when not medically stable [4].

Infographic on WHO guidelines for physical activity.jpg

WHO guidelines booklet

Health considerations[edit | edit source]

People living with HIV may exhibit metabolic changes with negative health implications. Some of these changes include increased blood lipids, central fat accumulation, lipodystrophy, and decreased aerobic capacity.[1]

Barriers to Exercise[edit | edit source]

ART side-effects[edit | edit source]

Symptoms of HIV and treatment-related toxicities may include:[1]

  • Impaired glucose tolerance
  • Increased fatigue
  • Increased blood lipid profile
  • Chronic inflammation
  • Anxiety
  • Depression
  • Circulating cortisol
  • Higher visceral fat levels[5]
  • Obesity

Benefits of Physical Activity[edit | edit source]

1. Psychological benefits[edit | edit source]

Mental Health[edit | edit source]
Quality of Life[edit | edit source]
Improved self-efficacy[6][edit | edit source]
Social Engagement[edit | edit source]

2. Cardiorespiratory benefits[edit | edit source]

3. Haemodynamic effects[edit | edit source]

Regular exercise can also reduce the risk of cardiovascular disease, high blood pressure, type 2 diabetes, and cancer and may help reduce symptoms associated with the virus and negative treatment-related side effects. [2]

4. Immunological effects[edit | edit source]

CD4 count[edit | edit source]
Inflammation[edit | edit source]

5. Physical benefits[edit | edit source]

  • Maintains or builds muscle mass

Types of Exercise[edit | edit source]

1. Aerobic

2. Strengthening and resistance training

3. Balance and functional strengthening

Frequency of Exercise[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Jaggers JR, Hand GA. Health Benefits of Exercise for People Living With HIV: A Review of the Literature. Am J Lifestyle Med. 2014;10(3):184-192. Published 2014 Jun 16. doi:10.1177/1559827614538750
  2. ↑ 2.0 2.1 https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/exercise-and-physical-activity
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Dempsey, P. C., Friedenreich, C. M., Leitzmann, M. F., Buman, M. P., Lambert, E., Willumsen, J., & Bull, F. (2021). Global public health guidelines on physical activity and sedentary behavior for people living with chronic conditions: A call to action. Journal of Physical Activity and Health, 18(1), 76–85. https://doi.org/10.1123/JPAH.2020-0525
  4. ↑ WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. EXECUTIVE SUMMARY. Available from: https://www.ncbi.nlm.nih.gov/books/NBK566048/
  5. ↑ Hand GA, Lyerly GW, Jaggers JR, Dudgeon WD. Impact of Aerobic and Resistance Exercise on the Health of HIV-Infected Persons. Am J Lifestyle Med. 2009;3(6):489-499.
  6. ↑ Fillipas S, Oldmeadow LB, Bailey MJ, Cherry CL. A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: a randomised controlled trial. Aust J Physiother. 2006;52(3):185-90.
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