Exercise for People Living with HIV
Original Editor - Audrey Brown
Top Contributors - Melissa Coetsee, Kim Jackson, Audrey Brown and Lucinda hampton
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]
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].
Health considerations[edit | edit source]
ART side-effects[edit | edit source]
People living with HIV 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, their general well-being and overall 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 lipids, central fat accumulation, lipodystrophy, and decreased aerobic capacity.[1]
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]
Physical activity has numerous benefits, including:[2][6]
- Maintains or builds muscle mass
- Reduces cholesterol and triglyceride levels (less risk of heart disease)
- Increases energy throughout the day
- Improved self-efficacy[7]
- Reduced risk of obesity
- Regulates bowel function
- Strengthens bones (less risk of osteoporosis)
- Improves blood circulation
- Increases lung capacity
- Helps with sound, restful sleep
- Lowers stress
- Improves appetite
- Improves mood
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] 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.[1]
Frequency of Physical Activity[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 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. [8]
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.[6]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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
- ↑ 2.0 2.1 2.2 https://www.hiv.gov/hiv-basics/living-well-with-hiv/taking-care-of-yourself/exercise-and-physical-activity
- ↑ 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
- ↑ 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/
- ↑ 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.
- ↑ 6.0 6.1 https://www.hiv.va.gov/patient/daily/exercise/index.asp
- ↑ 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.
- ↑ https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines/top-10-things-know
