Exercise is something I have actively tried to avoid my entire adult life. The very word fills my head with images of cold-hearted gym teachers forcing me to do somersaults on the parallel bars, when I couldn't even do one on the floor. Where do they get those people anyway?
All joking aside, exercise is important to maintain health. For people with HIV exercise is a basic treatment. When we speak of treatment we usually think in terms of pills or capsules, as something we take not something we do. Perhaps its time to re-evaluate how we view and approach exercise. Results from a number of studies indicate that exercise help you gain muscle, boost some parts of your immune system, improve mood/attitude, and enhance sex. I knew that would get your attention.
What is exercise? According to the dictionary it's any activity that causes "bodily or mental exertion, for the sake of training or improvement of health". Basically exercise falls into two groups: aerobic or cardiovascular exercise, and anabolic (resistance) or muscle-building exercise.
Aerobic exercise is all the rage, with Jane Fonda and a host of Hollywood beauties dancing to the oldies for only $19.95. Aerobic exercise is known for heart health. A number of studies in people with HIV/AIDS have shown that regular exercise can reduce stress and dispel the blues. Depression can have serious negative effects on your health. Exercise may be an effective non-drug approach to dealing with this demon.
One study from the Berlin conference, a small and temporary increases in CD4 cells had been seen after a period of aerobic exercise. In another study from Miami, aerobic exercise was shown to also increase the number of natural killer and CD8 cells. This increase was also temporary. The clinical benefit from this is unclear. It would be interesting to see a study that compared people on the new combinations and exercise, with those who take the combos and don't exercise, to see if the exercise group achieves higher CD4 counts. Of course, you could try this on your own.
Anabolic (resistance) exercise has been studied to combat Wasting. Wasting or HIV-related wieght loss is the slow process of muscle loss that begins early in infection. Wasting is one of the leading causes of death to AIDS. Michael Youssouf (a medical exercise specialist, experienced working with PWAs), strongly recommends beginning an exercise program early in infection for maximum benefit. Dr. Mary Romeyn, author of Nutrition and HIV a new model for treatment, says that "we now know you can add to your energy bank by building your muscle mass." The theory is to take full advantage of "well" time to build up a defense to protect you during possible "sick" time, and to prevent loss of lean body mass (muscle). Prevent wasting, prolong life. Both Romeyn and Youssouf advise healthy HIV+ people to begin a muscle-building program.
Exercise is also beneficial for people in later stages of infection. In a 1990 study, 24 HIV+ men who had recently recovered from PCP were divided into two groups. One group practiced resistive exercise with machines three times a week, the other group watched soap operas. All of those in the exercise group experienced small increases in strength, endurance, and muscle at the end of six weeks. The soap opera group did not receive such benefit, though they were fully informed as to Erica Kane's most recent divorce. It is important to note that the researchers in this study do not recommend exercising when you are sick. "A time to work, a time to rest". Listen to your body, it will tell you what it needs.
A strong testimonial to the benefits of exercise comes from a recent conversation with an HIV+ man in his forties. He had weighed 185 pounds and had gone down to 150. He was wasting and had a low testosterone level, his doctor started him on testosterone replacement therapy. He also began a progressive resistance exercise program, and eating a high calorie/high protein diet. He now weighs a solid 200 lbs. and looks great.
In one study on testosterone replacement therapy, half of the people reported that they were regularly doing some type of exercise. Those who exercised gained 4 1/2 lbs. in total body weight, most of which was muscle. The group who didn't exercise gained less than 2 lbs., of which about a 1/4 lb. was muscle. Though the results are less dramatic than the case history above, we see an impressive benefit from combining therapies in contrast with only taking the steroid. No specific exercise program was designed for the study. People were simply asked if they did or did not do some form of exercise. I wonder what the results would have been if they included a systematized resistance exercise program in the study design?
A point to consider: many people with HIV/AIDS have an increased need for calories, due to changes in metabolism, or if your fighting an active infection. Some (like people with a high viral load) may need to eat as much as 6000 calories a day. For people who exercise regularly it's even more important to get all the calories you need. If you are unsure of your caloric need speak with a nutritionist. They should be able to do the calculations and guide you.
As with most treatments, exercise needs to be tailored to individual need and ability. Michael gave this example: "if you are having trouble holding water, then a treadmill would not be practical at that time". This is where the help of a physical therapist or exercise trainer can be useful, if they have a lot of experience working with people with HIV/AIDS.
For many motivation remains a problem. Sometimes just knowing something is good for you isn't enough. It may be helpful to find an exercise that you like doing. It's a lot easier staying committed to something you enjoy. Another option is to find an exercise partner. Doing it with someone can make for a fun time. Also it's harder to say, "not today", when someone is there to challenge and encourage you. An exercise trainer is a great idea, though cost may make this out of the question for many. New York City's recreation centers have trainers available for $50 a month. Some AIDS service organizations have exercise programs, many do not. Does yours? If not, then its time to advocate for one! Exercise is not just recreation. Exercise is treatment.
Q-zone
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Last modified: 10/20/97