Skip Navigation LinksHome > January 1998 - Volume 30 - Issue 1 > The effect of exercise training on aerobic fitness, immune i...
Medicine & Science in Sports & Exercise:
Basic Sciences: Symposium: New insights into the control of human muscle blood flow and metabolism in vivo

The effect of exercise training on aerobic fitness, immune indices, and quality of life in HIV+ patients

STRINGER, WILLIAM W.; BEREZOVSKAYA, MARINA; O'BRIEN, WILLIAM A.; BECK, C. KEITH; CASABURI, RICHARD

Free Access
Article Outline
Collapse Box

Author Information

Harbor-UCLA Medical Center, Division of Respiratory and Critical, Care Physiology and Medicine, Torrance, CA 90509

Submitted for publication March 1997.

Accepted for publication September 1997.

Collapse Box

Abstract

Purpose: Thirty four HIV+ patients participated in a 6-wk aerobic exercise training program to determine whether exercise improved aerobic fitness, immune indices, and quality of life.

Methods: Subjects were assigned to three groups: control (no regular aerobic exercise), moderate exercise, and heavy exercise training. At study entry and exit (in each subject) we evaluated aerobic function with a symptom limited cardiopulmonary exercise test, immune indices with CD4 counts and Candida skin tests, viral replication with plasma HIV RNA measurements, and quality of life with a HIV+ population validated questionnaire.

Results: Aerobic fitness increased significantly in both exercise groups relative to the control group; immune indices changed very little among all three groups; however, the Candida skin tests (mm2) increased significantly in the moderate group; viral replication was essentially unchanged in all three groups; quality of life (QOL) markers improved in both exercising groups but not the control group. There were no opportunistic infections during the study.

Conclusions: Exercise training resulted in a substantial improvement in aerobic function while immune indices were essentially unchanged. Quality of life markers improved significantly with exercise. Exercise training is safe and effective in this patient group and should be promoted for HIV+ patients

Whether patients who are infected with the human immunodeficiency virus(HIV+) should perform regular aerobic exercise and what dose should be prescribed for maximum benefit remains unknown. In patients without HIV infection, exercise has been demonstrated to have beneficial effects on aerobic fitness, mood, immune indices, and disease incidence. In diseases such as ischemic heart disease, diabetes, hypertension, cancer, and emphysema, exercise has been widely recommended(1,4,7,10,13,26). However, the effects of high intensity exercise over a long period of time(“overtraining”) have been well documented to increase infections and worsen immune indices in humans(6,12,18,20,25,28,37) and to increase mortality in laboratory animals(3,9,17). Although the levels of exercise in these studies were very high and likely would not be reproduced in the HIV+ population, HIV+ patients have still routinely received the recommendation from health care practitioners to exercise very little if at all. All of this based on surprisingly few studies that address the HIV+ population.

The utility of exercise training as a therapeutic measure to improve the aerobic fitness, immune indices, and mental outlook in HIV+ patients has not been clearly defined(8,21-24,32,33). Previous studies have suffered from substantial dropout rates, lack of measured aerobic fitness levels, widely disparate disease severity among patients (mixtures of asymptomatic and gravely immunocompromised patients), lack of gender and ethnic diversity, and small sample sizes. To overcome these problems, we studied an ethnically and gender diverse population of HIV+ subjects at an intermediate stage of HIV disease (between 100 and 500 CD4 lymphocyte count/mm3 and no evidence of opportunistic infections). This group of patients seemed very appropriate since this group comprises a growing segment of the HIV+ population and is especially targeted for treatment to prevent further immunologic deterioration. These subjects were randomly assigned to one of two different aerobic cycle ergometer exercise training intensities (three times per week), or to a control (nonexercising) group. Outcome measures included improved aerobic fitness, immune indices, and quality of life. These results help to establish a rational basis for exercise prescriptions in HIV+ patients.

Back to Top | Article Outline

METHODS

Subjects

All subjects were HIV+ with CD4 lymphocyte counts between 100 and 500 cells/mm3 on initial evaluation and were without signs of opportunistic infections as determined by health questionnaire, physical examination, chest radiographs, and exercise testing (no evidence of high or low VA/Q abnormalities, pulse oximeter desaturation, etc.). This study was approved by our institutional human investigation review board, and each subject gave written informed consent before participation. Potential study subjects were recruited from the HIV clinic at Harbor-UCLA Medical Center (an inner city county hospital) and randomized to one of three groups (Control, Moderate, and Heavy) by means of a computer-generated randomization process.

Back to Top | Article Outline
Outcomes Measures

Exercise testing. Each subject performed a cardiopulmonary exercise test with gas exchange measurements at study entry and after 6 wk of study participation to accurately determine aerobic function as measured by the gas exchange lactic acidosis threshold (LAT) (5) and peak oxygen uptake (˙VO2max). The lactic acidosis threshold (LAT) was defined as the ˙VO2 above which the ˙VCO2 output(˙VCO2) increased more rapidly than the ˙VO2. This was determined from a plot of ˙VCO2 as a function of ˙VO2(19,38). Peak ˙VO2 was defined as the maximally tolerated ˙VO2.

The exercise protocol was performed on an electronically braked stationary cycle ergometer (CardiO2 ergometer, Medical Graphics, Minneapolis, MN) and consisted of 3 min of rest, 3 min of unloaded cycling (0 W), and a continuous increase in work rate of 15-25 W·min-1 until exhaustion (marked by inability to maintain a pedaling cadence greater than 50/min despite verbal encouragement by the investigator). Heart rate and rhythm were monitored continuously with a single lead (modified MCL 1) electrocardiogram. Subjects respired through a mouthpiece and wore a noseclip; breath-by-breath gas exchange was measured by an integrated computerized system (CPX/D Cardiopulmonary Exercise System, Medical Graphics, Minneapolis, MN) using a disposable symmetrically disposed Pitot tube flowmeter(31). This system is well suited for the study of HIV+ patients since it allows accurate breath-by-breath flow measurements as well as the disposal of all equipment that comes in contact with the subject. Pulse oximeter estimation of arterial saturation was monitored continuously during each exercise test. All exercise tests were performed with the principal investigator present.

Immunologic indices. Each subject underwent three forms of immune evaluation at entry and after 6 wk of study participation: 1) Skin testing was performed with 0.1 mL of Candida albicans antigen (Berkeley Biologicals, Berkeley, CA, 1:500 m·v-1). The antigen was introduced intradermally with a 25-gauge needle and 1-mL syringe. The resulting induration was measured by the principal investigator on both axes (mm) and the resulting area (mm2) was calculated using the formula for an ellipse (area = π × length × width). 2) Blood was drawn before exercise testing (approximately 9 a.m. in each subject) from an arm vein for measurement of CD4 lymphocyte counts. These assays were all performed using standard laboratory protocol in the hospital Pathology Department at Harbor-UCLA Medical Center.

Virologic testing. Plasma was frozen (-70°C) from the same blood draw for HIV reverse transcriptase polymerase chain reaction (PCR) measurements at entry and after completion of the 6 wk study. All samples were paired, batched, and run at the same time after completion of the study. The number of copies of HIV RNA per mL was determined using the Amplicor commercial assay (27).

Quality of life evaluation. Each subject completed a Quality of Life (QOL) questionnaire at entry and after completion of the study. This self-administered instrument was a subset of the QOL questionnaire validated in prior HIV studies at Harbor-UCLA Medical Center(15).

Physical activity recall questionnaire. Each subject completed a physical activity recall questionnaire at entry and after completion of the study to determine whether significant changes in the amount of exercise performed outside the study had occurred.

Study intervention. Subjects were randomized to one of three groups: 1) The control group was advised to maintain their current level of activity without changes. 2) The moderate intensity exercise training group performed 1 h of exercise training three times per week for 6 wk at a work rate which was 80% of the LAT work rate (determined from the entrance cardiopulmonary exercise test). 3) The heavy intensity exercise training group performed exercise training three times per week for 6 wk at a work rate equal to 50% of the difference between their LAT and their ˙VO2max. This group performed a proportionally shorter amount of exercise while maintaining the total work per session identical to the moderate group. In this study, this resulted in training times of approximately 30-40 min.

All exercise training sessions were performed on a calibrated electronically braked cycle ergometer. Training work rates were not altered during the study, nor were pulse rates or perceived exertion recorded during training sessions.

Statistical analysis. Mean values are expressed as ± SE, unless otherwise specified. Subject demographics at study entry (including the group of subjects who did not complete the study) were compared using an unpaired t-test. Repeated measures ANOVA was used to compare the three groups who completed the study. Individual differences between groups were isolated with post hoc testing. The changes in aerobic fitness parameters (in a given subject group) were compared by pairedt-testing. Nonparametric responses to the QOL questionnaire, HIV PCR, and skin testing were evaluated using the Mann-Whitney Rank Sum Test(Kruskal-Wallis statistic). Significant differences were determined asP < 0.05.

Back to Top | Article Outline

RESULTS

Thirty four subjects were enrolled and 26 (77%) completed the study(Table 1). Patients who dropped out of the study were uniformly distributed among the three groups (three control, three moderate training, two heavy training). The reasons for not completing the study included a lack of regular transportation, conflicting work schedule, lack of motivation to exercise, and parole violation. However, no subject dropped out because of infection or illness. The study population included 11% females, 29% Hispanics, and 20% African-Americans.

Table 1
Table 1
Image Tools

The subjects had a mean age (mean ± SD) of 36 ± 9 yr and they had been HIV+ 39 ± 33 months. Of the subjects who entered the study, 27% were smokers. The average CD4 count at entry was 266 ± 128 cells/mm3. All but two patients were on recommended antiretroviral therapy during the study (zidovudine, zidovudine, and didanosine). No HIV or cardiopulmonary medications were altered during the study. The compliance rate with the exercise regimen for subjects who completed the study was 91% across all training periods. There were no significant extracurricular changes in exercise as reported on the pre/post study physical activity recall.

Back to Top | Article Outline
Changes in Aerobic Function with Exercise Training

At entrance, the aerobic parameters of the subjects (LAT and˙VO2max) did not differ significantly among the three groups(Table 1). The measured ˙VO2max for the entire study group was low normal at entry (85% of predicted(38)) and the LAT was 54% of the measured˙VO2max. An intensity related aerobic training effect was observed(Heavy > Moderate) in the exercising training groups relative to the control group. The LAT increased in a statistically significantly fashion in both exercising groups (P < 0.01). However, the˙VO2max and WRMax increased significantly only in the Heavy group (P < 0.01). After 6 wk of exercise training, the LAT, WRMax, and ˙VO2max changes (%, pre to post) in the three groups were (mean ± SE): Control -4% ± 6, -4% ± 4, and-7% ± 5, Moderate 10% ± 9, 3% ± 2, and -2% ± 4, and Heavy 23% ± 8, 11% ± 4, and 13% ± 4, respectively(see Fig. 1 and Table 2)).

Figure 1-Changes in ...
Figure 1-Changes in ...
Image Tools
Table 2
Table 2
Image Tools
Back to Top | Article Outline
Changes in Immune Indices with Exercise Training

CD4 counts. At study entry, the CD4 counts were highest in the Heavy training group and lowest in the Control group. However, this difference at study entry did not reach statistical significance. During the study, the CD4 counts in each of the three groups changes minimally in all three groups: 18 ± 25, 13 ± 14, -3 ± 15 (cells/mm3) for the control, moderate, and heavy exercise training groups, respectively(Fig. 2a and Table 2).

Figure 2-Pre and pos...
Figure 2-Pre and pos...
Image Tools

Candida albicans antigen skin testing. The skin test reactivity after 6 wk of study participation increased significantly in the moderate exercise training group (463 ± 401 m2) but not the heavy exercise training group (111 ± 158), while a nonsignificant fall in skin test reactivity was observed in the control group (-35 ± 36)(Fig. 2b and Table 2).

Back to Top | Article Outline
Changes in Viral Replication

Plasma HIV RNA. The number of plasma HIV RNA copies is inversely related to the HIV disease status; thus, a decrease in plasma HIV RNA copies is generally thought to indicate an improvement in immune function(30): At study entry the plasma HIV RNA levels were highest in the moderate group, with lower levels in the heavy and control groups, although these differences did not reach significance(Tables 1 and 2). Although the variability of the plasma HIV RNA was large before study entry, and from the pre- to the post-exercise test, the number of plasma HIV RNA copies decreased the most in the moderate exercise group (-10,403 ± 21,099 copies·mL-1), with smaller decreases observed in the heavy(-1,380 ± 6,331) and control groups (-9,053 ± 3,436)(Fig. 2c). These changes were also not statistically significant.

Back to Top | Article Outline
Changes in Quality of Life with Exercise Training

The results of the self-administered QOL questionnaire are detailed inTable 3. In brief, statistically significant improvements occurred in both exercise training groups relative to the control group for the questions related to quality of life, hope, and desire to continuing living. There were no significant differences between the results of the two exercise groups.

Table 3
Table 3
Image Tools
Back to Top | Article Outline

DISCUSSION

The current study attempts to determine whether regular aerobic exercise training should be recommended to patients who are HIV+, and if so, what training intensity would serve best for the maximum improvement in aerobic fitness, immune indices, and quality of life. Since heavy exercise training is felt by some investigators to be harmful to patients with damaged immune systems (2,8), we specifically designed our investigation to include a heavy exercise training group to determine whether heavy exercise causes adverse effects on immune indices. In addition, a variety of factors result in increased HIV replication in blood, e.g., influenza vaccination (29,35,36) and cytokine therapy (34); therefore, we included an assay of plasma HIV RNA to determine the effects of exercise training at various intensities on this important marker.

To answer these questions, 34 HIV+ subjects with CD4 lymphocyte counts between 100 and 500 (cells/mm3) were entered in the study (75% of the subjects completed the study). This study is unique when compared with prior studies involving exercise training in HIV+ individuals(14,22,23,33) since the population was drawn from an inner city population and included substantial numbers of Hispanics (29%), African-Americans (20%), and females (11%). In addition, this study did not suffer from the high dropout rates (25-50%)(22,23,33) observed in prior studies in HIV+ patients. The study completion rate was quite good (77%). Finally, the current study addressed poor or nonexistent control groups and/or lack of directly measure aerobic fitness by cardiopulmonary exercise testing (pre and post study), and incorporates more sophisticated outcome markers (e.g., plasma HIV RNA) in addition to CD4 counts (16).

The current study demonstrated clear improvements in aerobic function with aerobic exercise training, with the most marked improvement occurring at the highest training level (Fig. 1). The changes in CD4 count and plasma HIV RNA were small and did not reach statistical significance. Statistically significant improvements in immune indices (as measured by skin testing) was observed only in the moderate exercise group(Table 2). There were no episodes of immuno-compromized infections in any group and no participant quit the study for health reasons. Importantly, heavy exercise training resulted in a more marked improvement in aerobic performance and was not statistically different from moderate intensity exercise training in terms of immune indices (except skin testing). Therefore, there was no trend for immune indices to worsen with high intensity exercise training as had been previously postulated. Finally, quality of life improved in all questions for both exercise levels relative to the control group (Table 3).

Although the most rigorous outcome measure regarding aerobic exercise training would be a change in morbidity and mortality for the HIV+ subjects, the proxy outcome markers examined in this study were CD4 counts and plasma HIV RNA. Since short-term changes in CD4 lymphocyte counts may be an incomplete marker of immune response and clinical outcome(11,16,30), skin test reactivity and plasma HIV RNA were also examined. The largest decrease in plasma HIV RNA occurred in the moderate exercise training group although the control and heavy exercise groups also decreased. Therefore, although we failed to demonstrate that exercise training relative to the control group benefits HIV+ patients(as measured by enhanced control of HIV replication), there was no acute worsening related to heavy or moderate intensity exercise training.

In conclusion, aerobic exercise training in an HIV+ patient group is safe and effective in improving exercise tolerance. In addition, it appears that the most marked improvements in aerobic function and quality of life occur with high intensity exercise training relative to the control group, whereas the moderate exercise training yields the most beneficial effect on skin test reactivity. Aerobic exercise training should be promoted as a nonpharmacological therapy for the treatment of HIV+ patients in the intermediate stages of their disease. Expanded studies of longer duration appear warranted.

The authors would like to thank Cindy Sullivan, M.A. for her contributions in the formative stages of this project.

Funding was provided through a University Wide AIDS Task Force Grant.

Current address for W. A. O'Brien is Department of Medicine, UCLA School of Medicine and West Los Angeles Veterans, Affairs Medical Center, Los Angeles, CA.

Address for correspondence: William W. Stringer, M.D., 7 Plank House Road, Savanna, GA 31410.

Back to Top | Article Outline

REFERENCES

1. Albanes, D. A., A. Blair, and P. Taylor. Physical activity and risk of cancer in the NHANES I population. Am. J. Public Health 79:744-750, 1989.

2. Antoni, M. H., H. Schneiderman, M. A. Fletcher, D. Goldstein, G. Ironson, and A. Laperriere. Psychoneuroimmunology and HIV-1.J. Consult. Clin. Psych. 58:38-49, 1990.

3. Bailey, G. H. The effect of fatigue upon the susceptibility of rabbits to intratracheal injections of type I pneumococcus.Am. J. Hyg. 5:175-195, 1925.

4. Ballard-Barbash, R., A. Schatzkin, D. A. Albanes, et al. Physical activity and risk of large bowel cancer in the Framingham study.Cancer Res. 50:3610-3613, 1990.

5. Beaver, W. L., K. Wasserman, and B. J. Whipp. A new method for detecting the anaerobic threshold by gas exchange. J. Appl. Physiol. 60:2020-2027, 1986.

6. Berglund, G. and P. Hemmingsson. Infectious disease in elite cross-country skiers: a one-year incidence study. Clin. Sports Med. 2:19-23, 1990.

7. Blair, A., H. Kohl, R. Paffenbarger, D. Clark, K. Cooper, and L. Gibbons. Physical fitness and all-cause mortality: A prospective study of healthy men and women. J. A. M. A. 262:2395-2401, 1989.

8. Calabrese, L. H. and A. Laperriere. Human immunodeficiency virus infection, exercise, and athletics. Sports Med. 15:6-13, 1993.

9. Cannon, J. and M. Kluger. Exercise enhances survival rate in mice infected with Salmonella Typhimurium. Proc. Soc. Exp. Biochem. Med. 175:518-521, 1984.

10. Casaburi, R., A. Patessio, F. Ioli, S. Zanaboni, C. F. Donner, and K. Wasserman. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am. Rev. Respir. Dis. 143:9-18, 1991.

11. Choi, S., S. W. Lagakos, R. T. Schooley, and P. A. Volberding. CD4+ lymphocytes are an incomplete surrogate marker for clinical progression in persons with asymptomatic HIV infection taking zidovudine.Ann. Intern Med. 118:674-680, 1993.

12. Cowles, W. Fatigue as a contributory cause of pneumonias. Boston Med. Surg. J. 179:55-56, 1918.

13. Douglas, K. and P. Hanson. Upper respiratory infections in the conditioned athlete. Med. Sci. Sports. Exerc. 10:551978.

14. Eichner, E. R. and L. H. Calabrese. Immunology and exercise. Physiology, pathophysiology, and implications for HIV infection.Med. Clin. N. Am. 78:377-388, 1994.

15. Ettl, M., R. D. Hays, W. Cunningham, M. F. Shapiro, and C. K. Beck. Assessing health-related quality of life in disadvantaged populations. In: Quality of Life and PharmacoEconomics in Clinical Trials. B. Spiker (Ed.). New York: Lippencott Raven Publishers, 1996, pp. 595-604.

16. Fei, D. T. W., H. Paxton, and A. B. Chen. Difficulties in precise quantification of CD4+ T lymphocytes for clinical trials: a review. Biologicals 21:221-231, 1993.

17. Gatmaitan, B., J. Chason, and A. Lerner. Augmentation of the virulence of murine coxsackie-virus-B-3 myocardiopathy by exercise.J. Exp. Med. 131:1121-1136, 1970.

18. Graham, N., R. Douglas, and P. Ryan. Stress and acute respiratory infection. Am. J. Epi. 124:389-401, 1986.

19. Hachamovitch, R., H. V. Brown, and S. A. Rubin. Respiratory and circulatory analysis of CO2 output during exercise in chronic heart failure. Circulation 84:605-612, 1991.

20. Horstmann, D. Relation of physical activity at the time of onset to the course of the disease. J. A. M. A. 142:236-241, 1950.

21. Johnson, J., G. Anders, H. Blanton, et al. Exercise dysfunction in patients seropositive for the human immunodeficiency virus-1.Am. Rev. Respir. Dis. 141:618-622, 1990.

22. Laperriere, A., M. A. Fletcher, M. H. Antoni, N. G. Klimas, G. Ironson, and H. Schneiderman. Aerobic exercise training in an AIDS risk group. Int. J. Sports Med. 12:S53-S57, 1991.

23. MacArthur, R. D., S. D. Levine, and T. J. Berk. Supervised exercise training improves cardiopulmonary fitness in HIV-infected persons. Med. Sci. Sports Exerc. 25:684-688, 1993.

24. Mackinnon, L. T. Exercise and Immunology. Champaign, IL: Human Kinetics Books, 1992, pp. 19-63.

25. Mackinnon, L. T., T. Chick, A. Van As, and T. Tomasi. Decreased secretory immunoglobulins following intense endurance exercise.Sports Train. Med. Rehab. 1:209-218, 1996.

26. MacVicar, M., M. Winningham, and J. Nickel. Effects of aerobic interval training on cancer patient's functional capacity.Nursing Res. 38:348-351, 1989.

27. Mulder, J., N. McKinney, C. Christopherson, J. Sninsky, L. Greenfield, and S. Kwok. Rapid and simple PCR assay for quantitation of human immunodeficiency virus type 1 RNA in plasma: application to acure retroviral infection. J. Clin. Microbiol 32:292-300, 1994.

28. Nieman, D., L. Johanssen, and L. Berk. Infectious episodes in runners before and after a roadrace. J. Sports Med. Physiol. Fitness 10:124-128, 1989.

29. O'Brien, W. A., K. Grovit-Ferbas, A. Namazi, S. Ovcak-Derzic, H. J. Wang, and J. Park. Human immunodeficiency virus-type 1 replication can be increased in peripheral blood of seropositive patients after influenza vaccination. Blood 86:1082-1089, 1995.

30. O'Brien, W. A., P. M. Hartigan, D. Martin, et al. Changes in plasma HIV-1 RNA and CD4+ lymphocyte counts and the risk of progression to AIDS. Veterans Affairs Cooperative Study Group on AIDS.N. Engl. J. Med. 334:426-431, 1996.

31. Porszasz, J., T. J. Barstow, and K. Wasserman. Evaluation of a symmetrically disposed Pitot tube flowmeter for measuring gas flow during exercise. J. Appl. Physiol. 77:2659-2665, 1994.

32. Pothoff, G., K. Wasserman, and H. Ostmann. Impairment of exercise capacity in various groups of HIV-infected patients.Respiration 61:80-85, 1994.

33. Rigsby, L. W., R. K. Dishman, A. W. Jackson, G. S. Baclean, and P. B. Raven. Effects of exercise training on men seropositive for the human immunodeficiency virus-1. Med. Sci. Sports Exerc. 24:6-12, 1992.

34. Skully, G., J. Kovacs, D. Chaitt, et al. Induction of HIV-1 by IL-2: in vivo and in vitro analysis. In:National Conference on Humun Retroviruses and Related Infections, 2nd Ed., 1995, pp. 150-155.

35. Stanley, S. K., M. A. Ostrowski, J. S. Justement, et al. Effect of immunization with a common recall antigen on viral expression in patients infected with human immunodeficiency virus type 1. N. Engl. J. Med. 334:1222-1230, 1996.

36. Staprans, S. I., B. L. Hamilton, S. E. Follansbee, T. Elbeik, P. Barbosa, and R. M. Grant. Activation of virus replication after vaccination of HIV-1 infected individuals. J. Exp. Med. 182:1727-1737, 1995.

37. Tomasi, T., T. Treudeau, D. Czerwinski, and S. Erredge. Immune parameters in athletes before and after strenous exercise. J. Clin. Immunol. 2:173-178, 1982.

38. Wasserman, K., J. E. Hansen, D. Y. Sue, B. J. Whipp, and R. Casaburi. Principles in Exercise Testing and Interpretation. Philadelphia, Lea & Febiger, 1994, pp. 40-125.

Cited By:

This article has been cited 47 time(s).

Biomed Research International
A Systematic Review of Effects of Concurrent Strength and Endurance Training on the Health-Related Quality of Life and Cardiopulmonary Status in Patients with HIV/AIDS
Neto, MG; Ogalha, C; Andrade, AM; Brites, C
Biomed Research International, (): -.
ARTN 319524
CrossRef
Janac-Journal of the Association of Nurses in AIDS Care
Development of Evidence-Based Exercise Recommendations for Older HIV-Infected Patients
Yahiaoui, A; McGough, EL; Voss, JG
Janac-Journal of the Association of Nurses in AIDS Care, 23(3): 204-219.
10.1016/j.jana.2011.06.001
CrossRef
Health and Quality of Life Outcomes
Health-related quality of life and physical functioning in people living with HIV/AIDS: a case-control design
Mbada, CE; Onayemi, O; Ogunmoyole, Y; Johnson, OE; Akosile, CO
Health and Quality of Life Outcomes, 11(): -.
ARTN 106
CrossRef
Clinics
Association between muscle strength and the cardiopulmonary status of individuals living with HIV/AIDS
Raso, V; Shephard, RJ; Casseb, J; Duarte, AJD; Silva, PRS; Greve, JMD
Clinics, 68(3): 359-364.
10.6061/clinics/2013(03)OA12
CrossRef
Jama-Journal of the American Medical Association
Testosterone replacement and resistance exercise in HIV-infected men with weight loss and low testosterone levels
Bhasin, S; Storer, TW; Javanbakht, M; Berman, N; Yarasheski, KE; Phillips, J; Dike, M; Sinha-Hikim, I; Shen, RQ; Hays, RD; Beall, G
Jama-Journal of the American Medical Association, 283(6): 763-770.

AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
Correlates of quality of life in symptomatic HIV patients living in Hong Kong
Molassiotis, A; Callaghan, P; Twinn, SF; Lam, SW
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 13(3): 319-334.

Journal of Clinical Endocrinology & Metabolism
Growth hormone treatment improves peripheral muscle oxygen extraction-utilization during exercise in patients with human immunodeficiency virus-associated wasting: A randomized controlled trial
Esposito, JG; Thomas, SG; Kingdon, L; Ezzat, S
Journal of Clinical Endocrinology & Metabolism, 89(): 5124-5131.
10.1210/jc.2004-0451
CrossRef
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
Moderate intensity exercise training reverses functional aerobic impairment in HIV-infected individuals
Hand, GA; Phillips, KD; Dudgeon, WD; Lyerly, GW; Durstine, JL; Burgess, SE
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 20(9): 1066-1074.
10.1080/09540120701796900
CrossRef
Archives of Internal Medicine
Effects of a supervised home-based aerobic and progressive resistance training regimen in women infected with human immunodeficiency virus - A randomized trial
Dolan, SE; Frontera, W; Librizzi, J; Ljungquist, K; Juan, S; Dorman, R; Cole, ME; Kanter, JR; Grinspoon, S
Archives of Internal Medicine, 166(): 1225-1231.

Quality of Life Research
The effects of exercise training on quality of life in HAART-treated HIV-positive Rwandan subjects with body fat redistribution
Mutimura, E; Stewart, A; Crowther, NJ; Yarasheski, KE; Cade, WT
Quality of Life Research, 17(3): 377-385.
10.1007/s11136-008-9319-4
CrossRef
International Journal of Sports Medicine
Moderate and high intensity exercise training in HIV-1 seropositive individuals: a randomized trial
Terry, L; Sprinz, E; Ribeiro, JP
International Journal of Sports Medicine, 20(2): 142-146.

Journal of Sport & Exercise Psychology
Effects of exercise training on quality of life, psychological well-being, immune status, and cardiopulmonary fitness in an HIV-1 positive population
Rojas, R; Schlicht, W; Hautzinger, M
Journal of Sport & Exercise Psychology, 25(4): 440-455.

Medicine and Science in Sports and Exercise
Effectiveness of aerobic exercise in adults living with HIV/AIDS: Systematic review
O'Brien, K; Nixon, S; Tynan, AM; Glazier, RH
Medicine and Science in Sports and Exercise, 36(): 1659-1666.
10.1249/01.MSS.0000142464.28165.9B
CrossRef
Journal of Psychosomatic Research
Depression in HIV-infected patients - Allopathic, complementary, and alternative treatments
Fulk, LJ; Kane, BE; Phillips, KD; Bopp, CM; Hand, GA
Journal of Psychosomatic Research, 57(4): 339-351.
10.1016/j.jpsychores.2004.02.019
CrossRef
Canadian Journal of Applied Physiology-Revue Canadienne De Physiologie Appliquee
Effects of different types of exercise on body composition and fat distribution in HIV-infected patients: A brief review
Malita, FM; Karelis, AD; Toma, E; Rabasa-Lhoret, R
Canadian Journal of Applied Physiology-Revue Canadienne De Physiologie Appliquee, 30(2): 233-245.

Janac-Journal of the Association of Nurses in AIDS Care
The International Physical Activity Questionnaire Overestimates Moderate and Vigorous Physical Activity in HIV-Infected Individuals Compared With Accelerometry
Fillipas, S; Cicuttini, F; Holland, AE; Cherry, CL
Janac-Journal of the Association of Nurses in AIDS Care, 21(2): 173-181.
10.1016/j.jana.2009.11.003
CrossRef
AIDS
Effect of exercise and strength training on cardiovascular status in HIV-infected patients receiving highly active antiretroviral therapy
Scevola, D; Di Matteo, A; Lanzarini, P; Uberti, F; Scevola, S; Bernini, V; Spoladore, G; Faga, A
AIDS, 17(): S123-S129.

Sports Medicine
HIV and aerobic exercise - Current recommendations
Stringer, WW
Sports Medicine, 28(6): 389-395.

Journal of Applied Physiology
Resistance exercise training reduces hypertriglyceridemia in HIV-infected men treated with antiviral therapy
Yarasheski, KE; Tebas, P; Stanerson, E; Claxton, S; Marin, D; Bae, K; Kennedy, M; Tantisiriwat, W; Powderly, WG
Journal of Applied Physiology, 90(1): 133-138.

Physikalische Medizin Rehabilitationsmedizin Kurortmedizin
Improvement of immunoregulation by physical therapies
Kreutzfeldt, A; Muller, K
Physikalische Medizin Rehabilitationsmedizin Kurortmedizin, 11(5): 188-195.

Cochrane Database of Systematic Reviews
Aerobic exercise interventions for adults living with HIV/AIDS
Nixon, S; O'Brien, K; Glazier, RH; Tynan, AM
Cochrane Database of Systematic Reviews, (2): -.
ARTN CD001796.pub2
CrossRef
Australian Journal of Physiotherapy
A six-month, supervised, aerobic and resistance exercise program improves self-efficacy in people with human immunodeficiency virus: A randomised controlled trial
Fillipas, S; Oldmeadow, LB; Bailey, MJ; Cherry, CL
Australian Journal of Physiotherapy, 52(3): 185-190.

AIDS Research and Human Retroviruses
Exercise training reduces central adiposity and improves metabolic indices in HAART-treated HIV-positive subjects in Rwanda: A randomized controlled trial
Mutimura, E; Crowther, NJ; Cade, TW; Yarasheski, KE; Stewart, A
AIDS Research and Human Retroviruses, 24(1): 15-23.
10.1089/aid.2007.0023
CrossRef
Chest
The role of passive immunization in HIV-positive patients - A case report
Veljkovic, V; Metlas, R; Jevtovic, D; Stringer, WW
Chest, 120(2): 662-666.

American Journal of Physiology-Endocrinology and Metabolism
Anabolic growth hormone action improves submaximal measures of physical performance in patients with HIV-associated wasting
Esposito, JG; Thomas, SG; Kingdon, L; Ezzat, S
American Journal of Physiology-Endocrinology and Metabolism, 289(3): E494-E503.
10.1152/ajpendo.00013.2005.
CrossRef
Health Psychology
Stress management interventions for HIV+ adults: A meta-analysis of Randomized controlled trials, 1989 to 2006
Scott-Sheldon, LAJ; Kalichman, SC; Carey, MP; Fielder, RL
Health Psychology, 27(2): 129-139.
10.1037/0278-6133.27.2.129
CrossRef
International Journal of Std & AIDS
Physical activity uptake in patients with HIV: who does how much?
Fillipas, S; Bowtell-Harris, CA; Oldmeadow, LB; Cicuttini, F; Holland, AE; Cherry, CL
International Journal of Std & AIDS, 19(8): 514-518.
10.1258/ijsa.2007.007237
CrossRef
Clinical Autonomic Research
Exercise training improves cardiovascular and autonomic profiles in HIV
Spierer, DK; DeMeersman, RE; Kleinfeld, J; McPherson, E; Fullilove, RE; Alba, A; Zion, AS
Clinical Autonomic Research, 17(6): 341-348.
10.1007/s10286-007-0441-0
CrossRef
AIDS Patient Care and Stds
Physiological and psychological effects of exercise interventions in HIV disease
Dudgeon, WD; Phillips, KD; Bopp, CM; Hand, GA
AIDS Patient Care and Stds, 18(2): 81-98.

Physical Therapy
Aerobic exercise dysfunction in human immunodeficiency virus: A potential link to physical disability
Cade, WT; Peralta, L; Keyser, RE
Physical Therapy, 84(7): 655-664.

Archives of Physical Medicine and Rehabilitation
Decreased peak arteriovenous oxygen difference during treadmill exercise testing in individuals infected with the human immunodeficiency virus
Cade, WT; Fantry, LE; Nabar, SR; Keyser, RE
Archives of Physical Medicine and Rehabilitation, 84(): 1595-1603.
10.1053/S0003-9993(03)00275-2
CrossRef
Sports Medicine
The benefits of exercise training for quality of life in HIV/AIDS in the post-HAART era
Ciccolo, JT; Jowers, EM; Bartholomew, JB
Sports Medicine, 34(8): 487-499.

Janac-Journal of the Association of Nurses in AIDS Care
Physical and leisure activity, body composition, and life satisfaction in HIV-positive Hispanics in Puerto Rico
Ramirez-Marrero, FA; Smith, BA; Melendez-Brau, N; Santana-Bagur, JL
Janac-Journal of the Association of Nurses in AIDS Care, 15(4): 68-77.
10.1177/1055329003261966
CrossRef
Clinics in Sports Medicine
HIV and the athlete
Clem, KL; Borchers, JR
Clinics in Sports Medicine, 26(3): 413-+.
10.1016/j.csm.2007.04.012
CrossRef
Primary Care
HIV: effectiveness of complementary and alternative medicine
Power, R; Gore-Felton, C; Vosvick, M; Israelski, DM; Spiegel, D
Primary Care, 29(2): 361-+.
PII S0095-4543(01)00013-6
CrossRef
American Journal of Hematology
Quality of life improvement for patients with sickle cell disease
Ramsey, LT; Woods, KF; Callahan, LA; Mensah, GA; Barbeau, P; Gutin, B
American Journal of Hematology, 66(2): 155-156.

American Journal of Health Behavior
The transtheoretical model and exercise among individuals living with HIV
Basta, TB; Reece, M; Wilson, MG
American Journal of Health Behavior, 32(4): 356-367.

Ajar-African Journal of AIDS Research
Assessment of HIV-positive in-patients using the International Classification of Functioning, Disability and Health (ICF) at Chris Hani Baragwanath Hospital, Johannesburg
Myezwa, H; Stewart, A; Musenge, E; Nesara, P
Ajar-African Journal of AIDS Research, 8(1): 93-105.
10.2989/AJAR.2009.8.1.10.723
CrossRef
Journal of Sports Medicine and Physical Fitness
Does physical activity affect quality of life, disease symptoms and immune measures in patients with inflammatory bowel disease? A systematic review
Packer, N; Hoffman-Goetz, L; Ward, G
Journal of Sports Medicine and Physical Fitness, 50(1): 1-18.

Journal of the American Dietetic Association
Complexities beyond simple survival: Challenges in providing care for HIV patients
Shattuck, D
Journal of the American Dietetic Association, 101(1): 13-15.

Annals of Behavioral Medicine
Physical Activity and Health Outcomes Among HIV-Infected Men Who Have Sex with Men: A Longitudinal Mediational Analysis
Blashill, AJ; Mayer, KH; Crane, H; Magidson, JF; Grasso, C; Mathews, WC; Saag, MS; Safren, SA
Annals of Behavioral Medicine, 46(2): 149-156.
10.1007/s12160-013-9489-3
CrossRef
Clinics
A systematic review of the effects of different types of therapeutic exercise on physiologic and functional measurements in patients with HIV/AIDS
Gomes-Neto, M; Conceicao, CS; Carvalho, VO; Brites, C
Clinics, 68(8): 1157-1167.
10.6061/clinics/2013(08)16
CrossRef
Medicine & Science in Sports & Exercise
Exercise Training in HIV-1-Infected Individuals with Dyslipidemia and Lipodystrophy
TERRY, L; SPRINZ, E; STEIN, R; MEDEIROS, NB; OLIVEIRA, J; RIBEIRO, JP
Medicine & Science in Sports & Exercise, 38(3): 411-417.
10.1249/01.mss.0000191347.73848.80
PDF (138) | CrossRef
Medicine & Science in Sports & Exercise
Cardiopulmonary and CD4 cell changes in response to exercise training in early symptomatic HIV infection
PERNA, FM; LaPERRIERE, A; KLIMAS, N; IRONSON, G; PERRY, A; PAVONE, J; GOLDSTEIN, A; MAJORS, P; MAKEMSON, D; TALUTTO, C; SCHNEIDERMAN, N; ANN FLETCHER, M; MEIJER, OG; KOPPES, L
Medicine & Science in Sports & Exercise, 31(7): 973-979.

Medicine & Science in Sports & Exercise
Mechanisms of exercise limitation in HIV+ individuals
STRINGER, WW
Medicine & Science in Sports & Exercise, 32(7): S412-S421.

Medicine & Science in Sports & Exercise
Predictors of Exercise Stage of Change among Individuals Living with HIV/AIDS
BASTA, TB; REECE, M; WILSON, MG
Medicine & Science in Sports & Exercise, 40(9): 1700-1706.
10.1249/MSS.0b013e318173f09e
PDF (152) | CrossRef
AIDS
Aerobic exercise: effects on parameters related to fatigue, dyspnea, weight and body composition in HIV-infected adults
Smith, BA; Neidig, JL; Nickel, JT; Mitchell, GL; Para, MF; Fass, RJ
AIDS, 15(6): 693-701.

PDF (163)
Back to Top | Article Outline
Keywords:

EXERCISE TRAINING; HIV+; AEROBIC FITNESS; SKIN TESTING; CD4 COUNTS; PLASMA HIV RNA; QUALITY OF LIFE

©1998The American College of Sports Medicine

Login

Article Tools

Images

Share

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.

Connect With Us