THINK OF EXERCISE AS MEDICINE

By Mary Jane Detroyer, MS, RD, CDN

In the past, exercise has been overlooked as a therapy to treat complications associated with HIV/AIDS because of fear that it might decrease immunity and a lack of evidence proving it to be effective. Now we are learning that specific types of exercise can strengthen immune function and relieve many of the complications associated with this debilitating disease.

It has been suggested that exercise works like medicine to help manage disease states such as high blood pressure, elevated cholesterol and triglyceride levels, diabetes, cancer, osteoporosis, and muscle wasting.^1,2 Imagine your response if your doctor told you he had medicine to strengthen your immune system without any complicating side affects. Most of us would jump at the chance to try this magical elixir.

Some HIV positive individuals have attributed their delayed onset AIDS diagnosis to regular exercise, a healthful diet, and stress management. Science is beginning to support this conclusion. A review article in the International Journal of Sports Medicine reported that HIV+ persons who exercised had improved cardiovascular fitness and muscle function, weight gain, mood, and coping skills.³ The authors also noted that exercise increased CD4 cell counts. Those in the early stage of the disease had the greatest increase. Another study observed that 6 weeks of moderate-intensity cycling resulted in a slight decrease in viral load.⁴ Exercising early after diagnosis with HIV may help your immune system respond better, but it is never too late to obtain the rewards of exercise.

Wasting associated with AIDS has always been a major concern because it leads to fatigue, depression, loss of appetite, infection, hospitalization, and death. Scientists are currently exploring resistance exercise as an effective therapy to prevent and treat AIDS wasting. A recent, preliminary study found that 8 weeks of intensive progressive-resistance training increased muscle tissue in HIV+ patients. Better yet, participants with wasting had the largest increases in muscle mass. This means that exercise may be therapeutic.⁵

Lipodystrophy, with its redistribution of fat to the abdominal area and elevated cholesterol and glucose resistance, presents a new cause for concern. Having a big belly with skinny arms and legs may be aesthetically upsetting, but more important, it suggests an increased risk of heart disease. If you are experiencing this syndrome, donÕt despair. A recent pilot study found that after 16 weeks of aerobic and resistance exercise participants lost fat, most of which was abdominal fat.⁶ Exercise can also help to lower cholesterol levels and improve insulin resistance.

Osteoporosis is another disease that is being seen at an early age in some AIDS patients.⁷ Very old people are at high risk for developing osteoporosis because they often have severe muscle wasting similar to that seen in AIDS. Weight-bearing exercise, along with other therapeutic agents, have been shown to increase bone mass and to prevent progression of bone loss.

Contrary to what some people might think, you donÕt have to belong to a fancy gym to receive the benefits of exercise. Simple exercises done at home can get you started. Once you start, it is important to be consistent if exercise is to be effective. As a matter of fact one study found that HIV+ persons who exercised sporadically weakened their immune system⁸. Exercise programs should include three components to be balanced: aerobic exercise, strength training, and stretching. Aerobic exercise may be difficult to accomplish in the beginning due to loss of muscle and inactivity. So for now I want you to get started on strength training and stretching.

Strength training makes you stronger and is the most effective way to build muscle. You donÕt need to belong to a gym or own fancy equipment to get started. Simple exercises using your own body weight, like push-ups, dips, pull-ups, squats, lunges, chair sits and crunches work very well. Free weights, resistance bands, and plastic milk containers filled with water also work well. Some people have even used 1 to 2 pound cans of food as weights. Cans will work for the small muscles in the shoulders and arms; the very weak, however, need more resistance to build muscle.

Research has shown that progressively increasing resistance as you get stronger is the most effective way to build muscle. This can be done by doing the same movement more times or by adding more weight or resistance. For example, you begin by doing 1 set of 5 push-ups, on two separate days the first week and add 1 push-up at each new session until you can do 12. The next progression would be to add a second set of 5 push-ups adding 1 more each time until you can do 2 sets of 12. You build those two sets until you can finish 2 sets of 25. Push-ups can be done on the wall (easiest), on the floor on your knees, or balancing your full body on your toes (hardest). I always have beginners start with the easiest form of any exercise. This progression is followed for each muscle group worked. It is necessary to work each muscle group at least two times a week to build muscle. You must rest your muscles between each strength-building workout to prevent overtraining. This can be accomplished by exercising every other day or by alternating different muscle groups at each exercise session. Resistance bands are inexpensive and come in light, medium, heavy, and extra heavy levels of resistance, which makes progression easy. They can be purchased in fitness stores, like Paragon, City Sports and Tops. You can also buy them through the mail. Fitness Wholesale sells a pack with four levels of resistance for $12.95 plus shipping and handling. The pack comes with general guidelines and a poster illustrating 16 exercises.

Stretching prevents injuries and keeps your body from stiffening up as you get older. Stretching is also a good way to ease into exercise after being inactive for many years. You benefit the most from stretching when it follows your workout because your muscles are warmed-up and more pliable. Stretching can provide supported, less stressful movement for people who are unstable or have neuropathies. It can be done on the floor, in a chair, or in bed. On days when you are too weak for strength exercises, or have a lot of pain, gentle stretching, breathing, and relaxation techniques can be very soothing.

It is always wise to consult with your doctor before starting an exercise program. Your doctor may want you to take a stress test before starting to make sure you are strong enough to exercise. You may be told to avoid certain exercises that could be harmful to you. If you have high blood pressure or other heart problems, you should avoid lifting heavy weights, especially overhead and in front of the chest. Always check to make sure you are not holding your breath when lifting weights. Making time for exercise will be very challenging. In the beginning you will be all fired up, but as the novelty wears off, youÕll find lots of excuses to skip workouts. Employers, family, and friends will place demands on your time, and you will have to stay very focused on your own needs to stay on track.

The following are tips from people I have trained who have successfully incorporated exercise into their lives.

• Exercise with a partner
• Find activities you enjoy to stay motivated
• Play stimulating music while you exercise
• Keep a list of the reasons you need to exercise where you can see it
• Add variety to prevent boredom
• Record your progress
• Set realistic goals, and reward yourself when you accomplish them

Mary Jane Detroyer is a registered dietitian and exercise physiologist who has been working with clients for over 14 years to improve their health through diet, exercise, and simple lifestyle changes. She has a private practice in Manhattan specializing in HIV/AIDS, WomenÕs Wellness, Weight Management, and Prevention.

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