Living with HIV? Here's why excercise is a priority

It was the incomparable and seemingly ageless Cher who said, "If exercise came in a pill, everyone would be fit."

Certainly exercise is beneficial for everyone regardless of their HIV status, but for those who are HIV positive, it should be considered a priority and an essential component, along with proper nutrition, in remaining healthy.

While treatment programs known as Highly Active Anti-Retroviral Therapy (HAART) have done an amazing job at suppressing HIV viral replication and the progression of the HIV disease, there is no disputing that these life-saving medications are tough on the body and produce unpleasant side effects.

The best-kept secret is that a strategic, consistent exercise program comprising cardio and resistance training can mitigate or minimize many of these metabolic problems.

Among a long list of benefits, exercise has been shown in studies of HIV-positive individuals to fight fatigue, lower high lipids (cholesterol and triglycerides) and increase HDL (the "good" cholesterol). Exercise can also improve bone density, increase CD4 cell counts (these are a subset of white blood cells which fight infection), lower blood pressure, increase lean muscle, and, not least important, lower body fat in general and abdominal fat in particular.

One of the most distressing developments for anyone living with HIV can be the onset of lipodystrophy, the redistribution of fat in the body. This occurs in two distinct ways: lipohypertrophy (fat gain), usually seen in the stomach, breasts and back of the neck where it is resembles a buffalo hump, and lipoatrophy (fat loss), typically in the arms, legs, buttocks and face where the cheeks appear sunken.

Experts remain uncertain about the precise cause of lipodystrophy, although it is often linked to use of certain HAART medications in some individuals. There is no magic pill for lipodystrophy, but resistance training can help to rebuild muscle, which has been lost in the arms and legs and can often help reduce the "protease paunch" - the build-up of belly fat. The use of testosterone for this purpose has had conflicting reviews. The FDA late last year approved a drug marketed as Egrifta (Testamorelin), which helped to reduce the build-up of visceral fat in the abdomen in some individuals during clinical trials. The long-term effectiveness of this drug has yet to be determined.

How much exercise, what type of program and frequency depend on a number of factors including the fitness level of the individual and the progression of the HIV. A baseline body composition assessment should be undertaken as soon as possible after diagnosis and monitored at least quarterly, with special attention paid to changes in weight and body fat.

Generally, in people who are asymptomatic, I first recommend a regimen of cardio exercise such as brisk walking, jogging, etc. three times a week for 30 to 45 minutes. Second I recommend strength training such as pushing and pulling movements like the Bench Press and Seated Row two to three times a week in sessions lasting 45 minutes to an hour. If exercise has not been a part of your lifestyle, start slowly by simply increasing your activity level: walking, taking stairs, dancing, etc.

Regardless of one's HIV status, nothing ages us faster than the inability to bend easily from the knees. Exercises that improve flexibility, particularly in the lower body, and strengthen the quadriceps and hamstrings are therefore important. These include a variety of weighted squats using dumbbells, barbells, and a hex bar.

Joint problems and bone density issues are a concern for individuals who have been on HIV meds for many years and I advise caution with exercises such as the Shoulder Press which require lifting weight over the head and can stress the joints in the shoulder. Never, never do exercises that require pulling weight behind the neck!

My colleague Nelson Vergel, author of a definitive book on HIV called "Built To Survive," offers the following advice:

BEST TIPS FOR LOSING FAT

Cut calories and fill yourself up with fruits, vegetables, grains and lean meats. Eat small, frequent meals.

Exercise with weights/machines 3-4 times a week for an hour and also do cardiovascular exercise (fast walking, light jogging, etc) for at least 30 minutes a day after weight training. Make sure that you sweat!

Ask your doctor to check your hormone levels and your thyroid function since low levels of testosterone or thyroxin can make you prone to gaining fat.

Get your lipids and blood sugar under control with a healthy diet, regular exercise and medicines, if necessary.

Beware of companies that claim their weight loss/appetite suppressant supplements or "growth hormone precursors" work. They don't. Most weight loss supplements have stimulants that can affect mood and increase blood pressure and cardiovascular risks.

BEST TIPS FOR GAINING WEIGHT

If you have diarrhea, make sure it is diagnosed correctly and treat it aggressively.

Talk to your doctor or dietician about ways to support your appetite or reduce nausea.

Ask your doctor to check your hormone levels and your thyroid function and/or the thyroid hormone, thyroxin, in case these levels are low.

Increase your protein intake to at least half a gram per half kilo of bodyweight per day, if you can. This is a moderate level not found to tax the kidneys in those with kidney dysfunction; those with healthy kidneys could possibly double this.

Exercise with weights, but minimize aerobic exercise. One hour 3-4 times a week is enough if done correctly.

Try to persuade your doctor to prescribe anabolic steroids if nothing else works.