That feel-good factor: exercise and HIV

Derek Thaczuk gets off the couch and finds out about exercise and HIV.

Does anyone really need to be told that it’s healthy to exercise? Probably not. Yet that knowledge often doesn’t translate into actual sweat and pounding hearts. Despite – or perhaps because of – a thriving gym culture, many people still view exercise as yet another onerous duty ("I suppose I should"), rather than something to look forward to and enjoy.

Does what’s ‘good for us’ have to be at odds with what we enjoy? Not so, says Garry Brough, former co-ordinator of the Positive Health Programme at the central London YMCA – a fitness programme developed specifically for people with HIV. At Positive Health, says Brough, even those who came in with reservations tended to leave happy and to come back for more.

“Many people didn’t really expect much from the programme. They didn’t come in with optimism and were sure they wouldn’t enjoy a gym environment. But once they got the hang of it, once they were actually there and getting a bit of a buzz from the exercise, they realised it made them feel good and wanted to do it again.”

Many ‘graduates’ went on to volunteer or teach at the YMCA, and at least five or six actually became personal trainers themselves.

Much of the Positive Health Programme’s success may have stemmed from the wide range of activities available to choose from, from weightlifting to yoga, as well as the personal attention and HIV focus. However, not having an HIV-tailored programme to guide and welcome you should be no deterrent to reaping the benefits of physical activity. “It's not all about the gym,” Brough says. “If you don't have access to a good facility, just do something active – gardening, playing frisbee, walking the dogs. Just as long as it’s something you enjoy and that doesn’t feel like a chore.”

And if you’re a driven desk-jockey who ‘hasn’t the time’? Then run or cycle at least some of the way to work instead of taking the train.

Choosing your goals

What to do, of course, depends not just on personal preferences, but on what you are trying to accomplish. Many joggers and gym goers would cite losing weight as their top goal. Some HIV-positive people need to lose weight too (I do – ed.). For others, widespread lipodystrophy and HIV-related metabolic problems are causing unhealthy fat gain.

Other HIV-positive people, though, most decidedly do not. Ongoing HIV infection causes many people to lose weight (particularly lean body mass: that is, muscle) involuntarily. This condition, called wasting, can be very serious if not addressed.

Exercise can help, whether you aim to lose or gain – but it’s important to choose the right kind or you may even make matters worse. A person experiencing involuntary weight loss probably shouldn’t be training for marathons. Equally, a person who needs to lose weight may be risking their health if all they concentrate on is resistance training.

There are three main components to exercise: resistance training, aerobics, and flexibility training.

Flexibility training should be part of any routine: stretching and loosening your muscles and joints protects them against injury, especially before and after weight lifting or other heavy-duty forms of exercise. It also makes you supple. A number of complementary health disciplines concentrate on flexibility, both active (most forms of yoga) and passive (shiatsu or Thai massage).

Resistance training means putting your muscles to work against weights or weight machines. This form of training builds muscle mass and muscle strength, and is often recommended for people with HIV who have difficulty maintaining enough body weight. Studies have found that properly designed resistance training routines safely help HIV-positive people build strength and lean body mass.^1,2 Note that when trying to build muscle, it’s crucial to have an adequate, healthy diet: your body needs enough protein and other essential nutrients from which to build new muscle.

High-intensity exercise may be safe for many otherwise fit and healthy HIV-positive people.

Aerobic exercise is the sweaty stuff that gets your heart and lungs going: cycling, running, spinning and the like. Aerobic exercise can accomplish two things: it burns off calories, helping you to lose extra body fat. It also forces your heart and lungs to work harder, keeping them healthier, hence its other name, ‘cardio’. Although HIV-specific studies are relatively scarce, there is a great deal of evidence that regular exercise reduces the risk of adult onset diabetes, high blood pressure (hypertension), and coronary artery disease in the population at large and in those with other chronic illnesses.^3,4

Improving cardiovascular health is especially important for people at risk of heart disease. This includes people with HIV, especially with other risks such as high cholesterol levels. People at risk of heart disease are encouraged to get regular, moderate amounts of aerobic exercise. Aerobics can lower the levels of “bad” LDL cholesterol and increase “good” HDL cholesterol levels in the blood and it’s having a high HDL-to-LDL cholesterol ratio that’s the key to reducing heart disease risk. While you may not be able to change your genetics (cardiac risk tends to run in families), you can change how much you exercise.

Beating the blues

Exercise has many other rewards – some of which may feel more immediately rewarding than the somewhat abstract notion of cardiac risk. Exercise can reduce anxiety, stress and depression, no matter what your HIV status. Getting sweaty has direct effects on stress-related hormones, and many people simply find it invigorating to physically release pent-up stress and tension.

Studies have shown that aerobic exercise can measurably improve mood and reduce depressive symptoms – both in the population at large⁵ and specifically in people with HIV⁶ – and aerobics and resistance training have both been found to decrease anxiety.⁷

It can also help you get more restful sleep, but make sure you schedule your exercise in the morning or afternoon, as exercising later at night can actually interfere with getting a good night’s sleep.

Exercise and CD4s

Does exercise actually strengthen your immune system, as often claimed? Well, some studies have shown temporary upswings in CD4 counts immediately after exercise. However, these increases don’t persist, and may reflect a temporary redistribution rather than an actual increase in the total number of CD4 cells. More to the point, essentially all studies have found exercise does not lower CD4 cell counts in HIV-positive people. In other words, while exercise may not help your CD4 count, it won’t hurt it either.

Putting the plan in action

How, then, to make your exercise regime happen, rather than allow it to fade away like a typical new year’s resolution? There’s no single answer or button to push that will suddenly turn you from sloth to athlete. But many experts suggest the following tips:

• Do something you enjoy: exercise should be a reward, not a punishment or a grim duty.
• Before you start, get advice from your doctor and a qualified trainer. Garry Brough says: “HIV in itself doesn’t preclude exercise in any way, so there is never any need to disclose your HIV status unless you want to do so. You should, however, disclose any conditions that may occur as a result of your infection and have a bearing on exercise, such as high cholesterol. But there is no need to tell anybody why you have those conditions.”
• Find out about proper technique and possible risks.
• Set reasonable goals. It’s easy to set yourself up for failure by reaching for the moon on your first day. Start slow and stay steady.
• When in doubt, moderation is best. High-intensity exercise may be safe for many otherwise fit and healthy HIV-positive people, but is best avoided by anyone with active symptoms. There is plenty of evidence that moderate exercise is safe and beneficial for nearly everyone with HIV.

Special cases

According to your personal health and preferences, various specific kinds of exercise may be more or less appropriate, or best avoided altogether. Be sure to discuss any planned new activities with your doctor, and preferably also with a fitness expert who is familiar with that activity.

Among people with HIV, a few conditions warrant particular attention.

Thinning bones

People with HIV are at risk of osteopenia and osteoporosis – conditions in which the bones become spongier and more easily broken. Exercise can help maintain and build bone density, so it is actually recommended for people with these conditions. However, it’s important to choose the right kind.⁸

DO: so-called weight-bearing exercises, in which you are working against gravity. These include weight training, walking and jogging, stair climbing, and low-impact aerobics – also skipping and trampolining. Swimming and cycling, while good for your heart, do not help combat thinning bones. Get expert advice about your exercise routine.

AVOID: high-impact activities like boxing, and movements that involve a lot of flexing or twisting of the spine. These types of activities can stress the bones and run the risk of breakage.

Cardiac risk

People at risk of heart disease are encouraged to get moderate amounts of aerobic exercise regularly. However, if you are not used to exercising and are already at risk of heart disease, sudden, vigorous exercise is not advisable – too much sudden stress can actually trigger a heart attack or stroke.

DO: plan your routine with a medical expert, start off slowly, and increase the intensity of your workouts gradually.

AVOID: sudden bursts of intense activity that you are not accustomed to.

Lipodystrophy

Unfortunately, since resistance training builds lean body mass (muscle), not fat, it can do little to correct HIV-related fat loss (lipoatrophy); studies have shown that exercise can indeed cause fat loss in people with ‘lipo’.⁹

However aerobic exercise may help fight the unwanted fat accumulation (lipohypertrophy) often seen in people with HIV. The fat that comes with lipodystrophy is typically much denser and more deeply rooted than the type seen in ‘normal’ obesity but small studies have shown that aerobic exercise can help burn it off.¹⁰

Don’t do it all alone

Finally, as the Positive Health Programme has seen, doing exercise with others – in a yoga or kickboxing class, for instance – adds a social aspect to exercise and a bit of pressure to turn up. More solitary activities such as jogging or weight training can be made less so by doing them with a buddy. Some people prefer exercise as a kind of solitary meditation and a break from stress, but others welcome the chance to ‘get physical’ with others and get positive feedback on how they’re doing.

It’s easy enough to find activities to suit all but the most confirmed couch potato. Nearly all fitness centres offer sports facilities, exercise equipment, classes and programmes. Nor are such facilities limited to the gym – think complementary health centres, bike trails, and outdoor running tracks. Trying new activities can lead to pleasant surprises, as people discover things they never thought they’d like. I barely lasted through one boxing class. But I was pleasantly shocked to discover I love running!