Aerobic Exercise Increases Cognition and Brain Volume in HIV+ People

Background: HIV infected (HIV+) individuals are now reaching an advanced age, through stable treatment with highly active anti-retroviral therapy (HAART). However, HIV and aging are still risk factors for cognitive decline and neuropathologic deterioration seen in magnetic resonance imaging (MRI). Healthy lifestyle factors such as regular exercise may provide benefits to HIV+ individuals. Few studies have shown definitive benefit of aerobic exercise (AE) to HIV+ cognitive status, and none have used MRI. In this study we determine if a history of AE is beneficial to brain integrity and neurocognitive test scores in a cohort of HIV+ individuals.

Methods: A cross-sectional cohort of 70 HIV+ individuals (19-82 age range) had neuropsychological performance (NP) testing, neuroimaging, and completed an extensive self-report AE questionnaire that split the cohort into physically active (n=22) and sedentary (n=48) groups. Student’s t-tests were used to analyze demographics. Analysis of variance (ANOVA) was used to study main effects of exercise on a brief NP battery, which consisted of the following tests: Trail Making Tests A and B, Hopkins Verbal Learning Test, Digit-Symbol Coding, F-A-S and Verbal Fluency. NP tests were grouped by executive and motor function for analysis. ANOVAs were also used to study the effects of exercise upon brain volumes. This included brain volumes affected by HIV, such as the caudate and putamen, regions affected by exercise, such as the hippocampus, and general brain regions like total gray and total white matter

Results: Active and sedentary HIV+ individuals were similar for age, sex, education, and laboratory values. Physically active HIV+ patients performed significantly better than sedentary HIV+ participants on NP tests of executive (p=.04, mean Z scores of -0.654 and -0.956 respectively, [95% CI, 0.27, 0.72]) but not motor function (p=.13, mean Z scores of -0.331 and -0.827, respectively). Additionally, physically active HIV+ individuals had a significantly larger putamen (p=0.028) across the lifespan compared to the sedentary cohort.

Conclusions: Across a range of ages, AE may maintain healthy brain volumetrics in HIV+ individuals and led to improved cognitive performance. Future studies should consider exercise as an adjunctive therapy to HAART for HIV+ individuals.

More here

EXERCISE FOR HIV + PERSONS

EXERCISES FOR HIV +VE PERSONS
Oct 2, 2012

Hi . My name is John. I tested HIV+ abt 5 yrs ago. My CD4 is still over 500, so am only on septrin . I see my doctor every 3 months. I go to the gym @ least 3 times a week but do road work (jogging) every weekend for abt 10KM. Gym work comprise of 15-30 min cardio, then assorted weights .. total 1 hr. I fell am in good health tho sometimes some cough wud come and go with no med.
Question: Is there any recommended training for HIV+? Is there some training that is detrimental to health? I realise my kidney not soo good, does training contribute i any way to kidney deterioration? Note: I eat healthy and take lots of water (more than 8 glasses a day)but kidney been deteriorating and am working.

Response from Mr. Vergel

I would read this article and watch a video I recently made to answer questions like yours:

Exercise and HIV

Nelson’s exercise tips

Let me know if there is any information that these two resources do not cover, please.

Nelson

Heart Disease and HIV- What to Do?

Some HIV+ people have emailed me worried about this report:

Heart Attacks Found Early and Frequently in HIV Positive People

Calculate your 5 year estimated cardiovascular risk: D-A-D Cardiovascular Risk Equation for HIV+ People

My suggestions to minimize heart disease (not in any other of importance):
1- Do not smoke
2- Keep your cholesterol and triglycerides within normal ranges (with exercise, diet, HIV medication change, fish oils, even medications)
3- Exercise 4 times a week for an hour
4- Take a baby aspirin every day (81 mg)
5- Take 200 mg of Coenzyme Q-10 and 2000 mg of carnitine per day
6- Get a stress test every two years 
7- Have one to two glasses a day of red wine, no more.
8- Controversial topic: avoid abacavir (Ziagen, Epzicom), D4T, AZT, Crixivan.
9- Control your HIV to under 50 copies all the time
10- Manage stress: meditate, take a hobby, do pleasurable things every day, let go of what you cannot control, etc
11- Avoid street drugs, except moderate pot for pain or appetite.
12- Get your blood pressure under control 
13- Keep your weight down
14- Keep your gums healthy
15- Eat cold water fish (salmon, sardines, etc) at least once a week
16- Have a hand full of nuts once a day
17- Keep your testosterone and thyroid hormones within healthy ranges.
18- Know the symptoms of a heart attack and call 911 immediately if you ever have them. Do not deny them or “sleep them off”.  Do not have a friend take you to the hospital. Call 911 and paramedics will pre-treat you right when they are driving you to the hospital. Read about symptoms: Symptoms of a heart attack

New treatments for HIV associated lipodystrophy beyond Egrifta

Question from a person living with HIV:
May 2, 2012

I body build and work out, eat right, etc. The lipodystrophy I accumulated during my early use of Crixivan and others doesn’t really go away that much. It’s frustrating, depressing.
I do also appear to have some features of “muscle belly” where there is a space between my lower abs (possibly caused by strain). I’ve read about adbominoplasty.
Apart from egrifta, which my ID doc does not recommend, what other options are there now or on the horizon?
I want to get a CT scan of my gut to see just how pervasive it is. But to my knowledge, it’s not just easy to go in to the organ area and remove the omentum, etc. That’s all very risky.
Over the years I’ve gotten very depressed about it, even to the verge of eating disorders. I have 2 closets full of nice shirts that I can’t/wont wear, as my gut protrudes. I’m otherwise very in shape and muscular.
What can I do? Is there any hope for this problem…

General practitioners are effective at increasing the level of physical activity among their inactive patients during the initial six-months of an intervention

Two-Year Longitudinal Analysis of a Cluster Randomized Trial of Physical Activity Promotion by General Practitioners

Gonzalo Grandes1*, Alvaro Sanchez1, Imanol Montoya1,Ricardo Ortega Sanchez-Pinilla2, Jesús Torcal3, for the PEPAF Group
1 Primary Care Research Unit of Bizkaia, Basque Healthcare Service (BHS), Bilbao, Spain, 2 Santa Barbara Primary Care Centre, Castilla-La Mancha Healthcare Service, Toledo, Spain, 3 Basauri-Ariz Primary Care Centre, Basque Healthcare Service, Basauri, Spain

Abstract Top

Background

We evaluate the effectiveness of a physical activity promotion programme carried out by general practitioners with inactive patients in routine care.

Methods and Findings

Pragmatic, cluster randomised clinical trial conducted in eleven public primary care centres in Spain. Fifty-six general practitioners (GPs) were randomly assigned to intervention (29) or standard care (27) groups. They assessed the physical activity level of a systematic sample of patients in routine practice and recruited 4317 individuals (2248 intervention and 2069 control) who did not meet minimum physical activity recommendations. Intervention GPs provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment (30%). A third of these prescriptions were opportunistically repeated. Control GPs provided standard care. Primary outcome measure was the change in self-reported physical activity from baseline to six, 12 and 24 months. Secondary outcomes included cardiorespiratory fitness and health-related quality of life.
A total of 3691 patients (85%) were included in the longitudinal analysis and overall trends over the whole 24 month follow-up were significantly better in the intervention group (p<0.01). The greatest differences with the control group were observed at six months (adjusted difference 1.7 MET*hr/wk [95% CI, 0.8 to 2.6], 25 min/wk [95% CI, 11.3 to 38.4], and a 5.3% higher percentage of patients meeting minimum recommendations [95% CI: 2.1% to 8.8%] NNT = 19). These differences were not statistically significant at 12 and 24 months. No differences were found in secondary outcomes. A significant difference was maintained until 24 months in the proportion of patients achieving minimum recommendation in the subgroup that received a repeat prescription (adjusted difference 10.2%, 95% CI 1.5% to 19.4%).

Conclusions

General practitioners are effective at increasing the level of physical activity among their inactive patients during the initial six-months of an intervention but this effect wears off at 12 and 24 months. Only in the subgroup of patients receiving repeat prescriptions of physical activity is the effect maintained in long-term.

Exercise: The Best Therapy for Managing Side Effects

Exercise: The Best Therapy for Managing Side Effects
How to Stay Active and Energetic

By Michael Mooney and Nelson VergelSeptember/October 2009

Exercise: The Best Therapy for Managing Side EffectsThere are many benefits of exercise in HIV disease. Besides the evident improved self-image, energy level, and mental outlook, several research studies performed with HIV-positive people have found the following clinical benefits in body composition and metabolism.Exercise produces improved muscle function, increased body dimensions and mass, and strength when used alone.1,2It may reduce trunk (belly) fat mass in patients with HIV lipodystrophy.3It increases muscle mass and decreases LDL (bad cholesterol) when combined with testosterone in eugonadal men (men with normal testosterone) with wasting.4It increases build-up of lean tissue and strength gain when combined with oxandrolone (Oxandrin, an oral anabolic) in eugonadal men with wasting.5Muscle hypertrophy (enlargement), induced by resistance training, may decrease triglyceride levels in the blood of hypertriglyceridemic (those with high triglycerides), HIV-positive men being treated with antiviral therapy.6Acute exercise does not have a deleterious effect on HIV replication in adults with high viral loads.7Moderate physical activity may slow HIV disease progression.8Exercise is associated with significant improvement in mood and overall distress, as well as a significant increase in body cell and lean body mass.9Exercise can increase bone density in men and women.10Testosterone and resistance exercise promote gains in body weight, muscle mass, muscle strength, and lean body mass in HIV-positive men experiencing weight loss and low testosterone levels.11Exercise training resulted in a substantial improvement in aerobic function while immune indices were essentially unchanged. Quality of life markers improved significantly with exercise.12

Getting Started

Before you start an exercise program, there are some things to consider. First, get your blood pressure, heart rate, weight, body dimensions, fasting cholesterol, triglycerides, and blood sugar measured. Your doctor should be able to advise you if you are capable of exercising without health if you can.If you feel tired and weak, start walking every day to your best ability. Walking can help increase energy levels to enable you to start a more intensive exercise program later on when you’re feeling better. Using a cheap pedometer to measure your daily steps is useful. Try to reach 10,000 steps a day since that has been associated with good cardiovascular health and fat loss.There are two types of exercise: resistance (or weight) training and cardiovascular (or aerobic) exercise. Resistance training uses weights to induce muscle growth. Cardiovascular exercise improves the way your body uses oxygen and increases metabolism so that you can burn fat and lower bad cholesterol and blood sugar.Do low-impact aerobic exercise three to four times a week. Exercising for 20-40 minutes by walking fast, bike riding, going up the stairs, using a stationary bike, elliptical trainer, or treadmill will increase your aerobic capacity, help to burn fat, and decrease cholesterol, triglycerides, and blood sugar. Jogging should only be an option if you have very strong joints and no problems with neuropathy. Do not do aerobic exercise if you are losing weight involuntarily or if you are tired or recovering from illness. Some people worry that cardiovascular (aerobic) exercise can increase fat wasting (lipoatrophy), but this fear is unfounded, in our opinion.

Recommendations

Train with weights and machines three times a week for one hour. Starting with machines is the safest way until you get familiar with the exercises. As you feel more confident and strong, bring in free weight exercise (hopefully with the help of a workout buddy). As you get stronger, increase your weights in every exercise. Exercise one body part per week, and do three exercises per body part. One light warm-up set and two heavier sets of eight to ten repetitions (to momentary muscular failure, meaning until you can not do another rep) are enough for each exercise. If you do not have access to a gym, do push ups on the floor and squats holding books or large bottles full of water at home. As long as you are “resisting” your own body weight, you are doing resistance exercise. You can also get an exercise ball and follow this great home-based workout: www.myfit.ca/exercisedatabase/search.asp?muscle=Home&equipment=yes.For examples of other exercises you can do at home, visit http://weboflife.nasa.gov/exerciseandaging/chapter4_strength.html.For great resistance exercises at the gym, visit: www.myfit.ca/exercisedatabase/weight_lifting_exercises.asp.

Important Things to Remember

  • Learn how to do each exercise correctly and concentrate on using strict form to get the most out of exercise and prevent injuries.
  • Make sure your muscles are warm before targeting them with more challenging weights. Warm them up with a light, high-repetition exercise set.
  • Don’t use your body to add momentum; cheating this way takes work away from the targeted muscles. Use a deliberate speed to increase the effectiveness of the movement.
  • Use a full range of motion on all exercises. Feel the muscle stretch at the bottom and go for a momentary peak contraction at the top. Don’t go too fast!
  • Warm up before you work out and stretch afterwards to prevent injury. Briefly stretch the major muscle groups before your training. Th is helps flexibility and muscle recovery. For stretching routines, go tohttp://weboflife.nasa.gov/exerciseandaging/chapter4_stretching.html.
  • Feel the muscles working by keeping your head in what you’re doing. Focus on your muscles contracting and relaxing. Concentrate on your body exercising, not on thoughts or people around you.
  • If the weight’s too light (more than 12 repetitions), try using a heavier one with more resistance or do the movement more slowly and really feel the contraction. You should be barely able to finish the tenth rep if your weight is the right one. Of course, as you get stronger with time, increase your weights.
  • Keep rest periods to no more than about 20-30 seconds, or shorter, depending on how tired you are from your last set. This will also help to give your heart a mini-workout.

Safety First

Always remember — safety first! If something you do in an exercise hurts, stop! Ask for help to figure out what you’re doing wrong. Maybe it’s improper form. If you hurt yourself, you will hinder your progress because you won’t want to work out! Learn proper form! Do not exercise if you feel you are coming down with a cold.

Commit Yourself

If you can afford it, join a gym. If you spend the money, you’ll be more likely to stay with it, and consistency is the key to success in any exercise program. Also, try to find someone who is enthusiastic to train with, or get a personal trainer (if you can afford one). It’s easier to stay motivated when you train with someone else who has a vital interest in your mutual success. It’s also safer to have someone to spot you when you lift heavy weight.

Avoid Overtraining

Working out for more than an hour can cause overtraining that can destroy your muscles, decreasing your strength. Overtraining is probably the factor most ignored by exercise enthusiasts. In order to build muscle, the body has to receive a stimulus, a reason, to grow bigger, or hypertrophy. It’s really very simple: the body only does what it needs to do, what it is required to do. It isn’t going to suddenly expand its muscle mass because it anticipates needing more muscles. But if it is challenged to move weights around, it will respond by growing.Another way to look at it is, if you take any body builder and put him in bed for weeks at a time, he’ll begin to rapidly lose muscle mass because the body will sense that it doesn’t need the extra muscle any more. So, one needs to deliver the stimulus to begin muscular hypertrophy (growth) and that’s what lifting weights does. However, overdoing exercise stresses out the body and initiates the process of actually breaking down muscle mass as the body begins to burn its own muscles to use for fuel. This is why so many people don’t grow at a satisfying rate. Even worse, often times these people will think they aren’t training hard enough, and increase their exercise routines, thinking they just need more stimuli! And this is where the biggest error is made — more is not necessarily better! It seems paradoxical that you could work out less and grow more, but this is very often the case.Therefore, any exercise beyond that which is the exact amount of stimulus necessary to induce optimal muscle growth is called overtraining.

A Workout Log Is Recommended

The best reason to keep track of your workouts is so you can see graphically what you are accomplishing, and analyze your pattern to see if you’re overtraining. You will also be able to see whether you’re gaining strength at a reasonable rate. You will find when you log your workouts, that if you are overtraining, you won’t be gaining in strength or muscle size. So document your workouts by keeping track of the weight you lift and the amount of reps you lift for each exercise, and then when you go in to train again the next week, you’ll know what you are trying to improve upon. If you find out that you’re weaker than you were the time before, and everything else like nutrition, etc. is in line, you may be training too often. For downloading workout logs, visit www.exrx.net/WeightTraining/WorkoutLogs.html.

Food and Hydration

Drink at least eight glasses of water a day to keep hydrated. Dehydration can rob you of energy for your workouts. Drink plenty of water while working out and avoid sugary drinks, since they will cause fatigue after an initial burst of energy. Some people like to drink green tea or creatine in juice before a workout to help increase energy levels through a workout.A light carbohydrate meal (fruits, carbohydrate drinks, etc.) before a workout and a protein-rich one afterwards is advisable. Keep yourself well hydrated with plenty of water throughout the workout. And get plenty of rest aft erwards.Do not work out after eating a regular meal. Wait at least two hours. If you need a snack, have some fruit and a slice of toast with peanut butter one hour or more before working out. Do not consume protein shakes before working out (leave them for after the workout). Digestion will slow down your workouts and bring your energy down. Within 30-60 minutes after the workout, feed your muscles with a balanced meal containing protein, good fats (olive oil, flaxseed oil), and complex carbohydrates, like fruits and whole grains.Supplements like glutamine, creatine, and whey protein may be a good thing to consider. A shake containing one heaping tablespoon of glutamine, two tablespoons of flaxseed oil, one or two scoops of whey protein, fruit, and milk (if you are not lactose intolerant, otherwise almond or rice milk, though not soy, since it has been shown to increase estrogen in both men and women), provides a good balanced meal after a workout.

Resources

Two of the best websites for video clips of exercises and an explanation of anatomy are: www.exrx.net/Lists/Directory.html and www.myfit.ca.Also, several exercise routines are provided on our website, http://medibolics.com/exercise.html.You can also find most exercise routines explained in videos on youtube.com and menshealth.com.Be sure to read Michael’s and Nelson’s book, Built To Survive. For more valuable information, go to powerusa.org.Nelson Vergel, a native of Venezuela, is a 26-year HIV survivor and advocate for wellness in HIV disease. He is the founding direct or of the Program for Wellness Restoration (PoWeR), the Body Positive Wellness Clinic in Houston, a founding member of the AIDS Treatment Activists Coalition (atac-usa.org), founder/moderator of the largest online HIV health support group (pozhealth at yahoogroups.com), an international speaker, an expert on nutrition and complementary therapies at TheBody.com, and the co-author of the book Built To Survive. Most recently, Nelson was select ed to be a member of the U.S. Department of Health and Human Services HIV Guidelines Panel. For more information about Nelson and his programs, please visit www.powerusa.org.Michael Mooney is a long-time medical researcher who co-authored “Built To Survive.” He was a columnist for Muscle Media for two years, has been interviewed in Sports Illustrated, quoted on ABC’s Good Morning America and is Director of Education at SuperNutrition, a best-selling vitamin line. Michael’s unique approaches to building bodies will be documented in an exercise video soon. Learn more about Michael’s research by visiting his websitewww.michaelmooney.net.References available online at www.positivelyaware.com.Got a comment on this article? Write to us at publications@tpan.com.

References

    1. Spence DW et al. Arch Phys Med Rehabil. 1990; 71:644-8.
    2. Rigsby LW et al. Med Sci Sports Exerc. 1992;24:6-12.
    3. Roubenoff R, et al. AIDS. 1999;13:1373-5.
    4. Grinspoon S et al. Ann Intern Med. 2000;133:348-55.
    5. Strawford A et al. JAMA. 1999;281:1282-90.
    6. Yarasheski KE et al. J Appl Physiol. 2001 Jan; 90(1):133-8.
    7. Roubenoff et al Appl Physiol. 1999 Apr;86(4):1197-201.
    8. Mustafa T et al. Ann Epidemiol. 1999 Feb;9(2):127-31.
    9. Rabkin J et al. Med Sci Sports Exerc. 1998 Jun; 30(6):811-7.
    10. Tebas P et al. Clinical Infectious Diseases. 2006; 42:108–114
    11. Basin S et al. JAMA. 2000;283:763-770.
    12. Stringer W et al. Medicine & Science in Sports & Exercise. 30(1):11-16, January 1998.

What Supplements Can I take with HIV medications?

Supplementation while on Meds
Apr 13, 2009Hi I have been + for 4 years now workout regularly have built some of the muscle back that I lost. I am on Prezista and Truvata with Norvir. Is it ok to supplement with Creatine (Cell-Tech), and Protein (Nitro-Tech) along wiht Glutamine?

    Response from Mr. VergelGreat question.Creatine+ Exercise versus Exercise alone in HIV+ Men:( from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2646129 )Dr Mulligan et al performed a randomized, double blind, placebo-controlled, clinical research center-based, outpatient study in San Francisco. 40 HIVpositive men (20 creatine, 20 placebo) enrolled in a 14-week study. Subjects were randomly assigned to receive creatine monohydrate or placebo for 14 weeks. Treatment began with a loading dose of 20 g/day or an equivalent number of placebo capsules for 5 days, followed by maintenance dosing of 4.8 g/day or placebo. Beginning at week 2 and continuing to week 14, all subjects underwent thrice-weekly supervised resistance exercise while continuing on the assigned study medication (with repeated 6-week cycles of loading and maintenance). The main outcome measurements included muscle strength (one repetition maximum), energetics (31P magnetic resonance spectroscopy), composition and size (magnetic resonance imaging), as well as total body composition (dual-energy X-ray absorptiometry). Thirty-three subjects completed the study (17 creatine, 16 placebo). Strength increased in all 8 muscle groups studied following progressive resistance exercise, but this increase was not augmented by creatine supplementation (average increase 44 vs. 42%, difference 2%, 95% CI −9.5% to 13.9%) in creatine and placebo, respectively). There were no differences between groups in changes in muscle energetics. Thigh muscle cross-sectional area increased following resistance exercise, with no additive effect of creatine. Lean body mass (LBM) increased to a significantly greater extent with creatine.They saw increases in creatinine in some patients taking creatine, so you need to watch your kidney function. They did not see changes in viral load so hopefully this means that there were no drug-drug interactions with this supplement.Whey Protein Use in HIV+ Women (From http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2001&issue=12070&article=00011&type=abstract)Denise Agin et al studied the use of whey protein plus or minus exercise in HIV+ women and found that resistance exercise significantly increased body cell mass (BCM), muscle mass, muscle strength, and QOL in HIV-infected women with reduced BCM. Whey protein had little effect on BCM accrual. Combined protein and exercise did not increase BCM in excess of gains achieved by exercise alone.Whey Protein in HIV+ Men (from http://www.ajcn.org/cgi/content/abstract/88/5/1313 )Dr Satler et al studied the use of whey protein supplement without exercise and found no increases in lean body mass in patients. Patients seem to adjust their calory intake daily when taking the shakes, so the net effect on calories was not improved. There seemed to be some improvement in CD4 cell counts with whey, though. Diarrhea and bloating also were more common in those taking whey.Glutamine (http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102231134.html):This supplement has been shown to improve gut function and diarrhea in some studies. There one was a study done by Dr Shabert et al that found that glutamine plus an antioxidant improved lean body mass in people taking that combination. She even compared her results with those obtained with growth hormone, I remember.So, it seems that there is some benefit of taking these popular body building supplements if used with exercise. But I would watch creatinine blood levels to make sure that your kidneys handle the extra load. Of course, we really cannot say much about specific brands since quality control may be an issue in some supplement companies.I always tell people to consult with the houstonbuyersclub.com for HIV specific information on supplements and brands to trust.I hope this helpedNelson

HIV Lipodystrophy: Where are We After 10 Years?

http://f1.grp.yahoofs.com/v1/EFLdR5ilPaVxAGznd1_SkpO6x-gEAJhwMccdRiItI3tZhDrmSZ-UkqTqOJLUFWeYHpDdtENW6uery9Kibf9Z/lipoupdateGMHCMAR08.pdf