Exercise as it relates to Disease/Benefits of progressive resistance training in elderly HIV positive patients

This is an in depth review of the journal article “Progressive Resistance Training in Elderly HIV-Positive Patients: Does it Work?” By De Souza et al (2008)

What is the background to this research?
HIV/AIDS

According to the World Health Organisation human immunodeficiency virus (HIV) is a retrovirus that infects specific cells of the immune system, destroying or impairing their function and weakening the body's ability to fight infections. One of the side effects of the virus is called AIDS wasting syndrome where rapid weight loss and muscle mass over 10% may occur. If left untreated it can significantly increase the risk of dementia and infection. HIV differs from AIDS because it is a virus whereas AIDS is a condition.When HIV is left untreated and does detrimental damage to the immune system then it is classified AIDS. Although there has been many medical advancements in slowing down the progress of the virus there is still no absolute cure.

In general physical activity has been linked to healthier aging by decreasing the risks of diseases and health problems. In the last decade there has been a heavy focus in understanding the affects different types of physical activity have on certain age populations. There is large amount of evidence to suggest that resistance training is renowned to increase and develop muscle strength. This study analyses the affects resistance training program has on elderly HIV positive patients.

Where is the research from?
The study was undertaken by a group of researchers from various branches of the medicine department from the University of São Paulo located in Brazil.

What kind of research was this?
This study was a case series study (also known as a clinical series). Data was collected over a one year period to determine the affect a progressive resistance training program had on 11 elderly HIV positive patients.

What did the research involve?
The research involved 11 HIV positive elderly patients over the age of 60 years old that lacked regular physical activity who were being treated for HIV/AIDS at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

An initial interview was conducted with each patient in order to obtain clinical data and record forms. After each individual was assessed by a professional they underwent several of procedures in order to obtain baseline data which included;
 * Anthropometric measurements such as body mass, circumferences, skinfolds and body composition using a DEXA scan.
 * Immunology evaluations such as T-CD4+ and T-CD8+ lymphocyte counts, and virological evaluations through quantities HIV-RNA PCR test which was measured every four months.
 * Muscular strength was measured by the duration it took to complete two functional tests, a 2.4m walk, and a sit-stand test from a chair, which was measured every four months.

The one year progressive resistance program was comprised of 4 different exercises ( muscles trained). 1) leg press (quadriceps), 2) seated row (latissimus dorsi), 3) lumbar extension (paravertebral muscles), and 4) chest press (pectoralis major). Exercises using free weights were performed in three sets of 8–12 repetitions at light, moderate and heavy resistance, respectively, with 1–2 minutes of rest between each set. Sessions were run twice a week for one year with supervision at all times. Data for each of these exercises were measured pre and post the one year program.All data was recorded on an excel spread sheet.

What were the basic results?
The results indicate after the one year progressive resistance program;


 * Significant increase in average load (kg) in each of the four exercises. Leg press increased by 97% (33.8 to 63.0), seated row increased by 78% (25.0 to 45.5), lumbar extension increased by 122% (31.2 to 66.5) and chest press increased by 74% (12.5 to 20.7).
 * Increase in muscular strength which was observed through the significant decrease in duration it took to complete both the sit-stand test (2.00s to 1.57s p=0.003) and the walking 2.4m test (9.25s to 6.58s, p=0.003).
 * Significant increase in CD4+ cell count ( 388 ± 163 to 539 ± 225), however there was only a slight increase in CD8+ cell count (762 ± 423 to 816 ± 376).
 * Anthropometric measurements stayed consistent throughout the whole duration of the study. Weight did not change and body composition remained constant.

How did the researchers interpret the results?
The results indicate that a progressive resistance training program can significantly benefit elderly HIV patients in various ways. This can been seen through increases in strength, physical fitness and immune function. Furthermore resistance training seemed to have no adverse effects on any of the individuals. The differences found in all variables were independent of age, gender, and HIV infection stage or comorbidity.

What conclusions should be taken away from this research?
Despite the relative small sample size and limitations of a case series study, the results indicate that a progressive resistance training program can help fight HIV/AIDS within elderly HIV positive patients with no worsening or adverse effects of the virus. Resistance training can increase muscular strength, physical fitness and strengthen the immune system by increasing the number of CD4+ cells and CD8+ cells. Further research needs to focus on how different types of physical activity may benefit elderly HIV positive patients with the use of randomised controlled trials and larger sample sizes.

What are the implications of this research?
Implementing a progressive resistance training program within the lives of elderly HIV positive patients seems to have many benefits. There is a lack of evidence suggesting that resistance training may be the most beneficial type of exercise in comparison to other types of physical activity for example aerobic training or a combination of both resistance/aerobic training in order to counteract HIV/AIDS in an elderly population. There is a number of studies that investigate the effects of different types of physical activity on adult HIV positive patients. The results of these studies suggest that each different type of exercise has its own unique benefits. However, there is a lack of evidence to suggest that these benefits will be replicated to the same extent in different aged populations. Future studies should focus on the effects that different types of physical activity have on elderly HIV patients.