Keep Moving, Keep Smiling

Physical exercise is a beneficial complement to treatment for HIV-positive individuals. For example, although anxiety, depression, and fatigue are common among the general population, the challenges that face an HIV-infected person often intensify these conditions. Relaxing the body and mind, improving mood, and allowing a longer and more restful sleep, regular physical activity can be an important self-administered treatment. In addition, hormonally based processes that kick in during exercise can decrease a person's perception of pain'thus essentially decreasing pain. Furthermore, since stress increases pain perception, it stands to reason that reducing stress through physical exercise will also help to diminish pain. No matter what the physiological reason, any decrease in pain helps improve quality of life. People with HIV also often experience unfavorable changes in their lipid profile: LDL cholesterol may become elevated, HDL cholesterol may decrease, and triglyceride levels may become elevated. A regular program of physical activity can reduce LDL cholesterol and triglycerides. Studies have not yet shown exercise to have significant effects on HDL for HIV-positive people, but more are under way. It is likely that HDL levels will also improve for HIVers, since they usually improve among the portion of the general population that exercises regularly. There are also physically visible effects that exercise can help with. An accumulation of abdominal fat, through the effects of HIV-associated lipodystrophy, has been linked with cardiovascular disease and insulin sensitivity (sometimes progressing to type 2 diabetes). Aerobic exercise (such as walking, swimming, and biking) helps to reduce abdominal fat in the general population, and so far, short-term studies show similar results for HIVers. Lean muscle loss may arguably be the most emotionally damaging of all the effects of HIV and its treatments. A loss of muscle size and strength often leads to a poor self-image as well as physical weakness. Reducing muscle wasting and recovering lost muscle has tremendous implications for maintaining and improving one's outlook on life. Resistance exercises can greatly benefit in improving lean muscle tissue. But how much exercise is necessary to achieve all these benefits? The American College of Sports Medicine recommends at least 30 minutes of moderate-intensity cardiovascular exercise a day on most (or all) days of the week. Other health authorities support that amount. The good news is that these 30 minutes can be accumulated in five- to 10-minute sessions, several times a day. For people just beginning physical activity or those who cannot exercise for 30 minutes straight, this is a great way to incorporate and work up to that amount. All it takes is a pair of sneakers and a sidewalk to get started. Even dancing to MTV in the living room works well. The recommendations for resistance (weight training) exercise are also easier to follow than you might think. You can gain dramatic health benefits by completing at least eight to 10 different exercises that target the body's various muscle groups. Consult with a trained professional when beginning an exercise regimen to ensure that you have a comprehensive program. A couple of dumbbells can be an easy and cheap way to begin. For exercise more vigorous than walking, be sure to get your physician's approval. HIV is serious and needs serious medical care. Empower yourself to take a more active role in your treatment. It may be a challenge, but getting yourself off that couch can do wonders for your physical and emotional well-being. Bowers is board-certified in family practice and is a senior partner with Pacific Oaks Medical Group, one of the nation's largest practices devoted to HIV care. Bryzelak, who is interning for Bowers, will receive his master's in nutrition and exercise physiology from Columbia University in May 2005.