Genetic predisposition, aging, chronic inflammation (from HIV and other infections or injuries), medications, and 'lifestyle' issues of diet, exercise, smoking, alcohol, and drug use all contribute to changes in body weight and shape over time. Some things we can change, and some things we have to live with'at least somewhat. Still, changing our behavior takes commitment and work that can be daunting if the person is not ready for it all. While physical activity is obviously important to anyone's health, starting and maintaining a reasonable amount of it can be the most daunting task of all. Think about your commitment level. And we'll look at some examples using a problem, matched-intervention, desired-outcome model.
It is important to define the problem that you want to address with exercise and the desired outcome of the effort you will make. Here are some examples:
Problem: fatigue in routine daily activities and lack of fitness. Intervention: exercise. Desired outcome: feeling energetic and fit.
Problem: altered fat/appearance. Intervention: exercise. Desired outcome: improved appearance.
Problem: metabolic changes. Intervention: exercise. Desired outcome: improved metabolic stability.
Next, let's look at some recent evidence to make a decision.
' In a study in Boston published in June, a home-based program that included both aerobic and resistance exercise was introduced to women to determine the impact on fitness, strength, and body composition. After 16 weeks the program improved all three; particularly, their self-reported energy levels were up, and they had a more slender appearance. Other benefits included better endurance and strength. There wasn't any significant impact on blood pressure, lipid levels, or changes in abdominal fat.
' In March a Brazilian clinic tested the addition of aerobic exercise to a low-fat diet to see if there was some impact in HIV-infected patients with lipodystrophy syndrome. The researchers found that the addition of exercise improved measures of fitness over a 12-week period. Both the diet-and-exercise and diet-only groups improved their waist-to-hip ratio, body weight, and body fat volume without significantly changing triglyceride, total cholesterol, or HDL cholesterol levels.
' In December 2005 in New Jersey two clinics were employed to look at effects of aerobic exercise or tai chi against a control group. Researchers reported improvements by both exercise groups for physical function and quality-of-life measures. The psychological improvements included improved social interactions and coping ability.
' In a Texas study published in July 2005, a group of patients on protease inhibitors with altered blood fats were evaluated for exercise, diet, and smoking to determine what role each might play. They discovered that diets high in animal protein were associated with markers of blood-fat changes, while exercise of the moderate to heavy aerobic style was associated with higher levels of the 'good' blood cholesterol and, thus, lower health risk. Interestingly, they did not find an association with smoking.
' In April 2005 in Montreal a group reviewed research on the effect of different kinds of exercise routines on body composition and fat deposits to suggest that aerobic exercise affects body fat deposits significantly, while the role for resistance exercise in such changes was less clear.
Decision time: In the first scenario we might choose to emphasize resistance exercise. Aerobic exercise might be emphasized in the second scenario, and a mix of both might be warranted in the third.
Keeping in good physical health and condition is a key factor in determining if you will stick with the program. And it is certainly easier to start from a good physical state than it is from the couch potato state.
Research done in Miami has suggested that a baseline measure of physical health can predict whether a person is likely to stick to an exercise program or drop out. Even expectations and perception of how well each participant was doing did not prove as reliable in predicting adherence. Still, it makes good sense to work with your health care team to plan an exercise program that you can do and feel you can follow, even in your more apathetic moments. Your health care team can help you set some shorter-term goals to reach so that you can realize some of your expectations along the way.