HIV infection: Does exercise help?

Regular aerobic and/or progressive resistance exercise could have a positive effect on heart and lung fitness in people living with HIV who are medically stable. It could also improve body shape and psychological wellbeing. This kind of exercise does not appear to have an effect on viral load or CD4 counts.

Exercise can have important health benefits: increased physical fitness can make the heart and lungs stronger, for example. That is called “cardiopulmonary fitness”. Exercise can also affect body shape, body image and improve people’s wellbeing. Being infected with the “Human Immunodeficiency Virus” (HIV), on the other hand, can have a negative impact in all of those areas – so exercise can be particularly important for people living with HIV.

HIV destroys cells, called CD4 cells, that are an essential part of the body’s defence system against illness. This means that the person’s immunity to disease is gradually weakened. “Antiretroviral” drugs are the treatments used to fight the effects of HIV in the body. But these drugs can have adverse effects, including a condition called lipodystrophy. Lipodystrophy changes people’s body shape because fat is redistributed in their body: for example, their face might become gaunt and they might have extra fat somewhere else, like their belly.

The illnesses that HIV infection can eventually cause include “AIDS wasting”. AIDS stands for “Acquired Immune Deficiency Syndrome” (or “Acquired Immunodeficiency Syndrome”). AIDS wasting is when people lose a lot of weight in combination with diarrhoea and weakness. For many reasons, then, trying to strengthen the immune system, and improve body image and general health is critical to many people affected by HIV.

Research has shown that exercising at least three times a week could help

Researchers from the Cochrane Collaboration looked for trials which tried to find out what benefits and risks might be associated with exercise for adults with HIV. They wanted to know whether people living with HIV benefit from aerobic exercise, progressive resistance training or a combination of both.

Aerobic exercise means any activity that increases the body’s use of oxygen – it makes the heart pump more and activates the cardiovascular system (heart and circulation). Examples of aerobic exercise include walking, jogging, cycling, using a step machine, swimming and rowing.

Progressive resistance exercise is also sometimes called strength training. The aim of these exercises is to build up or maintain muscles by repeating movements that challenge the muscles. These include using weights or elastic bands, doing exercise machine exercises like benchpresses, or using the body’s own weight, as with push-ups.

Altogether the researchers found 19 trials investigating the effect of exercise in people with HIV. More than 900 people took part in the trials, and most of them were men. The researchers looked at different kinds of exercise so there was not enough information to show whether one particular type is better than others. They combined the results of all the individual trials on aerobic exercise, progressive resistance training or combinations of both.

In the trials, the aerobic exercise was done for at least 24 minutes at a time and at least 3 times a week for 4 weeks or more. It included both aerobic exercises without breaks and aerobic exercises that switch between quieter and more strenuous phases, and also involve breaks.

Exercise: beneficial for cardiopulmonary fitness

The results showed that exercising can have several benefits for people with HIV.  Programmes with aerobic exercise improved people’s cardiopulmonary fitness: for example, the performance of their lungs. Programmes with progressive resistance training or a combination of both aerobic and resistance exercise had a positive effect in the small number of people with AIDS wasting in the trials: they built up muscle and put on weight. However, more research is needed to be certain of exactly what people can expect from exercising at different stages of HIV.

The trials measured the psychological impact of exercising in different ways. Some trials showed an improvement in quality of life or a reduction in the symptoms of depression among people who were exercising.

Exercise did not seem to cause particular adverse effects in people with HIV. In the trials, there was no major difference in people’s viral loads or their CD4 counts. This means that exercise does not seem to have an impact on the virus itself or on the immunity of adults living with HIV who are medically stable. The trials only lasted a few weeks or months, so we cannot be sure about the long-term effects of regular exercise for people living with HIV, or the effects at different stages of the disease.


Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)