Clinical implications of therapeutic exercise in HIV/AIDS.

HIV/AIDS poses serious risks to the health of millions around the globe. Despite decades of research, no cure or vaccine has been found to prevent this disease and the resultant morbidity and mortality. New antiretroviral drug regimens, such as highly active antiretroviral therapy (HAART), offer benefits at the cost of debilitating side effects. Other therapies, such as steroid and growth hormone administration, are also effective in treating HIV-related symptoms, but with serious side effects and increased cost (Basaria, Wahlstrom, & Dobs, 2001; Schambelan et al., 1996). Alternative therapies, the most commonly used of which is therapeutic exercise, are currently being explored to deal with symptoms and complications of chronic HIV infection without the unwanted side effects (Standish et al., 2001). Therapeutic exercise has been used successfully in the treatment of diabetes (Albright et al., 2000), dyslipidemias (Durstine & Haskell, 1994), hypertension (JNC VI, 1997), cardiovascular disease (American College of Sports Medicine, 1994) and certain types of cancer (Winningham, MacVicar, Bondoc, Anderson, & Minton, 1989). The benefits of regular exercise also extend to the population infected with HIV. Chronic HIV infection is associated with muscle wasting, muscle weakness, fatigue, impaired functional work capacity, depression, and decreased quality of life, which lead to disability and mortality. Exercise can positively affect many aspects of the physical and mental health of HIV-infected patients. The effects of prolonged, high-intensity exercise, or overtraining, have been well documented to increase the severity of infections and to negatively affect immune function in humans and increase mortality in animal models. It is for these reasons that many physicians still instruct their HIV-infected clients to avoid physical exertion, despite evidence that moderateintensity exercise can decrease symptoms of HIV infection and positively affect immune measures.