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A Randomized Trial

Sara E. Dolan, MSN, NP; Walter Frontera, MD, PhD; Jamie Librizzi, BA; Karin Ljungquist, BA; Sandra Juan, MS, PT; Robert Dorman, PT, DPT, GCS; Morgan E. Cole, PT, DPT; Jenna R. Kanter, BA; Steven Grinspoon, MD

Arch Intern Med. 2006;166:1225-1231.

Background  Women infected with human immunodeficiency virus (HIV) increasingly demonstrate abnormalities in fat distribution and metabolism; however, the effects of a home-based exercise regimen in this group have not been investigated.

Methods  We conducted a 16-week randomized intervention study of a supervised home-based progressive resistance training and aerobic exercise program in 40 HIV-infected women with increased waist-hip ratio and self-reported fat redistribution. Cross-sectional muscle area and muscle attenuation were measured by computed tomography. Cardiorespiratory fitness was determined by calculated maximum oxygen consumption (O₂max) and strength by 1-repetition maximum.

Results  Cardiorespiratory fitness (O₂max) was markedly lower at baseline (median [95% confidence interval], 15.4 [8.3-25.2] mL · kg^–1 · min^–1) than reported values for healthy female subjects (26-35 mL · kg^–1 · min^–1). Subjects randomized to exercise had significant improvement in mean ± SEM O₂max (1.5 ± 0.8 vs –2.5 ± 1.6 mL · kg^–1 · min^–1; P<.001) and endurance (1.0 ± 0.3 vs –0.6 ± 0.3 minute; P<.001). Strength increased at the knee extensors, pectoralis, knee flexors, shoulder abductors, ankle plantar flexors, and elbow flexors (all P<.001). Total muscle area (6 ± 1 vs 2 ± 1 cm²; P = .02) and attenuation (2 ± 1 vs –1 ± 1 Hounsfield unit; P = .03) increased in the exercise group. No significant difference was seen in lipid levels, blood pressure, or abdominal visceral fat between the groups, but subjects randomized to exercise reported improved energy and appearance.

Conclusions  A 16-week, supervised, home-based exercise regimen improved measures of physical fitness in HIV-infected women. The effects on strength were most significant, but improvements in cardiorespiratory fitness, endurance, and body composition were also seen.

Trial Registration  clinicaltrials.gov Identifier: NCT00111332.

Author Affiliations: Program in Nutritional Metabolism and Neuroendocrine Unit (Mss Dolan, Librizzi, Ljungquist, and Kanter and Dr Grinspoon) and Physical Therapy Department (Drs Dorman and Cole), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation Department, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston (Dr Frontera); and Partners Home Care Inc, Boston (Ms Juan).

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