A systematic review of the effects of different types of therapeutic
exercise on physiologic and functional measurements in patients with HIV/AIDS

Gomes-Neto, Mansueto; Conceição, Cristiano Sena; Carvalho, Vitor Oliveira; Brites, Carlos

doi:10.6061/clinics/2013(08)16

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Review • Clinics 68 (8) • 2013 • https://doi.org/10.6061/clinics/2013(08)16 copy

A systematic review of the effects of different types of therapeutic exercise on physiologic and functional measurements in patients with HIV/AIDS

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Several studies have reported the benefits of exercise training for adults with HIV, although there is no consensus regarding the most efficient modalities. The aim of this study was to determine the effects of different types of exercise on physiologic and functional measurements in patients with HIV using a systematic strategy for searching randomized controlled trials. The sources used in this review were the Cochrane Library, EMBASE, MEDLINE, and PEDro from 1950 to August 2012. We selected randomized controlled trials examining the effects of exercise on body composition, muscle strength, aerobic capacity, and/or quality of life in adults with HIV. Two independent reviewers screened the abstracts using the Cochrane Collaboration's protocol. The PEDro score was used to evaluate methodological quality. In total, 29 studies fulfilled the inclusion criteria. Individual studies suggested that exercise training contributed to improvement of physiologic and functional parameters, but that the gains were specific to the type of exercise performed. Resistance exercise training improved outcomes related to body composition and muscle strength, with little impact on quality of life. Aerobic exercise training improved body composition and aerobic capacity. Concurrent training produced significant gains in all outcomes evaluated, although moderate intensity and a long duration were necessary. We concluded that exercise training was shown to be a safe and beneficial intervention in the treatment of patients with HIV.

AIDS; HIV Infection; Exercise; Therapeutics

	Study	1	2	3	4	5	6	7	8	9	10	11	Total
1	Sakkas et al. 2010	✓	✓	✓	✓	✓	✓			✓	✓	✓	8
2	Lindegaard et al. 2008	✓	✓		✓				✓		✓	✓	5
3	Shevitz et al. 2006	✓	✓		✓	✓		✓	✓	✓	✓	✓	8
4	Roubenoff et al. 2001	✓	✓		✓						✓	✓	4
5	Agin et al. 2001	✓	✓	✓	✓						✓	✓	5
6	Bhasin et al. 2000		✓		✓					✓	✓	✓	5
7	Strawford et al. 1999		✓	✓	✓	✓	✓		✓		✓	✓	8
8	Sattler et al. 1999		✓		✓				✓		✓		4
9	Lox et al. 1995	✓	✓		✓				✓		✓	✓	5
10	Spence et al. 1990	✓	✓		✓				✓		✓	✓	5
11	Terry et al. 2006	✓	✓		✓						✓	✓	4
12	Galantino et al. 2001	✓	✓								✓	✓	3^* Excluded because PEDro <4. )
13	Neidig et al. 2000		✓		✓						✓	✓	4
14	Smith et al. 2000	✓	✓		✓			✓			✓	✓	5
15	Baigis et al. 2002	✓	✓	✓	✓						✓	✓	5
16	Perna et al. 1999	✓	✓		✓						✓	✓	4
17	Terry et al. 1999	✓	✓		✓						✓	✓	4
18	Stringer et al. 1999	✓	✓		✓						✓	✓	4
19	McArthur et al. 1993	✓	✓									✓	2^* Excluded because PEDro <4. )
20	LaPerrieri et al. 1990	✓	✓		✓						✓	✓	4
21	Yarakeshi et al. 2011	✓	✓		✓				✓		✓	✓	5
22	Multimura et al. 2008	✓	✓		✓				✓		✓	✓	5
23	Hand et al. 2008	✓	✓		✓			✓			✓	✓	5
24	Pérez-Moreno. 2007	✓	✓	✓	✓			✓			✓	✓	6
25	Dolan et al. 2006	✓	✓		✓				✓	✓	✓	✓	6
26	Filippas et al. 2006	✓	✓	✓	✓			✓		✓	✓	✓	7
27	Driscoll et al. 2004	✓	✓		✓						✓	✓	4
28	Driscol et al. 2004	✓	✓		✓						✓	✓	4
29	Rojas et al. 2003	✓			✓				✓		✓	✓	4
30	Grispoon et al. 2000	✓	✓		✓			✓			✓	✓	5
31	Rigsby et al. 1992		✓		✓						✓	✓	4

	Study	Participants (M:F)	Outcomes	Outcomes			Results
				Body composition (BC)	Muscle strength (MS)	>Aerobic capacity (AC)	HRQOL	BC	MS	AC	HRQOL
1	Sakkas et al. 2009	HIV 43 (42:1)	Body composition Muscle strength	DEXA MRI	1RM testing Isometric MVC	NA	NA	↑ LBM	↑ RM MVC	NA	NA
2	Lindegaard et al. 2008	HIV 20 (20:0)	BC Muscle strength Aerobic capacity	DEXA	3RM testing	VO₂max	NA	↑ LBM ↓ BW	↑ 3RM	↑ VO₂max	NA
3	Shevitz et al. 2005	HIV 50 (33:14)	Body composition Muscle strength	DEXA CSMA	Isokinetic dynamometer 1RM testing	TCAM6	HRQOL	↑ CSMA	↑ RM	↑ TCAM6	↑ HRQOL
4	Roubenoff,2001	HIV 20 (19:1)	Body composition Muscle strength HRQOL	DEXA	1RM testing	NA	SF-36	↑ LBM	↑ RM	NA	↑ SF-36
5	Agin et al. 2001	HIV 43 (0:43)	BC Muscle strength HRQOL	DEXA MRI	1RM testing	NA	MOS-HIV	↑ LBM	↑ RM	NA	↑ MOS
6	Basin et al. 1999	HIV 61 (NI:NI)	BC Muscle strength HRQOL	Anthropometric measurements DEXA MRI	1RM testing	NA	HRQOL	↑ LBM ↑ CSMA	↑ RM	NA	↑ HRQOL
7	Strawford et al. 1999	HIV 24 (24:0)	Body composition Muscle strength HRQOL	DEXA	Isokinetic dynamometer 1RM testing	NA	NA	↑ LBM	↑ RM	NA	NA
8	Sattler et al. 1999	HIV 33 (33:0)	Body composition Muscle strength	BIA DEXA MRI	1RM testing	NA	NA	↑ LBM ↑ CSMA	↑ RM	NA	NA
9	Lox et al, 1995	HIV 34 (34;0)	Body composition Aerobic capacity	Anthropometric measurements	1RM testing	VO₂max	NA	↑ LBM	↑ RM	NA	NA
10	Spence et al. 1990	HIV 24 (24:0)	Body composition Muscle strength	Anthropometric measurements	Hand-held dynamometer	NA	NA	↑ LBM	↑ RM	NA	NA
11	Terry et al. 2006	HIV 42 (32:10)	Body composition Aerobic capacity	Anthropometric measurements	NA	Treadmill stress test	NA	↓ BW ↓ BF ↓ WHR	NA	↑ VO₂max	NA
12	Neidig et al. 2003	HIV 60 (52:8)	Depression Aerobic capacity Stress	NA	NA	Graded exercise stress test	POMS	NA	NA	NA	↑ POMS
13	Baigis et al. 2002	HIV 123 (89:20)	Aerobic capacity HRQOL	NA	NA	Treadmill Stress test	MOS-HIV	NA	NA	- VO₂max	- MOS-HIV
14	Smith et al. 2001	HIV 60 (52:8)	Body composition Aerobic capacity	Anthropometric measurements	NA	Graded exercise test Time on treadmill	NA	↓ BMI ↓ TBF	NA	↑ TT - VO₂max	NA
15	Perna et al. 1999	HIV 43 (18:10)	Aerobic capacity	NA	NA	Graded exercise test		NA	NA	↑ VO₂peak ↑ O2 pulse
16	Terry et al. 1999	HIV 21 (14:7)	Body composition Aerobic capacity	Anthropometric measurements	NA	Time on treadmill	NA	NI	NA	↑ treadmill time	NA
17	Stringger et al. 1998	HIV 34 (31:3)	Aerobic capacity HRQOL	NA	NA	Graded exercise test	QOL	NA	NA	↑ VO₂max	↑ QOL
18	LaPerrieri et al. 1990	HIV 50 (50:0)	Aerobic capacity	NA	NA	Bicycle ergometer test	NA	NA	NA	↑ VO₂max	NA
19	Yarasheski et al. 2010	HIV 39 (34:5)	Body composition Muscle strength	DEXA	1RM testing	NA	NA	↑ LBM ↑ TMV	NA	NA	NA
20	Multimura et al. 2008^a	HIV 97 (36:61)	Body composition Aerobic capacity HRQOL	Anthropometric measurements	NA	Shuttle test	WHOQOL-BREF	↓ % BFM	NA	↑ VO₂peak	↑ QOL
21	Hand et al. 2008	HIV 40 (30:10)	Aerobic capacity	NA	NA	Graded treadmill stress test	NA	NA	NA	↑ VO₂peak	NA
22	Pérez-Moreno et al. 2007	HIV 19 (19:0)	BC Strength AC HRQOL	Body mass MRI	6RM testing	Stress test Cycle ergometer	QOL	NS	↑ 6RM	↑ VO₂peak	NS
23	Dolan et al. 2006	HIV 38 (0:38)	Body composition Aerobic capacity	Anthropometric measurements TC DEXA	1RM testing	Treadmill stress test TCAM6	NA	↑ CSMA	↑ 1 RM	↑ VO₂peak ↑ TCAM6	NA
24	Filipas et al. 2006	HIV 35 (35:0)	Aerobic capacity HRQOL	NA	1RM testing	Kasch pulse recovery test	MOS-HIV	NA	NA	↓ HR	↑ MOS-HIV
25	Driscoll et al. 2004^a	HIV 25 (20:5)	BC Strength Aerobic capacity	Anthropometric measurements DEXA TC	1RM testing	Submaximal exercise stress test	NA	↑ CSMA ↓ WHR	↑ 1 RM	↑ET	NA
26	Driscoll et al. 2004^b	HIV 25 (20:5)	Body composition Muscle strength	Anthropometric measurements CT DEXA	1RM testing	NA	NA	↓ BMI ↓ TMA	NA	NA	NA
27	Rojas et al. 2003	HIV 33 (23:10)	Aerobic capacity HRQOL	NA	NA	Graded exercise stress test	MOS-HIV	NA	NA	↑ VO₂max ↑ O2 pulse	↑ MOS-HIV
28	Grinspoon et al. 2000	HIV 43 (43:0)	BC Muscle strength	CT DEXA	2RM testing	NA	NA	↑ LBM ↑ CSMA	↑ 1 RM	NA	NA
29	Rigsby et al. 1992	HIV 37 (37:0)	Muscle strength Aerobic capacity	NA	2RM testing	YMCA cycle test protocol/Cycle ergometer	NA	NA	↑ 1 RM	↑ET ↓ HR	NA

N	Study	Intensity (RM)	Volume	Muscle	Contraction	Frequency (x wk)	Time (min)	Duration (wk)	Supervision (yes/no)
1	Sakkas et al. 2009	80% RM	3 sets x 8 reps	Upper body Lower body	NI	3	90	12	yes
2	Lindegaard et al. 2008	50-60% RM 70-80% RM	3 sets x 12 reps4 sets x 8-10 reps	Upper body Lower body	Concentric/Eccentric	3	45-60	16	NI
3	Shevitz et al. 2005	80% RM	3 sets x 8 reps	Large muscles	Dynamics	3	30-60	12	yes
4	Roubenoff et al. 2001	50-60% RM 75-90% RM	3 sets x 8 reps	Large muscles	NI	3	NI	8	yes
5	Agin et al. 2001	75% RM	3× (8-10) reps	NI	NI	3	NI	14	yes
6	Bhasin et al. 2000	60% RM	3× (12-15) reps	Upper body	NI	3	NI	16	NI
		70-90% RM	4× (4-6) reps	Lower body
7	Strawford et al. 1999	80% RM	3 sets x 10 reps	Major muscles	NI	3	60	7	yes
8	Sattler et al. 1999	70% RM	3 sets x 8 reps	Upper body	Concentric	3	NI	12	yes
		80% RM		Lower body	Eccentric
9	Lox et al. 1995	60% RM	3 sets x 10 reps	NI	NI	3	NI	12	yes
10	Spence et al. 1990	15 RM	1 set x 15 reps 3 sets x 10 reps	Bilateral	Concentric	3	NI	6	yes

	Study	Modality	Intensity/duration (wk)	Volume	Frequency (x per wk)	Time (min)	Length (wk)	Supervision
1	Lindegaard et al. 2008	NI	65% HRmax/8 75% HRmax/8	5 min warm-up 35 min IT	3	40	16	yes
2	Terry et al. 2006	Run	75-85% HRmax	15 min warm-up 30 min exercise 15 min cool-down	3	60	12	yes
3	Neidig et al. 2003	Treadmill Stationary bike Walking	50-70% HRmax	5 min warm-up 30 min exercise 5 min cool-down	3	60	12	yes
4	Baigis et al. 2002	Fitness Master ski machine	75-85% HRmax	10 min warm up 20 min exercise 10 min cool-down	3	40	15	yes
5	Smith et al. 2001	Walk or run Treadmill Jog	60-80 VO₂max	5 min warm-up 30 min exercise 5 min cool-down	3	30	12	yes
6	Perna et al. 1999	IT Cycling exercise	70-80% HRmax	3 min exercise task 2 min recovery	3	45	12	yes
7	Terry et al. 1999	Treadmill	G1 - 60 ±4% HRmax	NI	3	60	12	yes
			G2 - 80 ±4% HRmax
8	Stringer et al. 1998	Cycle ergometer	G3 MI G4 HI	60 min IT 30-40 min IT	3	30-60	6	yes
9	Lox et al. 1995	Bicycle ergometer	50-80% HRres	5 min warm-up 24 min exercise 15 min cool-down	3	45	12	yes
10	LaPerrieri et al. 1990	Bicycle ergometer	60-79% HRmax 80% HRmax	3 min exercise 2 min recovery	3	45	24	NI

N	Study	Type exercise	Intensity/duration (wk)	Volume	Frequency (x per Wk)	Time (min)	Length (wk)	Supervision
1	Yarasheski et al. 2010	Aerobic exercise cycling/treadmill	50-85% Hres	NI	3	90-120	16	Yes
		Resistance exercise	12 RM	1-2 sets 12 reps	3	90-120	16	Yes
2	Mutimura et al. 2008	Aerobic exercise	45% HRmax/3 60% HRmax/6 75% HRmax/15	15 min warm-up 60 min exercise 15 min cool-down	3	90	24	Yes
		Resistance exercise	NI	NI	3	90	24	Yes
3	Hand et al. 2008	Aerobic exercise	50-70% HRmax	5 min warm-up 30 min exercise 5 min cool-down	2	40	6	NI
		Resistance exercise	12 RM	1 set, 12 reps	2	20	6	NI
4	Pérez-Moreno et al. 2007	Aerobic exercise Cycle ergometer	70-80% HRmax	10 min warm-up 20 min exercise 10 min cool-down	3	20-40	16	Yes
		Resistance exercise	12-15 RM	1-2 sets 12-15 reps	3	50	16	Yes
5	Filipas et al. 2006	Aerobic exercise	60% HRmax/3 75% HRmax/3	5 min warm-up 20 min exercise 5 min cool-down	2	30	6	Yes
		Resistive exercise	60% RM 80% RM	3 sets 10 reps	2	30	6	Yes
6	Dolan et al. 2006	Aerobic exercise	60% HRmax/2 75% HRmax/14	5 min warm-up 20-30 min exercise	3	35	16	Yes
		Resistive exercise	60-70% RM/2 80% RM/12	3-4 sets 8-10 reps	3	85	16	Yes
7	Driscoll et al. 2004	Aerobic exercise stationary bicycle	60% HRmax/2 75% HRmax/14	5 min warm-up 20-30 min exercise 5 min cool-down	3	35	12	Yes
		Resistive exercise	60-70% RM/4 80% RM/12	3-4 sets 8-10 reps	3	25	12	Yes
8	Driscoll et al. 2004	Aerobic exercise stationary bicycle	60-75% HRmax	5 min warm-up 20-30 min exercise 5 min cool-down	3	36	12	Yes
		Resistive exercise	NI	3 sets, 10 reps	3	24	12	Yes
9	Rojas et al. 2003	Aerobic exercise	60-80% HRmax	10 min warm-up 25 min exercise 10 min cool-down	3	50	12	NI
		Resistive exercise	60-70% RM/4 80% RM/12	2-3 sets 8 reps	3	NI	12	NI
10	Grispoon et al. 2000	Aerobic exercise stationary bicycle	60-70% HRmax	30 min exercise 15 min cool-down	3	30	12	Yes
		Resistive exercise dynamic	60-70% RM/6 80% RM/6	2 sets, 8 reps 2 sets, 8 reps	3		12	Yes
11	Rigsby et al. 1992	Aerobic exercise	60-80% HRmax	2 min warm-up 30 min exercise 3 min cool-down	3	36	12	NI
		Resistive exercise	NI	1-3 sets 6-18 reps	3	24	12	NI

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[1] Gomes-Neto M, Conceição CS, Carvalho VO, and Brites C conceived the study and drafted the manuscript. Carvalho VO performed the search and the initial selection of potentially relevant studies. Gomes-Neto M and Conceição CS identified the articles in agreement with the inclusion and exclusion criteria and performed the data extraction. Brites C supervised the review process and resolved disagreements. All authors have read and approved the final manuscript.