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Revista Brasileira de Medicina do Esporte

Print version ISSN 1517-8692

Rev Bras Med Esporte vol.19 no.1 São Paulo Jan./Feb. 2013 



Physical training for HIV positive individuals submitted to haart: effects on anthropometric and functional parameters



Edmar Lacerda MendesI; Alynne Christian Ribeiro AndakiII; Paulo Roberto dos Santos AmorimIII; Antonio José NataliIII; Ciro José BritoIV; Sérgio Oliveira de PaulaV

IDepartment of Sports Sciences and Master's Course in Physical Education of the Federal University of the Minas Triangle - Uberaba, MG. Graduate Program in Cellular and Structural Biology of the Federal University of Viçosa - Viçosa, MG
IIDepartment of Sports Sciences of the Federal University of the Minas Triangle - Uberaba, MG. Stricto Sensu Graduate Program in Nutrition Science of the Federal University of Viçosa - Viçosa, MG
IIIStricto Sensu Graduate Program in Physical Education of the Federal University of Viçosa, Federal University of Juiz de Fora (UFV/UFJF) - Viçosa, MG and Juiz de Fora, MG
IVPhysical Education Department of the Federal University of Sergipe - Aracaju, SE. NEDES - Center of Studies in Sports Performance and Health of the Federal University of Sergipe - Aracaju, SE
VDepartment of General Biology of the Federal University of Viçosa - Viçosa, MG

Mailing address




INTRODUCTION: The use of highly active antiretroviral therapy (HAART) has improved the prognosis of HIV-infected individuals. However, HAART has been associated with the development of metabolic and fat distribution abnormalities, known as HIV-associated lipodystrophy syndrome (HIVALS).
OBJECTIVE: This study investigated the impact of 24 weeks of resistance exercise with aerobic component (REAC) on anthropometric and functional parameters in HIV-infected patients undergoing HAART.
METHODS: Ninety- nine HIV-infected patients were randomly allocated into four groups: exercise and lipodystrophy (n = 24; EX + LIP); exercise without lipodystrophy (n = 21; EX + NoLIP); control and lipodystrophy (n = 27; NoEX + LIP); control without lipodystrophy (n = 27; NoEX + NoLIP). Subjects from exercised groups (EX+LIP and EX+NoLIP) participated in a 24-week REAC program. Anthropometric, strength and cardiorespiratory fitness tests were assessed at baseline and 24 weeks after intervention.
RESULTS: Body circumferences (P < 0.0001) and waist-hip ratio (P = 0.017) changed after 24 weeks of REAC in both exercised groups. The sum of seven skinfolds assessed, body fat percentage, body fat mass, total fat, central fat and peripheral subcutaneous fat reduced (P < 0.0001) in response to REAC. Lean body mass increased (P < 0.0001) in exercised groups, regardless of the outcome (LIP or NoLIP). Strength and cardiorespiratory fitness increased (P < 0.0001) in both exercised groups in response to REAC.
CONCLUSION: 24 weeks of REAC prevented the manifestation of changes arising from HIVLDS and contributed to their reduction.

Keywords: exercise, therapeutics, body composition, muscular strength, physical fitness.




The highly active antiretroviral therapy results in remarkable suppression of the HIV and consequently, increase of survival in infected individuals1. However, it has been reported that HIV patients submitted to HAART may develop a syndrome of body fat redistribution, named HIV lipodystrophy syndrome (HIVLDS). HIVLDS is characterized by loss of subcutaneous body fat, increase of visceral fat, presence of dorsal gibbosity, gynecomastia, and breasts increase in women, loss of facial and extremities subcutaneous fat and severe metabolic collateral effects, including dyslipidemia, insulin resistance, blood hypertension and hence, higher risk of cardiovascular disease2.

Loss of lean body mass (LBM) occurs in HIV patients with relative maintenance of total body mass3. These alterations are associated with reduction of the capacity in generating strength and limitation of the functional status4. The antiretroviral therapy (ART) is not associated with increase of LBM in HIV patients5; hence, anabolic therapies should be incorporated to the routine of these individuals. To name some, pharmacological agents, including the human recombinant growth hormone (hrGH), nandrolone decanoate, testosterone and oxandrolone have been tested. Some investigations report metabolic collateral effects associated with drugs exposure, including increase of blood glucose6 and negative alterations in the lipid profile7. However, Grinspoon et al.8 reported that, independently, both progressive strength training and therapy involving testosterone increase muscle mass of HIV patients.

The HAART involved in the HIV treatment, defined as nucleoside analog reverse-transcriptase inhibitors (NARTIs), has been related to lipodysthophic alterations like lipoatrophy9, mitochondrial toxicity10 and reduction of the activity of oxidative enzymes11. Thus, the HIV and the HAART negatively influence on the oxygen kinetics (O2), limiting hence the extraction/use of O2 in the peripheral musculature12. Lower oxygen use capacity directly affects physical fitness, and consequently, the individual's motivation to perform routine activities. Few assays have been performed to test the effects of resistance exercise with aerobic component (REAC) in cardiorespiratory fitness. Robinson et al.13 reported improvement of 10% of maximum oxygen consumption (VO2max) after 16 training weeks. Perez-Moreno et al.14 also tested the combination of aerobic and resistance exercises in inmates, for 16 weeks; nevertheless, they did not report VO2max values. Controlled and random studies with longer intervention time are needed.

Brazil has a unified health system which provides assistance and free and universal access to the ART the HIV positive individuals. Until the end of 2009, over 197,000 HIV+ individuals received ARTr from the Brazilian government15. However, until the present moment, no randomized and controlled study has investigated the effects and safety of the REAC in the anthropometric and functional parameters in Brazilian HIV+ individuals submitted to HAART. Thus, the present study had the aim to analyze the effects of six months of REAC on the anthropometric and functional parameters of HIV patients submitted to HAART.




29 men (39.7 ± 9.3 years) and 51 women (38.8 ± 11.6 years) from the Center of Health Promotion (CPS) of Conselheiro Lafaiete, Minas Gerais participated in the study. They have been physically inactive for at least six months preceding the study, did not present contraindication for physical exercises practice and were undergoing HAART for at least one year. The patient who made use of drugs and those with acute infection or opportunistic diseases were excluded. This study was previously approved by the Ethics in Research with Humans Committee of the Federal University of Viçosa and the subjects signed the Free and Clarified Consent Form.

Experimental procedures

Initially, 45 patients with lipodystrophy and 54 without it were randomly sorted in four groups: exercise and lipodystrophy (n = 24; EX+LIP); exercise without lipodystrophy (n = 21; EX+NoLIP); control and lipodystrophy (n = 27; NoEX+LIP); control without lipodystrophy (n = 27; NoEX+NoLIP) with the use of the software (GraphPad StatMate, version 1.01, San Diego - USA). Nineteen individuals dropped the study (13 from the EX group and six from the NoEX group) for lack of interest, problems with commuting to the CPS, family problems or for having reached 30% of absence for the exercised group. The anthropometric parameters and cardiorespiratory fitness were evaluated in the pre and post 24 weeks of intervention moments. An additional measurement for muscular strength was performed in week 12 for training load adjustment. All measurements were performed after 24 h of suppression of heavy exercise and 12 h-fasting.

Lipodystrophy diagnosis

All volunteers underwent individual medical evaluation for diagnosis of lipodystrophy (LIP)16.

Nutritional control

During the whole experimental period, the volunteers had their diet controlled. The evaluation of the eating habits and dietetical prescription were done by a nutritionist from the CPS. The eating habits were evaluated through habitual record of the diet. All the volunteers received customized dietetical prescription17. The diets were calculated using the Diet-Pro program, version 4.018.

Anthropometric measurements

Anthropometric data of body mass, stature, perimeters and skinfolds were collected according to procedures described in the Anthropometric Standardization Reference Manual by Lohman et al.19. All measurements were taken three times and their mean value was considered. The body perimeters were obtained with a non-elastic measuring tape (Sanny®) with precision of 1cm. The neck, thorax, waist, hip, arm forearm, thigh and calf perimeters were obtained. The waist measure was performed on the median point between the iliac crest and the last rib. The waist/hip ratio (WHR) was obtained by the division of the waist perimeter (cm) by the hip perimeter (cm). The body mass and stature were measured using a mechanical scale with an attached stadiometer, brand name Filizola®, with 0.1kg and1cm of precision, respectively. The body mass index (BMI) was calculated using body mass (kg) divided by the square of the stature (m2). Skinfolds were measured with the use of the scientific adipometer brand name Lange®, with precision of 0.1mm. The following anatomic points were used: tricipital (TR), bicipital (BI), subscapular (SB), suprailiac (SI), chest (C), abdominal (AB), midaxillary (MA), thigh (T), midcalf (MC).

Arm muscle area

It was obtained using the circumference of the relaxed arm (CRA) and TR thickness20.

Body fat distribution

Body fat distribution was evaluated using the methodology described by Florindo et al.21. Total subcutaneous fat (TSF) was estimated from the sum of the BI, TR, SB, MA, SI, AB and MC skinfolds. Central subcutaneous fat (CSF) was estimated by the sum of the SB, MA, SI and AB skinfolds. Peripheral subcutaneous fat (PSF) was estimated by the sum of the BI, TR and MC skinfolds.

Body fat estimation

After calculation of body density (Bd) for women22 and men23, the estimation of the body fat percentage (%BF) was calculated for women and men24. The sum of seven skinfolds ( 7 SF) TR, SB, C, MA, SI, AB and T was also used.

Strength test

Tests of one repetition maximum (1-RM) were performed by a certified professional in six exercises: squat, bench press, hamstrings extension, triceps, back pulley, knee flexion and barbell curl.

Cardiorespiratory fitness test

It was measured by the modified multi-stage fitness test (20mMST)25 in the pre and post-intervention moments. The total number of completed stages during voluntary exhaustion, or when the individual was not able to follow the "audio signal" in three consecutive occasions, was used to calculate the peak velocity. Afterwards, the maximum oxygen consumption (VO2max) was estimated.

Intervention with exercise

The resistance exercise with aerobic component (REAC) program consisted of 24 weeks of supervised exercise performed three times per week in non-consecutive days. The subjects were submitted to two weeks of adaptation before the beginning of the REAC. Each training session was composed of warm-up and stretching exercises (10 min), aerobic training (15-20 min), resistance training (40 min) and return to calmness (10 min). The REAC program started after the interpretation of the results obtained in the 1-RM and 20mMST tests. Three sets of 8-10 repetitions were performed at 80% of 1-RM. Six exercises involving the large muscle groups were performed in the following order: squat, bench press, hamstring extension, back pulley, knee flexion, calf on bench. The prescription of the aerobic training was based on the reserve heart rate (HRres)26. Aerobic exercise was performed on treadmill or cycle ergometer, according to the individuals' adaptation, with intensity increase range from 50 to 80% of HRres. Heart rate was monitored during all the sessions to guarantee maintenance of training intensity.



All analyses were performed using the SPSS (version 17.0, SPSS Inc., Chicago, IL). Data normality was checked by the Kolmogorov-Smirnov test. Student's t test for independent samples was used to investigate differences between means of the LIP vs. NoLIP individuals in the pre moment for the continuous variables with normal distribution and Mann-Whitney for not normally distributed data. Two-way ANOVA considering the repeated measures was used to determine the effects of the exercise (treatment), lipodystrophy (closing) and interaction in the pre and post-intervention moments after 24 weeks of intervention. In case of statistical significance for effects or interactions, the paired t test was used to investigate differences between means for the pre and post moments. Subsequently, the Cohen d coefficient was calculated to estimate the effect magnitude (EM) of the intervention, interpreted as small (EM = 0.2), medium (EM = 0.5) or big (EM = 0.8). The type d effect magnitude is the standard quantification of increase, increment, improvement or benefit which is observed due to the studied intervention. Significance level adopted was of up to 5% in all procedures.



The individuals infected by the HIV and suffering from LIP presented narrower thigh (T = 0.021) and calf perimeter (P < 0.0001), wider neck (P = 0.023) thorax (P = 0.039) and waist perimeter (P = 0.016) and wider WHR (P < 0.005) compared with the HIV+ NoLIP in the pre-intervention moment (table 1). Twenty-four weeks of exercise significantly altered all the evaluated body perimeters (P < 0.0001) and the WHR (P = 0.017). Reduction in the neck, thorax and waist perimeters and increase in the arm, forearm and calf perimeters have been observed in the EX groups. The waist perimeter and the WHR increased and the arm, forearm and calf perimeters reduced only in the NoEX+LIP group (P < 0.05) after the intervention. Although the body mass and the BMI have not significantly reduced (P > 0.05) after the intervention, the body composition was considerably modified (table 2). Reduction in (P < 0.0001) in 7 SF (EM = 0.762), in %F (EM = 0.784) and FBM have been observed, as well as (EM = 0.409) increase in LBM (EM = 0.198) between the EX groups after the intervention, It is worth mentioning that the 7 SF, %F and FBM increased in the NoEX+LIP and NoEX+NoLIP groups (P < 0.05). Twenty-four weeks of intervention were effective in reducing (P < 0.0001) the TSF, BSF and PSF, regardless of the ending (LIP or NoLIP) (figure 1). TSF and BSF significantly increased for the NoEX+LIP and NoEX+NoLIP groups (P < 0.0001). Lipodystrophy effect in the PSF reduction was only observed (P < 0.0001, EM = 0.313) in the NoEX+LIP group (P < 0.0001). Twenty-four weeks of exercise resulted in significant strength improvement, regardless of the ending (LIP or NoLIP) for all selected muscle groups (P < 0.0001) (table 3). Although lipodystrophy had significantly interacted with the bench press responses (P = 0.042, EM = 0.047) and hamstring extension (P < 0.0001, EM = 0.173) along the time, only the EX groups significantly increased strength (P < 0.0001) after the intervention. The mean increase in strength of lower limbs for squat, hamstring extension and knee flexion was of 59.4 ± 28.8%, 77.5 ± 37.5% and 55.4 ± 26.1%, respectively. Concerning the exercises for upper limbs: bench press, triceps, back pulley and dumbbell curl, increase was of 44.9 ± 24.9%, 82 ± 37.4%, 55.2 ± 19.4% and 44.7 ± 19.6%, respectively. MAArm significantly increased after 24 weeks of REAC (P < 0.0001, EM = 0.252).









The individuals infected by the HIV with LIP presented lower VO2max compared with the NoLIP ones in the pre-moment (P = 0.027). The VO2max significantly increased (P < 0.0001, EM = 0.548) in the EX+LIP (from 28.6 ± 7.1 to 34.0 ± 6.7 and EX+NoLIP groups (from 32.0 ± 7.6 to 36.3 ± 7.9 after 24 weeks of intervention (figure 2). In NoEX+LIP and NoEx+NoLIP groups there was no significantly difference (P > 0.05) between the pre and post-moments, which reinforces the exercise effect as a single modulator of VO2max.




Our findings indicate that 24 weeks of REAC positively modulated the body perimeters, body composition, strength of upper and lower limbs and maximum oxygen consumption in HIV+ individuals submitted to HAART. This is the first random and controlled study to demonstrate that REAC is a safe, practical and effective method in controlling the anthropometric and functional alterations of HIV+ individuals submitted to HAART, in the southeast of Brazil. WE believe that our results are especially important due to the wide access of the HIV+ Brazilian population to the HAART15.

Exercised HIV-infected individuals, regardless of the ending (LIP orNoLIP), presented significant reduction of the thorax and waist measurements and increase of arm, forearm, thigh and calf measurements. Reduction in waist perimeter and WHR observed in the present study corroborates previous findings27,28, besides aiding in reducing the risk for cardiovascular disease29. On the other hand, our data show increase in waist perimeter and WHR only for the not exercised group with lipodystrophy, indicating hence that the sedentary condition added to lipodystrophy may contribute to the development of risk of cardiovascular disease30. Moreover, although the REAC has not influenced on body mass and BMI, positive alterations were confirmed by the increase of lean body mass and reduction of fat body mass, effects previously reported for strength exercise31 and aerobic exercise28.

REAC was effective in reducing TSF, CSF and PSF. Similar result was observed for reduction of trunk body fat 13 and visceral one32. Additionally, our results indicate increase of TSF and CSF and reduction of PSF during the 24 weeks for not exercised individuals HIV-infected. Thus, it is worth mentioning that besides contributing to the reduction of body fat, exercising prevents its build-up in HIV+ individuals 33. Alterations in the fat compartments in the central region of the body have been associated with insulin resistance, dyslipidemia, hypercholesterolemia and risk of cardiovascular disease. Although radiological image methods have not been used, the exercised women reduced waist perimeter (from 88.6 ± 12.7 cm to 81.2 ± 11.6 cm) to a value below the recommended cohort point (< 88 cm)34. Waist perimeter also reduced in men (83.8 ± 10.4 cm to 81.3 ± 8.5 cm) being below the recommended cohort point (< 102 cm)34.

Maximal voluntary muscular strength increased in the muscle groups evaluated. This fact can be explained by the increase of LBM and MAArm, as previously reported35. Muscular strength is an essential component to the performance of activities of daily living, besides being strongly related to physical and motor independence. The muscular strength increase observed in the present study was not related to the ending (LIP or NoLIP); that is to say, regardless of the distribution of body fat, REAC prevails and acts in a decisive manner in strength increase. Although the strength training prescription follows the recommendation for healthy adults 36, the training loads were well-tolerated and promoted morphological adaptations for the sample involved in the study. Similar results were reported for assays involving progressive strength exercise 31,37,38 and combined exercise13,14 for HIV+ individuals. Thus, 12 to 24 weeks of progressive strength training guaranteed significant increase of muscular strength when performed at least three times per week, 6-12 RM per exercise, at approximately 70-85% of 1-RM.

In the initial intervention moment, it was observed that HIV+ individuals with lipodystrophy presented lower VO2max when compared with the HIV+ individuals without lipodystrophy. It has been observed, in a decreasing scale, that compromising with the extraction capacity and use of oxygen by the muscle fiber occurs in a higher level in the HIV+ individuals submitted to HAART, then in the infected ones without use of HAART and finally in the HIV- 12. Possibly, the mechanisms involved in this process are related to the HIV infection and inflammation, with HAART or with a combination of these factors 39. Our data, like others 28,40 involving not trained HIV+ individuals, have revealed low estimated value of VO2max (~ 30 ml/kg/min) and increase after intervention with aerobic training 28 and combined training40. Although only 1/3 of the intervention time consisted in aerobic exercise, the increase in the oxygen consumption (16.5%) was very close to the one found for African individuals (19%) who participated in an aerobic training program for 24 weeks28. This result may be explained by the increase of lean mass (2.2 ± 3.2 kg) and by the fact that, after the HIV infection diagnosis, problems related to depression result in social isolation, a situation favorable to limitation of aerobic capacity.



Regular physical exercise acts in a decisive manner in the control of anthropometric and functional alterations in HIV patients submitted to HAART. Twenty-four weeks of REAC avoided the manifestation of alterations derived from the SLHIV and contributed to their reduction. REAC was an effective, practical and low-cost method to be incorporated in programs of basic health care, especially in fields with limited resources.

All authors have declared there is not any potential conflict of interests concerning this article.



1. Couzigou C, Semaille C, Strat YL, Pinget R, Pillonel J, Lot F, et al. Differential improvement in survival among patients with AIDS after the introduction of HAART. AIDS Care 2007;19:523-31.         [ Links ]

2. Terry L, Sprinz E, Stein R, Medeiros NB, Oliveira J, Ribeiro JP. Exercise training in HIV-1-infected individuals with dyslipidemia and lipodystrophy. Med Sci Sports Exerc 2006;38:411-7.         [ Links ]

3. Macera CA. A home-based exercise program for women with HIV. Clin J Sport Med 2007;17:172.         [ Links ]

4. O'Brien K, Nixon S, Glazier RH, Tynan AM. Progressive resistive exercise interventions for adults living with HIV/AIDS. Cochrane Database Syst Rev 2004:CD004248.         [ Links ]

5. Cade WT, Reeds DN, Mittendorfer B, Patterson BW, Powderly WG, Klein S, et al. Blunted lipolysis and fatty acid oxidation during moderate exercise in HIV-infected subjects taking HAART. Am J Physiol Endocrinol Metab 2007;292:E812-9.         [ Links ]

6. Gelato M, McNurlan M, Freedland E. Role of recombinant human growth hormone in HIV-associated wasting and cachexia: pathophysiology and rationale for treatment. Clin Ther 2007;29:2269-88.         [ Links ]

7. Grunfeld C, Kotler DP, Dobs A, Glesby M, Bhasin S. Oxandrolone in the treatment of HIV-associated weight loss in men: a randomized, double-blind, placebo-controlled study. J Acquir Immune Defic Syndr 2006;41:304-14.         [ Links ]

8. Grinspoon S, Corcoran C, Parlman K, Costello M, Rosenthal D, Anderson E, et al. Effects of testosterone and progressive resistance training in eugonadal men with AIDS wasting. A randomized, controlled trial. Ann Intern Med 2000;133:348-55.         [ Links ]

9. Dell'Isola C, Aprea L, Pizzella T, Izzo C. [Effect of anti-retroviral therapy on body composition changes: a literature review]. Infez Med 2006;14:5-12.         [ Links ]

10. Kohler JJ, Lewis W. A brief overview of mechanisms of mitochondrial toxicity from NRTIs. Environ Mol Mutagen 2007;48:166-72.         [ Links ]

11. Cade WT, Fantry LE, Nabar SR, Shaw DK, Keyser RE. Impaired oxygen on-kinetics in persons with human immunodeficiency virus are not due to highly active antiretroviral therapy. Arch Phys Med Rehabil 2003;84:1831-8.         [ Links ]

12. Cade WT, Fantry LE, Nabar SR, Shaw DK, Keyser RE. A comparison of Qt and a-vO2 in individuals with HIV taking and not taking HAART. Med Sci Sports Exerc 2003;35:1108-17.         [ Links ]

13. Robinson FP, Quinn LT, Rimmer JH. Effects of high-intensity endurance and resistance exercise on HIV metabolic abnormalities: a pilot study. Biol Res Nurs 2007;8:177-85.         [ Links ]

14. Perez-Moreno F, Camara-Sanchez M, Tremblay JF, Riera-Rubio VJ, Gil-Paisan L, Lucia A. Benefits of exercise training in Spanish prison inmates. Int J Sports Med 2007;28:1046-52.         [ Links ]

15. Brasil. Resposta brasileira 2008/2009. Relatório de progresso do país. Brasília: DST AIDS e Hepatites Virais, Ministério da Saúde, UNGASS; 2010.         [ Links ]

16. Lichtenstein KA, Ward DJ, Moorman AC, Delaney KM, Young B, Palella FJ, Jr., et al. Clinical assessment of HIV-associated lipodystrophy in an ambulatory population. AIDS 2001;15:1389-98.         [ Links ]

17. Food and Nutrition Technical Assistance Project Academy for Educational Development. HIV/AIDS: a guide for nutritional care and support. 2 ed. Washington (DC); 2004. p. 10-7.         [ Links ]

18. Monterio J, Esteves, EA, Mafia, UCC. Diet Pro versão 4.0. Agromidia, Viçosa. 2001.         [ Links ]

19. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual: Abridged Edition. Human Kinetics Books. Champaign, Illinois 1991        [ Links ]

20. Frisancho AR. New standards of weight and body composition by frame size and height for assessment of nutritional status of adults and the elderly. Am J Clin Nutr 1984;40:808-19.         [ Links ]

21. Florindo AA, Latorre Mdo R, Santos EC, Borelli A, Rocha Mde S, Segurado AA. [Validation of methods for estimating HIV/AIDS patients' body fat]. Rev Saude Publica 2004;38:643-9.         [ Links ]

22. Jackson AS, Pollock ML, Ward A. Generalized equations for predicting body density of women. Med Sci Sports Exerc 1980;12:175-81.         [ Links ]

23. Jackson AS, Pollock ML. Generalized equations for predicting body density of men. Br J Nutr 1978;40:497-504.         [ Links ]

24. Siri WE. Body composition from fluid spaces and density: analysis of methods In: Techniques for measuring body composition ed Henschel JBA, editor. Washington, DC: National Academy of Sciences, National Research Council; 1961. p. 223-43.         [ Links ]

25. Wilkinson DM, Fallowfield JL, Myers SD. A modified incremental shuttle run test for the determination of peak shuttle running speed and the prediction of maximal oxygen uptake. J Sports Sci 1999;17:413-9.         [ Links ]

26. Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate; a longitudinal study. Ann Med Exp Biol Fenn 1957;35:307-15.         [ Links ]

27. Guaraldi G, Orlando G, Squillace N, De Santis G, Pedone A, Spaggiari A, et al. Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy. HIV Clin Trials 2006;7:97-106.         [ Links ]

28. Mutimura E, Crowther NJ, Cade TW, Yarasheski KE, Stewart A. Exercise training reduces central adiposity and improves metabolic indices in HAART-treated HIV-positive subjects in Rwanda: a randomized controlled trial. AIDS Res Hum Retroviruses 2008;24:15-23.         [ Links ]

29. de Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007;28:850-6.         [ Links ]

30. Brown TT, Xu X, John M, Singh J, Kingsley LA, Palella FJ, et al. Fat distribution and longitudinal anthropometric changes in HIV-infected men with and without clinical evidence of lipodystrophy and HIV-uninfected controls: a substudy of the Multicenter AIDS Cohort Study. AIDS Res Ther 2009;6:8.         [ Links ]

31. Sakkas GK, Mulligan K, Dasilva M, Doyle JW, Khatami H, Schleich T, et al. Creatine fails to augment the benefits from resistance training in patients with HIV infection: a randomized, double-blind, placebo-controlled study. PLoS One 2009;4:e4605.         [ Links ]

32. Thoni GJ, Fedou C, Brun JF, Fabre J, Renard E, Reynes J, et al. Reduction of fat accumulation and lipid disorders by individualized light aerobic training in human immunodeficiency virus infected patients with lipodystrophy and/or dyslipidemia. Diabetes Metab 2002;28:397-404.         [ Links ]

33. Florindo AA, de Oliveira Latorre Mdo R, Jaime PC, Segurado AA. Leisure time physical activity prevents accumulation of central fat in HIV/AIDS subjects on highly active antiretroviral therapy. Int J STD AIDS 2007;18:692-6.         [ Links ]

34. Earthman CP, Reid PM, Harper IT, Ravussin E, Howell WH. Body cell mass repletion and improved quality of life in HIV-infected individuals receiving oxandrolone. JPEN J Parenter Enteral Nutr 2002;26:357-65.         [ Links ]

35. Yarasheski KE, Tebas P, Stanerson B, Claxton S, Marin D, Bae K, et al. Resistance exercise training reduces hypertriglyceridemia in HIV-infected men treated with antiviral therapy. J Appl Physiol 2001;90:133-8.         [ Links ]

36. Kraemer WJ, Adams K, Cafarelli E, Dudley GA, Dooly C, Feigenbaum MS, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2002;34:364-80.         [ Links ]

37. Souza PM, Jacob-Filho W, Santarem JM, Silva AR, Li HY, Burattini MN. Progressive resistance training in elderly HIV-positive patients: does it work? Clinics (Sao Paulo) 2008;63:619-24.         [ Links ]

38. O'Brien K, Tynan AM, Nixon S, Glazier RH. Effects of progressive resistive exercise in adults living with HIV/AIDS: systematic review and meta-analysis of randomized trials. AIDS Care 2008;20:631-53.         [ Links ]

39. Cade WT, Fantry LE, Nabar SR, Keyser RE. Decreased peak arteriovenous oxygen difference during treadmill exercise testing in individuals infected with the human immunodeficiency virus. Arch Phys Med Rehabil 2003;84:1595-603.         [ Links ]

40. Hand GA, Phillips KD, Dudgeon WD, William Lyerly G, Larry Durstine J, Burgess SE. Moderate intensity exercise training reverses functional aerobic impairment in HIV-infected individuals. AIDS Care 2008;20:1066-74.         [ Links ]


Mailing address:
Universidade Federal do Triângulo Mineiro
Instituto de Ciências da Saúde - ICS
Departamento de Ciências do Esporte - DCEs
38025-440 - Uberaba, MG, Brasil

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