A PILOT STUDY OF BRISK WALKING IN SEDENTARY CART-TREATED PATIENTS

Antiretroviral treatments (ART) have dramatically reduced HIV infection mortality, transforming HIV infection into a chronic disease requiring life-long treatment. Sadly, treatment is associated with a number of metabolic, cardiovascular, osteoarticular, renal and central nervous system toxicities. Moreover, Chronic HIV infection is associated with low-level inflammation and increased risk of chronic diseases and mortality. As a result, long-term treated patients may present with increased risk of cardiovascular and cerebrovascular disease, lypodystrophy, early diabetes, kidney failure, osteoporosis and cognitive impairment. These toxicities imitate age-associated comorbidities. Indeed, long-term HIV infection and ART use appear to predispose patients to premature aging and accelerate the risk of these comorbidities. In the general population the risk of cardiovascular and metabolic conditions can be reduced by lifestyle interventions, such as dietary adjustments, exercise, smoking cessation, and by pharmacological approaches. Similar general and pharmacological measures are also indicated in HIV persons and anti-hypertensive and lipid-lowering drugs are frequently used in association with ART. Among lifestyle measures, exercise, involving both aerobic and strength training, is associated with reduction of cardiovascular events in the normal population. In older persons regular physical activity has been shown to lower overall mortality, risk of coronary heart disease, colon cancer, diabetes, obesity and of developing high blood pressure; to improve mood and relief of symptoms of depression, quality of life and functioning. In addition to prevent these morbidities, physical activity is also effective in treating cardiovascular disease, high blood pressure, high cholesterol, chronic lung disease, diabetes, obesity, and osteoarthritis. There is evidence that exercise is also useful in people with HIV infection. Although studies have differed for design (controlled vs. single arm), sample size (up to 20 subjects per group), type of activity (aerobic vs. strength vs. both), training frequency (2-3 session a week), duration (weeks-few months), most have shown, with aerobic exercise, a reduction of abdominal and total body fat, total cholesterol, triglycerides, BMI, hip circumference, and increases in HDL. In contrast, strength exercise, either alone, or in association with aerobic exercise, seems to be associated with increased fat free mass and of muscle strength. The general objective was to study the effects at 12 weeks of supervised moderate aerobic exercise (walking) with/without strength training in patients with HIV infection on chronic ART. Ultimately, we aim to validate an exercise approach to propose for prevention and treatment of ART- For this reason a pilot study enrolling cART-treated, sedentary persons with metabolic complications in a 12-week protocol, consisting of three sessions per week of 60 min brisk walking with (strength walk group) or without (walk group) 30 min circuit-training, was proposes. Assessments at baseline and week 12 (W12) included body morphometrics and total body dual-energy X-ray absorptiometry; lipid and glucose blood profile; plasma level of high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), D-dimer, interleukin-18 (IL-18), soluble CD14 and myostatin, and CD38 and HLA-DR expression on CD4+ and CD8+ T-cells were done. Forty-nine patients were enrolled and 35 (71%) completed the program: 21 in the walk and 14 in the strength-walk group. Median adherence to the training sessions was 67%. At W12, significant improvements were observed of body mass index, waist and hip circumference, and total and LDL cholesterol, with no change differences between training groups. Overall, significant reductions were observed in hsCRP, IL-6, D-dimer, IL-18 and myostatin level, and of CD8+/CD38+/HLA-DR+ cell frequencies. HsCRP and CD8+/CD38+/HLA-DR+ frequency decreased significantly in both training groups; IL-6 and D-dimer in the walk group only and myostatin in the strength-walk group only. Brisk walking, with or without strength exercise, can improve lipid profile and inflammatory markers in chronic HIV infection.