Presentation on theme: "Physical Activity and HIV-AIDS: The Experience of the Project Vida+"— Presentation transcript:
1 Physical Activity and HIV-AIDS: The Experience of the Project Vida+ PAULO FARINATTIUniversity of Rio de Janeiro State, BrasilPhysical Activity and Sport forHealth and Development in Africa25-29 March, Maputo, Mozambique
5 Laboratory of Physical Activity and Health Promotion
6 Methodological aspects of exercise prescription RESEARCH LINESMethodological aspects of exercise prescriptionPhysical activity for special populations (elderly, HIV-AIDS, obese, cardiovascular disease, athletes)Acute and chronic cardio-respiratory responses to exercise
7 Structure of Presentation Describe some effects of HIV-infection and HAART treatment upon risk factors for chronic diseases;Discuss the effects of regular exercise on the immune function in HIV-infected patients;Present results from the “Project Vida+”, developed at the University of Rio de Janeiro State
8 Mutimura E et al. J Cardiometab Syndr. 2008;3:106–110.
10 Okie S. N Eng J Med 2006(11 May); 354(19):1977-1981
11 HIV PATIENTS UNDER HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) AND RISK OF CHRONIC DISEASES
12 Somarriba G. HIV/AIDS - Research and Palliative Care 2010:2 191–201
13 The study investigated the arterial stiffness and skin microvascular function of HIV-infected patients through photoplethysmography and laser Doppler perfusion monitoring (LDPM).It has been hypothesized that vascular reactivity would be reduced in HIV patients in comparison with healthy subjects.Borges J et al. HIV Clin Trials 2011;12(4):215–221
14 Lower endothelial-dependent and independent vasodilation in HIV patients HIV-infection independent factor even considering age effect on vasodilationBorges J et al. HIV Clin Trials 2011;12(4):215–221
15 The macrovascular reactivity (measured by SIDVP) indicated that HIV-infected patients had an increased arterial stiffness compared to younger HIV-negative.Borges J et al. HIV Clin Trials 2011;12(4):215–221
16 The study compared the autonomic control of the heart by means of HRV in HIV-infected patients under HAART and healthy subjects during and following a bout of continuous physical exercise.It was hypothesized that the HIV patients would exhibit altered autonomic balance, with higher sympathetic and lower parasympathetic activity compared to healthy subjects.Borges J et al. Int J Sports Med 2011; 32: 1–5
17 Time domain analysis at rest showed a decrease in SDNN, pNN50 and rMSSD in the HIV group. Int J Sports Med 2011; 32: 1–5
18 Frequency domain analysis at rest revealed a decrease in the combined parasympathetic and sympathetic modulation of the heart, since LF, HF and total power were lower in the HIV group.HIV patients showed no impairment in the expected vagal withdrawal and sympathetic activation during the continuous exercise; however it happened in a narrow range of modulation and reduced variability.Int J Sports Med 2011; 32: 1–5
19 TAKE HOME MESSAGEHIV-infected patients under HAART may have increased risk to develop chronic diseases.Regular exercise may counteract risk factors for several chronic diseases, related to lipodysthrophia, wasting syndrome, and autonomic imbalance.Exercise-related outcomes may have important clinical implications in HIV-patients under HAART.
20 Characteristics of the Disease Caused by the human immunodeficiency virus: HIV-1 and HIV-2Cells of the immune system:Helper T cells (CD4+)Cytotoxic and Supressor T cells (CD8+)Natural Killer CellsMonocytes
24 TAKE HOME MESSAGEImmune function in humans (innate and acquired systems) is affected by genetic and environmental factors;Environmental factors include age, exercise, gender, nutritional status, previous exposure to pathogens and stress.
25 Exercise x Immune System “Open window theory”Immune alterations3.5PhysiologicalStressProlonged (2-3h) or intense exerciseModerate exercise (30-45 min)2.51.5ImmuneStimulation0.5-0.5open window-1.5ImmuneSupresstion-2.50.5188.8.131.523.544.555.566.577.588.5910Beginningof exerciseHoursNieman, DC and Bishop, NC. J Sports Sci 2006;24(7):
27 Robson et al. Int J Sports Med 1999; 20:128-135 Effect of exercise intensity and duration on the circulating neutrophil and lymphocyte counts. High-intensity exercise (37 ± 19 minutes at 80% VO2max) initially increased neutrophil and lymphocyte counts, followed by lymphocytopenia and neutrophilia. During early recovery from thisbout there is a rapid remargination of leukocytes due to the falling cardiac output, shear stress and catecholamines, which is followed later in recovery by influx of neutrophils from the bone marrow and efflux of lymphocytes from the blood circulation under the influence of cortisol. In contrast, prolonged exercise (164 ± 23 minutes at 55% VO2max) produced a very large increase in neutrophils as cortisol has been elevated sufficiently long to allow new neutrophils into the circulation from the bone marrow. Mean ± SEM, n = 18. * Indicates significant difference from pre-exercise (P<0.05); # indicates significant difference compared with 80% VO2max trial.Effect of exercise intensity and duration on the circulating leukocytes (neutrophil and lymphocyte counts). Mean ± SEM, n = 18. * Significant difference from pre-exercise (P<0.05); # Significant difference compared with 80% VO2max trial.Robson et al. Int J Sports Med 1999; 20:
28 Changes in natural killer cell activity (expressed as lytic units per litre of blood) after 45 minutes of running at 80% VO2max. * Siginificant difference (P<0.05) from pre-exercise.Nieman DC et al. Med Sci Sports Exerc 1993; 25:
30 Absolute (A) and adjusted per T cell (B) changes in mitogen-stimulated lymphocyte proliferative responses to a 45-minute treadmill run at 80% VO2max (high) and 50% VO2max (moderate). * Indicates a significant difference from pre-exercise values, P<0.05,**P<0.01.Nieman DC et al. Int J Sports Med 1994; 15:
31 Changes in the absolute (A) and relative (B) circulating concentrations of CD4+ and CD8+ T cells in response to a 45-minute treadmill run at 80% VO2maxNieman DC et al. Int J Sports Med 1994; 15:
33 Number of days with symptoms of URTI in a group of mildly obese, young women randomly assigned to either 15 wks of moderate exercise training (walking training for 45 min, 5 days/wk at 60% HRR) or no exercise.From Nieman DC et al. Int J Sports Med 1990;11:
34 The J-shaped model of the relationship between risk of upper respiratory tract infection (URTI) and exercise volume.From Nieman DC. Int J Sports Med 1994;15:S131-S141
35 Effects of an acute increase in the training load on some immune variables in elite athletes. Robson PJ et al. J Physiol 1999; 515:84-85 and (B) Verde T et al. Br J Sports Med 1992;26:
36 SUMMARIZING…Acute bouts of exercise may cause a temporary depression in immune function that lasts ~3–24 hours after exercise, depending on the intensity and duration of the exercise bout (Gleeson & Bishop 1999).Periods of intensified training lasting 7 days or more result in chronically depressed immune function, and previous surveys indicate that sore throats and flu-like symptoms are more common in endurance athletes than in the general population (Bishop, 2006).
37 TAKE HOME MESSAGEThe participation in regular moderate exercise is associated with a lower risk of infections compared with that of a sedentary individual.Performing acute bouts of prolonged, intense exercise or heavy volumes of training is associated with an above-average risk of infections.In brief, when exercise is too intense and/or repeated frequently there may not be sufficient time for the immune system to recover fully.
38 “Open Window”InfectionModerateExerciseIntense or Prolonged
40 Balance Immunity x Exercise IntensityDurationNutritional StatusImunidadeExercício
41 What is the Vida+Intervention program including aerobic, resistive, and flexibility exercises for HIV-infected patients, with the aim of improving markers of immunological function, physical fitness and well-being.
42 The Project Vida+ GENERAL PURPOSES - To provide free access to HIV-patients to a supervised program of physical activities;To contribute with the formation of human resources to work with exercise prescription and evaluation of this specific population.
43 The project currently serves 59 subjects with a mean age of 45 years Target PopulationThe project currently serves 59 subjects with a mean age of 45 years
44 Training Program 3 times/ week, 90 min; Moderate intensity – imunodepression;Confort – avoid lower adherence;Medical, nutritional, and psychological assistance.
45 Training ProtocolAerobic – 30 min, PWC 150 or 10% lower CPX Anaerobic ThresholdTreadmill or cycloergometerStrength– 3 sets of 80% of 12 RM, 8 to 10 exercisesUpper and Lower BodyFlexibility – Static method, 1 set 30 s, 4 to 6 exercises
46 Observed Variables Absolute and relative (%) CD4 count Anthropometry (perimeters, skinflids) and body composition (DEXA)Muscle function (Isoinertial – RM and isokinetic – Biodex evaluations)FlexibilityCardiorespiratory fitness (VO2 peak and HR/W and VO2/HR relationships during submaximal effort)Body image and perceived well-being
54 HIV PATIENTS PRE-HAART Infections and high-grade inflammation Diarrhoea and intermittent feverMalabsorptionCatabolismWasting SyndromePOST-HAARTLow-grade inflammationNeuromuscular inflammationMitochondrial dysfunction Hormonal changesLipodistrophyCACHEXIASARCOPENIAMesmo com o uso da HAART no HIV, o risco de mortalidade entre esses pacientes continua elevado por fatores distintos daqueles apresentados na era pre HAART. Apesar de não ser mais tão evidente a mortalidade pela sindrome de wasting e a caquexia (observada em câncer e AIDS), o uso prolongado desses medicamentos causa nesses indivíduos o processo de envelhecimento acelerado no organismo em geral, e uma das condições que caracteriza bem esse processo é o surgimento precoce da sarcopenia (def).Nesses indivíduos, diferentemente dos idosos, o risco para a mortalidade pela sarcopenia é maior pois que apresentam per se , mais susceptibilidade à fraqueza, atrofia muscular, incapacidade física e acometimento por infecções respiratórias quando hospilatizados (acamados).Felizmente, o exercício é uma das estratégias potenciais para atenuar o processo de sarcopenia nesses individuos, reduzindo o risco de mortalidade, consequentemente. O exercício é capaz de aumentar a massa muscular e a força.RISK OF MORTALITY
55 Relationship between muscle mass indexes and muscle functionin HIV-infected patients aged years (n=48)r=0,835r=0,637p<0,0001p=0,0006Unpublished data
66 Rev Bras Fisioter 2010;14(5):390-5. * Significant difference vs. baseline (p<0.05). Whiskers represent CI 95%.
67 Body ImageConcerns the way which the individual realizes and appreciates his/her body. An analysis of body image is important in situations where there are significant changes in the composition and distribution of lean and fat mass, in order to assess how this affects the quality of life perception.KAKESHITA, ALMEIDA, 2006.
68 The physical deterioration that occurs in AIDS and the fear itself that such deterioration can happen, may cause various psychological problems, mainly related to body image perception.As a result, individuals frequently present a distorted perception of their own body.SONSTROEM apud FECHIO, CORONA, BRANDÃO, 2000.
69 Body ImageObjective measuresSubjective measures
70 Objective MeasuresThese measures pertain to the assessment of distortions in the appreciation of body posture or body image, in other words, with the precision of body size estimates.THOMPSON apud FERREIRA, LEITE, 2002
71 Silhouette Matching Task (SMT) Marsh HW, Roche LA. Res Quar Exerc Sport 1996;67:13-23
72 Kakeshita IS, Almeida SS. Rev Saúde Pública 2006;40(3):497-504 Gardner RM, Friedman BN, Jackson NA. Percept Mot Skills 1998;86(2):
73 Subjective MeasuresThese measures pertain to the evaluation of affective, attitudinal, and cognitive aspects of the body image, usually by means of questionnaires.Some scales evaluate the global satisfaction level with the weight, body or appearance, while others measure the satisfaction level with specific parts of the body.
74 Subjects 29 HIV-positive patients (44±2 anos) 7 lipodystrophic and physically active;8 no- lipodystrophic and sedentary;7 no-lipodystrophic and physically active;7 no-lipodystrophic and sedentary.
75 Objective analysis - body image Silhouette Matching Task (SMT), including nine scales of silhouettes/pictures, corresponding to BMI ranging between 17,5 and 37,5 kg/m2The degree of insatisfaction with the body was assessed by the difference between the actual silhouette (SA) and the ideal silhouette (SI), as pointed individually.
76 Subjective analysis - body image Bruchon-Schweitzer’sBody Image Questionnaire (QIC)1) Factor I (‘favorable vs. unfavorable body perception’);2) Factor II (‘exposed vs. hidden body’);3) Factor III (‘active vs. inactive body’);4) Factor IV (‘calm vs. nervous body’);5) ‘social acceptability of the body’ - addition of 'socially desirable responses’ (positive responses)
77 Arch Exerc Health Disease (in press) *diferença significativa em relação demais grupos (p<0,05). diferença significativa em relação as demais variáveis no mesmo grupo (p<0,05). NS – diferenças não significativas (p>0,05).
78 * Significant different vs. other groups (p<0,05). * Significant different vs. other groups (p<0,05).Arch Exerc Health Disease (in press)
79 Arch Exerc Health Disease (in press) * diferença significativa do valor mínimo em relação aos demais grupos (p<0,05).
80 Resistance and aerobic exercise are safe and may lead to clinically important improvements in outcomes of weight and body composition for medically stable adults living with HIV/AIDS.Individual study results suggest potential benefits to cardiopulmonary, strength and psychological outcomes.Further research is needed to develop recommendations pertaining to the parameters of frequency, intensity, time and type of exercise interventions that might be most beneficial to people living with HIV
81 Conclusion HIV-infected patients Moderate intensity/volume exercise ++Moderate intensity/volume exerciseImprovement of fitness, functional, and psychological markers, without compromising the immune function