Vitamins, exercise may help metabolic disorders

Early evidence is promising

While pharmaceutical companies and investigators work for a medication solution to the lipodystrophy and other metabolic disorders that plague some HIV patients, other research is looking into nonmedical solutions, such as vitamin use and exercise.

"This is a really new area of research, and very little has been done yet," notes F. Patrick Robinson, PhD, RN, ACRN, a biobehavioral research fellow at the University of Illinois — Chicago. Robinson spoke about metabolic abnormalities and exercise at the 2003 Association of Nurses in AIDS Care conference, held Nov. 20-23, 2003, in New York City. One of the first things he recommends to HIV patients experiencing these metabolic problems is exercise, including both aerobics and weight lifting.

"There’s a decade of research that shows that aerobics and weight lifting can reverse metabolic complications," Robinson says. "Now, it’s theoretical that it will have an impact on lipodystrophy." Some small pilot studies have shown that exercise does help decrease triglycerides levels and may help with the reduction of central weight gain and improve the sensitivity to insulin, he adds.

Robinson is involved in a study addressing these issues, as are other investigators.

Also, a recent observational study found a significant association between serum triglycerides levels and exercise in HIV-positive patients, says Alina Gavrila, MD, a clinical researcher for Beth Israel Deaconess Medical Center in Boston.

"It’s a negative association, meaning the patients who exercise more had lower levels of triglycerides and less insulin resistance," she says. Researchers then studied the patients’ diets to see if there was any association between food intake and metabolic abnormalities in HIV patients, and they found there was a negative association between blood pressure and vitamin E, Gavrila says.1

"The more vitamin E, the lower the blood pressure," she explains. "This association was only for patients taking vitamin E supplements, because we also looked at vitamin E found in regular food." The study did not prove causality, only associations, Gavrila says. "We need to go and design clinical trials in order to demonstrate causality. We are planning to, and other groups are planning to also."

At the very least, exercise appears to have a positive psychological impact on HIV patients who suffer from metabolic disorders, Robinson says. "As a nursing scientist, my goal is to look at the whole person, and I think exercise has tons of benefits beyond what we are seeing," he says. "Certainly, it can help a person feel better about himself, and we all know that when you exercise, you have more energy and so forth."

The mood enhancing effects of exercise are well documented in research literature, Robinson adds.

"And to a certain extent, there is evidence that exercise does promote a more competent immune system." Also, weight lifting builds muscle mass in the arms and legs and, therefore, improves the body’s appearance, which will in term provide a psychological boost to HIV patients, he says.

Even if clinical tests show no significant impact on lipodystrophy and metabolic disorders associated with HIV disease, it still would be a good idea for clinicians to recommend that patients engage in both aerobic and weight lifting exercise when it’s physically possible, Robinson notes.

"Basically, there are two mechanisms at work: With endurance exercise or aerobic exercise, you are increasing the oxidated rate, including the metabolism — the oxidating profile of cells," he explains. "Weight lifting, on the other hand, probably has the most significant effect on the insulin resistance because when you increase muscle mass, you increase the amount of muscle that is available to transport glucose into."

Some studies have shown that people with type 2 diabetes and who were significantly insulin-resistant were able to lower their blood sugar and insulin levels through weight lifting alone, Robinson says.

The study in which Robinson is involved will look at the combination of aerobic and weight lifting exercises. For clinicians who recommend exercise to HIV patients, one achievable goal might be to have them engage in an aerobic exercise for 20 to 30 minutes, three or four days a week, and perform muscle group repetitions in sets of 10, twice a week, he says. "Everyone should be exercising, and people with HIV are no exception."

Reference

1. Gavrila A, Tsiodras S, Doweiko J, et al. Exercise and vitamin E intake are independently associated with metabolic abnormalities in human immunodeficiency virus-positive subjects: A cross-sectional study. Clin Infect Dis 2003; 36(12):1,593-1,601.