Marathon training is safe for people with HIV

Marathon run training is safe for people with HIV, investigators from Germany report in BMC Infectious Diseases. Training also had a number of beneficial effects, including a significant increase in CD4 cell count and improvements in cholesterol and blood pressure, though the investigators note these were already normal at baseline.

«The main finding of our study was that regular aerobic activity resulting in performing a marathon was safe for people living with HIV. We could not show any potential harm, or increase in infections such as URTIs (upper respiratory tract infections),» write the authors. «Withdrawals from the study did not occur due to major health issues. There were no unfavourable effects on immunology and virological parameters.»

Little is known about the effects of sporting activities on the health and wellbeing of people with HIV. Studies involving people in the general population have shown that regular endurance training can be associated with short-term minor immune suppression and increased frequency of colds and coughs but also long-term boosts in immune function.

To establish a clearer understanding of the impact of a programme of regular moderate aerobic endurance training on the health of patients with HIV, investigators in Bonn designed a prospective study monitoring patients training for a marathon.

Sports scientists designed individualised training programmes lasting twelve months. Participants trained three to four times a weeks. A total of 21 patients were recruited. A total of eight patients (38%) dropped out but for reasons unrelated to the safety of exercise.

Analysis was restricted to the 13 individuals who completed the training programme and marathon (VIII Gay Games, Cologne, 2010). Median age was 42 years (27-50 years), twelve of the participants were male and one was female. Eleven patients were taking antiretroviral therapy, nine of whom had an undetectable viral load. Median CD4 cell count at baseline was 640 cells/mm3. Blood pressure, lipid profile, and liver and kidney function were all normal. Three patients had a history of AIDS-defining illnesses, and there were five significant current co-morbidities, including two cases of chronic hepatitis, two cases of depression and one case of dermal psoriasis. Self-reported quality of life was good.

At the end of the training programme, median CD4 cell count had increased significantly to 745 cells/mm3 (p = 0.001). This was accompanied by a significant fall in CD4-T cell apoptosis (53% at baseline to 32% at end of the study, p < 0.01). Training had no effect on viral load. Significant improvements were observed in total cholesterol (median 185 mg/dl vs. 167 mg/dl; 4.78 vs 4.31 mmol/L); p = 0.02) and systolic blood pressure (median 125mmHg vs. 120mmHg; p = 0.001). Liver and kidney function remained normal and there was no chance in reported quality of life. There was no spike in the frequency of upper respiratory tract infections during the training period, including during the winter months.

The authors recognise that their study has several limitations: lack of complete cardiovascular parameters; lack of data on individual training intensities; small sample size; no control group; and high drop out rate.

Moreover, they were unable to determine whether beneficial effects in terms of immune function were directly due to training or ART.

«HIV-infected persons can perform moderate endurance training,» conclude the authors.