Six-month study finds exercise and stretching beneficial for brain and body in people with HIV

• As HIV treatment improves, people are living longer with HIV and now face aging-related health issues
• Researchers in Missouri conducted a six-month trial of exercise and stretching among people with HIV
• Participants showed modest improvements in physical fitness, gut health and brain functioning

When used as directed, HIV treatment (antiretroviral therapy; ART) is highly effective at suppressing the production of this virus in the body. As virus levels fall, the immune system can begin to effect repairs. The benefits of ART are so profound that studies are projecting that many people with HIV who use it will have a similar life expectancy to people without HIV.

Studies have found that many people with HIV do not do sufficient physical activity; they are sedentary. This lack of exercise likely contributes to an increased risk of developing issues associated with aging, including excess weight, heart disease, type 2 diabetes and high blood pressure. Canadian and other researchers have found that over the long term these issues contribute to reduced overall health and degrade quality of life. It is also likely that such issues impact brain health.

Studies of exercise in people with HIV have either captured data only at one point in time or were a relatively short duration.

Now, a team of researchers at Washington University in St. Louis, Missouri, conducted a six-month randomized clinical trial of exercise (aerobic and resistance) versus stretching in 62 sedentary people with HIV. All participants were taking ART.

Study details

Participants underwent supervised programs of either exercise or stretching with the same personal trainer three times weekly. In addition, researchers obtained blood, urine and stool samples for analysis. The latter were used to uncover changes in the balance of gut bacteria that might occur due to exercise.

Participants also had magnetic scans of the brain (magnetic resonance imaging; MRI) and neuropsychological testing to help researchers better understand changes in the functioning of their brains.

A brief average profile of participants upon study entry was as follows:

• 77% were assigned male at birth; 23% were assigned female at birth
• age – 57 years
• most participants were overweight
• current CD4+ count – more than 600 cells/mm³
• HIV viral load – less than 50 copies/mL
• comorbidities – at least 30% had a diagnosis of high blood pressure; more than 10% had a diagnosis of diabetes; more than 30% were using lipid-lowering medicines called statins (drugs such as atorvastatin and rosuvastatin)

Results

According to the researchers, “small but significant improvements were observed” in brain function for participants in both study interventions—specifically, the time it takes to process information and respond to it, as well as attention and memory. There were no declines in other assessments of brain functioning.

There were modest improvements in body mass index, as participants in both groups lost some weight. But there were no significant changes between interventions when measures of cardio-respiratory fitness were analyzed.

Over time, bacterial species in the gut became more diverse. Changes in the balance of gut bacteria were linked to improvement of brain functioning. Again, participants receiving either intervention seemed to benefit.

Altogether, these results suggest that the study had an unexpected effect, in that both interventions appeared to show modest improvements in brain health, physical fitness and a more diverse balance of bacteria in the gut.   

Bear in mind

Conducting clinical trials is a complex undertaking and sometimes unexpected outcomes occur. One might have expected a greater improvement in the participants who were engaged in exercise. However, the research team noted that past studies have found that “low-intensity movement interventions, including stretching, can also improve physical and cognitive health. Interventions such as yoga or tai chi/qigong, which involve guided stretching movements and mindfulness, significantly improve blood pressure, health-related quality of life and cognitive performance [in both people with and without HIV].”

It is not certain how stretching and movement exercises can have such an effect, but the researchers theorize that a combination of factors, including leaving home to attend the supervised sessions, was likely associated with increased social interaction and physical activity in previously sedentary people, which were helpful. Other studies have suggested that stretching and movement exercises can have a beneficial effect on the brain and the mood, in particular.

At any rate, the overall impact of the study was positive and should add to the growing body of research that shows that people with HIV can benefit from exercise. Perhaps longer and larger studies will find further benefits. 

In the meantime, the researchers encourage clinicians to discuss the benefits of exercise and stretching with their sedentary patients.

—Sean R. Hosein

REFERENCES:

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