Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Veterans Affairs Maryland Health Care System, Baltimore, MD, United States of America.
Department of Medicine, Division Gerontology and Geriatric Medicine, The University of Maryland School of Medicine, Baltimore, MD, United States of America.
PLoS One. 2018 Jun 12;13(6):e0198855. doi: 10.1371/journal.pone.0198855. eCollection 2018.
HIV-infected adults have increased risk for age-related diseases and low cardiorespiratory fitness that can be prevented and improved with exercise. Yet, exercise strategies have not been well studied in older adults with HIV and may require substantial adaptation to this special population.
To determine the safety and efficacy of aerobic exercise in older HIV-infected men in a randomized trial comparing different levels of exercise intensity.
We conducted a pilot exercise trial in 22 HIV-infected men ≥50 years of age receiving antiretroviral therapy who were randomized 1:1 to moderate-intensity aerobic exercise (Mod-AEX) or high-intensity aerobic exercise (High-AEX) that was performed three times weekly for 16 weeks in a supervised setting. Primary outcome was cardiorespiratory fitness (VO2peak) measured by treadmill testing. Secondary outcomes were exercise endurance, six-minute walk distance (6-MWD), body composition measured by Dual-energy X-ray absorptiometry (DXA), and fasting plasma levels of lipids and glucose.
VO2peak increased in the High-AEX group (3.6 ±1.2 mL/kg/min, p = 0.02) but not in the Mod-AEX group (0.4 ±1.4 mL/kg/min, p = 0.7) with a significant between group difference (p<0.01). Exercise endurance increased in both the High-AEX group (27 ±11%, p = 0.02) and the Mod-AEX group (11 ±4%, p = 0.04). The 6-MWD increased in both the High-AEX (62 ±18m, p = 0.01) and the Mod-AEX group (54 ±14m, p = 0.01). Changes in VO2peak and 6-MWD were clinically relevant. There were no serious exercise-related adverse events. Dropouts were similar between group (27% overall) and were related to joint pain.
This pilot exercise trial demonstrates that moderate to high-intensity aerobic exercise in older HIV-infected men increases endurance and ambulatory function. However, increased cardiorespiratory fitness was observed only with high-intensity aerobic exercise despite substantial baseline impairment. Future research is needed to determine exercise strategies in older HIV-infected adults that address advanced aging and comorbidity yet are durable and feasible.
HIV 感染者发生与年龄相关疾病的风险增加，且心肺适能较低，这些可以通过运动得到预防和改善。然而，针对老年 HIV 感染者的运动策略研究甚少，且可能需要针对这一特殊人群进行大量调整。
通过比较不同强度的运动，在一项随机试验中确定有氧运动对老年 HIV 感染者的安全性和有效性。
我们对 22 名年龄在 50 岁及以上、正在接受抗逆转录病毒治疗且 HIV 感染的男性进行了一项试点运动试验，这些参与者按照 1:1 的比例随机分为中等强度有氧运动（Mod-AEX）组或高强度有氧运动（High-AEX）组，每周运动 3 次，持续 16 周，在监督环境下进行。主要结局指标是通过跑步机测试测量的心肺适能（VO2peak）。次要结局指标包括运动耐力、6 分钟步行距离（6-MWD）、双能 X 线吸收法（DXA）测量的身体成分以及空腹血浆脂质和葡萄糖水平。
High-AEX 组的 VO2peak 增加（3.6±1.2mL/kg/min，p=0.02），而 Mod-AEX 组没有增加（0.4±1.4mL/kg/min，p=0.7），两组之间存在显著差异（p<0.01）。High-AEX 组（27±11%，p=0.02）和 Mod-AEX 组（11±4%，p=0.04）的运动耐力均增加。High-AEX 组（62±18m，p=0.01）和 Mod-AEX 组（54±14m，p=0.01）的 6-MWD 均增加。VO2peak 和 6-MWD 的变化具有临床意义。没有发生严重的与运动相关的不良事件。两组的脱落率相似（总体为 27%），且与关节疼痛有关。
这项试点运动试验表明，在老年 HIV 感染者中进行中等至高强度的有氧运动可提高耐力和活动能力。然而，尽管基线心肺适能严重受损，但仅高强度有氧运动可增加心肺适能。需要进一步的研究来确定针对老年 HIV 感染者的运动策略，这些策略既要应对衰老和合并症，又要具有可持续性和可行性。
