Aerobic Exercise Dysfunction in Human Immunodeficiency Virus: A Potential Link to Physical Disability

Approximately 282,000 adults, adolescents, and children are currently living with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) in the United States as of the year 2002.1 With the advent of highly active antiretroviral therapy (HAART), the life span of these individuals has dramatically increased,2 and HIV infection is now considered a chronic illness with accompanying episodes of exacerbations and remissions of symptoms.3 Numerous conditions such as lipodystrophy syndrome4–6 and skeletal myopathy7–9 have been associated with HIV and its medical management, many of which may result in physical disability and diminished quality of life. Due to the chronic nature of this condition, physical therapists will continue to manage many of these conditions in increased numbers of people who are living with HIV. Although guidelines for physical therapy evaluation and management of this potentially disabling condition have not been established, it appears that aerobic exercise training may have a beneficial effect on the cardiorespiratory health of people who are living with HIV. Thus, an understanding of the factors that limit the oxidative metabolic response to physical activity is paramount in developing effective exercise training programs for people with this virus. The focus of this Update is to examine the biological factors that might limit the oxidative metabolic response to physical activity in people with HIV.HIV-related disability has been associated with fatigue and decreased physical functioning10–13 as well as other factors that may limit people's ability to carry out necessary life activities.12,14,15 Fatigue in adults with HIV has been identified using patient self-reports of physical and functional limitations while performing activities of daily living such as housework, climbing stairs, and walking15 and activities required for employment.10,11 Asymptomatic HIV …