HIV/AIDS AND EXERCISE PRESCRIPTION
HIV/AIDS and Exercise Prescription
Medical History and diagnosis
Mr. Xy is a banker ,42 years old. He was diagnosed with hypertension about 3 years ago. He has had difficulty adjusting to antihypertensive medications, and thus his hypertension is not well controlled. He was first diagnosed with HIV infection about 2 years ago following repeated bouts of upper respiratory infection, persistent generalized lymphadenopathy, and an unexplained weight loss of 16 Ib in 3 months. Since his HIV diagnosis he has been diagnosed with clinical depression.
At the time of diagnosis his weight was 186 Ib and blood pressure was 168/92,and his laboratory work revealed the following :
207 CD4+cells.mm-3
97,960 HIV RNA. ml-1
Total cholesterol 208mg. dl-
High density lipoprotein cholesterol =38mg. dl-1
Triglycerides 146 my. dl-1
He was placed on a HAART regime that included the protease inhibitor lndinavir, plus two NRTIs, AZT and ddl. He was also encouraged to see his internist regarding his blood pressure. Six months after beginning HAART his laboratory work was as follows :
388 CD4+cells.mm-3
1008 HIV RNA. ml-1
Total cholesterol 216mg. dl-1
Triglycerides 162mg. dl-1
At 2 years after diagnosis, he continues on the same therapy. His weight has returned to an almost normal 199 In, and his most recent blood pressure is 143/87. He reports that he is feeling better because his virus is under control and he is seeing a therapist to deal with his depression. He also complains about getting a real paunch in his abdominal area. Laboratory work at his second to last clinic visit revealed the following :
342 CD4+cells.mm-3
Less than 100 HIV RNA. ml-1
Total cholesterol 236mg. dl-1
Triglycerides 676 me. dl-1
Laboratory work at his last visit revealed the following :
328 CD4+cells.mm-3
Less than 100 HIV RNA. ml
Total cholesterol 272mg. dl
Triglycerides 1263 my. dl
At the second visit, his provider talked with him about increasing his exercise to help with his paunch to reduce his cholesterol and triglyceride levels, and to reduce his blood pressure. His physician also scheduled an exercise evaluation to determine his level of fitness and to attain some feedback from a clinical exercise physiologist regarding beginning an exercise programme.
Exercise Evaluation
At the time of the exercise evaluation the patient's resting vitals were as follows :
Heart rate 72
Blood pressure 145/99
Respiratory rate 22
The exercise evaluation resulted in the following maximal values :
Heart rate 183
Blood pressure 272/97
Respiratory rate 44
Peak oxygen consumption 36 my. min. kg
His resting electrocardiogram revealed normal sinus rhythm with nonspecific ST segment changes. No ST-segment changes or arrhythmias were noted during exercise.
Before beginning his exercise programme, the patient was advised to revisit his internist and have his blood pressure and his antihypertensive medication re-evaluated. The physician added a diuretic to the patient's medical regime. When he returned to the exercise facilities the next week, his resting blood pressure was 131/89.
Development of Aerobic Exercise Prescription
The following exercise prescription was developed by the clinical exercise professional who performed the exercise evaluation.
*Exercise mode - Stationary cycling or walking /jogging on a treadmill or track for at least 20 mins. Followed by 10 mins of aerobic exercise on either a stair stepper, cross country ski machine, or the elliptical trainer.
* Exercise Frequency - Three to five days each week.
* Exercise duration -30 mins, not including warm up and cool down.
Exercise Intensity -Exercise at a work load that will produce a heart rate of between 139 and 168 (60-85% of heart rate reserve).
* Exercise progression -As cardiovascular and muscular adaptations occur in response to training, adjust the workload to maintain the heart rate within the initially prescribed range. Consider adding a few minutes per week to reach a duration goal of 45 to 60 min.
The patient attended an average of four exercise sessions per week and over the next 12 weeks increased his exercise session duration from 30 to 45 total minutes. He lost approximately 8 lb, and although he complained of still having a bit of a paunch, he was feeling considerably better about how he looked. His therapist had indicated his depression was improving. His resting blood pressure was 130/82 and resting heart rate was 65.followed up laboratory work revealed the following :
318 CD4+cells.mm-3
Less than 400 HIV RNA. ml
Total cholesterol 248mg. dl
High density lipoprotein cholesterol 39 me. dl
Triglycerides 748mg. dl
His follow up exercise evaluation revealed a maximal heart rate of 187,maximal blood pressure of 221/85 ,and a maximal respiratory rate of 44 .Peak oxygen consumption was measured at 39.6ml.min.kg.
His electrocardiogram revealed normal sinus rhythm with nonspecific ST-segment changes, and no changes were noted during exercise.
Medical History and diagnosis
Mr. Xy is a banker ,42 years old. He was diagnosed with hypertension about 3 years ago. He has had difficulty adjusting to antihypertensive medications, and thus his hypertension is not well controlled. He was first diagnosed with HIV infection about 2 years ago following repeated bouts of upper respiratory infection, persistent generalized lymphadenopathy, and an unexplained weight loss of 16 Ib in 3 months. Since his HIV diagnosis he has been diagnosed with clinical depression.
At the time of diagnosis his weight was 186 Ib and blood pressure was 168/92,and his laboratory work revealed the following :
207 CD4+cells.mm-3
97,960 HIV RNA. ml-1
Total cholesterol 208mg. dl-
High density lipoprotein cholesterol =38mg. dl-1
Triglycerides 146 my. dl-1
He was placed on a HAART regime that included the protease inhibitor lndinavir, plus two NRTIs, AZT and ddl. He was also encouraged to see his internist regarding his blood pressure. Six months after beginning HAART his laboratory work was as follows :
388 CD4+cells.mm-3
1008 HIV RNA. ml-1
Total cholesterol 216mg. dl-1
Triglycerides 162mg. dl-1
At 2 years after diagnosis, he continues on the same therapy. His weight has returned to an almost normal 199 In, and his most recent blood pressure is 143/87. He reports that he is feeling better because his virus is under control and he is seeing a therapist to deal with his depression. He also complains about getting a real paunch in his abdominal area. Laboratory work at his second to last clinic visit revealed the following :
342 CD4+cells.mm-3
Less than 100 HIV RNA. ml-1
Total cholesterol 236mg. dl-1
Triglycerides 676 me. dl-1
Laboratory work at his last visit revealed the following :
328 CD4+cells.mm-3
Less than 100 HIV RNA. ml
Total cholesterol 272mg. dl
Triglycerides 1263 my. dl
At the second visit, his provider talked with him about increasing his exercise to help with his paunch to reduce his cholesterol and triglyceride levels, and to reduce his blood pressure. His physician also scheduled an exercise evaluation to determine his level of fitness and to attain some feedback from a clinical exercise physiologist regarding beginning an exercise programme.
Exercise Evaluation
At the time of the exercise evaluation the patient's resting vitals were as follows :
Heart rate 72
Blood pressure 145/99
Respiratory rate 22
The exercise evaluation resulted in the following maximal values :
Heart rate 183
Blood pressure 272/97
Respiratory rate 44
Peak oxygen consumption 36 my. min. kg
His resting electrocardiogram revealed normal sinus rhythm with nonspecific ST segment changes. No ST-segment changes or arrhythmias were noted during exercise.
Before beginning his exercise programme, the patient was advised to revisit his internist and have his blood pressure and his antihypertensive medication re-evaluated. The physician added a diuretic to the patient's medical regime. When he returned to the exercise facilities the next week, his resting blood pressure was 131/89.
Development of Aerobic Exercise Prescription
The following exercise prescription was developed by the clinical exercise professional who performed the exercise evaluation.
*Exercise mode - Stationary cycling or walking /jogging on a treadmill or track for at least 20 mins. Followed by 10 mins of aerobic exercise on either a stair stepper, cross country ski machine, or the elliptical trainer.
* Exercise Frequency - Three to five days each week.
* Exercise duration -30 mins, not including warm up and cool down.
Exercise Intensity -Exercise at a work load that will produce a heart rate of between 139 and 168 (60-85% of heart rate reserve).
* Exercise progression -As cardiovascular and muscular adaptations occur in response to training, adjust the workload to maintain the heart rate within the initially prescribed range. Consider adding a few minutes per week to reach a duration goal of 45 to 60 min.
The patient attended an average of four exercise sessions per week and over the next 12 weeks increased his exercise session duration from 30 to 45 total minutes. He lost approximately 8 lb, and although he complained of still having a bit of a paunch, he was feeling considerably better about how he looked. His therapist had indicated his depression was improving. His resting blood pressure was 130/82 and resting heart rate was 65.followed up laboratory work revealed the following :
318 CD4+cells.mm-3
Less than 400 HIV RNA. ml
Total cholesterol 248mg. dl
High density lipoprotein cholesterol 39 me. dl
Triglycerides 748mg. dl
His follow up exercise evaluation revealed a maximal heart rate of 187,maximal blood pressure of 221/85 ,and a maximal respiratory rate of 44 .Peak oxygen consumption was measured at 39.6ml.min.kg.
His electrocardiogram revealed normal sinus rhythm with nonspecific ST-segment changes, and no changes were noted during exercise.
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