Effects of exercise training and metformin on body composition and cardiovascular indices in HIV-infected patients.
OBJECTIVE
To determine whether exercise training in combination with metformin improves cardiovascular risk indices and insulin in comparison to metformin alone among HIV-infected patients.


METHODS
We conducted a prospective, randomized, 3-month study of HIV patients on stable antiretroviral therapy with hyperinsulinemia and fat redistribution. Subjects received metformin alone or metformin and exercise training consisting of 1 h of aerobic and resistance training three times a week. Cardiovascular parameters, including blood pressure and endurance during sub-maximal stress testing, body composition, strength, insulin and other biochemical parameters were determined.


RESULTS
Thirty-seven patients were randomized and 25 subjects completed the study. Subjects receiving exercise training and metformin demonstrated significant decreases in median waist-to-hip ratio [-0.02 (-0.06, -0.01) (median (interquartile range) versus -0.01 (0.03, 0.02), P = 0.026], resting systolic [-12 (-20, -4) versus 0 (-11, 11), P = 0.012] and diastolic blood pressures [-10 (-14, -8) versus 0 (-7, 8), P = 0.001], increased thigh muscle cross-sectional area [3 (-3, 12) versus -7 (-11, 0), P = 0.015], and improved exercise time [3 (0, 4) versus 0 (-1, 1), P = 0.045] compared with subjects receiving metformin alone. Fasting insulin and insulin area under the curve decreased significantly more in the exercise and metformin group (P < 0.05). Lipids and resting lactate did not change significantly between treatment groups.


CONCLUSIONS
These data demonstrate that exercise training in combination with metformin significantly improves cardiovascular and biochemical parameters more than metformin alone in HIV-infected patients with fat redistribution and hyperinsulinemia. Combined treatment was safe, well tolerated and may be a useful strategy to decrease cardiovascular risk in this population.
Driscoll
Susan D
SD
Program in Nutritional Metabolism, Massachusetts General Hospital, Boston, Massachusetts 02144-2696, USA.
Meininger
Gary E
GE
Lareau
Mark T
MT
Dolan
Sara E
SE
Killilea
Kathleen M
KM
Hadigan
Colleen M
CM
Lloyd-Jones
Donald M
DM
Klibanski
Anne
A
Frontera
Walter R
WR
Grinspoon
Steven K
SK
D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003131:Combined Modality Therapy; D015444:Exercise; D005260:Female; D039682:HIV-Associated Lipodystrophy Syndrome / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D010807:Physical Endurance; D011446:Prospective Studies
D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin