title: Exercise training reduces central adiposity and improves metabolic indices in HAART-treated HIV-positive subjects in Rwanda: a randomized controlled trial.
abstract: As HAART becomes more accessible in sub-Saharan Africa, metabolic syndromes, body fat redistribution (BFR), and cardiovascular disease may become more prevalent. We conducted a 6-month, randomized controlled trial to test whether cardiorespiratory exercise training (CET), improves metabolic, body composition and cardiorespiratory fitness parameters in HAART-treated HIV(+) African subjects with BFR. Six months of CET reduced waist circumference (-7.13 +/- 4.4 cm, p < 0.0001), WHR (-0.10 +/- 0.1, p < 0.0001), sum skinfold thickness (-6.15 +/- 8.2 mm, p < 0.0001) and % body fat mass (-1.5 +/- 3.3, p < 0.0001) in HIV(+)BFR(+)EXS. Hip circumference was unchanged in non-exercise control groups. CET reduced fasting total cholesterol (-0.03 +/- 1.11 mM, p < 0.05), triglycerides (-0.22 +/-0.48 mM, p < 0.05) and glucose levels (-0.21 +/- 0.71 mM, p < 0.05) (p < 0.0001). HDL-, LDL-cholesterol and HOMA values were unchanged after CET. Interestingly, HIV(+) subjects randomized to non-exercising groups experienced increases in fasting plasma glucose levels, whereas HIV seronegative controls did not (p < 0.001). Predicted VO(2) peak increased more in the HIV(+)BFR(+)EXS than in all other groups (4.7 +/- 3.9 ml/kg/min, p < 0.0001). Exercise training positively modulated body composition and metabolic profiles, and improved cardiorespiratory fitness in HAART-treated HIV(+) Africans. These beneficial adaptations imply that exercise training is a safe, inexpensive, practical, and effective treatment for evolving metabolic and cardiovascular syndromes associated with HIV and HAART exposure in resource-limited sub-Saharan countries, where treatment is improving, morbidity and mortality rates are declining, but where minimal resources are available to manage HIVand HAART-associated cardiovascular and metabolic syndromes.
authors.affiliation: Faculty of Allied Health Sciences and Programs in HIV/AIDS Clinical Research and Community Interventions, Kigali Health Institute, Kigali, Rwanda. eumuran@yahoo.co.uk
authors.forename: Eugene
authors.initials: E
authors.lastname: Mutimura
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Crowther
authors.forename: Todd W
authors.initials: TW
authors.lastname: Cade
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Yarasheski
authors.forename: Aimee
authors.initials: A
authors.lastname: Stewart
mesh_terms: D050154:Adiposity; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D050218:Body Fat Distribution; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D015444:Exercise; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000378:metabolism*; D006801:Humans; D008297:Male; D010807:Physical Endurance; D012432:Rwanda; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D049629:Waist-Hip Ratio
chemical_list: D014280:Triglycerides; D002784:Cholesterol