The effect of strength and endurance training on insulin sensitivity and fat distribution in human immunodeficiency virus-infected patients with lipodystrophy.
BACKGROUND
Fat redistribution, insulin resistance, and low-grade inflammation characterize HIV-infected patients with lipodystrophy. Currently, no effective therapies exist for the combined treatment of fat redistribution and insulin resistance.


OBJECTIVE
Our objective was to evaluate the effects of strength and endurance training on insulin sensitivity and fat distribution in HIV-infected patients with lipodystrophy.


METHODS
Twenty sedentary HIV-infected men with lipodystrophy were randomly assigned to supervised strength or endurance training three times a week for 16 wk. The primary endpoints were improved peripheral insulin sensitivity (euglycemic-hyperinsulinemic clamp combined with isotope-tracer infusion) and body fat composition (dual-energy x-ray absorptiometry scan). Secondary endpoints included fasting lipids and inflammatory markers.


RESULTS
Insulin-mediated glucose uptake increased with both endurance training (55.7 +/- 11 to 63.0 +/- 11 micromol glucose/kg lean mass.min, P = 0.02) and strength training (49.0 +/- 12 to 57.8 +/- 18 micromol glucose/kg lean mass.min, P = 0.005), irrespective of training modality (P = 0.24). Only strength training increased total lean mass 2.1 kg [95% confidence interval (CI), 0.8-3.3], decreased total fat 3.3 kg (95% CI, -4.6 to -2.0), trunk fat 2.5 kg (95% CI, -3.5 to -1.5), and limb fat 0.75 kg (95% CI, -1.1 to -0.4). Strength training significantly decreased total and limb fat mass to a larger extent than endurance training (P < 0.05). Endurance training reduced total cholesterol, low-density lipoprotein cholesterol, free fatty acids, high-sensitivity C-reactive protein, IL-6, IL-18, and TNF-alpha and increased high-density lipoprotein cholesterol, whereas strength training decreased triglycerides, free fatty acids, and IL-18 and increased high-density lipoprotein cholesterol (P < 0.05 for all measurements).


CONCLUSIONS
This study demonstrates that both strength and endurance training improve peripheral insulin sensitivity, whereas only strength training reduces total body fat in HIV-infected patients with lipodystrophy.
Lindegaard
B
B
Department of Infectious Diseases, Copenhagen Muscle Research Centre, DK-2100 Copenhagen, Denmark. blm@rh.dk
Hansen
T
T
Hvid
T
T
van Hall
G
G
Plomgaard
P
P
Ditlevsen
S
S
Gerstoft
J
J
Pedersen
B K
BK
D000328:Adult; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D050218:Body Fat Distribution; D002149:Energy Intake / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D010807:Physical Endurance / Q000502:physiology*; D010809:Physical Fitness / Q000502:physiology
D015415:Biomarkers; D018836:Inflammation Mediators; D008055:Lipids