HARVARD GAZETTE ARCHIVES

Research by Sara E. Dolan (center) and Steven K. Grinspoon (right) shows that home-based exercise programs vastly improve the lives of HIV infected women by lessening the risk of heart disease, increasing strength and endurance, and improving appearance and well-being. Morgan Cole (left) is a physical therapist who worked with Dolan and Grinspoon on the study. (Staff photo Rose Lincoln/Harvard News Office)

Betsy Lincoln felt pregnant all the time. Loss of muscle tone in her face, arms, and legs made her look so bad, she didn't want to leave her apartment. She had little strength or endurance. Lifting one of her children or climbing a flight of stairs exhausted her.

Lincoln (not her real name) is representative of many of the estimated 250,000 women in the United States infected with HIV (human immunodeficiency virus), or the deadly AIDS it causes. And that number is rising. In this country, most of the women are minorities and poor, with limited access to medical care. Recent research also suggests that they may be at increased risk for heart disease. Even the drugs they take to keep their infection under control can cause unwanted changes in body fat and loss of energy.

"Their waistlines are, on average, 20-25 percent above the normal range," says Steven Grinspoon, associate professor of medicine at Harvard Medical School and Massachusetts General Hospital. "They can be socially stigmatized by their disease, and the side effects may make them less likely to take their prescribed HIV medications."

"They wear their disease," adds nurse practitioner and Ph.D. candidate Sara Dolan. "Because of changes in their body shape and image, they often avoid public places."

With little time or money, going to the gym is out of the question, so Dolan, Grinspoon, and their Harvard-affiliated colleagues decided to bring the gym to them.

"These women face barriers to getting help they need and adhering to an exercise routine, including lack of child care and/or transportation," Grinspoon points out. "The use of a home-based exercise program was selected to help break down these barriers and to improve chances that the exercises would be done as instructed."

Physical therapists visited the women three times a week for 16 weeks. "This is the first time that the effects of supervised home exercise on HIV-infected women have been studied," Dolan points out. "We found that such a program significantly increases their strength. We also saw improvements in heart/lung fitness, endurance, and body shape, particularly waist size."

Increased well-being

Forty women between the ages of 18 and 60 participated in the study. Twenty of them were assigned to a home exercise program, 20 who were not, served as a comparison group against which to measure changes. Each of the exercisers received a stationary bicycle, weights, a workout bench, and a heart monitor, about $400 worth of equipment paid for by grants from the National Institutes of Health.

Each exercise session lasted two hours, including a five-minute warm-up. Aerobic bike pedaling lasted 20 minutes during the first two weeks, and then was increased to 30 minutes. Pedaling speed also increased after the first two weeks. Each woman wore a heart monitor.

A second element involved weight training, designed to build muscle strength from the shoulders to the ankles. Participants began with three sets of 10 repetitions each for each of six muscle groups. This was gradually increased to four sets of eight repetitions on each day of exercise. Every home session was overseen by a physical therapist. The overall health of each individual was tracked by physicians from Harvard Medical School, Massachusetts General Hospital, and Spaulding Rehabilitation Hospital, all in Boston.

At the end of the 16 weeks of training, 89 percent of those who exercised said that they felt better physically and mentally. They reported increased energy, strength, and endurance. Several admitted they had not done anything healthy in a long time, and didn't even believe themselves capable of completing an exercise program. However, in the end, "they were able to reconnect with their own health," Dolan remarks.

Full details of the results appear in the June 12 issue of the Archives of Internal Medicine.

Decreasing heart risks

Women who completed the exercise regimen felt delighted at being able to lift their children again, to climb stairs, and get outside more. Some of them took favorite clothing out of their closets and wore it again. Others started seeing friends again.

Their waist measurements declined dramatically compared with those who did not exercise. But that did not give them model bodies. Total fat remained the same for both groups, as did calorie intakes. The big difference occurred in lessening the abnormal distribution of fat brought on by their medications.

They also benefited from greater heart and lung capacity, as measured by increased oxygen intakes. They walked further and more comfortably during six-minute tests. "Such conditioning should lower their risk of heart disease and death from cardiac causes," Grinspoon believes.

"We were able to show that patients, who are representative of HIV-infected women in the U.S., can achieve significant improvement in heart and lung fitness," he says. "Such improvement can be achieved with relatively limited resources and equipment. The program is considered cost-effective and associated with little risk compared with medications, which do not improve fitness."

What's next? The researchers want to exercise larger groups of people. And they want to add diet changes. Both groups in their study ate much the same amount of fats, carbohydrates, and proteins. Grinspoon notes that, "We have applications in to conduct studies on much larger groups of both women and men and to look at the combined results of exercise and diet changes."