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LETTERS: Joanne L Atkins, Simon Eccles, and Peter E M Butler Antiretroviral therapy: new solutions bring new problems BMJ 2003; 326: 337 [Full text]

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Lipodystrophy: exercise as a therapeutic intervention

Rita Doerner   (14 February 2003)

Lipodystrophy: exercise as a therapeutic intervention 14 February 2003
Rita Doerner, Research Assistant York St. John College, YO31 7EX Send response to journal: Re: Lipodystrophy: exercise as a therapeutic intervention	Antiretroviral drugs used to manage HIV have been associated with a range of unwanted metabolic and morphological side effects1. In particular, lipodystrophy, the disposition of intra-abdominal and dorso- cervical (“buffalo hump”) fat and the atrophy of peripheral fat, can be psychologically distressing to patients. Research has shown that people suffering from lipodystrophy feel twice as likely to be recognised as HIV- positive as people without lipodystrophy2. People living with HIV but without lipodystrophy indicate that lipodystrophy would erode their quality of life by 20%2. Subjects are willing to take a mean value of 13% additional risk of death in order to avoid the disfigurement caused by lipodystrophy2. In a recent letter to the BMJ, Atkins, Eccles and Butler3 make a cautious argument for the use of plastic surgery to correct some morphological symptoms in some cases. I am writing to highlight a growing body of research that suggests that exercise can be an effective complementary therapeutic measure. Although the effects are not immediate, a well-designed exercise intervention, conducted in a safe and supervised environment can bring about considerable benefits to the patient. Progressive resistance exercise has shown a significant decline in abdominal obesity4, 5 and an increase in lean body mass6. Resistance exercise can reduce hypertriglyceridemia in HIV-infected men suffering from lipodystrophy7. Exercise can also improve functional capacity and also facilitate social interaction, which has a major impact on patients’ quality of life8. 1 Oette M, Juretzko P, Kroidl A, Sagir A, Wettstein M, Siegrist J, Haussinger D. Lipodystrophy and self-assessment of well-being and physical appearance in HIV-positive patients. AIDS Patient Care and STD 2002; 12 (9): 413-417. 2 Lenert LA, Feddersen M, Sturley A & Lee D. Adverse effects of medications and trade-offs between length of life and quality of life in human immunodeficiency virus infection. American Journal of Medicine 2002; 113: 229-232. 3 Atkins JL, Eccles S, Butler PEM. Antiretroviral therapy: new solutions bring new problems. BMJ 2003; 326: 337. (8 January). 4 Roubenoff R, Weiss L, McDermott A, Heflin T, Cloutier GJ, Wood M & Gorbach S. A pilot study of exercise training to reduce trunk fat in adults with HIV-associated fat redistribution. AIDS 1999; 13: 1373-1375. 5 Roubenoff R, Schmitz H, Bairos L, Layne J, Potts E, Cloutier GJ & Denry F. Reduction of abdominal obesity in liodystrophy associated with human immunodeficiency virus infection by means of diet and exercise: Case report and proof of principle. Clinical Infectious Diseases 2002; 34: 390-393. 6 Roubenoff R, McDermott A, Weiss L, Suri J, Wood M, Bloch R & Gorbach S. Short-term progressive resistance training increases strength and lean body mass in adults infected with human immunodeficiency virus. AIDS 1999; 13: 231-239. 7 Yaresheski KE, Tebas P, Stanerson B, Claxton S, Marin D, Bae K, Kennedy M, Tantisiriwat W & Powderly WG. Resistance exercise training reduces hypertriglyceridemia in HIV-infected men treated with antiviral therapy. Journal of Applied Physiology 2001; 90: 133-138. 8 Roubennoff R & Wilson IB. Effects of resistance training on self-reported physical functioning in HIV-infection. Medicine and Science in Sports and Exercise 2001; 33 (11): 1811-1817. Competing interests:   None declared