The Positive Side

Spring/Summer 2009 

Ask the Experts: Work It!

With the nice weather calling me outside, I’ve decided I want to get a bit more active this summer. I know exercise is good for everyone, including people with HIV, but I’m wondering if there is anything in particular I should know before I break a sweat.
— RR, Peterborough, Ontario


Physician, Northern Alberta HIV Clinic

The fact that more PHAs are asking about fitness shows how far we’ve come. Anti-HIV drug therapy has transformed a deadly disease into a chronic, manageable condition for most people in Canada. Instead of worrying about dying, people are getting on with their lives.

However, some of these lifesaving drugs can cause side effects like high cholesterol, high blood pressure, abdominal weight gain and diabetes. All of these can increase the risk of heart problems. What’s more, HIV itself may increase your risk of cardiovascular disease and your long-term risk of heart attack.

For a number of reasons we are just beginning to understand, people with HIV (PHAs) seem to have thinner bones than the general population. We give PHAs the same advice about osteoporosis that we give everyone. Get enough calcium and vitamin D in your diet and perform weight-bearing exercises, such as jogging, walking or stair climbing, to build your bone strength and density.

Consult a doctor before starting a vigorous exercise program. Most of the time, your doctor will review your medical history, ask about past injuries and then heartily encourage you to start exercising. But if you have severe heart disease or diabetes, your doctor may refer you to a cardiologist to make sure exercise is safe.



Registered dietitian, Oak Tree Clinic

Ten years ago, we did not advise people with HIV to lose weight because of the concern of wasting syndrome — uncontrolled weight loss. But wasting is much less of an issue for people taking effective anti-HIV therapy.

For patients who are obese but with otherwise stable health, I now recommend losing weight because obesity can lead to all kinds of serious diseases. Being overweight, as opposed to being obese, doesn’t pose the same health risks, but if you are overweight, you don’t have to fear shedding a few pounds.

The BMI (body mass index) is one tool for finding out if you are obese or overweight. You are obese if your BMI is 30 or greater and overweight if your BMI is between 25 and 30.

Your nutritional needs may change when you start exercising. This will depend on your individual health and exercise or weight goals, so I recommend consulting a dietitian. Most HIV clinics have one on staff. To have plenty of energy, fuel up with carbohydrates one hour before exercise and bring along a snack if you’re working out intensely for more than an hour.

Exercise can boost energy, but it takes time to start feeling energized after starting an exercise program. At first, you may feel more tired, so you need to stick with the program for about a month to reap that reward.

I tell clients to think about getting fit as a lifelong project because it stops them from getting too discouraged when they fall off the wagon for a few days. For detailed information about nutrition, weight loss and exercise, see CATIE’s Practical Guide to Nutrition. The guide also contains a chart that can help you quickly determine your BMI.



Certified Iyengar yoga instructor, Director of YogaBuds Studio

Therapeutic yoga is a branch of yoga that seeks to heal or treat the root causes of illness or injury. In our studio, all of our classes, including therapeutic yoga sessions, are taught in the Iyengar system of yoga, which seeks to achieve unity of mind, spirit and body — along with a meditative state — through breathing techniques and a system of asanas (poses).

Iyengar practitioners are trained to work with people with medical conditions and believe that certain poses benefit certain conditions. For example, chest openings and inversions can aid a compromised immune system by increasing lymphatic flow and reducing stress. And someone with gastrointestinal problems may benefit from poses that increase circulation to the pelvic area or cause the abdominal organs to relax.

For a student who is a beginner or is limited by pain, fatigue or another condition, yoga teachers can use props such as ropes, blankets or chairs, to modify poses and so allow the student to experience postures more fully. The props also help the students hold poses for longer, which allows the deeper therapeutic benefits of yoga to happen.



Personal trainer

If someone comes to my gym with central fat accumulation, cardiovascular exercise is more important to start with than resistance training (lifting weights). Keep in mind that it takes a little exercise to be healthier and happier, but a lot more to burn fat. But even if you aren’t losing weight, you can still derive benefit from keeping active, so start exercising at a comfortable level. Just start moving!

While exercise relieves stress, improves your mood and speeds weight loss, it can also help with serious health issues, like osteoporosis, potential heart problems, diabetes and high blood pressure. However, these conditions can actually make exercising dangerous if you are not aware of them. Many people do not get the counselling and supervision they need at a gym, which may put them more at risk. Fortunately, you don’t need a gym to exercise, just the go-ahead from your doctor and some simple guidelines to help keep your workout safe:

  • If you have heart disease, diabetes or high blood pressure (above 140/90 mmHg), or your resting heart rate is abnormally fast (over 100 beats per minute), check with your doctor before starting a vigorous exercise program.
  • When beginning an exercise program, start conservatively and keep your heart rate in a safe zone (which is 45 to 60 percent of your maximum heart rate). You’ll be less fatigued and actually start enjoying it!
  • The first week of your program, start by exercising for 10 to 15 minutes two to three times per week. Progressively increase the duration and frequency (times per week), but not the intensity. Increase intensity when you are able to exercise for 30 minutes or longer. For example, if you were walking, you may start a slow run, or increase intensity to the 60 to 85 percent maximum heart rate zone. Eventually, you should exercise for 35 to 40 minutes at least three times per week.
  • If you feel pain anywhere, rest and consult your doctor. Exercise can make injuries worse.
Jennifer McPhee is a freelance writer based in Toronto. After finishing her first article for The Positive Side about getting fit, she finally started working out regularly again.

To calculate your maximum heart rate, subtract your age from 220.

To calculate your target heart rate (HR), you will need your age, your resting heart rate (in beats per minute) and the percentage of maximum heart rate you wish to reach (as a decimal, for example, 0.45 for 45%). Calculate the target heart rate like this:

Target HR = [Target % x (220 – Age – Resting HR)] + Resting HR

There are several heart rate calculators online. Search for Karvonen heart rate calculator.

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