BACKGROUND: Elderly people present alterations in body composition and physical fitness, compromising their quality of life. Chronic diseases, including HIV/AIDS, worsen this situation. Resistance exercises are prescribed to improve fitness and promote healthier and independent aging. Recovery of strength and physical fitness is the goal of exercise in AIDS wasting syndrome. OBJECTIVE: This study describes a case series of HIV-positive elderly patients who participated in a progressive resistance training program and evaluates their body composition, muscular strength, physical fitness and the evolution of CD4 + and CD8 + cell counts. METHODS: Subjects were prospectively recruited for nine months. The training program consisted of three sets of 8-12 repetitions of leg press, seated row, lumbar extension and chest press, performed with free weight machines hts, twice/week for one year. Infectious disease physicians followed patients and reported all relevant clinical data. Body composition was assessed by anthropometric measures and dual-energy x-ray absorptiometry before and after the training program. RESULTS: Fourteen patients, aged 62-71 years old, of both genders, without regular physical activity who had an average of nine years of HIV/AIDS history were enrolled. The strengths of major muscle groups increased (74%-122%, p=0.003-0.021) with a corresponding improvement in sit-standing and walking 2.4 m tests (p=0.003). There were no changes in clinical conditions and body composition measures, but triceps and thigh skinfolds were significantly reduced (p=0.037). In addition, there were significant increases in the CD4 + counts (N=151 cells; p=0.008) and the CD4 + /CD8 + ratio (0.63 to 0.81, p=0.009). CONCLUSION: Resistance training increased strength, improved physical fitness, reduced upper and lower limb skinfolds, and were associated with an improvement in the CD4 + and CD4 + /CD8 + counts in HIV positive elderly patients without significant side effects.

OBJECTIVES:Human Immunodeficiency Virus (HIV) infection worsens the frailty of elderly people, compromising their quality of life. In this study we prospectively evaluated eleven patients living with HIV and 21 controls older than 60 years and without prior regular physical activity, who engaged in a one-year progressive resistance exercise program to compare its effects on muscular strength, physical fitness and body composition.METHODS:Exercises for major muscular groups were performed 2 times/week, under professional supervision. Strength increase was evaluated bimonthly, while body composition, lipid and glycaemic profiles (only of those living with HIV) and physical fitness were evaluated before and after the one-year training.RESULTS:The participants living with HIV were lighter, had smaller Body Mass Index and were initially much weaker than controls. However, their strength increased more (1.52-2.33 times the baseline values for those living with HIV x 1.21-1.48 times for controls, p<0.01), nullifying the differences initially seen. These effects were seen independently of gender, age or baseline physical activity. In addition, those living with HIV improved their fasting glucose levels and showed a tendency to improve their lipids after the one year training program. These effects were slightly more pronounced among those not using protease inhibitors, although not significantly. CONCLUSIONS:Resistance exercise safely increased the strength of older patients living with HIV adults, allowing them to achieve performance levels observed among otherwise healthy controls. These findings favor the recommendation of resistance exercise for elderly adults living with HIV adults.

Abstract:Elderly people present significant alterations on body composition and physical fitness, compromising their quality of life. Chronic diseases, including HIV/AIDS, worsen this situation by increasing aging effects on body composition and muscle strength. Resistance exercises are prescribed by major health organizations for improving fitness and promoting a shift towards a healthier and more independent aging. In addition, recovering strength and physical fitness is the major goal of exercise in AIDS wasting syndrome. To analyze progressive resistance training effects on body composition, physical fitness and clinical/immunological evolution of HIV + elderly. Subjects were prospectively recruited between November 2003 and July 2004. Training program consisted of 3 sets of 8-12 repetitions of Leg press, seated row, lumbar extension and chest press, performed with free weights machines, 2 times week −1 during 1 year. The Research Ethical Committee of HCFMUSP approved the study and all participants signed a written informed consent. ID specialized physicians followed patients throughout the study, reporting all relevant clinical data. Body composition was assessed by anthropometric measures and DEXA before and after the training program. 14 patients, aged 61-69 years old, of both genders and without regular physical activity, with an average 9 years HIV/AIDS history, were enrolled. Strength of major muscular groups increased (74-122%, p = 0.003-0.021), with a corresponding improvement on sit-standing and walking 2.4 m tests (p = 0.003). There were no changes on clinical conditions and on most body composition measures, but triceps and thigh skinfoldssignificantly reduced (p = 0.037).

Dedico esse trabalho a minha família por todo apoio e compreensão e em especial ao Paulo César que esteve ao meu lado em todos os momentos me apoiando e contribuindo para a realização deste estudo. AGRADECIMENTOS O tempo parece longo quando iniciamos um trabalho desses. Alguns anos se passaram e a ajuda de vários profissionais foi muito importante em cada momento para a realização desse projeto.Agradecimento especial ao meu orientador Prof. Wilson Jacob Filho que me deu a oportunidade de estar aqui realizando um sonho e também pela colaboração em todos os momentos durante esse processo.Ao Dr. José Maria Santarém, agradeço por acreditar em mim e ter me dado todas as oportunidades profissionais nesses quase 10 anos de amizade.Aos Professores Marcelo Burattini, Olavo Munhoz, Aluízio Segurado, Dra Ho Yeh Li e Dr. Alexandre Silva agradeço pela disposição e colaboração desde o início do projeto. À Disciplina de Informática Médica e em especial ao Professor EduardoMassad pelo espaço cedido no departamento no momento que mais precisei e também pelas sugestões dadas durante o desenvolvimento do projeto, muito obrigada.A minha amiga e também colaboradora Dra Leila Strazza, muito obrigada pela luz oferecida desde a época da "malhação".Ao Dr. Aurélio Borelli, os técnicos do Instituto de radiologia e os colegas da Casa da AIDS, sem a colaboração de todos vocês tudo ficaria mais difícil.Á todos do CECAFI agradeço pela equipe eficiente que me ajudou muito durante todo o projeto. À Coordenação de Aperfeiçoamento de Pessoal de Nível Superior(CAPES), pela bolsa de mestrado que me proporcionou uma condição melhor de estudo.Enfim, agradeço a todos os pacientes da Casa da AIDS e espero que de alguma maneira esse estudo sirva para melhorar a vida de cada um. Àqueles que participaram do projeto, um beijo no coração. SUMÁRIO LISTA DE GRÁFICOS Gráfico 1Evolução das cargas sub-máximas suportadas no Leg Press no decorrer de um ano de treinamento. 23 Gráfico 2Evolução das cargas sub-máximas suportadas no Seated Row no decorrer de um ano de treinamento. 23 Gráfico 3Evolução das cargas sub-máximas suportadas noLumbar Extension no decorrer de um a no de treinamento. 24 Gráfico 4Evolução das cargas sub-máximas suportadas noChest Press no decorrer de um ano de treinamento. 25 Gráfico 5Evolução do tempo necessário para caminhar 2,4 m no decorrer de um ano de treinamento. 26 Gráfico 6Evolução do tempo necessário para sentar e levantar no decorrer de um ano de treinamento. 26 Gráfico 7Evolução da dobra cutânea triciptal no decorrer de um ano de treinamento. 28 Gráfico 8Evolução da dobra cutânea anterior das coxas no decorrer de um ano de treinamento. 28 Gráfico 9Variação da contagem absoluta de linfóitos CD4. 29Gráfico 10 Variação da contagem absoluta de linfóitos CD8.