By Michael Youssouf, MA, and Mitchell Charap, MD
Despite advances in care, AIDS cases are still on the rise. Learn how fitness professionals can modify training programs to assist clients in different stages of this disease.
TRAINING CLIENTS WITH HIV OR AIDS
made life more manageable for people with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), the incidence of these conditions continues to grow. While the virus at first affected mostly homosexual men, its victims are now "overwhelmingly heterosexual," according to the World Health Organization (WHO 2000). In fact, of the 33.6 million people estimated to be living with HIV/AIDS, 14.8 million are women (WHO 2000). With the epidemic still unchecked, it is very likely that fitness professionals will encounter more and more clients who are HIV positive. Many personal trainers and group fitness instructors may already be working with affected clients and not even know it!
lthough recent scientific breakthroughs have
Research has shown that people living with HIV/AIDS can significantly benefit both physically and psychologically from exercise training (Macarthur, Levine & Birk 1993; Rigsby et al. 1992). In addition to supporting a healthier lifestyle in general, exercise training has been shown to positively influence immune suppression, anxiety, depression, muscle atrophy, balance and posture (LaPerriere et al. 1990; Macarthur, Levine & Birk 1993). Unfortunately, exercise adherence can be quite a challenge in the face of periodic health setbacks, especially for clients with fullblown AIDS. Therefore, fitness professionals must consider a variety of factors prior to designing and implementing an exercise program for a client living with HIV/AIDS.
Understanding the Disease
In 1981, numerous reports of Kaposi's sarcoma (a rare cancer) and Pneumocystis carinii pneumonia (a form of pneumonia associated with compromised immune function) began to surface in the male homosexual community (Gottlieb et al. 1981; Hymes et al. 1981). Although the increased incidence of these conditions could not be explained at the time, a common denominator was that all the victims had a suppressed immune system. Over time, this kind of immune system failure was also noted in intravenous drug users, hemophiliacs and recipients of blood transfusions, bisexual men and, ultimately, heterosexual people. By 1983, researchers had identified the HIV retrovirus and the syndrome that came to be known as AIDS. In the years since, the quest to define and manage this deadly disease has progressed considerably through advances in early detection, treatment and drug intervention. HIV infection occurs when the virus enters cells such as lymphocytes (white blood cells of a certain type). By becoming part of a cell's DNA, the virus can reproduce itself inside the cell. Eventually, the cell is destroyed and new virus particles are released into other cells, a process that cascades as more and more cells are infected and killed. The lymphocytes the virus attaches to are called CD4-positive (CD4+) or helper T lymphocytes (CD4+ T-cells). HIV infection causes selective degeneration of the CD4+ T-cells, which are needed to activate and coordinate other cells in the immune system. This degeneration, in turn, weakens the body's ability to protect itself against infection and disease. The progression of the virus can manifest itself in a wide variety of symptoms. Most sufferers are asymptomatic in the beginning stages of the disease. By the later stages, typical symptoms include muscle wasting, inability to cope with daily physical tasks and severe immunosuppression, resulting in potential cancers or secondary infections.
CDC 1992). The latest revision categorizes the virus into four stages, which correlate to an infected person's CD4+ T-lymphocyte count; quantifying a specific cell count helps to express the health status of the immune system (CDC 1992). The four stages are as follows: Stage 1: Acute Infection. This is the period--immediately following HIV contraction--when an infected person typically experiences symptoms similar to those associated with mononucleosis (e.g., fever, rashes and general discomfort). This stage lasts several weeks, after which symptoms usually disappear, although lymph modes may remain enlarged. It is unlikely that a client would be participating in exercise training during this stage. Stage 2: Asymptomatic HIV Infection. During this period, which can last from 10 to 15 years, the HIV-positive client is free of symptoms and appears to be healthy. Although the client is not medically compromised at this time, fitness professionals may need to make minor modifications to the exercise program. Stage 3: Symptomatic HIV Infection. This is the point when the client's CD4+ T-cell count begins to decrease moderately. Stage 3 is marked by the onset of symptoms such as weight loss, fatigue, fever, nausea and diarrhea, which together are referred to as AIDS-Related Complex (ARC). During stage 3, fitness professionals need to make more substantial modifications to the client's training program, as necessary. Stage 4: AIDS. Often referred to as "full-blown AIDS," this period of severe immunosuppression can result in a wide variety of opportunistic infections and cancers. Consistent training participation is difficult for the client, as exercise is interrupted by acute episodes caused by opportunistic infections; for example, the client may be dealing with vision problems, neuropathy, severe diarrhea or pulmonary obstructions. As the virus progresses, the client may sometimes improve, decline and rebound due to fluctuations in the CD4+ T-cell count. That is why it is vital for fitness professionals to know about the stages of the disease and monitor the client's current status by remaining in close contact with the attending physician. This knowledge and constant communication will make it possible to modify the client's training program as needed during symptomatic periods.
While the goal of this article is to encourage group fitness instructors and personal trainers to work with clients with HIV/AIDS, you need certain qualifications to serve this population. Because of the medical and emotional complexities that can arise when working with these clients, you are advised to begin by training people who have been diagnosed with HIV but are currently asymptomatic. It is recommended that you have the following qualifications
Recognizing the Stages of HIV/AIDS
As information on HIV/AIDS has accumulated, the Centers for Disease Control and Prevention (CDC) has published and revised a description of the stages of the virus (CDC 1986;
November-December 2001 IDEA HEALTH & FITNESS SOURCE
before training clients with HIV/AIDS: The Exercise Adherence Challenge
© 2001 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.