One of the more challenging areas that personal trainers may deal with one day is working with somebody infected with HIV – but it doesn’t have to be. What I’d like to do is cover some issues to be considered when working with somebody who has HIV/AIDS as well as exercise guidelines to help people properly manage this condition. Print this up and put it in your files so you can refer back to it easily if you ever need to.
First off, personal trainers should know that they cannot get the HIV virus simply by working with somebody who has HIV/AIDS. HIV has been in the public spotlight since the 1980s and others have written much more about this than I will here, but I wanted to mention this for the personal trainer out there who may be new to the fitness industry and have not given much thought to this topic. Personal trainers don’t need to wear gloves or masks when they work with somebody infected with HIV.
Scientist have known for over 100 years that exercise can change how the immune system works – and the results can be both positive and negative. Because some people may have heard that exercise can reduce the effectiveness of the immune system, it’s possible that personal trainers may run into people with HIV/AIDS who are afraid to exercise.
In reality however it is only hard core types of exercise - like running a marathon – that might be detrimental to the immune system. The good news is that exercise at low to moderate intensities (example, 2-4 on the RPE scale) does not increase the risk of other infections in persons infected with HIV as well as those who have AIDS.
Some research also suggests that resistance training can improve the concentration of CD4 cells (immune system cells that are known to decrease with HIV/AIDS).
Both aerobic exercise as well as strength training have been shown to improve muscle endurance and cardiovascular endurance as well as strength, even in people with HIV induced muscle loss. Resistance training has even been shown to improve strength in older adults with HIV.
This is important because people infected with HIV tend to have greater degrees of muscle loss, sarcopenia and being frail – no matter what age they are. Some evidence also suggests that resistance training may also increase levels of CD 4 cells – which means better immune system function!
For the personal trainer who finds him/herself working with somebody with HIV/AIDS, make sure the person has a clearance from his/her physician before starting an exercise program. I suggest writing a short note to the doctor asking for permission. In the letter give the doctor an idea of the persons goals and what types of exercises you would do. This is important because the doctor may give you feedback on what they recommend for their patient. The letter should also include your email, cell phone number and website -if you have one – to make it easier for the doctor to contact you if he /she wishes.
After the doctor gives the OK, here are some guidelines on how to properly proscribe exercise.
Aerobic exercise should include the large muscles of the body - legs, chest, back – to improve exercise efficiency as well as to better enhance the ability of the person to continue to perform their daily activities. This is generally the same guideline as recommended for pretty much everybody.
If possible, people should exercise 3-4 days per week for at least 30-60 minutes per session. If you want to use a percentage of max heart rate to determine exercise intensity, the ACSM recommends using the Karvoneon method and aiming for an intensity of 40%-60%
If working with people who have very low strength, isometric (static) exercises may be used until the person is able to perform dynamic (isotonic) strength training – those that include both concentric and eccentric components.
For example, most free-weight and machine exercises are appropriate as theses all concentric (lifting) and eccentric (lowering) parts.
Just as for generally healthy people, resistance training for those with HIV/AIDS should occur 2-3 days per week and include a range of exercises that recruit the major muscle groups.
The ACSM recommends 10-12 different exercise but this can be less depending on the persons fitness level and time they are able to devote to exercise. The intensity of exercise should be moderate, approximating 60% 1RM which ideally should allow for about 8-10 repetitions per exercise.
While, programs that use one exercise per body part is a smart way to go for beginners, more advanced people may do more than one exercise per body part. I am not aware of any research looking at “bodybuilding programs” and HIV infection so use your best instincts if you employ these types of programs.
Because of the risk of gym-related infections, the personal trainer should wipe down gym equipment with a disinfectant before it is used. This will reduce the chances of the person getting infected.
While most gyms have disinfectant that people can use to sterilize equipment after use, whether gym members actually use it is another story. Of all the gyms I have been in, only Planet Fitness seems to be ahead of the curve when it comes to disinfecting exercise equipment. All members are required to wipe down equipment after each use.
While the severity of HIV infection can impact exercise progression, the goal of exercise is usually not to increase the number of repetitions performed. Doing so would recruit large numbers target type I fibers. While these are useful muscle fibers, in the long run, lifting for high numbers of reps would lead to more muscle endurance and less strength. This might reduce muscle mass.
Ideally, the reps should stay within the 8-10 rep range. This is done by increasing the resistance in a logical fashion. For example, consider increasing the resistance 5-10 pounds when the person can perform 2 extra reps on all sets on 2 different days.
Personal trainers should be vigilant to avoid overtraining syndrome at all costs. I can’t stress this more seriously. Overtraining syndrome can decrease the immune system and cause to MORE infections – not good!
While not foolproof, one way to keep tabs for overtraining is to record resting heart rate each week. Remember, overtraining syndrome is associated with an increase in resting heart rate. So, if the personal trainer notices that the RHR of the person is increasing from one week to the next, cut back on exercise intensity and the number of times per week the person works out until resting heart rate gets back to its normal range.
If possible, teach the person to take their own resting heart rate in the morning before getting out of bed as this will give a better indicator than if a personal trainer takes it in the gym.
I know for some people, taking on a client who has HIV/AIDS might be scary – but it shouldn’t be. Helping people who have health issues -any health issue – is one of the best things about being a personal trainer. You can make such a difference!
