EXERCISE INTERVENTIONS IN HIV INFECTED ADULTS

该项目将研究运动训练对HIV消瘦患者功能状态的影响;以及运动对HIV相关脂肪再分布患者腹部内脏脂肪和胰岛素抵抗的影响。在过去的几年里，我们已经证明：1）一轮艰苦的运动不会提高HIV RNA水平; 2）渐进式抗阻运动（RE）导致瘦体重增加，与生长激素或雄激素治疗相当; 3）RE导致正常体重受试者的脂肪减少，但脂肪减少的程度与运动有关。（和总质量）增加; 4）在脂肪重新分布的患者中，有氧加阻力运动（ARE）导致躯干脂肪量显著下降，而不损失瘦体重或外周脂肪量。此外，我们有初步证据表明，5）RE通过增加力量和瘦体重改善功能状态; 6）对一轮艰苦运动的蛋白质代谢反应在浪费和非浪费患者之间有很大不同; 7）这种反应可以用来预测谁将受益于RE，获得瘦体重。因此，运动在治疗和预防HIV感染者的消瘦和腹部肥胖方面可能具有独特的优势。这项研究的长期目标是开发利用运动预防和治疗艾滋病毒感染引起的身体成分异常的实用方法。我们计划招募100名HIV感染的消瘦或脂肪再分布患者，并将他们纳入一项长期、随机、门诊的运动和饮食研究。消瘦组的主要结果将是瘦体重和功能状态的增加，以及对一次急性运动的蛋白质代谢反应是否预测对RE的反应。对于脂肪再分布组，预期结果是腹部内脏脂肪减少，胰岛素抵抗改善，肌肉葡萄糖转运蛋白-4（GLUT-4）水平增加，脂蛋白状态改善。

This project will examine the effect of exercise training on functional status in patients with HIV wasting; and the effect of exercise on abdominal visceral fat and insulin resistance in patients with HIV-associated fat redistribution. In the past several years, we have shown that 1) one bout of hard exercise does not raise HIV RNA levels; 2) progressive resistance exercise (RE) leads to increase in lean mass, comparable to that seen with growth hormone or androgen therapy; 3) RE leads to fat loss in normal- weight subjects, but to fat (and total mass) gain in wasted subjects; 4) in patients with fat redistribution, aerobic plus resistance exercise (ARE) leads to significant decline in trunk fat mass without loss of lean body mass or peripheral fat mass. In addition, we have preliminary evidence that 5) RE improves functional status via increases in strength and lean mass; 6) the protein metabolic response to one bout of hard exercise differs substantially between wasted and non-wasted patients; and 7) that this response can be used to predict who will benefit from RE with a gain in lean mass. Thus exercise potentially offers singular advantages in treatment and prevention of both wasting and abdominal obesity in HIV infection. The long-range goal of this research is to develop practical ways of using exercise to prevent and treat body composition abnormalities caused by HIV infection. We propose to recruit 100 patients with HIV infection with either wasting or fat redistribution, and enroll them in a long-term, randomized, outpatient study of exercise and diet. The major outcomes for the wasting group will be increased in lean mass and functional status, and whether the protein metabolic response to one bout of acute exercise predicts the response to RE. For the fat redistribution group, the expected outcomes are a decrease in abdominal visceral ft, improved insulin resistance, increased muscle glucose transporter-4 (GLUT-4) levels, and improved lipoprotein status.