Exercise is defined by physical activity above and beyond normal activities of daily living, or ADL's for short. These may include walking to the train or bus, brushing your teeth, bathing, moderate house or yard work. Examples of exercise might be extensive yard work, walking to or from work, swimming, running, biking, gym workouts, or anything you wouldn't normally do as a day to day chore. (Yes, taking the stairs instead of the elevator counts!)
Now that we have defined and described some exercises, we can break the exercise as a whole down to its three major parts, which are:
- Cardiovascular, or aerobic exercise. Examples include jogging, rollerblading, hiking, and biking. The main benefits here are increased respiratory function and cardiopulmonary health (a healthy heart) along with fat loss, although this does not optimally occur until about 20 minutes has elapsed.
- Flexibility. Includes any and all stretching techniques. Yoga and Pilates incorporate flexibility into the workouts. Benefits include increased range of motion, joint function, and injury prevention.
- Strength. Here muscles work to become bigger and stronger through resistance training. Lifting weights or heavy items, push-ups, pull-ups, and working on various machines at a gym are all forms of strength training.
This article concentrates on strength training, because a major fitness goal for most HIV-positive individuals should be to improve muscle mass and prevent further de-conditioning while maintaining the highest possible degree of immune function. The best way to do this is through a comprehensive yet moderate strength-training regimen, due to the increased demands placed on the body. But before you tackle the local health club or start going crazy with push-ups and lunges to build your muscles, remember a couple of pointers.
- It's best to have supervision or a workout partner. The point is to get healthy and fit, not injured and weak. So make sure you have a spot, and if you don't know how to use something, ASK!
- Train major muscle groups with compound movements. This is especially important if you want to save time. Also, compound movements (movement in more than one joint) are much more functional than smaller, single joint motions. So let the little stuff go and SQUAT!
- Progressive Resistance Technique, or PRT for short, is important. This involves increasing poundages or repetitions with each successive set. That way, you warm up to your "big weight" and keep from being injured by doing too much too soon.
- Take at least one day's rest in between any one muscle group (yes, that includes abdominals as well). That 48 hour or more rest period will help sore muscles recover and grow, allowing the right amount of food and sleep. Any less rest, and you're doing your body more harm than good. So something like upper body on Monday and Thursday, and lower body on Tuesday and Friday is fine, since there are no consecutive days of the same body parts in that split.
Combating Side Effects
By following the guidelines you may be able to combat some of the potentially nasty side effects from your medications with the benefits of strength training, which are many. Here are a few: increased testosterone; improved self-esteem; increased body cell mass; improved sex drive; increased appetite; improved appearance; increased metabolism; improved mood; increased bone density; improved sleep habits; increased functionality; and improved energy levels.
Strength training may also help lipodystrophy (thinning of the face and buttocks due to loss of fat deposits) and wasting (10% weight loss accompanied by chronic fever and diarrhea) in HIV-positive individuals. Also, new studies show resistance exercise could increase a persons' phase angle, which along with CD4 (T-cell) count and viral load is an important indicator of long-term survival. Phase angle is the summary of the density and therefore the healthfulness of the body's tissue. It serves as a mathematical equation between the reactance and resistance of your body's tissue. Normal ranges anywhere from 4 to 12, but ideally men should be around 6 and women around 5.
Stages of Change
Did you know that the recent Surgeon General's report recommends moderate physical activity for at least 30 minutes five or more days a week as part of a healthy lifestyle. Wow! Sounds like a lot, right? So how about starting with something smaller, maybe only two or three days. Still scared, or just not convinced? Either way, you'll definitely find yourself somewhere in the seven stages of change. Try to imagine these steps in a circular pattern, and you'll get the idea. The seven stages of change are:
- Precontemplation: Working out has never crossed your mind.
- Contemplation: You have thought about starting an exercise program.
- Preparation: You have made steps towards exercising, but haven't yet.
- Action: You have started participating in an exercise program.
- Maintenance: You are cruising along in your routine, comfortably.
- Relapse: Uh oh! A week off and it's back to the drawing board.
- Recycle: You start again somewhere within the first four steps.
Anyone who has ever worked out has probably experienced all seven of these phases, and knows that action and maintenance feel the best. If you have never exercised, hopefully you will soon agree.
There are five points to a successful exercise regimen. They are as follows:
- Type: Pick something you LIKE! You are less likely to do it if you don't like it. (Jogging anyone?)
- Time: Plan your chosen activity as you would any other appointment. Writing workout time in a daily planner is a good reminder. It's not going to magically happen, so make the time.
- Consistency: Stick with it! Even if you don't have time for a full workout, something is better than nothing. Results come with consistency and perseverance, so just do it.
- Goals: Set both short and long-term goals for your progress. By working toward something, anything, your labor becomes focused and you'll strive to achieve.
- Reward: Finally, that week of "being good" pays off as you kick back on Saturday night with some pizza and beer. Life is good! Enjoy it.
Rewards are great, just don't get carried away. There's a fine line between treating yourself and ruining all that hard work with a poor diet or not enough sleep. Remember, you'll only see the fruits of your labor if you take care of yourself. And if you do, over time, with increased strength, function, and desire, activity increases to tone muscles. Good luck, and live two ways: long and strong.
Sean P. Crawford, a clinical exercise specialist, can be reached at firstname.lastname@example.org.
Back to the August 2001
Issue of Body Positive