Exercise, combined with nutrition and medication, is a safe method of improving the quality of life in people with HIV/AIDS. Progressive holistic exercise programs, containing all major components of exercise (aerobic, strength, flexibility, and balance), should be included with therapy in people with HIV/AIDS. Resistance training should focus on large muscle groups with a moderate intensity (60% to 80% of the one rep maximum). Overloading of the muscle should be performed with the comfort of the client, 8-12 repetitions. Aerobic exercise should aim to achieve 150 minutes of moderate intensity exercise (11 to 14 on the Borg Rating of Perceived Exertion scale, 45-85% VO2max, and 50%-85% of peak heart rate) three to five times a week. Exercise programs should be tailored to accommodate for the various limitations in functional capacity and symptoms presented by persons with HIV/AIDS. A person with HIV/AIDS participating in an exercise program should have their health monitored frequently, to limit any adverse effects of exercise.

Exercise Testing in HIV/AIDS

For persons with HIV who are asymptomatic, responses to a single-bout of exercise may be unchanged. However, at a higher stage of immunodeficiency, people with HIV experience a decrease in training response and performance. Traditional maximal or sub-maximal exercise tests may be used. However, functional or adapted tests, such as activities of daily living performance based exercise, may be tailored to meet the needs of each individual.

Stage 1: Acute Infection

• Generally no limitations on maximum graded exercise testing in these persons.

Stage 2: Clinical Latency

• Reduced aerobic capacity along with other variables associated with cardiovascular fitness (VO2max, VO2 at ventilatory threshold, heart rate reserve, and ventilator reserve).

Stage 3: AIDS

• There is a greatly reduced aerobic capacity in this stage, reducing the possibility of a maximum graded exercise test.

In accordance with American College of Sports Medicine (ACSM) guidelines for people with HIV there are some special considerations before exercise testing. Fatigue is common and may signify the progression of the disease. Clinicians should take extra care to observe common conditions with HIV, such as anemia, muscle wasting/weakness, scarring from pneumocystis pneumonia, and diarrhea. Strict universal precautions for the prevention of transmission of HIV must be followed as outlined by the CDC/OSHA. Moreover, an acute change in general health status since the last visit is a contraindication to exercise.