The Effect of a Organized Exercise Program on Nutrition and Suitability
Outcomes in Human Immunodeficiency Virus-Infected Children
Tracie L. Miller
1Division of Pediatric Clinical Research, Department of Pediatric
medication, Miller School of Medicine, University of Miami, Miami, Florida
33101.
Gabriel Somarriba
1Division of Pediatric Clinical Research, Subdivision of
Pediatrics, Miller School of Medicine, Campus of Miami, Miami, Florida 33101.
Daniel D. Kinnamon
1Division of Pediatric Clinical Research, Subdivision of
Pediatrics, Miller School of Medicine, Campus of Miami, Miami, Florida 33101.
Geoffrey A. Weinberg
2Division of Pediatric Infectious Disease, University of
Rochester Medical School, Rochester, New York 14642.
Lawrence B. Friedman
3Division of Adolescent Medicine, Section of Pediatric medication,
Miller School of Medicine, Campus of Miami, Miami, Florida 33101. @ Read More imtechaddicted
Gwendolyn B. Scott
4Division of Immunology and Infectious Diseases, Section of Pediatric
medicine, Miller School of Medicine, University of Miami, Miami, Florida 33101.
Abstract
The feasibility and effectiveness of a hospital-based
exercise-training application observed by way of a home-based software for
enhancing fitness, strength, and modifications in body composition in children
and young people with HIV were evaluated. Subjects participated in
nonrandomized 24-consultation, sanatorium supervised exercise schooling program
observed by an unmonitored home-based totally preservation program. Outcome
measurements blanketed muscular energy/staying power, flexibility, relative top
VO2, body composition, and lipids. Seventeen subjects (eight females) with a
median age of 15.0 years (variety: 6.0–22.6) and BMI z-score of 0.Sixty one
(variety: −1.70–2.Fifty seven) at entry finished the intervention. After 24
training sessions, the median increases in muscular energy had been between
eight% and 50%, depending on muscle institution. The median will increase in
muscle staying power, relative height VO2, and lean frame mass had been 38.7%
(95% CI: 12.5–ninety four.7; p = 0.006), 3.0 ml/kg/min (ninety five% CI:
1.Five–6.0; p < 0.001), and four.Five% (95% CI: 2.Four–6.6; p < 0.001),
respectively. Twelve children completed the home-based maintenance program.
Median changes in these outcomes between completion of the hospital-based
intervention and a follow-up after completion of the home-based program were
near zero. No adverse events occurred during the intervention. A supervised
hospital-based fitness program is feasible, safe, and effective for improving
general fitness and strength as well as lean body mass in children with HIV.
Introduction
Physical activity contributes to positive health outcomes
for adults who participate in regular exercise programs. These include
decreased rates of coronary artery disease, hypertension, obesity, diabetes,
incidences of some cancers, and improved quality of life.1 With greater
recognition of sedentary behaviors of children, interest has turned toward
exploring the effects of exercise in children, with the recognition that early
implementation of healthy habits may have positive behavioral effects later in
adulthood, when physical activity usually declines.2,3 Previous studies have
shown that active children, compared with inactive peers, have greater muscular
strength, advanced motor skills, higher cardiovascular fitness,4 and often
improved disease-specific endpoints. Specific programs designed to improve
strength, flexibility, and endurance in healthy children have been studied and
appear to be safe in children as young as 6 years of age.5,6
The presence of cardiovascular risk factors (adiposity,
decreased lean body mass, hyperlipidemia and insulin resistance), a result of
highly active antiretroviral therapy (HAART) or chronic viral infection, is
common in both HIV-infected adults and children.7,8 Abnormal cardiovascular
risk profiles may contribute to or be exacerbated by a sedentary lifestyle. The
positive effects and safety of exercise training have been well documented in
adults with HIV and cardiovascular risk,9–11 with only preliminary studies
noted in children.12 As HIV has become a chronic illness, with long-term
toxicities relating to the infection and its therapies, it will be important to
determine if lifestyle interventions, such as structured exercise programs, are
practical, safe, and effective for children with HIV. We present the results on
the effects of a supervised, hospital-based exercise program followed by an
unsupervised, home-based maintenance program for HIV-infected children. Our
goal was to determine if a structured training program in HIV-infected children
is feasible and safe, improves fitness and strength, and changes body
composition. A secondary goal was to determine whether gains from a
hospital-based exercise program can be maintained at home. @ Read More fitliza
Materials and Methods
Participants
Between 2001 and 2007, HIV-infected children age 6 years or
older followed at the University of Rochester Pediatric HIV and the University
of Miami Pediatric Special Immunology and Adolescent Medicine Programs were
invited to participate in this nonrandomized exercise intervention study.
Children received medical clearance from their primary physician (e.G., no
medical conditions that would be contraindicated) to participate and the
children understood the training program. Informed consent was signed by
parents/legal guardians and assent was signed, if applicable. This study
received approval from the Human Subjects Review Office, University of Miami;
Western Institutional Review Board, Olympia, WA; and Office for Human Subject
Protection at the University of Rochester Medical Center, Rochester, NY.
Outcome measures
Exercise strength assessment occurred at one of three time
points: at baseline, at completion (24 visits over approximately 12 weeks), and
at postcompletion follow-up (approximately 3 months after completion). Other
clinical and body composition outcome measures were collected over a series of
visits scheduled for the study or regular clinical care and were matched as
closely a possible within ±60 days to each exercise strength assessment. The
same clinician at each center performed all measures on a given patient.
Subjects were familiarized with equipment during a visit prior to baseline
testing.
Strength testing
Hand dynamometry assessed upper extremity strength. Testing
procedures followed the recommendations of The American College of Sports
Medicine (ACSM).13 A Jamar hand dynamometer (Sammons Preston, Bolingbrook, IL)
measured grip strength (lb, mean of three attempts). For other strength
measurements, the subjects tested on either the pediatric equipment (Promaxima
Manufacturing, Houston, TX) or the adult resistance equipment (Life Fitness,
Schiller Park, IL). Maximal strength (lb) was assessed on all resistance
equipment. A one repetition maximum (1-RM) measured maximal strength and was
calculated using the Mayhew regression equation.14 Subjects were allowed
several warm-up repetitions on each piece of equipment. Based on clinical
assessment,15 subjects were instructed to complete as many repetitions as
possible with incremental resistance until unable to complete greater than
eight repetitions. For subjects (n = 2) who failed to complete a single
repetition on the lowest weight setting for leg extensions and curls, we
estimated the actual 1-RM as 5 lb, the midpoint between zero and the lowest
weight setting (10 lb).
Flexibility and muscular endurance testing
A sit-and-reach test (Figure Finder, Rockton, IL) measured
flexibility (cms), recording the highest value of three attempts. Muscular
endurance was measured by the sit-up test (maximal number of sit-ups completed
in 1 min). One subject failed to complete a single sit-up at baseline; a
baseline value of 0.5 was used to calculate percent changes. Standardized procedures
were used when testing, as recommended by the ACSM.13
Aerobic fitness testing
A maximal metabolic stress test to volitional exhaustion was
completed on a motor-driven treadmill. The modified Balke protocol [constant
speed 3.3 (mph) with increasing grade] was used to assess cardiorespiratory
fitness [peak VO2 (ml/min/kg)].16 Baseline heart rate, blood pressure, and
respiratory rate were measured. Rate of perceived effort (RPE) scales assessed
perception of effort. The test was considered maximal if the subject could not
maintain workload, if the RPE was at least 17, and if the exercise physiologist
determined maximal effort had been reached. Relative peak VO2 (ml/min/kg) was
calculated using Balke's formula for treadmill testing.16
Anthropometrics and body composition
Body weight (kg), height (cm), waist and hip circumference
(cm), and body mass index (BMI) were measured and calculated by conventional
techniques.17 Age- and sex-specific BMI z-scores were calculated from the CDC
growth curves.17 For patients >20 years, BMI z-ratings were calculated based
totally on parameters for a 20-12 months-old person. Body composition was
measured by way of dual x-ray absorptiometry (DXA) (GE/Lunar Prodigy, Madison,
WI; enCORE 2006 software program model 10.50.086) the usage of strategies
formerly described.18 @ Read More technologyiesinnovation
