Training someone who is HIV positive may seem like one of the more challenging things a personal trainers may do – but it doesn't have to be. What I'd like to do now is cover some issues to be considered when working with somebody who has HIV/AIDS as well as give fitness trainers some exercise guidelines to help properly manage this condition.
You Can't Catch HIV
Personal trainers need to know they cannot be infected with the HIV virus by working with somebody who has HIV/AIDS. HIV has been in the public spotlight since the 1980s -so we know a lot about this. There has never been a recorded instance of a fitness trainer becoming infected while working with a client. Personal trainers also don't need to wear gloves or masks when they work with somebody infected with HIV.
Exercise Benefits People With HIV
Some people with HIV/AIDS may be afraid to exercise because they think it's bad for their immune system. As a rule, it's just the opposite. While exercise can have both positive and negative effects on immunity, the negative effects only start to occur when exercise is exhaustive. For example, running a marathon.
If you do too much activity, immunity tends to go down. But, if you keep the intensity so that it is not exhausting, this can actually boost the immune system, making it more effective. This is even true in older adults with the virus too.
Research also suggests resistance training can improve the concentration of CD4 cells (immune system cells that decrease with HIV/AIDS).
Both aerobic exercise as well as strength training have been shown to improve muscle endurance and cardiovascular endurance, VO2max 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.
In reality however it is only hard core types of exercise – like running a marathon – that might be detrimental to the immune system and contribute to over-training syndrome. The good news is 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/AIDS.
Speaking of over training syndrome, one way to keep tabs on this is to record resting heart rate each week. Remember, over training syndrome is associated with an increase in resting heart rate. So, if the personal trainer notices RHR 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.
Exercise HIV Benefits Summary
Here is a quick overview of some of the major benefits regular exercise has with HIV infection
|Improved muscle strength||Less sarcopenia|
|Improved muscle endurance||Better mental outlook|
|Improved VO2max||Better ability to do daily activities|
|Improved Immunity||Less disability|
|Higher CD4 count||Better energy levels|
Exercise Guidelines For HIV
OK, so your a fitness trainer and you have a client who has HIV. What should you do? Here are some suggestions. If you have a question, leave a comment below and I'll address you personally.
Call me Mr. conservative but I feel clients with HIV should have medical clearance from his/her physician before starting an exercise program. I believe this is wise for all new clients who have health issues, not just HIV. One thing you might do is write a short note to the persons doctor. Your client can present this to the physician at their next appointment.
In the letter, give the doctor an idea of the types of exercises you will be doing. For example, you might state your goals are to gradually improve muscle endurance, strength and flexibility to help improve quality of life. Telling the doctor what your workouts will be like is important because the doctor may give you feedback (do this/don't do that) on what she/he recommends for their patient.
The letter should also include your name, cell phone number, email 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.
Now, lets take a brief look at the aerobic and strength training guidelines.
Aerobic Exercise Guidelines
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 the person can only do 1 day of exercise in the beginning, this is OK. One day is better than none! If the person can only do 20 minutes (or less) of exercise, that's fine too. Our goal as fitness trainers is to meet them where they are on the fitness continuum and gradully progress them as their fitness levels improve.
If possible, eventually aim for 3-4 days per week for at least 30-60 minutes per session. I know target heart rate is popular with trainers and if you do this, ACSM guidelines suggest using the Karvoneon formula and aiming for an intensity of 40%-60%. Personally, I prefer the RPE scale (Borg Scale) when working with people. If you using a zero to 10 scale, aim for an RPE of 2-4, which is light to moderate intensity.
Strength Training Guidelines
There are no official strength training guidelines for HIV infection. If working with people who have very low strength, then isometric (static) exercises may be used until the person is able to perform dynamic (isotonic) strength training. Generally though, most people will not require isometric exercise.
Strength training guidelines for someone with HIV/AIDS is really no different than anyone else. Here's a summary:
- While I suggest starting with only 1-2 days per week to reduce muscle soreness and help them ease into exercise, the general guidelines call for 2-3 days per week.
- When creating exercise programs, the ACSM recommends 10-12 different exercises but it can be fewer than this depending on the individuals fitness level and time they can devote to exercise. If you are perform strength testing, its recommended to use about 60% of 1RM. This should allow the person to perform 8-10 reps.
- I'm not a fan of doing 1RM strength testing in beginners. It requires the person to lift a LOT of weight. If you are going to perform baseline strength testing, I'd suggest going lighter and determining 10RM resistances and then using a percentage of that. I think its safer. Also remember, strength testing can result in muscle soreness which may be significant.
- When progressing someone, I feel it's better/safer to increase the reps they can do before increasing the weight or sets. This will focus on muscle endurance. Strength will also be improved but the goal for beginners is to give their ligaments and tendons time to adapt to exercise. This can reduce injuries to ligaments and tendons.
- Some evidence suggests HIV meds may increase the risk of plantar fasciitis. This makes me wonder if other tendon or ligament issues might be more common in those with HIV infection?
- When you do increase the resistances, I feel adding 2.5-10 pounds for upper body exercises and 10-20 pounds for lower body exercises is safe for most people.
While I feel circuit training is one of the most efficient ways to train people, clients who are more advanced may prefer to do more than exercise per body part. For those who are less advanced, circuit training, using 1 exercise per body part has many advantages. Research shows circuit training will
- improve muscle strength
- improve muscle power
- improve muscle endurance
- improve aerobic endurance
- improve flexibility
- keep muscle soreness to a minimum
- isn't boring
- is very time efficient
HIV And Rhabdomyolysis
One other benefit of circuit training is I also believe it can also reduce the the risk of rhabdomyolysis too. I believe rhabdo should be considered by personal training because it can accompany HIV infection. If you are not familiar with what rhabdomyolysis is, I direct you to these other posts where I discuss it in more detail
- Rhabdo and Personal Training
- Reasons Rhabdo Is Occurring in Fitness Centers
- Is it Muscle Sorness or Rhabdo
Can Spinning Classes Cause Rhabdo?
- Can You Have a Mild Case Of Rhabdo?
- Can Rhabdo Kill You?
As you can tell, I have a lot to say about this topic. That's because I wrote the first book on rhabdo and exercise.
Minimizing Infection In Fitness Centers
It should be no surprise that gyms can be breeding grounds for microbes. For someone with HIV, this is important to know about and take steps to reduce. In one investigation, researchers found disease causing Staphylococcus and even Salmonella in fitness centers!
Because of the risk of gym-related infections, the personal trainer should wipe down gym equipment with a disinfectant before it is used. This includes
- elliptical handles / consoles
- treadmill handles / consoles
- gym mats
- barbells and dumbbells
If showering in the gym, wear sandals so feel don't come in contact with shower facilities. Obviously hand-washing with soap after workouts should be high on the priority list. While getting an infection at the gym cant be completely prevented, steps like these will reduce it from happening.
While most gyms have disinfectant sprays and wipes to sterilize equipment after use, whether gym members actually use the disinfectants is another story. When it comes to disinfectant sprays, I sometimes wonder if they are diluted to save money. If this sounds like I'm being paranoid, I can tell you some gyms dilute the soap in restrooms. If soap is being diluted, then what is too?
Supplements And HIV
It's possible clients may ask you about dietary supplements. While someone with HIV may be taking a variety of supplements such as those to boost immunity and increase antioxidant status, trainers need to know that supplement recommendations are outside outside the boundaries of what they do. Fitness trainers make exercise programs -not recommend dietary supplements.
One supplement which you may be asked about are black seeds. In some circles black seeds (also called black cumin) are rumored to cure HIV infection. To be clear, I highly doubt black seeds cure HIV. I have looked at the research and while there is a report of them clearing HIV infection, it seems to be an isolated case.
Here's my video review of black seeds and HIV infection
See my SupplementClarity.com site for more on supplements. I've been investigating supplements since the 1990s.
How To Find A Personal Trainer
OK, now let me switch gears and speak directly to those who have HIV. How can you choose a personal trainer who is best able to help you? It's good to know that not all fitness trainers are equally educated when it comes to HIV. Some trainers may specialize in helping people with health issues while others may tend to focus on injury rehab, pregnancy or other aspects of fitness. To help you find a trainer who is best suited for you, here are some questions to ask them:
- How long have you been training?
- Have you ever worked with an HIV client before?
- Do you specialize in any particular area of fitness training?
- Who are you certified by? Tip: don't accept the letters of the organization (NASM, ACE, AAAI etc). Make them tell you what the letters mean. If they can't tell you in 1 second what the letters stand for, don't hire them. This is my “1 question litmus test” for hiring trainers.
- Can you tell me how exercise effects the immune system (they should be able to tell you how it can increase AND decrease immunity based on intensity)
- Ive never worked out before, what do you think is the best program for me (the answer should be circuit training).
- What can you tell me about rhabdomyolysis (rhabdo). to be fair, this question will stump most trainers. I say ask it anyway.
If you workout at a gym and are considering hiring a fitness trainer at the facility, make sure the person is certified. Some gyms hire unqualified people. Also, don't assume the fitness director at the gym is certified either. See my Gym Scams Review for more on this.
Fitness Training People With HIV
Hopefully this review is of help to personal trainers as well as those with HIV who are looking for help improving their fitness levels. For the trainers reading this, I also hope I was able to ease some of your apprehensions too. Remember, being a personal trainer is a calling. Helping people with health issues -any health issue – is one of the best things about being a personal trainer. You really can make a big difference in the lives of others.