HIV Fitness Basics: Do This Before You Hit The Gym

red ribbon in front of HIV pic

( — Living with HIV is a multifaceted challenge. No two people living with HIV are exactly the same. However, four treatment factors are usually consistent from one person to the next. These factors are to eat right, get plenty of sleep, manage your stress levels, and get some exercise, which can play a role in controlling some of your long-term side
effects such as altered body composition and elevated elevated
cholesterol, triglycerides, and blood glucose.

However, very few health professionals know what recommendations to make regarding exercise. Exercise and HIV is not as simple as telling you to “just workout.” On top of that, the thought of exercise may make you cringe with memories of high school gym class, not to mention the fatigue you may experience on a daily basis.

Exercise may come easily to people who have always exercised or participated in sports. But if you have never exercised regularly, exercise may seem like learning a new language. In an ideal world you could hire a fitness professional who works with people with HIV to design a program that is perfect for you. However, not all fitness professionals know about the special needs of someone with HIV or you may not be able to afford one.


Before starting any exercise program, consult with your physician to see if he or she has wants to set any limitations on your activities. It is also important to be in touch with and listen to your body. When you really are not feeling good you should not exercise, but you need to figure out what is just general malaise and what is a more serious fatigue or illness. The general rule of thumb is that if you are feverish, dizzy, have swollen joints, pain in your feet or hands, vomiting, diarrhea, open sores, bleeding gums, or blood in the urine or stool, do not exercise. If you are experiencing neuropathy, you should consult your physician about any exercise restrictions. Otherwise listen to your body. If you get overly tired in the middle of a workout, it is time to stop. Be flexible and be patient with your body and your workout.

Set Some Fitness Goals. You should set some goals. These goals should be realistic, measurable and attainable. You can base some of these goals on simple measurements you can take before starting your program, including weight, Body Mass Index (BMI), and circumference measurements of your arms, legs, chest, stomach, and hips. You can also base goals on body composition if you have access to someone who can measure it for you, ideally using bioelectrical impedance, but if that is not available, then skinfold calipers are also acceptable. If you are new to exercise, you may want to set simple goals such as walking for 5, 10, or 20 minutes every day and doing some form of strength training 1 or 2 times per week.

How To Get Started. Once you have seen your doctor and set goals, it is time to get started. If you have been exercising, that’s great. Keep it up, and whatever you do, try not to stop exercising. If you are new to exercise, start slowly. Your body needs time to adjust to the new stresses you are putting on it, not to mention all the stress already on your body. It is also important when exercising to keep your body well hydrated. You should drink water before, during, and after your workouts as well as trying to average eight 8-ounce glasses of water (or non-caffeinated/non-carbonated beverages) per day.

Resistance Training

Resistance training is probably the most important part of fitness for the person living with HIV. Strength training can help you add muscle mass or enhance the muscle mass you already have. Muscle mass is important because of the role muscle and the proteins in muscle play in your body’s immune system. Muscle wasting is a big problem with HIV, and as the muscles waste they lose their function. If you have experienced or are currently experiencing muscle wasting, then resistance training can help slow down or reverse this wasting as well as improve muscle function. Your goal with resistance training is to increase the size of the muscle fibers all over the body. Your goals are not to increase endurance or strength.

Resistance training is moving a force. It can take a variety of forms, the most common being weight lifting. Resistance training can include weight training (with free weights or machines), rubber tubing, body weight (including yoga and T’ai Chi), or a variety of home-made objects. You can use soup cans, filled milk jugs, or any number of objects. Be creative!

Ideally, your resistance training program should take place 3 or 4 days per week (every other day). You should include 10 to 12 major muscles or muscle groups in your workouts. You should lift comfortable weight or resistance 8 to 12 repetitions for 2 or 3 sets. A repetition or rep is a single contraction of the muscle through its full range of motion. A set is a predetermined number of repetitions. You should never do an exercise to exhaustion. Rest at least 45 to 60 seconds between sets. If you are new to resistance training you may need to start with one day per week doing one set of 8 to 12 repetitions for the first couple of weeks and gradually increase the number of sets to 2 or 3 as your body adjusts to the workout.

Muscle groups that should be worked include the chest (pectoralis major and minor), the back (latissimus dorsi, the rhomboids, and the lower trapezius), the shoulders (deltoids and upper trapezius), the arms (biceps and triceps), the legs (the quadriceps, hamstrings, gluteals, calves, and tibialis anterior), the abdominals and the erector spinae muscles of the neck and back.

Cardiovascular Training

Cardio (or aerobic) training involves activities of moderate intensity that use the major muscle groups for an extended period of time (12 minutes or more). These activities can include walking, running, swimming laps, bicycling, and aerobic dance to name a few. When choosing cardiovascular exercise, select an activity you can do easily and you will enjoy.

When including cardiovascular training in your workout regimen it is extremely important to avoid over-training. Cardiovascular training improves overall health by helping to control blood pressure, blood sugar, blood lipids, and stress, but over-training can have negative effects on the person with HIV, such as the loss of lean body mass (muscle) and suppression of immune responses. Interestingly enough, the signs of over-training are similar to the worsening of HIV disease. Signs of over-training include decreased ability to exercise, changes in mood, general fatigue, depression, irritability, sore muscles, over-use injuries, elevated resting heart rate, weight loss, insomnia, and increased susceptibility to upper respiratory infections and gastrointestinal disturbances. Since it is difficult to tell the difference between over-training and worsening HIV disease, you should take some time off from working out. If in a few days you do not start to feel better, it is time to call your physician. When recovering from a secondary infection you may want to take some time off from the cardiovascular training, but continue with the resistance training.

When training on a treadmill be very careful if you have developed any balance problems. If you have few limitations and want to be challenged, the stair climbers, elliptical trainers, or group exercise classes can add variety and fun to your workouts, as well as a challenge. If you enjoy exercising outside continue to work out outside as much as possible, but monitor pollution levels, pollen levels, and other allergens in the air in your area. You may also want to take note of where the restrooms are on your route and carry water so you do not become dehydrated.

If you are accustomed to doing cardiovascular training, by all means continue doing so. If you are new to it, start slow, especially if your CD4 T-cell count is less than 500 cells/mL. Slow means one or more times per week, for as long as you can tolerate (sometimes only 5 to 10 minutes), then progressing as comfort permits. Walking and stationary cycling are generally the easiest forms of cardiovascular exercise, but set your own pace. Pay attention to your body. If you start to get short of breath or hurt somewhere, stop what you are doing immediately. You can also monitor your intensity by using “perceived exertion.” There are several scales of “perceived exertion” — The Borg Scale (1-20) is used with cardiac rehab patients while the “simple scale” is used with many other populations. The “simple scale” is a scale of 1 – 2 – 3 (1 = easy, 2 = moderate, 3 = difficult).

Recommendations for your cardiovascular exercise program vary depending on your overall health and your CD4 count. Again, these are general recommendations and you should confer with your physician on an individual basis before undertaking new exercise programs.

Asymptomatic Person with HIV (CD4 count over 500 cells/mL) — You might start working out 2 or 3 times per week for 20 to 30 minutes at the easy level. Over the next several weeks, consider increase the time up to 30 minutes but probably not over 60 minutes per session for up to five times per week, working mostly in the moderate range but every so often going into the difficult range (not staying there for long).

Symptomatic Person with HIV (CD4 count ranging from 200-500 cells/mL) — You might start off working out up to three times per week in the easy range for 15 to 20 minutes or as tolerated. Some days you may be able to go longer and other days you may not. As you get stronger, you may be able to gradually move up into the moderate range for as long as 40 minutes per session up to four times per week. Monitor yourself and do not overtrain. If you are overly fatigued or exhausted, take a couple of days off to recover. Then start exercising again at a slightly lower intensity.

Persons living with AIDS (CD4 <200 cells/mL) — You will want to begin very gently. You might workout up to 15 to 20 minutes, up to three times per week as tolerated. You should progress cautiously over the next several weeks up into the moderate range for 20 to 30 minutes 3 times per week at the most. The rule of thumb here is to do what you can do but do not overdo it. Be aware of your fatigue and exhaustion level and stop before you reach critical.