Clinical Autonomic Research

, Volume 17, Issue 6, pp 341–348

Exercise training improves cardiovascular and autonomic profiles in HIV

  • David K. Spierer
  • Ronald E. DeMeersman
  • Jay Kleinfeld
  • Eugene McPherson
  • Robert E. Fullilove
  • Augusta Alba
  • Adrienne S. Zion
RESEARCH ARTICLE

Abstract

Objectives

Human immunodeficiency virus (HIV) is associated with cardiovascular (CV) and autonomic dysfunction, however the effects of fitness on vascular and autonomic mechanisms in HIV disease are unknown.

Methods

We studied forty-eight subjects (40.4 ± 4.2 years) in a cross-sectional design matched for age, gender, BMI, and fitness. Participants were assigned to 1 in 4 groups: 1) Healthy Unfit (HU), 2) Healthy Fit (HF), 3) HIV Positive Unfit (HPU), and 4) HIV Positive Fit (HPF). Fitness was assessed via open-circuit spirometry; arterial compliance and autonomic modulations were measured via applanation tonometry and power spectral analysis, respectively, and baroreflex sensitivity was obtained using the alpha index.

Results

Arterial compliance was augmented in HPF vs. HPU [7.4 ± 1.9 mmHg × second vs. 4.4 ± 1.7 mmHg × second (P = 0.006)]. Parasympathetic modulation was higher in HPF vs. HPU [2244.5 ± 2997.6 msecond2 vs. 489.1 ± 552.9 msecond2 (P < 0.05)]. Sympathetic modulation was lower in HPF vs. HU [4.7 ± 5.0 mmHg2 vs. 12.9 ± 9.7 mmHg2 (P < 0.05)]. Baroreflex sensitivity was higher in HPF vs. HPU [17.3 ± 10.2 msecond/mmHg vs. 7.4 ± 3.8 msecond/mmHg (P = 0.003)], and HPF vs. HU [17.3 ± 10.2 msecond/mmHg vs. 6.2 ± 3.0 msecond/mmHg (P = 0.004)].

Conclusions

Augmentations in arterial compliance and baroreflex sensitivity associated with fitness portent an improved CV and autonomic profile for HIV-positive individuals. Physical activity may be an adjuvant method to enhance the overall vascular health in HIV-compromised individuals.

Key words

immunodeficiency HIV exercise fitness baroreflex autonomic nervous system 

References

  1. 1.
    Akselrod S, et al. (1981) Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat to beat cardiovascular control. Science 213:220–222.PubMedCrossRefGoogle Scholar
  2. 2.
    Avolio A, Chen S, Wang R, Zhang C, Li M, O’Rourke M, et al. (1983) Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community. Circulation 68:50–58.PubMedGoogle Scholar
  3. 3.
    Bigger J, Fleiss J, Steinman R, Rolintzky L, Kleiger R, Rottman JN, et al. (1992) Frequency domain measures of heart period variability and mortality after myocardial infarction. Circulation 85:164–171.PubMedGoogle Scholar
  4. 4.
    Billman GE, Schwartz PJ, Stone HL (1982) Barroreceptor control of heart rate: a predictor of sudden cardiac death. Circulation 66:874–879.PubMedGoogle Scholar
  5. 5.
    Billman G, Schwartz P, Stone L, et al. (1984) The effects of daily exercise on susceptibility to sudden cardiac death. Ciculation 69:1182–1189.Google Scholar
  6. 6.
    Bloomfield P (1976) Fourier analysis of time series: an introduction. John Wiley Publishing, New York.Google Scholar
  7. 7.
    Bonaduce D, Petretta M, Betocchi S, Lanniciello A, Marciano F, Apicella C, et al. (1997) Heart rate variability in patients with hypertrophic cardiomyopathy: association with clinical and echocardiographic features. Am Heart J 134:165–172.PubMedCrossRefGoogle Scholar
  8. 8.
    Brownley K, Milanovich J, Motivala S, Schneiderman N, Fillion L, Graves JA, et al. (2001) Autonomic and cardiovascular function in HIV spectrum disease: early indications of cardiac pathophysiology. Clin Auton Res 11:319–326.PubMedCrossRefGoogle Scholar
  9. 9.
    Cerati D, Schwartz PJ (1991) Single cardiac vagal fiber activity, acute myocardial ischemia, and risk for sudden death. Circ Res 69:1389–1401.PubMedGoogle Scholar
  10. 10.
    Cheminot N, Gariepy J, Chironi G, et al. (2000) Diagnosis and determinants of sub-clinical arterial disease in HIV-1 infected patients on HAART. In: 7th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA.Google Scholar
  11. 11.
    Cohen J, Laudenslager M (1989) Autonomic nervous system involvement in patients with HIV infection. Neurology 39:1111–1112.PubMedGoogle Scholar
  12. 12.
    Cohn J, Finkelstein S, McVeigh G, Morgan D, Le May L, et al. (1995) Noninvasive pulse wave analysis for the early detection of vascular disease. Hypertension 26:503–508.PubMedGoogle Scholar
  13. 13.
    Cupps T, Fauci A (1982) Corticosteroid-mediated immmunoregulation in man. Immunol Rev 65:133–155.PubMedCrossRefGoogle Scholar
  14. 14.
    Davey K, Miniciler N, Taylor A, et al. (1996) Elevated heart rate variability in physically active postmenopausal women: a cardioprotective effect? Am J Physiol 271:H455–H460.Google Scholar
  15. 15.
    De Castro S, et al. (1992) Heart involvement in AIDS: a prospective study during various stages of the disease. Eur Heart J 11:1452–1459.Google Scholar
  16. 16.
    DeMeersman R (1989) New noninvasive computerized method for the area measurement of the dicrotic notch. Comp Biol Med 9:189–195.CrossRefGoogle Scholar
  17. 17.
    DeMeersman R (1992) Respiratory sinus arrhythmia alteration following training in endurance athletes. Eur J Appl Physiol 64:434–436.CrossRefGoogle Scholar
  18. 18.
    DeMeersman R (1993) Heart rate variability and aerobic fitness. Am Heart J 125:726–731.CrossRefGoogle Scholar
  19. 19.
    De Souza C, Shapiro L, Clevenger C, et al. (2000) Regular aerobic exercise prevents/restores the age related decline in endothelium-dependent vasodilation in healthy men. Circulation 102:1351–1357.Google Scholar
  20. 20.
    Dixon E, Kamath M, McCartney N, et al. (1992) Neural regulation of heart rate variability in endurance athletes and sedentary controls. Cardiovasc Res 26:713–719.PubMedGoogle Scholar
  21. 21.
    Farrell T, Paul V, Crippe T, Malik M, et al. (1991) Baroreflex sensitivity and electrophysiological correlates in patients after acute myocardial infarction. Circulation 83:945–952.PubMedGoogle Scholar
  22. 22.
    Freeman R (1997) Autonomic failure and AIDS. In: Low PA (ed) Clinical autonomic disorders, 2nd edn. Lippincott-Raven, Philadelphia, pp 727–735.Google Scholar
  23. 23.
    Freeman R, Roberts M, Friedman L, Broadbridge C, et al. (1990) Autonomic function and human immunodeficiency virus infection. Neurology 40(4):575–580.PubMedGoogle Scholar
  24. 24.
    Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. (1997) ACC/AHA guidelines for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 30(1):260–311.PubMedCrossRefGoogle Scholar
  25. 25.
    Goldsmith RL, Bigger JT, Steinman RC, et al. (1992) Comparison of 24-hour parasympathetic activity in endurance-trained and untrained young men. J Am Coll Cardiol 20:552–558.PubMedCrossRefGoogle Scholar
  26. 26.
    Goldsmith R, Bigger J, Bloomfield D, Steinmann R, et al. (1997) Physical fitness as a determinant of vagal modualtion. Med Sci Sports Exerc 29(6):812–817.PubMedGoogle Scholar
  27. 27.
    Hoffman C, Jaeger H (2001) Cardiology and AIDS: HAART and the consequences Ann NY Acad Sci 946:130–144.CrossRefGoogle Scholar
  28. 28.
    Ironson G, Friedman A, Klimas N, et al. (1994) Distress, denial, and low adherence to behavioral interventions predict faster disease progression in gay men infected with human immunodeficiency virus. Int J Behav Med 1:90–105.PubMedCrossRefGoogle Scholar
  29. 29.
    Johnson J, Anders G, Blanton H, et al. (1990) Exercise dysfunction in patients seropositive for the human immunodeficiency virus-1. Am Rev Respir Dis 141:618–622.PubMedGoogle Scholar
  30. 30.
    Kelleher T, Cross A, Dunkle L (1999) Relation of peripheral neuropathy to HIV treatment in four randomized clinical trials including didanosine. Clin Ther 21:1182–1192.PubMedCrossRefGoogle Scholar
  31. 31.
    Kleiger RE, Miller JP, Bigger JT, Moss AJ (1987) Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 59:256–262.PubMedCrossRefGoogle Scholar
  32. 32.
    La Rovere MT, Bigger JT, Marcus Fl, Mortara A, Schwartz PJ, et al. (1998) Baroreflex sensitivity and heart period variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet 14:478–484.CrossRefGoogle Scholar
  33. 33.
    Laperriere A, Klimas N, Fletcher MA, et al. (1997) Change in CD4+ cell ennumeration following aerobic exercise in HIV disease: possible mechanisms and practical applications. Int J Sports Med 18:S56–S61.PubMedCrossRefGoogle Scholar
  34. 34.
    Lenormand-Welckenaer C, Cazaubon M, Joly V, et al. (2000) Carotid intima media thickness in protease inhibitors-treated HIV-1 infected patients with hyperlipidemia. In: 40th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, Ontario.Google Scholar
  35. 35.
    Liang Y, Teede H, Kotsopoulos D, et al. (1998) Non-invasive measurements of arterial structure and function: repeatability, interrelationships, and trial sample size. Clin Sci 95:669–679.PubMedCrossRefGoogle Scholar
  36. 36.
    Milei J, Grana D, Alonso GF, Matturi L, et al. (1998) Cardiac involvement in the acquired immune deficiency syndrome—a review to push action. Committee for the Study of Cardiac Involvement in AIDS. Clin Cardiol 21:465–472.PubMedGoogle Scholar
  37. 37.
    Monahan KD, Dinenno FA, Tanaka H, et al. (2000) Regular aerobic exercise modulates age-associated declines in cardiovagal baroreflex sensitivity in healthy men. J Physiol 529(pt1):263–271.PubMedCrossRefGoogle Scholar
  38. 38.
    Monahan KD, Tanaka H, Dinenno FA, Seals DR (2001) Central arterial compliance is associated with age- and habitual exercise-related differences in cardiovagal barroreflex sensitivity. Circulation 104:1627–1632.PubMedCrossRefGoogle Scholar
  39. 39.
    Morris JN, Everett MG, Pollard R, Chave SPW, AMS (1980) Vigorous exercise in leisure time: protection against coronary heart disease. Lancet 2:1207–1210.PubMedCrossRefGoogle Scholar
  40. 40.
    Nichols WW, O’Rourke MF (1998) McDonald’s blood flow in arteries, 4th edn. Arnold, London.Google Scholar
  41. 41.
    Nolan J, Flapan AD, Capewell S, MacDonald TM, Neilson JM, Ewing DJ, et al. (1992) Decreased cardiac sympathetic activity in chronic heart failure. Br Heart J 67:482–485.PubMedCrossRefGoogle Scholar
  42. 42.
    Paffenbarger RS Jr, Blair SN, Lee IM, Hyde RT (1993) Measurement of physical activity to assess health effects in free-living populations. Med Sci Sports Exerc 25:60–70.PubMedCrossRefGoogle Scholar
  43. 43.
    Paton P, Tabib A, Loire R, Tete R (1993) Coronary artery lesions and human immunodeficiency virus infection. Res Virol 144(3):225–231.PubMedCrossRefGoogle Scholar
  44. 44.
    Perna FM, Laperriere NG, Klimas N, et al. (1999) Cardiopulmonary and CD4 changes in response to exercise training in early symptomatic HIV infection. Med Sci Sports Exerc 31:973–979.PubMedCrossRefGoogle Scholar
  45. 45.
    Pothoff G, Wasserman K, Ostmann H (1994) Impairment of exercise capacity in various groups of HIV-infected patients. Respiration 61:80–85.PubMedCrossRefGoogle Scholar
  46. 46.
    Raab W, Silva PP, Machet H, Kimura E, YK S (1960) Cardiac adrenergic preponderence due to lack of physical exercise and its pathogenic complications Am J Cardiol 5:300–320.Google Scholar
  47. 47.
    Rogstad KE, Shah R, Tesfaladet G, Abdullah M, Ahmed-Jushuf I, et al. (1999) Cardiovascular autonomic neuropathy in HIV infected patients. Sex Transm Infect 75(4):264–267.PubMedGoogle Scholar
  48. 48.
    Sakhuja A, Goyal A, Jaryal AK, Wig N, Vajpayee M, Kumar A, et al. (2007) Heart rate variability and autonomic function tests in HIV positive individuals in India. Clin Auton Res 17:193–196.PubMedCrossRefGoogle Scholar
  49. 49.
    Saul JP, Yutaka A, Berger RD, Lilly LS, Colucci WS, Cohen RJ, et al. (1988) Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. Am J Cardiol 61:1292–1299.PubMedCrossRefGoogle Scholar
  50. 50.
    Seals DR (2003) Habitual exercise and the age-associated decline in larger artery compliance. Med Sci Sports Exerc 31(2):68–72.Google Scholar
  51. 51.
    Seals DR, Chase PB (1989) Influence on physical training on heart rate variability and barroreceptor circulatory control. J Appl Physiol 66:1886–1895.PubMedCrossRefGoogle Scholar
  52. 52.
    Shi X, Walter DW, Formes KJ, et al. (2000) Orthostatic hypotension in aging humans. Am J Physiol 279:H1548–H1554.Google Scholar
  53. 53.
    Stringer WW, Berezovskaya M, O’brien WA, Beck CK, Casburi R, et al. (1998) The effect of exercise training on aerobic fitness, immune idices, and quality of life in HIV+ patients. Med Sci Sports Exerc 30:11–16.PubMedGoogle Scholar
  54. 54.
    TaskForce of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use Circulation 93(5):1043–1065.Google Scholar
  55. 55.
    The different stages of HIV infection. Avert 2002 June 26.Google Scholar
  56. 56.
    Thomas D, Zimmerman S, Hansen T, et al. (2000) Collagen gene expression in rat left ventricle: interactive effect of age and exercise training. J Appl Physiol 89:1462–1468.PubMedGoogle Scholar
  57. 57.
    Villa A, Foresti V, Confalonieri F (1987) Autonomic neuropathy and HIV infection. Lancet 1:915.CrossRefGoogle Scholar
  58. 58.
    Watt TB, Burrus C (1976) Arterial pressure contour analysis for estimating human vascular properties. J Appl Physiol 40:171–176.PubMedGoogle Scholar
  59. 59.
    Whiteside TL, Herberman RB (1989) Short analytical review. The role of natural killer cells in human diseases. Clin Immunol Immunopathol 53:1–23.PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2007

Authors and Affiliations

  • David K. Spierer
    • 1
    • 2
  • Ronald E. DeMeersman
    • 3
  • Jay Kleinfeld
    • 1
  • Eugene McPherson
    • 1
  • Robert E. Fullilove
    • 4
  • Augusta Alba
    • 1
  • Adrienne S. Zion
    • 5
  1. 1.Coler Goldwater Specialty Hospital and Nursing FacilityRoosevelt IslandUSA
  2. 2.Division of Sports Sciences, School of Health ProfessionsLong Island University, Brooklyn CampusBrooklynUSA
  3. 3.Dept. of Rehabilitation MedicineCollege of Physicians & SurgeonsNew YorkUSA
  4. 4.Mailman School of Public HealthColumbia UniversityNew YorkUSA
  5. 5.Teachers CollegeColumbia UniversityNew YorkUSA

Personalised recommendations