EQOL Journal (2020) 12(1):
ORIGINAL ARTICLE
Lipid profile alterations following aerobic and resistance training programmes among HIV- seropositive female patients
Elvis I. Agbonlahor 1 ✉ • Oluwaseun Susan Kubeyinje 2
Received: 28th April, 2020 |
DOI: 10.31382/eqol.200602 |
Accepted: 3rd June, 2020 |
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© The Author(s) 2020. This article is published with open access. |
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Abstract
This study was designed to assess the changes in lipid profile of
The
The findings of this study revealed that short duration exercise training improved some of the components of the lipid profile (high density lipoprotein and triglycerides).
It was therefore concluded based on the findings
✉elvisagbon@yahoo.com
1University of Benin, Department of Human Kinetics and Sports Science, Benin City, Nigeria
2University of Benin, Department of Physiotherapy, Teaching Hospital, Benin City, Nigeria
of this study that health professionals should recommend exercise for female
Keywords HIV- seropositive • lipid profile • aerobic and resistance Training
Introduction
Exercise is generally regarded as safe because it does not compromise the immune function, and is beneficial in boosting functional capacity, strength, physical fitness, mood, and sense of wellbeing, and in ameliorating wasting and lipodystrophy (Bopp, Phillips, Fulk & Hand, 2003; Hand, Lyerly & Jaggers, 2009). Aerobic and resistance exercises have been shown to improve the quality of life and cardiovascular fitness. The prevalence of HIV/AIDS in Nigeria has recently reduced. However, the prevalence is higher in females across all age groups but more in young adults. The diverse immunosuppressive effect of HIV affects all systems of the human body; however, the advent of Highly Active Antiretroviral Therapy (HAART) has significantly reduced the progression of the infection to the stage of AIDS but not without its
attendant consequences such as HIV Lipodystrophy Syndrome (HIVLDS). HIVLDS is characterized by abnormal distribution of body fat (Terry, Sprinz, Stein, Medeiros, Oliveira & Ribeiro, 2006). The lipodystrophy alterations following the use of HAART have been documented by several authors to include lipoatrophy, mitochondrial toxicity, and reduction
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of the activity of oxidative enzymes. These could lead to impairment/deficiency in extraction and use of oxygen in the peripheral musculature, thereby greatly affecting physical fitness.
Despite all these negative sequelae of HIV infection and the use of HAART that impact on the physical functioning of affected individuals, HIV- seropositive patients are usually referred to physiotherapy units only at the end stage of the infection (AIDS) for palliative care. Due to these late referrals, most of the patients do not benefit from the preventive aspects of exercise. Exercise, when prescribed and monitored by exercise specialist is very beneficial in improving Quality of Life (QoL) of patients diagnosed with chronic diseases as well as helping to slow down the progress of such diseases. However, there is very few documented evidences of the effect of aerobics and resistance exercise in a special population such as
The HIV infects cells of the immune system, destroying or impairing their functions leading to progressive deterioration of the immune system called "immune deficiency". Presentations associated with chronic HIV infection that eventually lead to disability and mortality include muscle wasting, muscle weakness, fatigue, impaired functional work capacity, depression and decreased quality of life (Bopp, Phillips, Fulk & Hand, 2003), however the mortality rate of HIV - infected persons has greatly reduced since the advent of Highly Active Anti- Retroviral Therapy (HAART), thus making HIV/AIDS a chronic disease. This increase in the life- expectancy of People living with HIV/AIDS (PLWHA) has several negative metabolic, physiologic and morphologic changes that have an impact on their Quality of Life (QoL) as well as the
muscular strength, muscular endurance, cardiorespiratory endurance, and body composition. These adverse changes cut across the entire systems of the body and the common physical adverse effects include gastrointestinal tract (nausea, vomiting, and diarrhoea), integumentary system (rash, dry skin), metabolic processes (glucose, lipid alterations, and bone disease) and
&Bartholomew, 2004). Likewise, lipodystrophy is associated with physical and metabolic changes whereby the body is unable to produce and maintain healthy fat tissue with resultant alteration in body composition. This alteration in body composition results in accumulation and reduction of fat in some parts of the body. These morphological changes also
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augment alteration in lipid profile. Abnormality of serum lipid is common and showed female preponderance among
The following hypotheses were formulated to address the study:
1.There would be no significant difference in the trigycerides level of female HIV- seropositive patients prior to and following a
2.There would be no significant difference in the LDL level of female
3.There would be no significant difference in the HDL level of female
4.There would be no significant difference in the total cholesterol level of female HIV- seropositive patients prior to and following a
Method
The design for this study was the
Two hundred and seventy (276)
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patients met the inclusion criteria thus making the population for this study.
A total of sixty (60) participants were selected out of the entire female patients with
The inclusion criteria include:
Young and
Table 1. ACSM (2009) exercise training protocol
indicating positive (+ve); and who volunteered to participate in the study were recruited.
The sample included patients diagnosed to be in stages 1 and 2 of the CDC classification using the CD4 count and clinical symptoms.
Only sedentary (no involvement in a regular exercise program defined as two or more structured exercise sessions weekly for more than or equal to six months prior to enrolment) female adults living with HIV/AIDS participated in the study.
The instrument that was used is an adaptation of ACSM (2009) exercise training protocol. The training protocol was as follows:
Exercises |
Set, Repetition, Rest between sets |
Bicycle ergometer |
1*, - (60%HRmax) |
Dumbbells |
3*, 10 (60% 1RM), 30 seconds |
Ankle weight |
3*, 10 (60% 1RM), 30 seconds |
An ethical approval to conduct this study was received from the Research Ethics Committee of the University of Benin Teaching Hospital, Nigeria. Prior to the exercise programmes, a detailed explanation of the test, training programmes and; the objectives and intricacies of the study was provided to the participants and then the participants signed a participant’s informed consent form before participating in this study. Thereafter, the participants were made to undergo a
Physicians (Infectious disease specialist) at the PEPFAR clinic of the hospital screened the participants for eligibility based on the inclusion/exclusion criteria and conducted a physical examination on each participant. Each participant in addition to the screening and physical examination filled a Physical Activity Readiness Questionnaire
Medical laboratory scientists of the Department of Medical Laboratory Science of UBTH collected blood samples from the participants. The blood samples were collected with tripotassiumethylene diaminetetracetic acid (K3EDTA) bottles for analysis of full blood count and lipid profile of the participants. These evaluations were performed at baseline and after the 6th week of the exercise training by the same medical laboratory scientists in order to minimize error and ensure reliability. The blood samples were collected from the participants in the morning following an overnight fast of
This was carried out on a stationary bicycle ergometer for duration of 20 minutes at 60% of target heart rate due to the fact that individuals who are
Free weights in the form of dumbbells and ankle weights was used for upper and lower limbs’ strengthening using 60% of 10 Repetition Maximum (RM). RM is the heaviest weight that can be
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successfully lifted 10 times before fatiguing. Each exercise was done at the dosage of 3 sets of 10 repetitions with 30 seconds rest between each set. The session ended with a
Inferential statistics of analysis of variance (ANOVA) was used to test the hypotheses. Where there were significances, Tukey’s LSD
difference. Statistical significance was set as
Results
Table 2 presents the results for hypotheses 1 to 4 showing ANOVA analysis of the lipid profile of participants. It shows that the F ratio of HDL and triglycerides were significant (F=5.789, 4.127; p<0.05) while it was not significant for total cholesterol and LDL (F= 2.181, 0.981; p>0.05). Thus, the null hypotheses 1 and 3 were accepted while the null hypotheses 2 and 4 were rejected. LSD post hoc analysis was performed to ascertain where the significant differences occurred (Table 2).
Table 2. Differences between groups and multiple comparations
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Post- |
Pre- |
Post- |
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Experimentalb |
Controlc |
Controld |
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(n=25) |
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(n=25) |
(n=19) |
(n=19) |
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Variable |
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M±SD |
M±SD |
M±SD |
M±SD |
F |
p |
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Total Cholesterol |
209.52±52.61 |
184.04±37.90 |
175.74±47.25 |
180.89±58.11 |
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2.181 |
0.096 |
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HDL |
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67.68±16.35d |
58.84±18.14d |
56.42±14.65d |
43.68±26.05a,b,c |
5.789 |
0.001 |
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LDL |
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117.80±38.42 |
115.68±36.80 |
99.26±30.67 |
114.00±46.34 |
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0.981 |
0.406 |
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Triglycerides |
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115.24±47.27b,c,d |
92.68±36.02a |
80.36±34.68a |
82.47±25.21a |
4.127 |
0.009 |
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different from: a |
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Same table shows the Tukey’s LSD post hoc |
Discussion |
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analysis of the lipid profile of the control and |
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experimental |
groups prior to and |
after 6 |
weeks |
Changes in lipid profile of female |
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exercise training. It shows that the mean difference of |
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patients following six weeks of aerobic and resistance |
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HDL in |
the |
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exercise training was assessed |
in this |
study. The |
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groups |
and |
the |
versus |
post- |
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results of the study showed that exercise training did |
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experimental groups had significantly different mean |
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not affect total |
cholesterol and |
LDL significantly. |
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difference. Therefore, it was concluded that there was |
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However, there was statistically significant effect on |
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no significant effect of the |
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HDL and triglycerides. This agrees with Maduagwu |
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on the HDL of female |
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et al (2015) who reported significant improvement in |
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It also shows that the mean difference of |
the lipid profile of HIV infected persons following 12 |
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triglycerides was significantly different in the pre- |
weeks of aerobic training programme. Garcia et al |
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control versus |
(2014) also reported an increase in HDL cholesterol |
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experimental versus |
following combined exercise training. Terry et al |
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there was no significant difference in the mean |
(2006) however reported insignificant changes in |
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difference of triglycerides of |
triglycerides, total cholesterol and HDL after 12 |
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control groups and |
weeks of aerobic training. Tiozzo et al (2013) |
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experimental groups. Therefore, it was concluded that |
following their study believed that the insignificant |
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changes in the lipid profile of their participants after |
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altered the triglycerides of female |
12 weeks of training could be due to the fact that the |
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patients. |
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participants were not dyslipidaemic at baseline. That |
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is unlike this study in which the participants had |
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baseline dyslipidaemia. Therefore, the |
significant |
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EQOL Journal (2020) 12(1):
changes in lipid profile observed in this study could be due to baseline dyslipidaemia which is not unexpected in PLWHA whether they are on HAART or not. Changes in blood lipids is expected to occur naturally during the course of HIV infection resulting in early reduction in both total cholesterol and HDL cholesterol with subsequent reduction in triglycerides (Sellmeyer & Grunfeld, 1996). Thus, assessment of HIV infected person’s lipid profile is important because it has also been shown in some studies that intake of HAART results in increase in cholesterol (Denue et al., 2013). In fact, Denue and colleagues found that abnormality of serum lipid is common and showed female preponderance among treatment- naive HIV patients in Maiduguri. It has been observed that an HDL increase is associated with a significant decrease in mortality from coronary heart disease independent of changes in LDL (Denue et al., 2013).
Conclusion
Based on the results that elicited from this study, it was concluded that high density lipoprotein and triglycerides of female
Recommendations
It is therefore recommended that health care team should acknowledge the health benefits of exercise to HIV patients in order to improve their quality of life and appropriate recommendation/referrals should be made to exercise specialists such as human kinetics professionals and physiotherapists;
Also, exercise is safe when prescribed by qualified professionals and it improves several components of subjects health, they should include exercise in their routine care.
References
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(2003). Clinical implications of therapeutic exercise in
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Ciccolo, J.T., Jowers, E.M. & Bartholomew, J.B. (2004). The Benefits of Exercise Training for Quality of Life in HIV/AIDS in the
Denue, B.A., Alkali, M.B., Abjah, A.U., Kida, I.M., Ajayi, B. & Fate, B.Z. (2013). Changes in lipid profile and other biochemical parameters in
Garcia, A., Fraga, G.A., Vieira, R.C., Silva, C.M.S., Trombeta. J.C., Navalta, J.W., Prestes, J. & Voltarelli, F.A. (2014). Effect of combined exercise training on immunological, physical and biochemical parameters in individuals with HIV/AIDS. Journal of Sports Sciences, 32(8),
Hand, G.A., Lyerly, G.W. & Jaggers, J.R. (2009). Impact of aerobic and resistance exercise on the health of HIV infected persons. American Journal of Lifestyle Medicine. 3,
Maduagwu, S.M., Kaidal, A., Gashau, W., Balami, A., Ojiakor, A.C., Denue, B.A. & Kida, I. (2015). Effect of Aerobic Exercise on CD4 Cell Count and Lipid Profile of HIV Infected Persons in North Eastern Nigeria. Journal of AIDS Clinical Research. 6,508.
Sellmeyer, D.E. & Grunfeld, C. (1996). Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocrine Review, 17(5),
Terry, L., Sprinz, E., Stein, R., Medeiros, N.B., Oliveira, J. &Ribeiro, J.P. (2006). Exercise training in
Tiozzo, E., Jayaweera, D., Rodriguez, A., Konefal, J., Melillo, A.B., Dawn, S. et al. (2013).
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How to cite this article:
Agbonlahor, E., & Kubeyinj, O. S. (2020). Lipid profile alterations following aerobic and resistance training programmes among HIV- seropositive female
APA:patients. Exercise and Quality of Life, 12(1),
Agbonlahor, Elvis I. and Oluwaseun Susan Kubeyinj. "Lipid profile alterations following aerobic and resistance training programmes among HIV-
MLA:seropositive female patients." Exercise and Quality of Life 12.1 (2020): 15- 20.
Agbonlahor, Elvis I., and Oluwaseun Susan Kubeyinj. "Lipid profile alterations following aerobic and resistance training programmes among HIV-
Chicago:seropositive female patients." Exercise and Quality of Life 12, no. 1 (2020):
20