Bone mineral density loss can be a complication of having HIV. This means people living with HIV (PLHIVPerson (or people) Living with HIV. This term is now preferred over the older PLWHA.) are at a greater risk of experiencing a bone fracture. Bone loss has been associated with the duration of HIV infection, immune reconstitution on treatment, and treatment with specific anti-HIV drugs which may also affect bone metabolism.
Other interactions are also at play which affect bone fragility in PLHIV such as increasing age (where HIV may also increase the rate of ageing), low body mass index
BMI), smoking, diabetes[Diabetes mellitus] A disorder in which sugars in the diet cannot be metabolised into energy due to a lack of the enzyme insulin. Late-onset diabetes mellitus may be a long-term side effect of some anti-HIV drugs., hepatitis C co-infection, alcohol and substance use, low testosterone (in men) and estrogen levels (in women), low vitamin D levels, and (according to one study*) having ever had a CD4 count below 200.
Whilst the HIV treatment-related and other medical causes of bone loss are best left to discussion between you and your doctor, there are things you can do yourself to prevent bone loss and maintain bone density.
One of the biggest factors for improving bone density is exercise. It is also important to try to quit smoking, limit alcohol (to two drinks per day), eat nutritious foods and get 15 minutes of daily sun exposure to increase your vitamin D levels.
‘So how does exercise help my bones?’ Well, bone density (just like muscle tone) is not static or constant – bone is constantly being built-up and broken down in a cycle process called ‘bone turnover’. Weightbearing exercise and resistanceHIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. exercise put a mechanical stress on the bones to bring this cycle into greater balance. When more bone is being lost than can be built back up again — in conditions such as osteoporosis (porous bones) and osteopenia (thinning bones) — this type of exercise can greatly assist to improve bone density.
YOU DON’T HAVE TO GO TO THE GYM TO EXERCISE
There are many ways to provide weight and resistance during exercise right in your own home. It’s not necessary to do the heavy iron weights at the gym, especially when you are first starting out.
It’s not always the amount of weight that is important, it’s the degree of resistance.
Whilst lifting heavier weights improves and enhances bone health more than lifting light weights, lighter weights can be moved more rapidly, which is more stimulating to bone than slow movements.
Weights are but one way of providing resistance to create a tension or load upon your bones, but resistance can be achieved in all sorts of ways other than weights.
Water is a form of resistance (although not a strong resistance), so swimming or aqua-aerobics can have some bone-building benefits.
Increasing the amount of resistance will also increase the bone-building benefit.
This can be achieved by using paddles on the ankles and wrist during water-based exercise.
Cycling is another way to apply a resistance load onto bones, although similar principles apply to level of resistance and the benefits gained, e.g., rolling down hills won’t build your bones, but harder cycling up hills will. The more resistance applied, the greater the benefit.
Ankle and wrist lightweights and cuffs (available in most sports stores) can be strapped to your ankles and/or wrists, providing a weight resistance as you exercise. Whether you walk, run, cycle, hike or dance — or whatever you might do for exercise activity — ankle and wrist weights will assist bone health. The old phrase ‘take a weight off your feet’ doesn’t apply to bone health — but putting a weight on your feet does!
Many exercises that strengthen bone can be done at home on your own, or with a partner:
- Sit-ups — with knees bent to take the strain[HIV strain] Any subgroup of the HIV species. Because HIV mutates very easily, there are many different strains (and may be multiple strains within a single person). off your lower back — are an example.
To increase the amount of resistance and load, you can hold a small weight (such as a text book) folded into your arms (and resting on your chest) — this will not only eventually give you that ‘sixpack’ abdomen you’ve always wanted; it will strengthen your spine.
- Push-ups can also be done at home. Push-ups can be done at various angles from parallel to the floor (which is harder), to holding a high balcony rail with your body at an angle.
- Isometric exercises, involving pushing an immovable weight, also assists bone and can be done in the comfort of your own home using a wall or other solid and secure object.
Isometric benefit can also be gained by pushing one part of body against the other — such as clasping your hands together at your chest level and applying pressure in both directions not allowing either hand to move off centre. Hold for 5 seconds and release, take a break for 5-10 seconds and repeat.
Breathe throughout the exercise, don’t hold your breath as you push.
- A can of baked beans is not only nutritious protein for muscle building, but before you open it you can do 20 or 30 arm curls holding it in each hand, whilst at the kitchen sink!
You can increase this over time to heavier items. You can graduate to purchasing a set of dumbbells for home or you can join a gym and do a program of weight training — setting your own goals with the gym instructors, whether it be muscle toning, muscle strengthening or muscle building or just continuing to improve your bone health.
You don’t have to use heavy weights to build some muscle, since muscle can also be developed with lower weights and resistance exercises, especially muscle tone and shape (rather than muscle size).
- High-impact exercise has recently been shown to be particularly beneficial to bone health. In high impact exercise, the bones of the spine and legs incur high stresses as the feet hit the ground. This can include skipping with a rope, jumping or hopping (including up and down stairs and on and off boxes).
These exercises are highly suitable to do at home especially if you had a previous injury or have osteoarthritis of the knee or hips. Sports such as hurdling, high jumping and basketball, netball, volleyball, tennis, are more advanced forms of this type of highly beneficial exercise.
Remember: before any exercise it’s important to warm-up by doing gentle muscle stretching, especially during winter when the body is cold. The more rigorous your exercise regimen the more you need to warm-up before exertion during exercise. Otherwise you may tear a muscle or ligament.
It’s also important to warmdown after exercise and this is a similar process of gentle stretching. The warm-up should be about 10-15 minutes and can include running on the spot to get your heart rate up too. The warm-down should be about the same time period, maybe a little less, but decreasing in intensity until your body temperature and heart rate lowers back to normal again.
It’s important to get expert information and professional exercise advice and instruction from a trained fitness instructor or exercise specialist (including physiotherapists). However, as a start the following guidelines are generally recommended for exercise for bone health:
- Exercise 2 or 3 times per week, with at least one day of rest between sessions. Each session should take about 30-45 minutes. Exercising more frequently than this — and incorporating different forms of fitness and exercise — will have increasing and differential benefits to other areas of health and fitness such as cardiovascular (heart) health depending on the exercise type chosen.
- High-intensity/high-impact exercise such as jogging, jumping, skipping are more stimulating to bone than sustained, low impact activities such as walking or swimming. The higher the impact, the greater the benefit to bones.
- Exercise that involves changes in direction and different height jumps (such as AFL football, basketball, volleyball or squash) is more stimulating to bone than repetitive actions (such as running, swimming and cycling).
- Exercise has to get progressively harder to continue to improve bone health. This need only be within your limits, and it does not mean you have to do hard exercise nor that you won’t get bone health benefits if you don’t progress to harder exercise levels and intensity. For effective resistance training, use weights that feel hard to lift (requiring a reasonable, but not excessive, level of exertion). As soon as the weight for lifting two sets of eight repetitions no longer feels hard, move up to the next level and increase the weight.
- Exercise does not have to be weight-bearing to enhance bone health. Resistance training exercises done in the sitting, lying or standing position improve bone health (e.g., push-ups, squats or leg-raises). In these instances your body weight and gravity provide the resistance. If necessary you hold onto the back of a chair for support or use other props and inclines or declines (slant boards or benches) to support these exercises to make them harder or easier. Ask a professional how to do this if you’re not sure.
It’s also important to consult your doctor before starting an exercise program, just in case there are special reasons you should only do certain exercises or none at all, due to another current health complaint or issue.
A good song to listen to while you’re exercising is The
Delta Rhythm Boys’ “the hip bone’s connected to your
thigh bone, the thigh bone’s connected to your knee bone. . .”
Or pick your own music!
Young B et.al Increased rates of bone fracture among HIV infected persons in the HIV Outpatient Study (HOPS) compared with the US general population, 2000-2006. Clin Infect Dis 2011 April 15; 52:1061