This condition is a suppression of the immune system from a progressive loss of cell-mediated and humoral immunity. The condition begins with the infection by the human immunodeficiency retrovirus (HIV) leading to the loss of T4-cell lymphocytes. A state of immunodeficiency results in clients being susceptible to infections, cancers, and other conditions. Clients will be on highly active antiretroviral therapies to suppress the effects of the HIV. Clients may have fatigue from secondary infections and other conditions that limit their daily activities, thus leading to deconditioning.1,2 The implementation of a prescribed exercise program will reverse the effects of deconditioning without adversely affecting the clients' immune deficiency.3
Comorbidities to Consider
Keys to Examination of Clients
Ask the clients about their current level of lymphocytes; a CD4 lymphocyte count below 500/mm3 indicates immune deficiency.
Discuss with the clients what type of testing and treatment are being received for secondary conditions.
Recommended Baseline Testing of Fitness Levels
Cardiovascular fitness can be assessed with submaximal testing via treadmill, cycle ergometer, or walking tests.
Muscle strength can be determined through free or machine weights using one-repetition or ten-repetition maximum testing.
An assessment of the clients' level of anxiety or depression can be useful to determine the psychological effects of an exercise program.3,4
Type: Combination of aerobic and resistive exercise
Intensity: 60%–75% of maximum heart rate3,5
Duration: Start at 20 minutes
Frequency: Three to five sessions per week.
Carefully choose the initial exercise parameters, and instruct your clients to avoid overexertion as they will need to avoid excessive fatigue to maintain a healthy immune system. Clients suffering bouts of depression, excessive anxiety, or poor sleep quality should maintain some level of exercise but may need to decrease the intensity of their exercise program.6 Clients should maintain their exercise program for at least 6 months to attain age-normal levels of endurance and cardiovascular fitness. Clients should benefit from the physical and psychologic effects of their exercise program.3,4 When clients have progressed to a consistent exercise program, add resistive exercises for major muscle groups. Resistive exercises can be performed with intensities at 60% of maximum with 3 sets of 10 repetitions and a rest period of 1 to 2 minutes between sets.3,7,8 Clients with AIDS may be able to progress their exercise programs to include moderate- and high-intensity aerobic and recreational activities.3