The Role of Physical Activity for the Management of Sarcopenia in People Living with HIV

Abstract

Sarcopenia is a physiopathological process associated with aging, caused by reduction of muscle strength, muscle quality and physical performance, and associated with an increased risk of falls, physical disability and premature death. There is no effective treatment for sarcopenia, but physical exercise seems to be highly effective at counteracting the decline in muscle mass and strength associated with aging. Recently, sarcopenia has been recognized as an emerging issue in people living with HIV (PLWH). Despite adequate treatment with combination antiretroviral therapy (cART), PLWH may exhibit an early occurrence of some aging-related conditions, including sarcopenia, frailty and falls, and this is likely resulting from high rates of comorbidities, high-risk behaviours, chronic immune activation and cART-specific factors. In this review, we discuss the potential mechanisms and the clinical relevance of sarcopenia in PLWH, and present data from longitudinal studies of physical activity in this population. Despite none of these studies having specifically addressed the benefits of physical exercise on sarcopenia, there is evidence that exercise is effective to increase aerobic capacity and muscle strength, and to improve body composition and inflammatory outcomes in PLWH. Therefore, the expected benefits of physical exercise are likely to translate into a successful and specific intervention for prevention and treatment of sarcopenia in this population.

Keywords: HIV; cART; immune activation; muscle; orthopaedic.

Figure 1

Persistent HIV infection and ageing contribute to development of sarcopenia in people with HIV. Chronic immune activation, common to both conditions, may favour this process through mitochondrial dysfunction, increased muscle protein catabolism and muscle fat accumulation. Other factors include a low protein intake and vitamin D deficiency, among others. In contrast, physical exercise may prevent and partly reduce sarcopenia through increasing muscle mass and function and reducing chronic inflammation.