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Exercise-induced inflammatory changes among older adults with and without HIV
Inflammation does not drop more with HIV after 24 weeks of exercise
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9th International Workshop on HIV and Aging, September 13-14, 2018, New York
Mark Mascolini
In a randomized trial of moderate or high-intensity exercise in older adults with or without HIV, 24 weeks of exercise did not lower inflammatory marker levels significantly more in the HIV group, even though people with HIV had higher baseline inflammation [1]. Better adherence to the supervised exercise regimen did promote lower levels of IL-6 and C-reactive protein (CRP).
University of Colorado researchers who conducted this study noted that physical activity generally cuts levels of inflammatory markers, but some studies suggest higher-intensity exercise may boost inflammation in people with chronic inflammation, while lower-intensity exercise may lower inflammation. Previous work by this group found greater strength gains with higher-intensity exercise than with moderate-intensity exercise in sedentary older people with HIV [2].
The new study assessed the impact of exercise intensity on inflammatory markers in older adults with or without HIV. The Colorado team recruited HIV-positive adults and HIV-negative controls 50 to 75 years old. People with HIV had taken antiretroviral therapy for at least 2 years All participants enrolled in a supervised 3-times-weekly cardiovascular and resistance exercise program. Everyone followed a moderate-intensity routine for 12 weeks then got randomized to continue moderate exercise or advance to high-intensity exercise for another 12 weeks.
Before exercise began and again at 24 weeks, researchers measured serum and plasma levels of IL-6, TNF-alpha, soluble TNF receptor (sTNFR) 1 and 2, CRP, sCD14, intestinal fatty-acid binding protein (iFABP), and IL-10. They also measured IL-6, TNF-alpha, and sTNFR1 at week 12. To gauge average percent differences from baseline and weeks 12 and 24, the investigators used mixed and multiple regression models adjusted for baseline marker level, age, and body mass index.
The study group included 32 people with HIV and 37 HIV-negative controls, 91% of them men. Age averaged 57.8 years (standard deviation 6.4) and body mass index 28.7 kg/m2 (standard deviation 4.8). Before the exercise program began, people with HIV had significantly higher inflammation levels than controls as measured by IL-6 (34% higher, P = 0.033), CRP (103% higher, P = 0.004), sCD14 (17% higher, P = 0.026), sTNFR2 (29% higher, P = 0.022), and iFABP (113% higher, P = 0.014).
From week 0 to week 12, IL-6 fell in HIV-negative controls (-14%, P = 0.058), while sTNFR1 dropped in people with HIV (-5%, P = 0.02). From week 0 to week 24, overall changes in inflammatory markers did not differ significantly between people with and without HIV (P > 0.11), but there were some individual marker-change differences in the two groups: IL-10 rose 66% in controls (P = 0.005), while iFABP fell in the HIV group (-51%, P = 0.045). sCD14 rose 8% in people with HIV (P = 0.014) and 11% in controls (P < 0.001).
In the combined HIV-positive and negative groups, over 24 weeks people randomized to high-intensity exercise had a significant decline in CRP (-24%, P = 0.033) but significant gains in sCD14 (14%, P < 0.001). Compared with people randomized to moderate-intensity exercise, those who advanced to high-intensity exercise had 30% lower CRP (P = 0.062) and 8% higher sCD14 (P = 0.043).
Every 10% higher adherence to the exercise program translated into 5% lower IL-6 levels (P = 0.018) and 42% lower CRP (P = 0.002) at week 24.
The University of Colorado team concluded that, even though people with HIV had significantly higher inflammatory marker levels before starting the exercise regimen, this exercise program did not significantly decrease inflammation compared with HIV-negative controls. Significant gains in sCD14 in people with and without HIV "raise questions regarding the role of monocyte activation and changes in gut permeability with exercise."
References
1. Wilson M, Jankowski C, MaWhinney S, Rapaport R, Kohrt W, Brown T, Erlandson K. Exercise-induced inflammatory changes among older adults with and without HIV. 9th International Workshop on HIV and Aging, September 13-14, 2018, New York. Abstract 3.
2. Erlandson KM, MaWhinney S, Wilson M, et al. Physical function improvements with moderate or high-intensity exercise among older adults with or without HIV infection. AIDS. 2018 Aug 20. doi 10.1097/QAD.0000000000001984. https://www.ncbi.nlm.nih.gov/pubmed/30134299
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