HIV and AIDS patients find exercise improves their health

NEVER AN ATHLETE -- simply from lack of interest, not lack of innate ability -- Travis Tanner at first did not realize the magnitude of the challenge that lay ahead.

Still, a challenge was exactly what Tanner, 29, sought. He had just come out of a darkness so intense that he could hardly bring himself to leave his midtown Sacramento apartment. His life had been in a downward spiral since February 2003 when he tested positive for HIV.

Drug addiction and depression, however, gave way in the past year to a renewed interest in work and college. And Tanner was ready to try something else, something healthier. So when he saw a flier in January for the NorCal AIDS Challenge, a four-day, 325-mile charity cycling event that begins Thursday, he thought, why not?

On a borrowed bike, he hit the American River trail one day four months ago, full of hope.

"I could only go 10 miles before being winded," he recalls. "But I started getting better right away."

Now, he's doing 100-mile rides with relative ease, lifting weights regularly at a gym and talking about hill-climbing like an experienced cyclist.

"This is definitely the best shape I've ever been in," says Tanner, whose lithe body shows distinct muscle definition. "And it's ironic because I got so sick when I first became (HIV) positive and now I'm the healthiest I've ever felt."

Such a refrain is not unusual among HIV and AIDS patients. In the decade since protease inhibitor medications have helped manage the virus, many patients have either begun exercise regimens or resumed endurance training with a vengeance.

Mounting evidence suggests that exercise not only provides a boost to well-being, but also can help the immune system fight off illness and AIDS-wasting disease by increasing muscle mass and improving heart and lung endurance.

In addition, a study in 2006 by Massachusetts General Hospital found that exercise manages symptoms of "metabolic syndrome," which increases the risk of heart disease and diabetes. Reports say as many as 45 percent of HIV-positive patients have metabolic syndrome.

And a 2005 Columbia University study found that moderate exercise, in combination with anti-retroviral drugs, led to improved nervous-system function and circulation in HIV patients.

Psychological benefits, too

Such preliminary reports are heartening to people living with HIV. Even so, many say that they would be exercising even if it showed no healthful indications.

"For me, the effects are more psychological than biochemical," says Bob Katz, a member of the Positive Pedalers, an HIV-positive cycling club in California with a membership of around 275, mostly in the Bay Area and Los Angeles. "Having a sense of self-worth, feeling comfortable in your body, is something exercising will do.

"We (HIV patients) need to be able to pay attention to what our bodies are telling us. There's nothing like physical exercise to make you aware of what's going on in your body."

Dr. Archana Maniar, an infectious disease specialist and assistant professor at UC Davis, agrees that HIV patients are no different from noninfected people -- they need proper exercise.

"With the advent of anti-retrovirals, patients are living long enough to get the diseases everybody else gets -- diabetes, hypertension, cardiovascular disease, strokes," Maniar says. "From that standpoint, exercise promotes their general wellness and increases their chances of avoiding those things.

"Some HIV patients are concerned about being prone to complications if they exercise a lot, and I tell them that listening to their body is the key, just like for anyone else."

A few HIV-positive endurance athletes say they have never let the disease limit their activity.

Perhaps the most noteworthy is Ric Munoz, 50, a Los Angeles marathoner featured in a widely aired 1995 Nike TV ad. It showed him running through the Malibu hills and ends with this message: "Eighty miles every week. Ten marathons a year. HIV positive. Just do it!"

And Munoz has done it, over and over. He tested positive for HIV in 1987, four years after he started running. He remembers telling the physician who gave him the news that he was a marathoner and he had no plans to give it up. This was, remember, before any enhanced drug regimens were developed.

"If he had objected to that, I would've found another doctor," Munoz says.

All these years later, Munoz is still running. He completed last month's Boston Marathon in 3 hours, 22 minutes, a time he wasn't happy with. He's training now for a 56-mile ultramarathon in South Africa.

Over the years, Munoz says, running as much as 80 miles a week hasn't affected his health and does not adversely interact with the "drug cocktail" he takes.

"I always thought it was a genetic thing, the way some folks are better able to fight HIV," he says.

Ten years ago, deep into his running career, Munoz chose to stop all medication. That experiment lasted for three years.

"My doctor said, 'I'm not going to force you to take it, but I can guarantee at some point, you'll come down with an opportunistic infection,' " Munoz recalls. "And I did. It was cryptosporidiosis (an intestinal infection). But even when I wasn't on medication and my T cells were dropping, that didn't affect my (marathon) performance."

Once he returned to his drug regimen, Munoz says, the condition went away. Since then, he boasts, he's running nearly as much as ever and "I've built T cells up to undetectable range."

One runner is unsure

Not all HIV athletes have been as fortunate.

Larry Teeter, a 48-year-old AIDS patient and a biomedical researcher at the Baylor College of Medicine in Houston, has run 108 races of marathon length or longer, including the Western States 100 endurance event in 2004.

All this, despite losing vision in his right eye as a result of AIDS-related CMV retinitis in 1994 and, in 2005, suffering from avascular necrosis -- bone deterioration due to lack of blood supply -- in his right hip.

For years, Teeter ran with an IV catheter poking out of his chest. (Now, he takes anti-retrovirals orally.) And his hip degeneration was corrected after surgery in 2005.

Teeter says he has seen the ravages of the disease take a toll on his body. And he says he's not sure whether his exercise routine has hastened a decline. He just knows he doesn't want to stop doing it.

"Certainly the muscle mass is there for the legs, but I have a loss of body fat and facial wasting that's characteristic for (HIV patients)," he says. "And there are some studies that suggest marathon or longer events might be detrimental to your (cell) count."

But that's countered by Richard Brodsky, an HIV-positive New York man who runs a marathon each month. Brodsky says his cell count has been "900, higher than they've ever been." But Brodsky also has brain cancer, which he says his doctors have determined is not related to his HIV status.

Exercising keeps him alive, he says.

"A lot of it just has to do with, pardon the pun, being positive about it," Brodsky says. "When I run, I tend not to get colds or any of the opportunistic infections. Some days, it feels like the HIV isn't even there."

For Tanner, the Sacramento cyclist, extreme endurance events probably won't become a habit. But he says he definitely will continue exercising after the four-day AIDS ride.

"It makes me feel better about myself," Tanner says. "When I go on a ride, the first few miles I'm thinking, 'Uh, why am I doing this?' Then I go through what I call the wall and I get into this zone -- just me and the bike. It's kind of meditative, you know?"