LETTERS From CAMP Rehoboth |
An Exercise in Life: Physical Trainer Helps Combat HIV Wasting |
With 18 years experience as an exercise trainer, Mark Rincon knows his way around the gym. But for the last seven years, he has turned his attention to the particular needs of people with HIV. Now, Rincon has played a key part in a new clinical study which documents the significant role exercise may play in the treatment of HIV wasting.
Rincon provided progressive resistance training to clinical research participants as part of an innovative study by researchers at the University of California at Berkeley and the University of California at San Francisco that combined exercise with testosterone replacement therapy and an anabolic agent, oxandrolone. In the study, which was presented at the 12th World AIDS Conference in Geneva in July, participants gained an average of more that 15 pounds over eight weeks. "We had a range of people in the study, from those who had exercised in the past to those who never imagined themselves in a gym. But once they started to see the changes in their weight, strength and energy, they all came through," said Rincon. "Some felt good enough to go back to work, to start new relationships, all the things they had experienced before wasting." Involuntary weight loss due to HIV is a problem for up to 50% of people living with HIV or AIDS. HIV infection often results in abnormal metabolic processing of nutrients, causing the body to deplete its own muscle mass. Nutritional therapies alone may be ineffective due to the altered metabolism caused by HIV. "You see people with HIV wasting who have shuttered themselves behind their doors because of how they look," Rincon explained. "Now we have the opportunity to offer them an alternative, a chance to take their lives back." Rincons own work with people experiencing HIV wasting led him to Dr. Marc Hellerstein of the University of California at Berkeley in 1997. Dr. Hellerstein was planning a clinical study of a "combination approach" to treating HIV-related weight loss, using pharmaceutical therapy together with nutritional counseling and an exercise regimen. The therapeutic portion of the study consisted of a comparison between a combination of a low "replacement dose" of testosterone (100 mg per week) plus a placebo pill, versus the replacement dose of testosterone plus a well tolerated anabolic agent (oxandrolone, 20 mg per day). Oxandrolone is an oral anabolic medication that is used in the treatment of HIV-related weight loss and other disease-related wasting conditions to promote protein synthesis and weight gain. Oxandrolone has been given for several years at the relatively low dose of 20 mg per day safely for other conditions, such as alcohol-related liver disease, without causing toxicities to the liver or other organs. In addition, masculinizing side effects are rare at this dose. For the exercise component, Rincon and several other trainers provided an hour-long exercise session, three times weekly, that consisted of six upper body exercises and three lower body exercises on standard weight-stack exercise equipment. After eight weeks of the study treatment regime, substantial gains in body weight, lean body mass and muscle strength were observed in both the placebo group and the oxandrolone group; however, the group that received oxandrolone had almost twice the gains of the placebo group. The results of the Hellerstein study were so encouraging, Rincon has now developed a community based model of the program to be piloted in San Francisco. The programs goal is to provide, under medical guidance, supervised resistance training to those with HIV-related weight loss, to show the approach works in real-life settings and to encourage insurance companies to provide coverage for this approach by demonstrating its cost-effectiveness when compared to the cost of hospitalization for wasting. A similar approach is being offered by Dr. Allen Huff and Ed Kinser through Kinetic Sports, a non-profit HIV wasting management clinic in Houston, Texas. Dr. Huff and Kinetic Sports provide technical assistance to people across the country engaged in community-based wasting treatment projects. "We provide a comprehensive approach for managing weight loss due to HIV, emphasizing nutrition and exercise," explains Dr. Huff. "Community-based efforts like ours and Mark Rincons are essential in getting the current science of wasting treatment into day-to-day practice among people who need it." Mark Rincon has approached the City of San Francisco and local AIDS organizations to fund the pilot program. Inquiries can be directed to him at (415)621-8539. Mark Rincon has spent 18 years as an exercise trainer, including 7 years as a trainer for people with HIV. He has worked with Projecto Contra SIDA y Pro La Vida to design a seminar on exercise training for people with AIDS. The Huff Fund is a non-profit organization dedicated to providing information and technical support to professionals and community members involved in the treatment of HIV-related weight loss and wasting. Mark Rincons Conditioning Tips
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LETTERS From CAMP Rehoboth, Vol. 8, No. 14, October 16, 1998. |