Efeito do treinamento físico na densidade mineral óssea de pacientes vivendo com HIV/AIDS: um estudo retrospectivo

Abstract

Background: People living with Human Immunodeficiency Virus (PLHIV) experience reductions in bone mineral density (BMD). However, evidence on the effects of exercise training in bone health of PLHIV is limited. Objective: To investigate the effects of a long-term multimodal exercise program on BMD of PLHIV. Methods: A retrospective cohort of 39 PLHIV (48.4 ± 7.6 yrs; 15.5 ± 6.5 years of HIV-infection; 12.2 ± 7.0 years on antiretrovirals) who performed a multimodal exercise program (aerobic, resistance and flexibility exercises during 9 to 106 months; 60 minutes/session; 3 times/week) was allocated into two groups according to sex (MLHIV or WLHIV), and assigned into presence or not of osteopenia/osteoporosis (+ or -). Pre and post-training data of BMD was obtained from dual x- ray absorptiometry tests performed routinely by the participants of the exercise program. Additionally, associations of exercise-related effects vs. determinant factors of BMD were calculated. Results: MLHIV+ exhibited greater increases than MLHIV- in BMD at femoral neck (0.01 ± 0.01 vs. -0.02 ± 0.02 g.cm-2; P < 0.001), total femur (0.01 ± 0.02 vs. -0.01 ± 0.02 g.cm-2; P < 0.01), and lumbar spine (0.03 ± 0.04 vs. -0.00 ± 0.02 g.cm-2; P = 0.03), while no difference was detected between groups for whole body (0.00 ± 0.01 vs. 0.01 ± 0.03 g.cm-2; P = 0.55). As for women, lowering in BMD at femoral neck was slightly greater in WLHIV+ vs. WLHIV- (-0.04 ± 0.03 vs. 0.00 ± 0.04 g.cm-2; P = 0.04), whereas no difference was observed for BMD at total femur (-0.03 ± 0.03 vs. -0.02 ± 0.04 g.cm-2; P = 0.59), and lumbar spine (-0.05 ± 0.04 vs. -0.02 ± 0.02 g.cm-2; P = 0.25), and whole body (-0.03 ± 0.02 vs. -0.01 ± 0.04 g.cm-2; P = 0.35). In men, exercise training-induced changes from baseline in BMD at femoral neck were inversely correlated to femoral neck T-score (r = -0.62; P < 0.001), but not to time of follow up (r = -0.26; P = 0.09), appendicular skeletal muscle mass index (r = -0.28; P = 0.08), or age (r = 0.12; P = 0.26). In women, changes from baseline in BMD at femoral neck were inversely correlated to time of follow up (r = -0.58; P = 0.01) and age (r = -0.70; P < 0.01), and positively correlated to femoral neck T-score (r = 0.46; P = 0.05) and appendicular skeletal muscle mass index (r = 0.47; P = 0.05). Conclusion: Multimodal exercise programs may improve the bone health of PLHIV, especially men with osteopenia or osteoporosis. Adjuvant therapies to exercise should be considered to contain BMD losses in women living with HIV