Effectiveness of Resistance Training on HIV Patient’s Immune System:

A Systematic Review

Nursalam1, Natalia C. T. Revita2, Handira N. Aini2, Jaka S. Hakim2

1
Lecturer from Faculty of Nursing Universitas Airlangga, Kampus C, Mulyorejo, Surabaya,
Indonesia
1
Students from Faculty of Nursing Universitas Airlangga, Kampus C, Mulyorejo, Surabaya,
Indonesia
Corresponding author: Nursalam, nursalam@fkp.unair.ac.id

ABSTRACT

Introduction: HIV affected the immune system with decreasing CD4 + T lymphocyte cell.

Alternative to maintain and even increase CD4+ count was doing resistance training. The

purpose of this study was to examine effectiveness of resistance training on HIV patient’s

immune system.

Method: A systematic review was conducted by using five electronic databases (Scopus,

EBSCO, PubMed, ProQuest and SAGE) from 2010-2020. We were searched for studies

which investigating the effectiveness of resistance training and combination between

resistance training with aerobic on HIV patient. Primary outcomes on this study was immune

system. The articles were assessed for risk of bias using the JBI critical appraisal checklist.

Results: We removed duplicates articles of the 363 citations identified and determined the

eligibility of the studies. 13 studis met inclusion criteria, there were 9 RCT articles and 4

experiment articles. Resistance training was effective for HIV patients. People living with

HIV could do resistance training alone or with aerobic training. Based on several evidences,

this intervention increases CD4 counts, muscle strength, body mass and decrease in body fat.

The impact also varies on immune status after doing resistance training consistently.

Conclusions: Resistance training is physical activity that can be alternative for HIV patients

not only maintain stability of immune system but also cardiometabolic system.

Keywords: HIV, immune system, resistance training.

1. Introduction HIV had been growing faster since

HIV is increasingly contributed a 1981 (Bessa et al., 2017). Indonesia

chronic illness, especially HIV patients was the fifth high risk HIV in Asian. In

who consumed combination of ARV the 2017, amount of HIV cases was

(Brito-neto et al., 2019). People living 48.300 cases that had been

with HIV has big consequences like approximately increasing 7.050 cases

multiple morbidities such as physical since the last year. Mainly men get

disorders, emotional disorders, infected with HIV than women because

cognitive, and mental disorders which it showed that 62 percent on men and

offended activity daily living (Brito- 38 percent on women (Kementrian

neto et al., 2019). HIV not only causes Kesehatan RI, 2018). People living

multiple morbidites but also affected with HIV were 330.000 who consumed

the immune system with decreasing antiretroviral therapy were 130.000 and

CD4+ T lymphocyte cell (Holbrook et PLWH who have suppressed viral loads

al., 2019). If CD4+ count was 130.000 on 2019 (UNAIDS, 2019).

decreasing then HIV patients would be People living with HIV who have

vulnerable with pathogen and become suppressed viral only 25% from PLWH

opportunistic infections (Holbrook et who consumed antiretroviral therapy

al., 2019). However, the problem of and alternative activity to maintain and

using combination antiretroviral on even increase CD4+ count was doing

people living with HIV as an emerge resistance training (Anandh et al.,

issue to advent risk of cardiovascular 2014).

disease, diabetes, and changes in the Resistance training is physical

body composition. activity that improve body strength and

increase muscle mass (Anandh et al.,

2014). Resistance training uses the basic guidelines or evidence-based

muscular framework with the purposes minimum set of items for systematic

not only reduce the depletion of muscle reviews.

functional due chronic illness but also 2.1 Search strategies

generating physiological adaptation A systematic review conducted by

(Brito-neto et al., 2019). Resistance using five electronic databases:

training can be combination with Scopus, EBSCO, PubMed, ProQuest

another physical activity like aerobic and SAGE. All of those articles were

training but a recent systematic review in English language. The studies had

focused on aerobic exercise and the been used since 2010 until 2020. This

results was body composition, quality study was using keywords (“HIV” OR

of life, strenght and weight of the body “AIDS” OR “Acquired Immune

on people living with HIV (Stanley and Deficiency Syndrome Virus” OR

Grinspoon, 2012). “Acquired Immunodeficiency

The aim of this study was to Syndrome Virus” OR “Human

examine effectiveness of resistance Immunodeficiency Virus” OR “Human

training alone or with aerobic training Immunodeficiency Viruses”) AND

on HIV patient’s immune system. By (“Resistance Training” OR “Strength

understanding suitable exercise for Training” OR “Weight-Bearing

people living with HIV, healthcare Exercise Program” OR “Weight-

providers may promote safety and Bearing Strengthening Program” OR

effective exercises in clinical practice. “Weight-Lifting Exercise Program”

2. Methods OR “Weight-Lifting Strengthening

We conducted a systematic review Program”) AND (“Immune system”

using PRISMA method. PRISMA is OR “Antibody Formation” OR

“Immunity” OR “Immunity, Cellular” inclusion criteria. All of relevant

OR “Lymphocyte Transformation” OR articles has been selected by three

“Lymphocytes” OR “T independent reviewers then we would

Lymphocytes”). be including those articles on

2.2 Inclusion and exclusion criteria systematic review.As we seen on figure

Inclusion criteria was using PICOT 1.

framework. 2.4 Risk of bias

PICOT Inclusion criteria Risk of bias could be diminished by

Framework
Population HIV/AIDS patient using critical appraisal tools.
without opportunistic
infections Reviewers were used Joanna Briggs
Intervention Resistance training
Comparator Combination between Institute (JBI) critical appraisal tools.
resistance training
with aerobic JBI critical appraisal tools was
Outcome Immune system
Time 2010-2020 checklist questionnaire with list of
Study design Randomized Control
Trial, experiment, items requires, things had to be done,
quasi-experiment
Language English and points to be considered. Every

study design has different question.

2.3 Study selection
Reviewers had to be scoring articles
A systematic review based on
that had been chosen. Result of scoring
PRISMA guidelines. First, we searched
was from low risk, mild risk, high risk
articles on electronic databases. We
or unclear risk.
identified articles from title and
2.5 Data extraction
abstract to knew how many articles
This study was using a structured
were duplicated. Second, we removed
form to extract articles from title, year,
articles were duplicated. Third, we read
study design, sample size, variable,
again article has been selected then we
intervention, analysis, the outcome
searched which were suited with
measures used to evaluate intervention feasibility test of the full text article,

and results. the remaining 13 research articles are

to be reviewed. After identified 13

3. Results
articles, there were 9 articles using

3.1. Study selection RCT and 4 articles using experiment.

A total of 363 articles were Physical activity used in this study is

identified. After removal of duplicates, resistance training, but several articles

the titles and abstracts of 147 articles combine resistance training with

were reviewed for eligibility. Articles aerobic exercise. Researchers

screened based on title identification evaluated the effect of resistance

resulted in 121 articles. From the training on the immune systems of

HIV patients.

I Articles identified from Scopus (n= 12), Proquest

d (n= 240), EBSCO (n= 13), Pubmed (n=12), SAGE
e (n=84)
n
ti Records after duplicates removed
S (n = 147)
c
r Records excluded (n=203)
e Records screened based on title Population
e (n = 216) Does not focus on the
problems of HIV patients
E Intervention
li Intervention is not
b appropriate with resistance
Full text articles assessed for eligibility training
il
(n = 15) Comparation
it
Does not discuss the
I combination of resistance
n training with aerobic
c Articles used training
l (n = 13) Outcome
u Does not discuss the effect
of interventions on the
Figure 1. Flow chart of Study selection
 3.2 Risk of bias

Table 2. Risk assessment of bias using the JBI critical appraisal checklist

No Author, Year 1 2 3 4 5 6 7 8 9 10 11 12 13 Total

1. Brito-neto et al., v v v v v v v v v v v v 92,30%
(2019)
2. Bessa et al., v v v v v v v v 88,88%
(2017)
3. Anandh et al., v v v v v v v v v v v v v 100%
(2014)
4. Zanetti et al., v v v v v v v v v v v 84,61%
(2016)
5. Ghayomzadeh et v v v v v v v v v v v 84,61%
al., (2019)
6 Farinatti et al., v v v v v v v v v v v v 92,30%
(2010)
7 Harper, (2012) v v v v v v v v v v 76,92%
8 Anandh & v v v v v v v v v v v v 92,30%
Alagesan, (2014)
9 Ley et al., (2014) v v v v v v v v 88,88%
10 Garcia et al., v v v v v v v v 88,88%
(2014)
11. Schlabe et al., v v v v v v v v 80%
(2017)
12. Dianatinasab et v v v v v v v v v v v 84,61%
al., (2018)
13. Tiozzo et al., v v v v v v v v v v v 84,61%
(2013)

Based on the identification in table The articles included in the

2, thirteen articles were assessed for risk discussion were published in 2010 to

of bias using the JBI critical appraisal 2020. The 13 articles identified all came

checklist for the design of a randomized from outside Indonesia, from United

controlled trial and quasy experimental. States of America: 2 (Harper, 2012;

The results found were 13 articles had Tiozzo et al., 2013), Brazil: 5 (Brito-neto

scores above 75%. et al., 2019; Bessa et al., 2017; Zanetti et

3.3 Study Characteristics al., 2016; Farinatti et al., 2010; Garcia et

3.3.1 Participants and Setting al., 2014), Germany: 1 (Schlabe et al.,

2017), India: 2 (Anandh et al., 2014;

Anandh & Alagesan, 2014), Iran: 2 aerobic exercise. Resistance training was

(Ghayomzadeh et al., 2019; Dianatinasab an activity that used muscle endurance

et al., 2018) and South Africa: 1 (Ley et training by performing specific

al., 2014). Total respondents for this movements such as the use of weights in

review were 295. The total population order to produce physiological

involved was between 10 until 36 adaptations. This type of training can be

participants. Participants who were used as a resource to reduce the

involved limited by several criteria such depletion of muscle functionality due to

as: clinical condition (infectious disease, its chronic effects (Brito-neto et al.,

opportunistic disease, pregnancy, 2019). Another intervention was

breastfeeding) and drug use (insulin, combination of resistance training with

hormone therapy). The average age in aerobic exercise. Respondents can do

the study was between 20 and 59 years. resistance training first then do aerobic

3.3.2 Interventions characteristic exercise (Tiozzo et al., 2013).

The interventions given to the Interventions were provided by certified

respondents were resistance training and instructors, physiotherapists and

a combination of resistance training with specialist trainers.

Table 3. Exercise Type

No Exercise Author (n=responden)
.
1 Resistance training Brito-neto et al., (n=19), Bessa et al., (n=16), Anandh et
al., (n=24), Zanetti et al., (n=30), Ghayomzadeh et al.,
(n=18), Harper, (n=16), Schlabe et al., (n=13)
2 Combination Farinatti et al., (n=27), Anandh & Alagesan, (n=36),
Resistance Training Ley et al., (n=23), Garcia et al., (n=10), Dianatinasab et
and Aerobic al., (n=40), Tiozzo et al., (n=23)

The length of the studies varied combination training exercises three

from 1.5 months until 12 months. All times a week with 6 to 15 repetitions of

studies in the article do frequency and

 the movement. Each session was carried out an average of 1 hour a day.

Table 4. Duration of physical exercise

No. Duration Author (n=responden)
1 < 3 months Ghayomzadeh et al., (n=18), Harper,
(n=16), Ley et al., (n=23)
2 3 months Brito-neto et al., (n=19), Bessa et al.,
(n=16), Anandh et al., (n=24), Zanetti et al.,
(n=30), Farinatti et al., (n=27), Anandh &
Alagesan, (n=36), Dianatinasab et al.,
(n=40), Tiozzo et al., (n=23)
3 > 3 months Garcia et al., (n=10), Schlabe et al., (n=13)

3.3.3 Clinical Outcome

The outcome measures of each on the respondent. Some studies also

study used the CD4 cell count in HIV measure body composition, muscle

patients. Measurement of results was strength, and the patient's quality of life.

carried out before and after intervention

Table 5. Effects of physical exercise

No. Clinical outcome Author
1. CD4 Brito-neto et al, Bessa et al, Anandh et al,
Zanetti et al, Ghayomzadeh et al, Anandh
& Alagesan,,Garcia et al, Schlabe et al,
Tiozzo et al
2. Body composition Brito-neto et al, Bessa et al, Zanetti et al,
Ghayomzadeh et al
3. Muscle strength Brito-neto et al, Bessa et al, Zanetti et al,
Farinatti et al, Harper, Anandh & Alagesan,
Ley et al, Garcia et al, Tiozzo et al
4. Quality of life Anandh et al, Anandh & Alagesan, Tiozzo
et al

3.3.4 Immune System results explain that doing resistance

The research of Poton, Polito and training can increase CD4 counts.

Farinatti, (2017) was explained that Research by Brito-neto et al., (2019)

resistance training has the potential to explained that CD4 + lymphocyte levels

improve a person's immune status. Some showed a significant increase after a period
of resistance training in the intervention result of the study, when doing resistance

group, while the control group found no training, the replication of the HIV virus

different results both pre- and did not increase. This study emphasizes

postresistance training intervention. that the resistance training program

Other studies have explained the provides respondents with good health

effect is not too significant on the immune benefits without having a negative effect

system of HIV patients, even some studies on the respondent's immune status.

have not found an increase in CD4+ counts Several studies have conducted

despite resistance training interventions. resistance training interventions using

This can happen due to several factors. A combination aerobics, and have beneficial

study by Farinatti et al., (2010) found that results for patients with HIV. This

there was only a slight increase in CD4 + combination exercise can be done by

counts in the intervention group, but in this alternately. Respondents can do resistance

study also explained that physical exercise training first then do aerobic exercise

can improve muscle function in HIV (Tiozzo et al., 2013). Research Anandh &

patients without having a negative effect Alagesan (2014), Garcia et al., (2014),

on the immune system. In O’Brien et al., Schlabe et al., (2017) and Tiozzo et al.,

(2017) study, there were also no (2013) found that by doing resistance

significant differences in progressive training and combined with aerobic

resistant exercise against CD4 + and viral showed a significant increase in HIV

load. Meanwhile, Harper, (2012) research patient's CD4 count.

shows that respondents experience an 3.3.5 Body Composition

increase in strength, muscle mass, and Resistance training is one of the

strength with exercise, but do not show recommended physical activities for HIV

changes in TNF-α consistently. Another patients, because it can improve body

composition (Poton, Polito and Farinatti, (2016), Ghayomzadeh et al., (2019) and

2017). Research by Garcia et al., (2014), Poton et al., (2017) explained that in

also explained that by doing a combination addition to increased CD4 cells, the effect

of training from resistance training and of resistance training interventions in HIV

aerobic training, the impact of increasing patients were increase muscle strength and

CD4 + cell counts, increased muscle body mass and a decrease in the amount of

endurance, and no replication of the HIV fat in the body. Research by Bessa et al.,

virus. The combination of resistance (2017) in addition to explaining an

training with exercises aerobic can be used increase in the number of CD4 + cells,

as an important tool for preventing respondents who took part in resistance

cardiovascular disorders and metabolism training also experienced an increase in

caused long exposure to HIV infection and body strength and a decrease in body fat

the use of antiretroviral therapy (Garcia et which these effects can provide good

al., 2014). Research by Bessa et al., (2017) benefits for HIV patients.

stated that the post-exercise training Another effect of using resistance

skinfold sum was significantly decreased. training interventions are increased body

In line with that, research by Zanetti et al., functional capacity and quality of life in

(2016) explained that exercise provides HIV patients, that described in the study of

changes in body composition such as Anandh et al., (2014). The many benefits

decreases on subcutaneous body fat and of doing resistance training such as

body circumferences (neck, abdomen, increasing CD4 + counts, increasing body

waist). strength, quality of life and decreasing the

3.3.6 Muscle Strength amount of fat in the body have a positive

Research by Brito-neto et al., impact on HIV patients.

(2019), Bessa et al., (2017), Zanetti et al., 3.3.7 Quality of Life

 Research by Anandh & Alagesan combination of exercise has only a positive

(2014) and Tiozzo et al., (2013) in addition effect on the mental health of HIV

to finding changes in CD4 cell counts, patients. This can happen because the

HIV patients who did resistance training in number of respondents is too small. In line

combination experienced an increase in with this study, research by Ley et al.,

quality of life. Patients get benefits both (2014) found that there was no significant

physically, an increase in the immune effect on changes in CD4 + counts in the

system, mental aspects and the status of group adhering to the intervention. The

the patient's quality of life increases heterogeneity of respondents and

(Tiozzo et al., 2013). influencing factors such as disease

The study by Dianatinasab et al., progression, antiretroviral drugs and the

(2018) found that there was no significant small sample size limited the results of the

effect of the combination of exercise on analysis study.

the CD4 + count of HIV patients. The

 Table 6. Study characteristics

Title, Author, Target

No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
1. Strength D: RCT The research Respondents
EG was given an There was a The RCT The weakness
training S: 19 PLWHA (11 objective was to consisted of
introduction to change in body fat research design is of the study is
improves body male and 8 female) determine the effect 11 men and 8
resistance training percentage and an advantage in that the
composition, V: body fat, body of resistance women and SPE activities for body mass and a this study to analysis of the
muscle strength mass, muscle training using living with
one week prior to the significant increase the results in the
and increases strength, TCD4+ Subjective HIV who
study. After increase in muscle validity and study is also
CD4+ T lymphocyte count Perception of Effort were divided
introduction , strength during the reliability of the influenced by
lymphocyte I: body mass and (SPE) on body into two
resistance training one repetition findings, allow a hormone
levels in people height: stadiometer; composition, groups, was carried out for 12 maximum (1RM) small sample and levels,
living with body fat: Sanny muscle strength, namely: 6
weeks with 2 sessions test in the exercise be able to control biochemical
HIV/AIDS adipometer; 1RM: and TCD4+ men and 3per week. Each evaluation. TCD4 the specific markers , sleep
(Brito-neto et Kraemer & Fry; lymphocyte levels women in the
exercise consists of 3 + lymphocyte factors of each time, and
al., 2019) TCD4+ in PLWHA. Exercise sets with 1 minute levels showed a respondent. The nutrition which
lymphocytes: flow Group (EG)
rest. This exercise is significant research was were not
cytometry and 5 mencarried out for 12 increase after a conducted in the studied.
A: Shapiro-Wilk and 5 women
weeks with variations period of same place, so
test, paired t test, Control of the bench press, resistance training the bias was
student's t-test, Group (CG).
45° leg press, lat on EG. small.
Wilcoxon test pulldown, knee Meanwhile, CG
flexion, elbow did not find any
flexion, ankle different results
extension, and triceps both pre- and post-
pulley. intervention.
2. Lymphocyte D: Experiment There are two 16 men Respondents attended The mean number Respondent There was no
CD4 + cell S: 16 male PLWHA objectives of this living with the intervention for of CD4 + cells criteria are the control group
count , strength V: TCD4 + research is to HIV who 12 weeks. Each increased (% = same and the in the study so
improvements , lymphocyte count, determine the took program has 3 23%, P = 0.0005), possibility of bias there was no
heart rate and body composition, impact of HAART training sessions with increased body is very small significant
body body strength and progressive a duration of 1 hour strength (% = difference
composition of heart rate strength training for per week. The eight 95%, P = 0.0001), regarding the
HIV-positive I: Physical test: 3 months in the movements used are decreased body fat intervention
patients during 1RM test; amount of TCD4 + bench press, knee (% 16 = 16%, P = given
a 3-month CD4+: flow lymphocyte cells in extension, lat pull 0.002), decreased
strength cytometry; people living with down, leg press, heart rate (% =
 Title, Author, Target
No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
training Body composition: HIV and know the shoulder press, biceps 9%, P = 0.0042)
program Rosscraft Inc. strength of the curls, triceps curls,
(Bessa et al., Tomkit and a Lufkin movement, and and abdominal curls.
2017) metal changes in body Each session consists
anthropometric tape composition pasa of 3 sets with 12-15
A: Student's t-test, cardiovascular repetitions of
Kolmogorov- system. movements and rest
Smirnov test every 2 minutes after
1 set.
3. Effect of D: Experimental Knowing the 24 PLWHA The intervention There was a Random division No biochemical
Progressive design effectiveness of respondents group carried out significant of the group tests were
Resistance S: 24 participants Progressive were divided activities for 3 increase in the reduces the risk performed on
Training on V: body functional Resistance Training into 2 months with 3 days of intervention group of bias, the lymphocyte
Functional capacity, quality of on body functional groups, exercise per week and with CD4 cell assessment of the counts, platelet
Capacity, life, and immune capacity, quality of namely the the duration of each count (p = 0.041), results of the counts, and
Quality of Life system life and CD4 count intervention training session was 1 body functional study is carried leukocyte
and CD4 Count I: body functional in PLWHA group that hour. The exercise capacity (p = out by a random counts on CD3
in People with capacity: six received consists of a warm up 0.027), and quality evaluator . and CD8 which
HIV / AIDS minutes walk test; Progressive of 10 minutes then 30 of life (p = 0.004). might affect the
(Anandh et al., Quality of life: Resistance minutes of results. The
2014) MOS-HIV; Training and progressive training follow- up time
Immune system: the control and a cool down of 10 was too short
CD4 count group that minutes. Exercise and the
A: Independent t test did not movements according samples were
for continuous receive the to the DeLorme too small
variables and Mann intervention protocol and are
Whitney U test for repeated for a
ordinal variables maximum of 10
times.
4. Non-linear D: RCT Analyzing the 30 PLWHA The NLRT group was In the NLRT NLRT has Research has
resistance S: 30 PLWHA effectiveness of with a given 2 weeks of group, there was a effectiveness in yet to compare
training reduces V: anthroprometry , non-linear sedentary exercise introduction decrease in increasing the the effects of
inflammatory muscle strength and resistance training lifestyle who (6 exercises total) inflammatory number of CD4 + different
biomarkers in inflammation (NLRT) for 12 were divided prior to the 12 weeks biomarkers (IL- and CD8 + cells physical
persons living biomarkers weeks on into 2 groups of the intervention. 1BETA, IL-6, IL- effectiveness as
with HIV: A I: body fat: Sanny anthropometry , randomly, The NLRT group 8 and TNF-alpha), aerobic vs.
 Title, Author, Target
No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
randomized adipometer; muscle strength, namely the consistently decreased resistance and
controlled trial Inflammatory and inflammatory NLRT group performed 6 exercises subcutaneous different
(Zanetti et al., markers: flow biomarkers in of 15 people with the aim of body fat, waist to periods (linear
2016) cytometry; PLHIV and the increasing muscle hip ratio and versus
Immunological control group mass, namely squats, increased muscle nonlinear)
markers: flow of 15 people. bench press, strength, IL-10,
cytometry; hamstring curls, CD4 +, and CD8 +
Muscle strength: frontal pulls, seated levels.
1RM calf raises, and
A: Shapiro-Wilk shoulder presses.
test, ANCOVA
5. Effect Of 8- D: RCT To determine the 21 PLWHA The RES group was There was a The study The number of
Week of S: 21 PLWHA effectiveness of were divided given an introduction significant combines the use samples is
Hospital-Based patients taking resistance training into two to the exercise for 1 increase in the of elastic bands small and it is
Resistance ARVs training for 8 weeks groups, week with 3 training number of TCD4 and body weight not balanced
Training V: CD4 + and using elastic bands namely the sessions using an + in the RES exercise which between the
Program on anthropometry against the immune RES group elastic band. The group, there was a can stimulate intervention
TCD4 + Cell I: the number of system and (14 people) intervention period decrease in fat changes in group and the
Count and CD4 + cells; anthroprometry in and the was carried out for 8 mass in the RES variations in control group.
Anthropometric Anthropometry: PLWHA control group weeks divided into 2 group. Meanwhile, anthropometry
Characteristic Height: stadiometer, (7 people) phases and each in the control and TCD4 +
of HIV Patients Waist to hip : phase 4 weeks. group there was a counts.
in Tehran , SECA, In the first phase, the decrease in the
Iran: A BMI RES group did an amount of TCD4
Randomized A: Pearson exercise with an + and an increase
Controlled Trial elastic band 3x / week in fat mass
(Ghayomzadeh with 1 day of rest per
et al., 2019) training session. In
the second phase, the
RES group was given
additional exercise in
the form of
bodyweight exercises
to increase exercise
intensity.
6. Effects of a D: RCT The aim of the Respondents EG intervene during There is no Previous studies Even though
 Title, Author, Target
No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
supervised S: 27 seropositive study was to consisted of the first two weeks , significant only describe jus the fulfillment
exercise patients determine the effect 27 which consists of difference was the effects of of respondents
program on the V: of a controlled seropositive training aerobic, found in the aerobic exercise. in this study
physical fitness CD4 T-cells , Body physical activity patients. strength and number of CD4 T- This study also was quite a lot,
and Mass Index , Body training program on Respondents flexibility. The cell relative and describes the the respondents
immunological Mass and supervised the physical health were divided training is carried out absolute between effects of who took part
function of physical exercise and immune into two 3x / week with 30 the two groups strength and in the training
HIV- infected I: exercise aids and function of HIV groups, minutes of aerobics, both before and flexibility were still
patients CD4 examination patients namely: 19 150 Physical after practice, but training. relatively low,
(Farinatti et al., tools people in the Working Capacity, 50 there is a slight so that it was
2010) A: Exercise minutes of strength increase in EG. possible to
ANOVA Group (EG) training, 3 sets of Muscle strength make errors in
and 8 people exercises, 10 minutes increased from the
in the of flexibility and 2 30% to 50%, and interpretation
Control sets of range of fat-free mass also of the findings
Group (CG) motion. Training is increased. There in this study.
supervised by people was no negative
with special skills and effect on the
is carried out in small respondent's
groups. immune system.
7. Effect Of D: RCT The aim of the The 16 HIV Group interventions There was an Previous research This study was
Resistance S: 16 HIV positive study was to positive monitored three times increase the has never only conducted
Training On patients determine the effect respondents a week using a strength of muscle explained the for 6 weeks,
Cytokines In V: resistance of resistance who had progressive method mass but no effects of whereas the
Hiv + Men training and training on substance and program non- change in TNF-α exercise and previous study
With cytokine cytokine abuse history linear periodically for consistently. cytokines, so this was conducted
Chemical concentrations (Th1 concentrations (Th1 were divided six weeks. Before and Besides i tu, IL-4, study could show for 8 to 12
Dependence vs. Th2: IFN-γ, vs. Th2: IFN-γ, into 2 after the 6 week IL-10 and IFN-γ the benefits of weeks.
(Harper, 2012) TNF-α, IL-4, IL-10) TNF-α, IL-4, IL- groups. 8 period, resting and fallow da under exercise related
I: practice aids and 10) in men with people in the fasting blood samples concentration. to HIV patient
ELISA test kits HIV. intervention were taken and However, immunity and
A: ANOVA group and 8 analyzed using high resistance training chemical
people in the sensitivity ELISA. programs provide dependence.
control fitness to
group. respondents
without having a
 Title, Author, Target
No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
negative effect on
immune status.
8. Effect of D: The aim of this 36 The intervention The aerobic All exercises are This research
Aerobic and RCT study was to find respondents group exercised 1 exercise group and carried out under would be better
Progressive S: the effects of were divided hour per day the progressive the supervision of if the
Resistance 36 respondents aerobic and into 3 performed 3 days / resistance training a trained person. respondents
Training on V: progressive groups. 12 week for 3 months. group showed This study is the were
Functional Aerobic exercise , resistance training people in the Aerobic exercise is significant first to carry out a differentiated
Capacity , progressive on functional aerobic done with 30 minutes improvements in comparison from using
Quality of Life resistance training , capacity, quality of exercise of warming up then CD4 cell count between the HAART
and CD4 Count functional capacity, life and CD4 cell group, 12 30 minutes of and quality of life. aerobic exercise (Highly Active
in People with quality of life and count in people people in the aerobics and 10 Aerobic and group and the Anti Retro
HIV / AIDS CD4 count with HIV. progressive minutes of cooling progressive progressive Viral Therapy)
(Anandh & I: Six Minute Walk resistance down. Progressive resistance training resistance or not.
Alagesan, Test, MOS-HIV training resistance training is can be training group in Limitations of
2014) Health Survey group and done by 10 minutes recommended for India. this study has
A: 12 people in of warming up improvement not examined
ANOVA, paired t- the control followed by 30 functional the analysis of
test and Wilcoxon group minutes of capacity, immune biochemical
signed rank test progressive resistance system and quality such as
training and 10 of life. lymphocytes,
minutes of cooling platelets, WBC,
down CD3 and CD8.
9. Effects of an D: experiment The aim of this 23 HIV Group A did the In the adherent Exercises are The RCT
exercise Pre - post test design study was to positive exercise group (Group A), carried out under research design
program with S: 23 respondents analyze the health respondents independently strength increased the supervision of was planned at
people living were HIV positive effects of a 10- were divided without supervision significantly more a trained person. the initial stage
with HIV: V: Immunological week physical into 2 with exercise 60-70 than in the non- The research was of the study,
research in (CD4, viral load), activity program in groups, minutes. Group B adherent group. conducted but it could not
a disadvantaged anthropometry HIV patients namely exercises with the However, according to the be
setting (weight, height, skin group A group for 90 minutes. adherence to recommendations implemented
(Ley et al., folds, waist to hip consisting of Exercise activities for physical activity for 10 weeks . because at the
2014) ratio), muscle 11 non- both groups were the program had no implementation
strength and adherent same, namely aerobic significant effect stage there
cardiopulmonary group and exercise, progressive on changes in were obstacles
I: anthropometric group B resistance training CD4 cell count. to recruitment
 Title, Author, Target
No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
measuring device, consisting of and stretching. All The heterogeneity of respondents
blood sampling 12 adherent respondents did the in this study limits and compliance
device, treadmill and group exercise 3 times per the analysis and with training,
ECG week for 10 weeks. results of the because
A: Chi square test , study. respondents
t-tests, Mann- experienced
Whitney U-test and fear of
ANCOVA community
stigma.
10 Effects of D : Experiment The aim of this 10 Respondents did a Combination This study has This study only
. combined S: 10 respondents study was to respondents combination of exercises show many measured had an
exercise who use HAART analyze the effects who use training from an increase in the variables and has intervention
training on (Highly Active Anti of a 20 week HAART resistance training number of TCD4 a long duration of group and did
immunological, Retro Viral combined exercise (Highly and aerobic training. + cells and also an research. not use a
physical and Therapy) program with Active Anti Respondents did increase in the control group
biochemical V: Resistance biochemical and Retro Viral resistance training CD4 + / CD8 +
parameters in training, aerobic immunological Therapy) first, then continued ratio.
individuals with training, parameters in HIV with aerobic training. But viral counts
HIV / AIDS immunological patients Sessions were did not change
(Garcia et al., aspects, (viral load, conducted for 60 over 20 weeks of
2014) and CD4 count), minutes / day, 3x per exercise.
cardio-respiratory, week for 20 weeks. In the biochemical
body composition, All respondents were profile, only HDL-
biochemical profile evaluated with the c levels were
and oxidative stress same conditions present increased
biomarkers before and after On physical tests,
I: treadmill, Gas exercise there is an
Analyzer VO2000 increase in muscle
from Medgraphics; strength.
Ergomet 13
software
A: Shapiro – Wilk
test and Wilcoxon
test
11 Moderate D: Quasy- Assess effect on 13 people Participants exercised There was a The number of Lack of
. endurance Experiment immunological infected with for 3-4 hours per significant samples is small, cardiovascular
 Title, Author, Target
No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
training S: 13 people systems, endurance HIV who week until they increase in CD4 the exercise paramenter,
(marathon- infected with HIV training and regular completed reached 60-70% cell count in the intensity is exercise
training) - who completed the aerobic training in the study out maximum heart rate, exercise-adherent gradually intensity, small
effect on study out of 21 people infected of 21 people then increased it to 6 group, while the increased, the number of
immunologic people with HIV hours per week to 70- non-adherent basic exercises participants,
and metabolic V: blood pressure, 80% maximum heart group had a are carried out lack of control
parameters in pulse, CD4-cells, rate. The 7th month decrease. before the group,
HIV-infected CD8 +, T-cells, B- after the first Participants who marathon participants
patients: the 42 cells, NK-cells, viral exercise, the intensity did combined who drop out
KM cologne load, fasting fat, increase was 7-10 exercise of school have
project glucose, creatinine hours per week with (resistance difficulty
(Schlabe et al., kinase, phosphate, moderate endurance exercise and assessing
2017) liver transaminases runs (2 weeks before aerobics) showed infection
I: flow cytometry the marathon, a 31% increase in outcome
using BD Trucount participants did basic CD4 cell counts. parameters,
tubes exercises using 60- some
Quality of life : 70% maximum heart respondents do
Medical Outcomes rate) exercise only in
Study HIV Health their spare time
Survey ( MOS-HIV
A: GraphPad Prism,
Student t-test,
HOMA
(Homeostatic Model
Assessment)
12 The effect of D: RCT Assessed the effect 30 women The treatment group The results of this A meta-analysis All participants
. 12-weeks S: 30 women with of combined with HIV (14 did physical exercise study showed that was conducted to are aware of
combinational HIV (14 treatment aerobic exercise for treatment 3 times for 12 weeks, the effect of assess CD4 the intervention
exercise on groups and 16 12 weeks and groups and which was monitored exercise had a results, a small action.
CD4 count and control groups) resistance on 16 control by the positive effect on number of Research can
mental health V: anxiety, immune function groups) physiotherapist. Prior the mental health respondents made not detect the
aiming HIV insomnia, somatic and mental health to the intervention, of HIV patients it easier for effect of
infected women signs, social status blood samples were and did not show a researchers interventions
: A randomized dysfunction, taken in both groups. significant effect on CD4 well as
control trial depression, CD4 CD4 and GHQ48 on CD4 cells the number of
(Dianatinasab I: measure health tests were performed respondents
 Title, Author, Target
No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
et al., 2018) status with GHQ28 before and after the slightly.
A: Pair t-test for intervention.
data comparison.
Chi-square analysis
13 Short-term D: RCT Knowing the 23 PLWHA In the intervention In the control The combination Small sample
. combined S: 23 PLWHA (11 effectiveness of (11 control group (EX), CARET group there was a of exercise can size. Race
exercise control groups and combined aerobic groups and was carried out for 12 decrease in the affect both the influences the
training 12 intervention and resistance 12 weeks with 3 sessions number of CD4 + immune system reduction of
improves the groups) exercise training intervention each week (Monday, T cells while in and the body's respondents.
health of HIV- V: CD4 T (CARET) in groups) Wednesday and the intervention metabolic system The study only
infected lymphocytes, PLWHA who take Friday) and a total of group the number used CD4 T
patients plasma glucose, total ARVs on immune 36 sessions of of CD4 + T cells lymphocytes as
(Tiozzo et al., cholesterol plasma, function, metabolic, interventions were was stable. There a marker of
2013) and triglycerides, quality of life, given. The duration is a decrease in immunity.
HDL, LDL, quality physical of each session is 45- waist size, fasting Some
of life, BMI, blood characteristics 60 minutes with a blood sugar, a respondents did
pressure, variety of different good quality of not comply
cardiorespiratory, movements per day: life from a with taking
pulse 1) Endurance sessions physical and ARVs that
I: CD4 T such as a treadmill or mental aspect, an could affect the
lymphocytes: flow cycling with an increase in VO immune
cytometry; ergometer 2) Core 2max, increased system.
Plasma glucose: exercises (back upper and lower
glucose hexokinase extensions and body strength.
method; abdominal crunches)
Total plasma and 3) 10
cholesterol and strengthening
triglycerides: exercises (leg press,
enzymatic leg extension, leg
procedures ; curl, chest press, lat
HDL: selective pull, shoulder press,
inhibition ; seated row, triceps
LDL: Very Low- press, biceps curl, and
density Lipoprotein chest fly) are repeated
Cholesterol (VLDL- 10-20 times on heavy
C ); equipment. All
 Title, Author, Target
No DSVIA Aim / Purpose Intervention Result Advantages Weakness
Year Group
Quality of life: SF- training sessions were
36 Health Survey ; supervised by
BMI; blood researchers. In the
pressure: random- control group (CON)
zero no intervention was
sphygmomanometer given.
; cardiorespiratory:
treadmill with
Asymptomatic
Cardiac Ischemia
Pilot protocol;
Pulse: chest-band
transmitter and
wristwatch display
A: Independent t-
test for data
comparison.
ANOVA.
3. Discussion combination of resistance training and

The results of this review are indicative aerobic training did not mention changes in

of the influence of resistance training and viral load.

the combination of resistance training and Patients with HIV are expected to

aerobic training on the immune system in increase muscle and body strength so that it

people with HIV. The effects obtained are can provide positive benefits for them.

CD4+ improvement, viral load, muscle Poton et al., (2017) explained that in

strength and quality of life. addition to the increased CD4+, the effect of

The improvement of the immune system resistance training interventions in HIV

in CD4+ was shown in the Brito-neto et al., patients is an increase in muscle strength

(2019) study. In addition, CD4+ was also and body mass as well as a decrease in the

found to be a significant increase in amount of fat in the body

respondents who conducted resistance A more significant effect was found in

training and combined with aerobic training the combination of resistance training and

in Schlabe et al., (2017) and Tiozzo et al., aerobic training in Garcia et al. (2014)

(2013). This improvement is obtained in research, in addition to increased muscle

training that is carried out consistently. The endurance was found there was also no

training must be done by professional replication of HIV virus.

awareness and adjusted to the ability of Another effect of using resistance

participants to get maximum results of training interventions is the increasing

change. functional capacity of the body and quality

In O’Brien et al., (2017) found of life in HIV patients (Anandh et al., 2014).

significant differences in resistence training In addition, in the study Tiozzo et al. (2013)

on CD4+ and viral load. Research that did a found improvements in the immune system
and the status of quality of life of patients 4. Implications

increased in resistence training combined Scientific research has shown that

with aerobic training. interventions in the form of resistance

The combination of resistance training training and a combination of resistance

with aerobic exercise can be used as an training and aerobic training can improve

important means to prevent cardiovascular the immune system in patients with HIV.

and metabolic disorders caused by These results are certainly very useful in the

prolonged exposure to HIV infection and the field of nursing, because it can help nurses

use of active antiretroviral therapy (Garcia et provide nursing interventions.

al., 2014). In addition, the combination of 5. Limitation

resistance training can also cause an increase This overview of systematic reviews has

in the number of CD4+ (Garcia et al., 2014). several limitations. The number of

These findings were based on the adherence systematic reviews included in this overview

and consistency of patients with HIV who was small (n = 13). Our review may also be

conduct exercise programs. biases subject from the included systematic

It can be concluded that the resulting reviews. As an example, the narrative

influence on the combination of resistance findings might not be a result of a resistance

training with aerobic training can provide training alone since some articles include the

better benefits to the immune system of combination of resistance training and

patients with HIV, it also affects the changes aerobic training.

in the quality of life towards a more positive 6. Conclusion

direction. The results of this study showed the

effect of resistance training and a

combination of resistance training with

aerobic on the immune system in people month strength training program’,

with HIV, such as CD4+ improvement, viral Journal of Sports Medicine and

load, muscle strength and quality of life. Physical Fitness, 57(7–8), pp. 1051–

1056. doi: 10.23736/S0022-

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