Yoga and exercise to reduce metabolic problems in people living with HIV

As the New Year begins, millions of people are resolving to exercise more in 2006. A team of researchers at Washington University School of Medicine in St. Louis hopes that similar lifestyle changes will help HIV-positive people avoid metabolic and cardiovascular problems associated with HIV and anti-HIV drugs.

The researchers also are studying a new drug therapy and are recruiting volunteers for two clinical trials to test the benefits of exercise and the investigational drug.

Many HIV-positive patients develop diabetes, dyslipidemia, obesity and other metabolic changes that increase cardiovascular disease risk. Led by Kevin E. Yarasheski, Ph.D., associate professor of medicine and of cell biology and physiology, the researchers are testing interventions designed to reduce these metabolic and cardiovascular problems.

“Medical therapy has dramatically improved survival and quality of life for HIV-positive people, but they are living longer and developing traditional cardiovascular disease risk factors,” Yarasheski says. “We don’t know why, but HIV-positive people are developing insulin resistance, high blood cholesterol, abdominal adiposity, and high blood pressure at an alarming rate; so we’re looking for safe, effective therapies. Established therapies, like exercise and diabetes medications, work well in HIV-negative people, but they need to be tested in HIV-positive people. Other therapies, like yoga, are novel alternative approaches that complement the standard-of-care for HIV, but very little empirical evidence exists to support those approaches.”

Yarasheski has studied metabolic syndromes in HIV-positive people for more than 10 years, attempting to discover the underlying biologic impairments in muscle and fat tissue metabolism that cause these syndromes, which are linked both to HIV infection and to anti-HIV drugs, and to identify effective treatments.

His team is studying the effects of exercise and of the investigational drug pioglitazone (Actos®) on metabolic syndromes in people living with HIV. The drug helps lower blood sugar levels. In one study, volunteers are assigned either to four months on the drug, or to four months of drug therapy combined with exercise training, to see whether it’s possible to reduce blood sugar levels and reduce the amount of fat that can collect in the organs and blood vessels of people with HIV.

In another study, Yarasheski and colleagues at Living By Design in St. Louis are investigating whether a four-month yoga lifestyle intervention program might help alleviate HIV-related metabolic syndromes and reduce cardiovascular disease risk.

The ancient practice of a Hatha/Ashtanga yoga lifestyle has been re-popularized as a complementary therapy for metabolic, body composition, and cardiovascular problems, because it provides integrated control of eating habits, exercise, rest, breathing style and the mind. Through a focus on postures and controlled breathing, yoga is meant to establish a balance among physiological processes.

In this study, volunteers are assigned to a four-month yoga program, taught by certified instructors, or to no yoga (standard-of-care), to see if their metabolic, cardiovascular, and quality-of-life profiles improve. Volunteers originally assigned to no yoga, can re-enroll in the study after four months to receive the yoga program.

Volunteers will receive nutrition counseling and assessments of metabolism, body composition and cardiovascular function. All screening tests and research-related procedures for these studies are free of charge. Participants also receive either a supervised gym membership or membership in the yoga program, compensation for their time and effort and travel support to get to and from appointments and workouts.

For more information or to volunteer for one of the studies, please call Debra at (314) 747-1090 or Coco at (314) 747-1982.

Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked third in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.