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OTHER IMMUNE CONDTIONS • HIV and AIDS • LUPUS • FIBROMYALGIA HUMAN IMMUNODEFICIENCY VIRUS and AQUIRED IMMUNODEFICIENCY SYNDROME AIDS 1. Immunodeficiency disorder caused by a virus that destroys TCells. 2. The HIV Virus is harbored in the macrophage and Helper T-Cells. 3. The DNA of the virus directs the cells to create new viruses. CELLS OF THE IMMUNE SYSTEM Leukocytes Neutrophil Granulocytes Monocytes Eosinophil Basophil Lymphocytes T-CELL B-CELL HELPER & INFLAMMATORY CYTOTOXIC T LGL/NK CELLS OF THE IMMUNE SYSTEM Leukocytes Neutrophil Granulocytes Monocytes Eosinophil Basophil Lymphocytes T-CELL B-CELL HELPER & INFLAMMATORY CYTOTOXIC T LGL/NK ADAPTIVE IMMUNITY • Cytotoxic T-Cells • Specific Antigens • Natural Killer Cells • Any Antigen • Kills on Contact • Releasing Granules INFECTION • Bad Flu-like • Several weeks ASYMPTOMATIC • 10 YRS CLINICAL AIDS • Infection of an opportunistic organism, not normally infectious EXERCISE CONCERNS in HIV and AIDS • DECONDITIONING • MUSCLE WASTING • LIPODYSTROPHY DECONDITIONING Deleterious effects of bed rest • Cardiovascular • Skeletal muscle • Bone and calcium metabolism • Metabolic and endocrine • Psychosocial WASTING • 5% Loss in Body Weight increases Mortality • Loss is directly related to lack of modern AIDS treatment • Decreased Strength • Decreased Muscle Mass LIPODYSTROPHY Fat Redistribution Syndrome • Loss of subcutaneous fat • Arms • Legs • Face • Increase in visceral abdominal fat LIPODYSTROPHY • Insulin Resistance • Elevated Glucose • Decreased HDL • Upper Body Obesity • Cardiovascular Disease • Stroke • Diabetes EXERCISE EFFECTIVENESS • Improve Physical Work Capacity • Improve Mood • Improve Immune Function • Decrease Chronic Disease Incidence • Increase Muscle Strength • Increase Muscle Mass Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998. CONTROL • Maintain current level of activity MODERATE INTENSITY • 60 min • 3/wk • 80% of Lactate Threshold Cycle Ergometry Total Amount of Work Moderate = Heavy 6 weeks HEAVY INTENSITY • 3/wk • 30-40 min • 50% of VO2max – Lactate Threshold Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998. SKIN REACTIVITY TESTS 600 Area (mm2) 500 400 Pre Post 300 200 100 0 Control Moderate Heavy Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998. HIV VIRAL REPLICATION 60000 Copies /mL 50000 40000 Pre Post 30000 20000 10000 0 Control Moderate Heavy Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998. QUALITY OF LIFE 1. How would you rate the quality of your life now? 2. How much longer do you want to live 3. How much longer do you think you will live? 4. Compared to one year ago, how much does your health limit your daily activities? (1=none; 5 = Very limited) 5. I look forward to the future with hope. (1=agree; 5 = disagree) 6. Overall, how would your rate your quality of life? (0=worst; 10 = best). 7. Which best describes how your feel about our life as a whole? (1=terrible; 7=delighted) Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998. QUALITY OF LIFE Change in Score 0.8 0.6 0.4 0.2 Control Moderate Heavy 0 -0.2 NS -0.4 -0.6 -0.8 1 2 3 4 5 6 7 Stringer WW., et al Med Sci Sports Exerc 30:11-16, 1998. OTHER INTERVENTION STUDIES • CD4 COUNTS INCREASED IN THOSE pts WHO ADHERED MacArthur, RD et al Med Sci Sports Exerc 25:684-688, 1993 PHARAMCOLOGY HIGHLY ACTIVE ANTIRETROVIRAL THERAPY HAART • 1-4 doses/day • Nucleoside ReverseTranscriptase Inhibitors (NRTI) • Eating & Drinking restrictions with 1-2 hrs of taking meds • Nonnucleoside ReverseTrancriptase Inhibitors (NNRTI) • 2-5 Meds • Protease Inhibitors PHARAMCOLOGY Increase in Lean Mass (kg) ANABOLIC STERIODS 7 6 5 4 Control Exercise 3 2 1 0 ND • Nandrolone decanoate • Oxandrolone OX EXERCISE TESTING • BODY COMPOSITION • Lean Body Mass • Body Fat Distribution • Skinfold thickness at each site • FUNCTIONAL ASSESSMENT Cardiovascular Endurance • 6 min walk • Stress Testing • Muscle Strength • Flexibility • EXERCISE PRESCRIPTION GOALS: 1. Improve Physical Work Capacity 2. Increase Muscle Mass 3. Increase Muscle Strength 4. Counteract lipodystrophy 5. Improve Immune Function EXERCISE PRESCRIPTION ENDURANCE STRENGTH MODE CV Resistance FREQUENCY 3/wk 3/wk DURATION 15-25 min 45 min INTENSITY 65-85% 60-80% RM PRECAUTIONS • Intercurrent Illness • Decrease Intensity • Discontinue • Fever >100o • Acute Symptoms • Nausea • Vomiting • Uncontrolled Diarrhea • Dehydration • Injury (wasting) LUPUS LUPUS ERYTHEMATOSUS • Chronic Autoimmune Disease • Produces Antibodies to Fight own Tissues INCIDENCE: • 1.4 – 1.5 Million • 16,000 / year • 90% Women • 15-45 years old • 2-3x in Minorities TYPES OF LUPUS DISCOID • Affects the Skin • Rash • Abnormal Skin Biopsy • Can evolve to Systemic in 10% of cases SYSTEMIC • Any Organ of the Body • Predominantly Skin & Joints • Heart, Lungs, Kidneys, Blood DRUG-INDUCED • Only 4% who take • Hydralazine • Procainamide Sx: • • • • • • • • • • • • • Arthraligia (achy joints) Fever >100o Arthritis (swollen joints) Prolonged or Extreme Fatigue Skin Rashes Anemia Kidney Involvement Butterfly Rash on cheeks/nose Sun or Light Sensitivity Abnormal blood clotting Raynaud’s Phenomenon Seizures Mouth or Nose Ulcers 95% 90% 90% 81% 74% 71% 50% 42% 30% 20% 17% 15% 12% ETIOLOGY • Susceptible Genes • Environmental Factors • Infectious Agents • Meds • Anticonvulsants • Penicillins • Estrogen Therapy • Excessive Ultraviolet Light • Physical Trauma • Emotional Stress DIAGNOSIS Medical History • Physical Examination • Blood Tests • RHEUMATOLOGIST must rule out • Chronic Fatigue Syndrome • Mononucleosis POSITIVE: • Butterfly Rash • Sun Sensitivity • Kidney Disorder • Blood Abnormalities • +4/11 other criteria THE ELEVEN CRITERIA • Malar Rash Cheeks • Discoid Rash Red Raised Patches • Photosensitivity • Oral Ulcers Nose or mouth • Arthritis Nonerosive >2 peripheral joints • Serositis Inflamation of lining of lung or heart • Renal Disorder Excessive protein in urine • Neurologic Disorder Seizures and/or psychosis • Hematologic Disorder Anemia or Leukopenia or lymphopenia or thrombocytopenia • Antinuclear Antibody + antibodies • Immunologic Disorder + anti-DNA test + anti-SM test false +syphilis test + antiphospholipid antibody TREATMENT • Medications • Aspirin • Non-Steroidal Anti-Inflammatory (NSAIDs) • Acetaminophen (tylenol) • Antimalarials • Corticosteroids • Anticoalgulants • Avoid Sunlight • Eat Healthy Diet • Exercise • Minimize Stress • Bone Marrow Transplant (experimental) FIBROMYALGIA • Pain in Muscles and Joints • Poor Sleep • Headaches • Stiffness • Muscle Aches • Sensitivity to • Bright Light • Loud Noise • Meds • Fatigue • 5% of Population • More common in Women • Women of Child Bearing Ages CLINICAL FEATURES • 90-100% • Generalized Pain • Fatigue • Stiffness • Morning Fatigue • 70-90% • • • • • • • • • • • • • Post-exertional malaise Sleep disturbances Morning stiffness Headaches Tenderness Swollen Feeling in tissues Numbness & tingling Cognitive Impairment Dizziness Sensitivity to Noise Sensitivity to Smell & Stress Menstrual cramping Dry mouth • 50-70% • Irritable bowel syndrome • Blurred Vision • Mood Swings • Heart Palpatations • Cold Extremities • Feverous feeling • Allergies • 15-50% • Restless legs • Muscle twitches • Itchy skin • Hearing disturbances • Night sweats • Migraines • Breathing problems • Skin rashes • TMJ dysfunction • Chemical sensitivities CLINICAL FEATURES • Below 15% • Major depression DIAGNOSIS 11/18 + POINTS TREATMENT • Medications • Sleep Meds • Seritonin • NSIADs • Exercise • Relaxation Techniques • Educational Programs • Diet EXERCISE MODE Walking, Jogging, Cycling Swimming, Flexibility, ROM FREQUENCY 4/wk DURATION up to 60 min INTENSITY Moderate Exercise in the afternoon or early evening