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Effects of Pharmacological Doses of Nandrolone Decanoate and Progressive Resistance Training in Immunodeficient Patients Infected with Human Immunodeficiency Virus¹

Department of Medicine, Division of Infectious Diseases (F.R.S., C.O., M.P.D.) and Endocrinology (C.M., R.H.), Department of Biokinesiology and Physical Therapy (S.V.J., E.T.S.), and Department of Preventive Medicine (S.A.), University of Southern California School of Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, California 90033

Address all correspondence and requests for reprints to: Dr. Fred R. Sattler, Los Angeles County-University of Southern California Medical Center, 1300 North Mission Road, Los Angeles, California 90033.

This nonplacebo-controlled, open label, randomized study was conducted to test the hypotheses that pharmacological doses of nandrolone decanoate would increase lean body tissue, muscle mass, and strength in immunodeficient human immunodeficiency virus-infected men, and that these effects would be enhanced with progressive resistance training (PRT). Thirty human immunodeficiency virus-positive men with fewer than 400 CD4 lymphocytes/mm³ were randomly assigned to receive weekly injections of nandrolone alone or in combination with supervised PRT at 80% of the one-repetition maximum three times weekly for 12 weeks. Total body weight increased significantly in both groups (3.2 ± 2.7 and 4.0 ± 2.0 kg, respectively; P < 0.001), with increases due primarily to augmentation of lean tissue. Lean body mass determined by dual energy x-ray absorptiometry increased significantly more in the PRT group (3.9 ± 2.3 vs. 5.2 ± 5.7 kg, respectively; P = 0.03). Body cell mass by bioelectrical impedance analysis increased significantly (P < 0.001) in both groups (2.6 ± 1.0 vs. 2.9 ± 0.8 kg), but to a similar magnitude (P = NS). Significant increases in cross-sectional area by magnetic resonance imaging of total thigh muscles (1538 ± 767 and 1480 ± 532 mm²), quadriceps (705 ± 365 and 717 ± 288 mm²), and hamstrings (842 ± 409 and 771 ± 295 mm²) occurred with both treatment strategies (P < 0.001 for the three muscle areas); these increases were similar in both groups (P = NS). By the one-repetition method, strength increased in both upper and lower body exercises, with gains ranging from 10.3–31% in the nandrolone group and from 14.4–53.0% in the PRT group (P < 0.006 with one exception). Gains in strength were of significantly greater magnitude in the PRT group (P 0.005 for all comparisons), even after correction for lean body mass. Thus, pharmacological doses of nandrolone decanoate yielded significant gains in total weight, lean body mass, body cell mass, muscle size, and strength. The increases in lean body mass and muscular strength were significantly augmented with PRT.

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