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The Effect of Strength and Endurance Training on Insulin Sensitivity and Fat Distribution in Human Immunodeficiency Virus-Infected Patients with Lipodystrophy

The Centre of Inflammation and Metabolism at the Department of Infectious Diseases (B.L., T.Ha., T.Hv., G.v.H., P.P., B.K.P.), the Copenhagen Muscle Research Centre (B.L., T.Ha., T.Hv., G.v.H., P.P., B.K.P.), and Department of Infectious Diseases (B.L., P.P., J.G., B.K.P.), Rigshospitalet, DK-2100 Copenhagen, Denmark; and Department of Mathematical Sciences (S.D.), University of Copenhagen, DK-2100 Copenhagen, Denmark

Address all correspondence and requests for reprints to: Birgitte Lindegaard, Centre of Inflammation and Metabolism, Rigshospitalet–7641, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. Email: blm{at}rh.dk.

Context: Fat redistribution, insulin resistance, and low-grade inflammation characterize HIV-infected patients with lipodystrophy. Currently, no effective therapies exist for the combined treatment of fat redistribution and insulin resistance.

Objective: Our objective was to evaluate the effects of strength and endurance training on insulin sensitivity and fat distribution in HIV-infected patients with lipodystrophy.

Subjects and Methods: Twenty sedentary HIV-infected men with lipodystrophy were randomly assigned to supervised strength or endurance training three times a week for 16 wk. The primary endpoints were improved peripheral insulin sensitivity (euglycemic-hyperinsulinemic clamp combined with isotope-tracer infusion) and body fat composition (dual-energy x-ray absorptiometry scan). Secondary endpoints included fasting lipids and inflammatory markers.

Results: Insulin-mediated glucose uptake increased with both endurance training (55.7 ± 11 to 63.0 ± 11 µmol glucose/kg lean mass·min, P = 0.02) and strength training (49.0 ± 12 to 57.8 ± 18 µmol glucose/kg lean mass·min, P = 0.005), irrespective of training modality (P = 0.24). Only strength training increased total lean mass 2.1 kg [95% confidence interval (CI), 0.8–3.3], decreased total fat 3.3 kg (95% CI, –4.6 to –2.0), trunk fat 2.5 kg (95% CI, –3.5 to –1.5), and limb fat 0.75 kg (95% CI, –1.1 to –0.4). Strength training significantly decreased total and limb fat mass to a larger extent than endurance training (P < 0.05). Endurance training reduced total cholesterol, low-density lipoprotein cholesterol, free fatty acids, high-sensitivity C-reactive protein, IL-6, IL-18, and TNF- and increased high-density lipoprotein cholesterol, whereas strength training decreased triglycerides, free fatty acids, and IL-18 and increased high-density lipoprotein cholesterol (P < 0.05 for all measurements).

Conclusion: This study demonstrates that both strength and endurance training improve peripheral insulin sensitivity, whereas only strength training reduces total body fat in HIV-infected patients with lipodystrophy.