Exercise regimens for men with HIV.

To the Editor: Dr Bhasin and colleagues reported that testosterone replacement therapy or resistance training resulted in gains in body weight, muscle mass, strength, and lean body mass in men infected with the human immunodeficiency virus (HIV) who have weight loss and low testosterone levels. However, the training protocol does not reflect the scientific basis for effective resistance training. Bhasin et al described a resistance training protocol that featured whole-body training with 5 exercises 3 times per week. After testing for 1-repetition maximum (1-RM), the first 4 weeks of the protocol involved 3 sets of 12 to 15 repetitions at 60% of the 1-RM. This was followed by 6 weeks of a periodized program using 4 sets of 4 to 6 repetitions with 1 day at 90% of 1-RM, 1 day at 80%, and 1 day at 70%. A similar protocol, but with 5 sets and greater resistance, was used during the last 5 weeks. There is very little evidence supporting the efficacy of using more than 1 set of repetitions for each exercise. One set is as effectiveasmultiple sets.Usingmultiple sets,particularly forpeople already with compromised health, may cause overtraining and immunosuppression (eg, natural killer cell cytotoxic activity) that can undermine strength gains and body composition changes. Also, there is little evidence to suggest that training 3 times per week results in greater strength or lean body mass than training twice per week. Twice-weekly training is recommended over more frequent sessions because it is less time consuming, improves compliance, allows adequate recovery time, and produces the most health and fitness benefits. In addition, there is a lack of evidence to recommend periodized programs, which vary the training volume at specific intervals, over training regimens that simply allow sufficient rest between training sessions. Most evidence indicates that the key stimulus promoting adaptation in the musculoskeletal system is the intensity of training, not volume, as was used in the protocol of this study. By the last 5 weeks of the intervention, men were receiving an exercise dose that was 7.5 times greater (5 sets of each exercise, 3 times per week) than what appears required for significant improvement (1 set of each exercise, 2 times per week). Resistance training research indicates that the same outcomes could have been produced with a fraction of the training and that weight gain, muscle mass, and strength may have shown better outcomes with a prescribed dose of 1 set per exercise twice per week.