Transcript Slide 1

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:
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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%
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•
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