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[NEWS BRIEF]

With Magic Back, What are the Medical Messages?

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 4 - APRIL 96


The landscape has changed dramatically since the last time Magic Johnson returned to the National Basketball Association. Johnson's brief return in 1992 was stunted by a few players who feared on-court human immunodeficiency virus (HIV) transmission. This time, fellow players have enthusiastically welcomed him back. "I'm pleased to see players' reactions. They're much more matter-of-fact about his condition," says Michael Sheran, MD, deputy director of the AIDS Center at St Vincent's Hospital and Medical Center in New York City. "Magic Johnson's HIV status is quickly becoming a nonissue," he says. Instead, Johnson's return raises broader questions about the role of fitness in treating HIV patients: Is vigorous exercise safe? What are the exercise benefits?

Few details of Magic Johnson's health status are known. His physician, David Ho, MD, of the Aaron Diamond AIDS Research Center in New York City, chose not to comment for this article. He had previously told Sports Illustrated (1) that Johnson's virus is under very good control through a combination of drugs, his routine, and his attitude. Ho told Sports Illustrated: "Looking through the retroscope, he probably didn't need to retire, but we just didn't know that then." According to several news reports, Johnson had continued to train with his all-star touring team and had followed an intensive strength-training routine during his retirement. Since his return to professional basketball he has played well, averaging 15 points per game and 7 assists.

Johnson's impressive box scores are no surprise to AIDS specialists, who have long known that asymptomatic HIV-positive people are capable of attaining and maintaining high levels of physical activity. "You can't make blanket statements about HIV and activity; however, people who have no complications can pretty much compete as normal," Sheran says.

Exercise isn't just allowed for HIV-positive patients—it's strongly encouraged, says Leonard H. Calabrese, DO, head of the Section of Clinical Immunology at the Cleveland Clinic Foundation and editorial board member of The Physician and Sportsmedicine. "Exercise is part of the game plan to make a patient a long-term survivor of the disease," he says. It's important to institute exercise interventions in the early stages of the disease when T cells are still up. Calabrese says regular exercise not only has cardiovascular benefits for these patients, it can also reduce depression and stress. "Exercise provides a focus on health instead of disease," he says.

Physicians base their activity recommendations on the HIV patient's general health status. Patients who are free of malignancy, opportunistic infection, or other signs of the disease may participate at any level, even if their T-cell count is low, Sheran says. He has two main recommendations for active patients who are HIV-positive and asymptomatic:

(1) Increase calorie intake as needed: Resting metabolic rate may be increased, even in patients who are asymptomatic.

(2) Take a balanced multivitamin: Vitamin deficiencies can occur early in HIV infection.

In addition, patients should be advised to avoid overtraining, and for elite athletes, physicians should advise ways to minimize stress related to competition (2).

Activity is only limited when the patient is symptomatic and has an active infection that is not under control, Sheran says. In such instances, exercise can increase an already-high metabolic rate.

Though there is no evidence that exercise slows HIV progression, regular exercise probably makes immunologic sense, Calabrese says. Studies (3) suggest that exercise may increase natural killer cell activity and has no demonstrable adverse effects on CD4 cell numbers.

Building lean body mass through exercise is important for people who are HIV-positive, Calabrese says, because it can cushion against the wasting that occurs in the later stages of the disease. Researchers are currently evaluating the use of anabolic steroids for the treatment of muscle wasting. Sheran says some physicians have already started prescribing steroids for their HIV-positive patients, and some patients are obtaining the drugs on their own. "The jury is still out on the effectiveness of anabolic steroids," Sheran says. If researchers find that there are HIV-related testosterone decreases, anabolic steroids may be effective, he says. "But if testosterone is normal it is not clear that anabolic steroids will help." Calabrese adds that anabolic steroid treatment may not be effective unless combined with exercise.

Meanwhile, Magic Johnson may be setting a good active example for other people who are HIV positive. "In the long run, it will be to Magic Johnson's benefit to have been healthy and active," Sheran says.

References

  1. Smith G: True lies: all along Magic Johnson insisted he wasn't coming back. Was he kidding us, his family-or himself? Sports Illus 1996;84(6):32-42
  2. Eichner RE, Calabrese LH: Immunology and exercise: physiology, pathophysiology, and implications for HIV infection. Med Clin North Am 1994; 78(2):377-388
  3. La Perriere A, Ironson G, Antoni MH, et al: Exercise and psychoneuroimmunology. Med Sci Sports Exerc 1994;26(2):182-190

Lisa Schnirring
Minneapolis


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