Antiretroviral therapy (ART) has transformed HIV from a life-threatening disease into a manageable chronic condition. By controlling the virus, ART allows people living with HIV to lead longer, healthier lives. However, like any medication, ART comes with potential side effects that may impact everyday living, including physical fitness. These side effects can affect energy levels, physical performance, and even body composition, making exercise adaptations vital for maintaining health and well-being.

Staying active is one of the best ways to counteract the physical effects of both HIV and ART. It’s also a practical way to boost mood, improve immune function, and promote overall quality of life. Here’s a closer look at how ART can influence physical fitness and strategies to adapt your workout routine while staying active and healthy.

How ART Can Affect Physical Performance

Antiretroviral therapy works by suppressing the HIV virus and preventing it from damaging the immune system. While this results in immense health benefits, some medications can also introduce side effects that impact physical performance. Here are the most common ways ART may influence fitness:

1. Fatigue and Low Energy

Many people on ART report experiencing fatigue or low energy. This feeling of exhaustion can make it difficult to find motivation for physical activity, especially high-intensity exercise.

2. Weight Gain or Loss

Certain ART medications may cause changes in weight. Some people experience weight gain, while others may lose weight. These shifts often affect body composition, including fat distribution and muscle mass.

Lipoatrophy refers to the loss of fat in specific areas, like the face, arms, or legs.

Lipodystrophy refers to the uneven distribution of fat, often leading to increased fat around the abdomen or back of the neck.

Both conditions may alter physical appearance and impact how you feel during physical activity.

3. Muscle Weakness or Loss

Prolonged use of ART can sometimes lead to muscle wasting, especially if the virus or medication affects protein metabolism. This can reduce physical strength and endurance, making tasks that require strength more challenging.

4. Bone Density Loss

People living with HIV, especially those on ART, may face a higher risk of bone density loss or osteoporosis. Weak bones can contribute to a greater likelihood of fractures or injuries, particularly during high-impact activities.

5. Digestive Issues

Some ART drugs may cause gastrointestinal side effects like nausea or diarrhea, which can interfere with nutrition. Poor nutrition can, in turn, impact energy levels and muscle recovery.

6. Mental Health and Motivation

Living with HIV and managing the side effects of ART can sometimes impact mental health, leading to anxiety or depression. These mental health challenges may reduce motivation to exercise or make sticking to a fitness routine seem overwhelming.

Adapting Fitness Routines to Accommodate ART-Related Changes

While ART might produce some obstacles, exercise remains a crucial part of staying healthy. With a few modifications, it’s possible to maintain physical fitness and even improve your quality of life. Below are actionable strategies to help you adapt your fitness routine:

Modify Exercise Intensity

Due to fatigue or low energy, high-intensity workouts may not always feel achievable. Focus on incorporating moderate exercise instead, such as brisk walking, gentle cycling, or swimming. These activities can still provide cardiovascular and endurance benefits without overexerting yourself.

If you do feel up for more intense activity, try high-intensity interval training (HIIT) with shorter bursts of exercise followed by rest periods—this can help you maximize energy while avoiding burnout.

Prioritize Strength Training

Muscle mass preservation is critical for individuals on ART, especially if muscle loss or weakness is present. Strength training helps counteract muscle wasting and supports metabolic health. Examples include:

• Bodyweight exercises like push-ups, squats, and lunges.
• Resistance band workouts for low-impact strength building.
• Weightlifting to target large muscle groups.

Aim for 2–3 strength training sessions per week, ensuring you use proper form to prevent injuries.

Focus on Flexibility and Mobility

Flexibility exercises can reduce stiffness, improve posture, and increase overall range of motion. They’re also particularly beneficial if low bone density makes high-impact activities risky. Incorporate:

• Yoga or Pilates for flexibility, balance, and gentle core strengthening.
• Dynamic stretches before workouts to improve mobility.
• Static stretches after workouts to enhance recovery.

Boost Cardiovascular Health

Since HIV and ART can elevate the risk of heart disease, prioritize moderate cardiovascular activities. Walking is a simple yet effective way to improve heart health. Other options include stationary cycling or low-intensity aerobics. Set a realistic goal—30 minutes most days of the week—and tailor the pace to how your body feels.

Build an Incremental Plan

If you’re new to fitness or returning after a break, start small. Gradual progress prevents overexertion and minimizes the risk of injuries. Begin with 10–15 minutes of activity, and slowly add more time or intensity as your stamina improves.

Consider Low-Impact Alternatives

For those dealing with joint pain, muscle weakness, or low bone density, low-impact exercises are ideal. Try activities such as:

• Swimming or water aerobics, which are gentle on joints but effective for building strength and endurance.
• Elliptical machines or stationary bikes for cardiovascular workouts with minimal impact.

ART routines and their effects may vary from person to person. On days you feel particularly fatigued or unwell, prioritize rest and recovery. Modify your activities based on your energy levels, and don’t push yourself too hard.

• Additional Tips for Success
• Stay Hydrated and Nourished: A nutritious diet is a vital partner to fitness. Ensure you’re consuming enough protein, healthy fats, and complex carbohydrates to fuel your workouts and support muscle recovery. Consider consulting a dietitian specializing in HIV nutrition if you have unique dietary needs.
• Track Your Progress: Keeping a fitness journal can help you monitor progress, understand limitations, and set realistic goals. Whether it’s tracking how far you’ve walked or the weights you’ve lifted, visible progress can be a strong motivator.
• Build a Support Network: Working out with friends, joining fitness groups, or finding a personal trainer with experience working with individuals living with HIV can offer encouragement and accountability.
• Consult Healthcare Professionals: Talk to your doctor or a fitness specialist if you have any concerns about exercise while on ART. They can help you create a tailored fitness plan that aligns with your health needs and lifestyle.

Being on antiretroviral therapy doesn’t mean giving up on physical fitness—it simply means adapting to new challenges. By staying mindful of how ART may affect your body and modifying your fitness routines accordingly, you can continue to build strength, improve mental well-being, and support your long-term health.