Effects of resistance training on muscle strength, body composition and immune-inflammatory markers in people living with HIV: a systematic review and Meta-analysis of randomized controlled trials

Figures & data

Figure 1. PRISMA flow diagram and selection of articles.

Table 1. Summary of included studies.

Study	Initial Study Design	Final participants	Male /Female	Age years (M ± SD)	Training Protocol	Outcomes Results*
Brito 2013 ^10	45 PLHIV randomized to RT or CON	RT n = 23; CON n = 22	14/31	NR	24 weeks of RT; 3x/week; 7 exercises; 3 sets; 8–10 reps; 80% 1RM	↑ Muscle strength ↔ LBM ↓ FBM ↓ BF% ↔ CD4+
Ghayomzadeh 2019 ^11	21 PLHIV randomized to RT or CON	RT n = 12; CON n = 6	12/6	39 ± 9	8 weeks of RT; 3x/week; Circuit training; phase 1 (week1 to 4): 2 to 3 circuit laps; 8 exercises; 12 to 15 repetitions using elastic band and body weight; phase 2 (week 5 to 8): 3 circuit lap; 10 exercises; 8 to 12 repetitions using elastic band and body weight	↑ LBM ↓ FBM ↓ BF% ↑ CD4+
Vingren 2018 ^15	16 PLHIV randomized to RT or CON	RT n = 8; CON n = 8	16/0	41 ± 11	6 weeks of RT; 3x/week; 13 exercises. 3 to 5 sets; 5 to 12 repetitions with the individual load.	↑ Muscle strength ↔ LBM ↓ FBM ↓ BF% ↔ IL-6 ↔ TNF-α
Zanetti 2016a ^14	30 PLHIV randomized to RT or CON	RT n = 15; CON n = 15	17/13	41.1 ± 10.1	12 weeks of RT; 3x/week; 6 exercises; 1^st session: 3 sets of 4–6 RM; 2^nd session: 3 sets of 15–20 RM; 3^rd session: 3 sets of 8–12 RM	↑ LBM ↓ FBM ↓ BF%
Zanetti 2016 b ^12	30 PLHIV randomized to RT or CON	RT n = 15; CON n = 15	17/13	41.1 ± 10.1	12 weeks of RT; 3x/week; 6 exercises; 1^st session: 3 sets of 4–6 RM; 2^nd session: 3 sets of 15–20 RM; 3^rd session: 3 sets of 8–12 RM	↑ Muscle strength ↑ CD4+ ↓ IL-6 ↓ TNF-α
Zanetti 2017 ^13	21 PLHIV with metabolic syndrome randomized to RT or CON	RT n= 10; CON n = 11	9/12	43 ± 10.5	12 weeks of RT; 3x/week; 6 exercises; 1^st session: 3 sets of 4–6 RM; 2^nd session: 3 sets of 15–20 RM; 3^rd session: 3 sets of 8–12 RM	↑ LBM ↓ FBM ↓ BF%
Sookan 2020 ^16	128 PLHIV randomized to RT or CON	RT = 64; CON = 64	27/101	NR	12 weeks of RT; 3x/week; 4 exercises; 1-2 weeks (3 sets of 10 repetition with 50% 1RM); 3-4 weeks (3 sets of 10 repetition with 60% 1RM); 5-6 weeks (3 sets of 10 repetition with 65% 1RM) ; 7-8 weeks (2 sets of 8 repetition with 70% 1RM); 9-10 weeks (2 sets of 8 repetition with 75% 1RM); 11-12 weeks (2 sets of 8 repetition with 80% 1RM)	↑ Muscle strength ↑ LBM ↓ FBM ↓ BF%

* Compared to the CON group. NR: not reported; LBM: lean body mass; FBM: fat body mass; BF%: body fat percentage; IL-6: interleukin-6; TNF-α: tumor necrosis factor alpha.

Figure 2. Risk of bias of included RCTs: (a) risk of bias graph and (b) risk of bias summary. Green circle with plus sign indicates low risk of bias and red circle with minus sign indicates high risk of bias.

Table 2. Summary of grading of recommendations assessment development and evaluation (GRADE).

Certainty assessment							Summary of findings
Participants (studies) Follow up	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Overall certainty of evidence	Study event rates (%)			Anticipated absolute effects
							With control	With RT		Risk with control	Risk difference with RT
Muscle Stregnth in Bench Press
219 (4 RCTs)	serious^a	not serious	not serious	not serious	none	⨁⨁⨁◯ MODERATE	109	110		The mean muscle Stregnth in Bench Press was 0.3 kg	MD 10.69 kg higher (3.44 higher to 17.93 higher)
Muscle Strength for Squat
203 (3 RCTs)	Serious^a	not serious	not serious	not serious	none	⨁⨁⨁◯ MODERATE	101	102		The mean muscle Strength for Squat was 0.3 kg	MD 22.66 kg higher (7.82 higher to 37.5 higher)
Lean Body Mass (LBM)
258 (6 RCTs)	serious^a	not serious	not serious	not serious	none	⨁⨁⨁◯ MODERATE	126	132		The mean LBM was 0.5 kg	MD 2.96 kg higher (0.98 higher to 4.94 higher)
Fat Body Mass (FBM)
242 (5 RCTs)	Serious^a	not serious	not serious	not serious	none	⨁⨁⨁◯ MODERATE	118	124		The mean FBM was 0.39 kg	MD 2.67 kg lower (4.95 lower to 0.39 lower)
Body fat percentage (BF%)
242 (5 RCTs)	Serious^a	not serious	not serious	not serious	none	⨁⨁⨁◯ MODERATE	118	124		The mean BF% was 0.6 %	MD 3.66 % lower (6.04 lower to 1.29 lower)
CD4
93 (3 RCTs)	Serious^a	not serious	not serious	not serious	none	⨁⨁⨁◯ MODERATE	43	50		The mean CD4 was 21.3 cell/mm3	MD 100.15 cell/mm3 higher (12.21 higher to 188.08 higher)
Interleukin-6 (IL-6)
46 (2 RCTs)	serious^a	not serious	not serious	not serious	none	⨁⨁⨁◯ MODERATE	23	23		The mean IL-6 was 0.19 pg/mL	MD 1.18 pg/mL lower (3.71 lower to 1.35 higher)
Tumor Necrosis Factor-alpha (TNF-α)
46 (2 RCTs)	serious^a	not serious	not serious	not serious	none	⨁⨁⨁◯ MODERATE	23	23		The mean tNF-alpha was 0.8 pg/mL	MD 4.76 pg/mL lower (10.81 lower to 1.29 higher)

a (-1) lack of blinding information on study participants.; CI: confidence interval; SMD: standardized mean difference.

Figure 3. Effects of RT on muscle strength in PLHIV. (a) bench press exercise; (b) squat exercise.

Figure 4. Effects of RT on body composition and imune-inflammatory markers. (a) lean body mass; (b) fat body mass; (c) body fat percentage; (d) T CD4 ⁺ cell counts; (e) interleukin-6; (f) tumor necrosis factor alpha.

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Ghayomzadeh M, SeyedAlinaghi S, Shamsi MM, et al. Effect of 8 weeks of hospital-based resistance training program on TCD4+ cell count and anthropometric characteristic of patients with HIV in Tehran, Iran: A randomized controlled trial. J Strength Cond Res. 2019;33(4):1146–1155.

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Vingren JL, Curtis JH, Levitt DE, et al. Adding resistance training to the standard of care for inpatient substance abuse treatment in men with human immunodeficiency virus improves skeletal muscle health without altering cytokine concentrations. J Strength Cond Res. 2018;32(1):76–82.

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Zanetti HR, da Cruz LG, Lourenço CLM, et al. Nonlinear resistance training enhances the lipid profile and reduces inflammation marker in people living with HIV: A randomized clinical trial. J Phys Act Health. 2016;13(7):765–770.

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Zanetti HR, Cruz L. G d, Lourenço CLM, Neves F. d F, Silva-Vergara ML, Mendes EL. Non-linear resistance training reduces inflammatory biomarkers in persons living with HIV: A randomized controlled trial. Eur J Sport Sci. 2016;16(8):1232–1239.

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Zanetti HR, Lucas G, Cruz d, et al. Does nonlinear resistance training reduce metabolic syndrome in people living with HIV? A randomized clinical trial. J Sports Med Phys Fitness. 2017;57(5):678–684.

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Sookan T. Effects of a resistance training programme in people living with HIV in Zimbabwe. Sport Sciences for Health 2020;16:551–560.

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