Regular exercise is an essential part of a healthy lifestyle for everybody. It can improve your appearance and increase your life expectancy. It’s good for the heart, lungs, circulation, mobility and posture.

Exercise is also good for you mentally, since the body releases endorphins and other natural chemicals that make us feel good. It can help relieve stress, tension, anxiety and depression. You may feel relaxed, energised, and sleep better.

Specifically for people with HIV:

• Moderate exercise can help strengthen the immune system (although very rigorous exercise may not be helpful).
• If you often feel tired, exercise can actually make you feel better.
• If you’ve lost too much weight, the right exercise can help you build muscle.

If you want to reduce the effects of lipodystrophy, exercise is very important. Regular exercise can help improve your blood sugar and blood fat levels, and so reduces the risk of cardiovascular disease.

If you have put on weight because of lipodystrophy, exercise will help you lose body fat. If you have fat loss on your arms and legs, you may lose more weight. But a carefully planned programme of resistance training could help you build muscles to improve the appearance of your arms and legs.

• Lipodystrophy is a side-effect of some anti-HIV drugs. It involves losing or gaining fat from different parts of the body. These visible changes often happen at the same time as increases in the amount of fat and sugar in our blood.
• Raised blood fats and sugars can increase your chance of having cardiovascular diseases such as heart disease, heart attack, stroke and high blood pressure.
• The risk of cardiovascular disease is further increased if you smoke, don’t get much exercise or are overweight. That’s why it’s recommended to stop smoking, exercise regularly and eat a healthy diet.
• For more information, see the Your Shape booklet in this series.

Lots of people’s feelings about exercise were formed during sports lessons at school. This makes some people think that only strenuous and competitive sport counts.

In fact, to improve health, just a little mild or moderate activity can make a difference. You can start by:

• Getting off the bus a stop earlier, and then walking.
• Walking to the local shop rather than taking the car or bus.
• Using the stairs instead of the lift.
• Going dancing. (But not on drugs, which won’t do much for your health).

If you’re a bit more ambitious, and want to change your body shape or increase your strength, you can try a more intensive and structured training programme.

It’s worth speaking to your doctor before you start an exercise programme. He or she will probably think it’s a good idea, but it’s worth checking that there aren’t any limits on what’s safe for you.

There are three main types of exercise - cardiovascular, resistance training and stretching.

This is any activity that works the body and limbs in a rhythmical and continuous way. It can be a brisk walk in the park, a cycle to work or some laps in a swimming pool. It’s also known as aerobic exercise.

At the gym, you can use machines like steppers, treadmills and bikes. But special equipment isn’t necessary – dancing or climbing the stairs is good exercise too.

If you are concerned about the risk of cardiovascular disease, this kind of exercise is  particularly important. It strengthens the heart and circulatory system. If you want to lose weight, it will also help.

Cardiovascular exercise: how much?

It should be energetic enough to make you feel slightly hot, and a little out of breath. If you don’t, the exercise is too easy, and won’t make much of a difference to your health. As you get into shape, you can build up to more intense and tiring activity – but it shouldn’t ever be so difficult that you have to really force yourself  to continue.

It’s recommended to be active for 20-30 minutes a day, at least three times a week. If you find this too strenuous, you could try three brisk 10 minute walks a day.

This strengthens your muscles, for example by using weight machines in a gym. It also includes:

• lifting free weights (dumb-bells and bar-bells),
• doing push-ups, sit-ups and squats,
• exercising at home with heavy objects like bottles of water and bags of sugar.

The aim is always to make your muscles lift heavier weights and work harder than they are used to. It’s the best way to improve muscle mass, strength and endurance, which will give you more strength for everyday tasks.

Gym instructors can show you how to do exercises safely, and can prepare an individual  exercise programme that works all the main muscles.

Build muscle and burn fat at the same time

Resistance training actually helps you lose fat. The more muscle you have, the more fat you burn off, even when you aren’t doing anything. And if you’ve gained  fat around the waist because of lipodystrophy, resistance training may help you lose it.

Stretching exercises improve flexibility and movement.

Simple stretching exercises should be done before and after more vigorous activity. They involve holding different parts of the body in particular positions for 10 to 30 seconds. You don’t need any special equipment, but it is important to be shown how to do it correctly.

You can also do yoga, pilates, tai chi and classes just for stretching. Apart from being good for flexibility, posture and muscle tone, they may also help you relax.

• Local authorities usually have information on sports clubs and facilities. They may list them on their website, or you could ask at a library. Or use www.activeplaces.com, a website listing sports facilities across England.
• Local authority gyms are usually cheaper than private gyms. If you’re on benefits, local authority sports facilities normally offer reduced rates.
• In some areas, there are gyms that can develop special programmes for people with lipodystrophy. Ask at your HIV clinic.
• There are lots of books and DVDs to help you plan a programme, or to exercise with at home.

It’s very important to drink enough liquids when you exercise – before, during and after. Extra water can help you replace the fluids you lose through sweat.

It’s not a good idea to exercise either on an empty stomach or too soon after a full meal. Half an hour after a light snack should be OK.

Have something to eat after you’ve finished – no more than two hours later. Also, exercise increases your need for calories and improves appetite, so you may need to eat more. See Food and diet for more on a healthy diet.

Listen to your body

If you’re recovering from a cold, feeling feverish or dizzy, have swollen joints, are vomiting, have diarrhoea or are otherwise under the weather, it’s probably not  a good idea to exercise that day.

Also, if you are overly tired in the middle of exercise, it’s probably time to stop.

Lost too much weight?

People with HIV sometimes have problems with weight loss, which is also known as wasting. In terms of exercise, too much cardiovascular exercise could make the problem worse. However, resistance training can help you build muscle. It will also be important to increase your calorie intake.

1. It’ll be easier to stick to a programme if you choose activities that you enjoy.
2. Don’t set yourself up to fail by being over-ambitious. Start slowly and build up to more difficult things.
3. Motivate yourself with goals (and rewards for when you’ve achieved them).
4. Set goals that you can realistically achieve in a month or two, and that are precise and measurable. For example “swim ten lengths without stopping” is clearer than “go swimming”.
5. Make exercise part of your weekly routine, otherwise you may not keep it up. Don’t feel guilty if you miss it once or twice – but do go back.
6. Change your programme and activities if you’re getting bored.
7. If you don’t feel comfortable in a gym or sports club, try another one.
8. It may be more fun to exercise with other people. You could join a running, swimming or soccer club. Sports and team games are good exercise too.

Steroids are drugs which can help people build muscle mass. They are synthetic versions of male sex hormones, and are usually only taken by men. Doctors sometimes give them to people experiencing weight loss, and they are also sold illegally by dealers in gyms.

People often see them as a short cut to weight gain and larger muscles. But they can damage your health in other ways:

• serious liver problems
• raised blood fats, leading to heart disease
• acne, baldness and shrunk testicles
• anger, mood-swings and other psychological problems
• hepatitis C and other infections (if injection needles are shared)

If you’re thinking of taking them, it’s worth getting more detailed information. Speak frankly to your doctor, who will want to pay special attention to your liver,  kidney and cholesterol tests. People who take them need to work out regularly, drink a lot of water, eat well and get lots of rest.

A booklet, In Gear: a gay man’s  guide to steroids is available from Camden Primary Care Trust on 020 7530 3956, or goodsexualhealthteam@camdenpct.nhs.uk