Everyone knows that swimming is good for you. Everyone also knows that being 
infected with the human immunodeficiency virus (HIV) is quite serious and can 
lead to Acquired Immune Deficiency Syndrome (AIDS) and death. At the Gay 
Games IV in New  York City in 1994, of the 11,000 participating athletes, 1,200 were 
swimmers — many of them HIV+. Can swimming have a positive effect on the 
immune system and slow down and/or halt the progression of HIV infection?

A search of the medical/scientific research revealed that so far there are no studies 
dealing specifically with HIV+ swimmers. However there are a few review articles 
on the immune system, HIV, and exercise. ,   

HIV infection is considered a chronic illness of 10 or more years duration, which 
manifests itself with a wide spectrum of immunological abnormalities. While many 
people with HIV show no symptoms after 15 years or more, others may come down 
with opportunistic infections, such as pneumocystis carinii pneumonia (PCP), 
herpes zoster (shingles), toxoplasmosis, or other illnesses such as Kaposi’s Sarcoma 
(KS). These illnesses are considered opportunistic in that the infectious agent is 
taking advantage of an immune system which is not operating optimally. 

Unlike the cardiovascular system, the immune system is not comprised of a large 
organ (the heart) which is relatively accessible. The immune system consists of cells 
(white blood cells: B and T lymphocytes, macrophages, neutrophils, eosinophils, 
natural killer cells) and soluble factors (complement fragments, acute-phase 
proteins, and others). The last 20 years has seen enormous advances in our 
knowledge of the immune system and how it functions. As we learn more, new 
fields such as pyschoneuroimmunology (the interaction between the psyche, 
nervous system, and immune system) and neuroimmunoendocrinology 
(interaction between hormones and the immune and nervous systems) have been 

Increasingly, doctors and researchers are looking to long-term survivors of HIV 
infection for factors that contribute to their longevity.  Exercise, along with prayer, 
meditation, and special diets may contribute to long-term survival [see sidebar 
story]. In the last few years research has directed its focus to how exercise and the 
immune system interact.  Within this context, several studies have also looked at 
the effect of exercise on those infected with the HIV virus. Generally these effects 
can be divided into two groups: psychological effects and physical effects. 

Psychological effects

During or following stressful events many people will get sick, especially with upper 
respiratory infections. There is a known relationship between stressors 
(circumstances or events exerting a stressful influence) and elevated stress 
hormones (such as cortisol and catecholamines). These hormones, in turn, have 
been shown to adversely affect the immune system, and may even facilitate the 
ability of the HIV virus to infect human lymphocytes.  

It has also been fairly well established that depression is also positively correlated 
with various illnesses. An article published in 1989 concluded that HIV+ patients 
who were chronically depressed showed steeper declines in their T4 lymphocytes 
over a 5 year period than those who were not depressed.  

In a workshop sponsored by the National Institute of Mental Health, the following 
consensus statement was issued: “Exercise has been associated with a decreased level 
of mild to moderate depression and anxiety, symptoms of failure to cope with 
mental stress.” 

Studies have shown that aerobic exercise reduces the amount of stress hormones 
the body releases in response to mental stress. A study published in 1990  consisting 
of 50 healthy, asymptomatic homosexual men who were unaware of their HIV 
status, showed the effect that aerobic exercise can have on the immune system after 
notification of HIV status. Those men who had been doing aerobic exercise for 45 
minutes per day, three times a week for five weeks, were less depressed and anxious 
and did not demonstrate negative immune responses (decrease in natural killer cell 
number), following notification of being HIV+ in contrast to those who were not 

Endogenous opiates and neuropeptides (such as endorphins), the substances 
responsible for the exercise “high,” are released in response to aerobic exercise. In 
fact, individuals who maintain their aerobic fitness tend to release higher levels of 
these endogenous opiates than non-exercising individuals. 

Physiological Effects

When looking at many of the studies that have been done regarding the effects of 
exercise on the immune system, it is readily clear that we are dealing with a 
multifaceted system with many variables. Maximal and submaximal exercise have 
different effects on both the function and quantity of the components of the 
immune system. Therefore one study may appear to contradict another one. 

However, if one looks at the big picture on can generally draw the following 

∑ Moderate exercise and conditioning enhances the immune system. It appears 
that this holds true for those with HIV as well.
∑ Chronic, infrequent bouts of maximal exercise does appear to exert a short-term, 
transient (approximately 30 minutes) immunosuppressive effect. It appears to 
have no long term effect on the immune system in non-infected individuals.  
Although research is non-existent here, most doctors do not recommend that 
HIV+ patients exercise exhaustively. 

More recently exercise has been recommended for those with HIV in order to 
increase their muscle mass and counteract the devastating effects of wasting 
(patients with HIV tend to lose lean body mass rather than fat). Christopher Ried, 
M.D., a Los Angeles internist specializing in patients with HIV and AIDS, says 
“people that increase their lean body mass do better in the long run.” 

HIV and Drugs

While not everyone who is HIV+ is taking medication [see sidebar story], many are. 
Many of these drugs have side effects which can effect one’s swimming performance 
such as nausea, fatigue, headaches, numbness if the hands and feet, etc.. The more 
recent generation of protease inhibitors has allowed many HIV+ people to feel 
healthier. Says Dr. Ried “the new drugs make them feel better. They want to and can 
exercise more frequently.”

HIV and Pool Water

While we like to think of our chlorinated pool water as able to kill anything 
microbial, there is a small risk of infection with the parasite cryptosporidium.  
Around the time the drinking water in Milwaukee was infested with 
cryptosporidium (April 1993), it appears a resort pool was having the same problem. 
Parasitic infections can cause more of a problem in individuals whose immune 
system is compromised. Although this is not the case, one would hope that all 
public pools would regularly check their water for parasites. 

Implications for Masters Swimming

While most of the studies examining exercise and the immune system were done 
using the cycle ergometer or treadmill (easier for testing), the conclusions that were 
drawn most likely hold true for swimming as well.

An additional benefit that those who swim with a masters team may enjoy, could be 
the health enhancing benefits of social contact. Masters teams also offer the chance 
for good coaching and encouragement.  

It appears that remaining physically active is important for HIV infected persons at 
all stages of the infection. As with anyone with a chronic illness, it is recommended 
that they have a complete physical examination prior to beginning any type of 
exercise program. Most doctors recommend that people infected with HIV should 
begin exercising while they are asymptomatic and healthy. Symptomatic individuals 
should avoid overtraining and exhaustive exercise. The American College of Sports 
Medicine publishes excellent guidelines for exercise testing and prescription that can 
be used for all individuals.
  Eicher, E.R., L.H. Calabrese. Immunology and exercise: Physiology, pathophysiology, and 
implications for HIV infection. Medical Clinics of North America. 78 (2):377–388, 1994.
  Lawless, D., C.G.R. Jackson, J. E. Greenleaf. Exercise and Human Immunodefiency Virus (HIV-1) 
infection. Sports Medicine. 19 (4): 235–239, 1995. 
  Smith, J.A.. Guidelines, standards, and perspectives in exercise immunology. Medicine & Science in 
Sports & Exercise. 27 (4): 497-506, 1995. 
  Caron, V.B..Prayer, meditation, exercise, and special diets: behaviors of the hardy person with 
HIV/AIDS. J Assoc Nurses AIDS Care. 4: 18-28, 1993.
  See: Clinically relevant symposium: exercise and immunology. Chairperson: D.C. Nieman in Medicine 
and Science in Sports and Exercise, 26(2): 125–194, 1994.
   LaPerriere, A., G. Ironson, M.H. Antoni, et al. Exercise and psychoneuroimmunology. Medicine and 
Science in Sports and Exercise. 26(2): 182–190, 1994.
   Kemeny, M. E., J.L. Fahey, S. Schneider, et al. Psychosocial co-factors in HIV infection: bereavement, 
depression and immune status in HIV seropositive homosexual men. Psychosom. Med. 51:255, 1989. 
   Morgan, W.P. Coping with mental stress: the potential and limits of exercise intervention (a state-of-
the-art workshop). Final report. Rockville, MD: National Institute of Mental Health, 1984. 
  LaPerriere, A., M.H. Antoni, N. Schneiderman, et al. Exercise intervention attenuates emotional 
distress and natural killer cell decrements following notification of positive serologic status for HIV-1. 
Biofeedback Self-Regul. 15: 229-242, 1990. 
  Lawless, D., C.G.R. Jackson, J. E. Greenleaf. Exercise and Human Immunodefiency Virus (HIV-1) 
infection. Sports Medicine. 19 (4): 235–239, 1995. 
  MacKenzie WR, J.J. Kazmierczak, J.P. Davis. An outbreak of cryptosporidiosis associated with a 
resort swimming pool. Epidemiol Infect. 115: 545-553, 1995. 
  Eicher, E.R., L.H. Calabrese. Immunology and exercise: Physiology, pathophysiology, and 
implications for HIV infection. Medical Clinics of North America. 78 (2):377–388, 1994.

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