Effects of Testosterone and Progressive Resistance Training in Eugonadal Men with AIDS Wasting

A Randomized, Controlled Trial

  1. Steven Grinspoon, MD;
  2. Colleen Corcoran, ANP;
  3. Kristin Parlman, MSPT;
  4. Madeline Costello, PT;
  5. Dan Rosenthal, MD;
  6. Ellen Anderson, MSRD;
  7. Takara Stanley, AB;
  8. David Schoenfeld, PhD;
  9. Belton Burrows, MD;
  10. Doug Hayden, MA;
  11. Nesli Basgoz, MD; and
  12. Anne Klibanski, MD
  1. From Massachusetts General Hospital, Harvard Medical School, Boston University School of Medicine, and Boston Veterans Administration Medical Center, Boston, Massachusetts.

    Abstract

    Background: Substantial loss of muscle mass occurs among men with AIDS wasting.

    Objective: To investigate the independent effects of testosterone therapy and progressive resistance training in eugonadal men with AIDS wasting.

    Design: Randomized, controlled trial.

    Setting: University hospital.

    Patients: 54 eugonadal men with AIDS wasting (weight < 90% ideal body weight or weight loss > 10%).

    Intervention: In a 2 × 2 factorial design, patients were assigned to receive testosterone enanthate (200 mg/wk) or placebo injections and progressive resistance training (three times weekly) or no training for 12 weeks.

    Measurements: Cross-sectional muscle area and other indices of muscle mass.

    Results: Cross-sectional muscle area increased in response to training compared with nontraining (change in arm muscle mass, 499 ± 349 mm2 vs. 206 ± 264 mm2 [P = 0.004]; change in leg muscle mass, 1106 ± 854 mm2 vs. 523 ± 872 mm2 [P = 0.045]) and in response to testosterone therapy compared with placebo (change in arm muscle mass, 512 ± 371 mm2 vs. 194 ± 215 mm2 [P < 0.001]; change in leg muscle mass, 1236 ± 881 mm2 vs. 399 ± 729 mm2 [P = 0.002]). Levels of high-density lipoprotein cholesterol decreased in response to testosterone therapy compared with placebo (−0.03 ± 0.13 mmol/L vs. 0.05 ± 0.13 mmol/L [−1 ± 5 mg/dL vs. 2 ± 5 mg/dL]; P = 0.011) and increased in response to training compared with nontraining (0.05 ± 0.13 mmol/L vs. 0.00 ± 0.16 mmol/L [2 ± 5 mg/dL vs. 0 ± 6 mg/dL]; P = 0.052).

    Conclusions: In contrast to anabolic therapies that may have adverse effects on metabolic variables, supervised exercise effectively increases muscle mass and is associated with significant positive health benefits in eugonadal men with AIDS wasting.

    Article and Author Information

    • Acknowledgments: The authors thank the bionutrition and nursing staffs of the General Clinical Research Center of the Massachusetts General Hospital for their dedicated patient care; Mike Treat for assistance with cross-sectional computed tomography; Gregory Neubauer for assistance with performing radioimmunoassays; and Karen Hopcia, NP, for help with implementation of the protocol. The authors also thank the staff of the Charles River Park Health Club for the use of their exercise facilities and Deborah Watts, MPT; Kimberly Halloran, MSPT; R. Derek Munn, MPT; Keith Wade; MPT; Laura Plummer, PT; Cynthia Smestad, PT; and Agatha Czerska, MSPT, of the physical therapy department of Massachusetts General Hospital for their dedicated assistance in the training program.

    • Grant Support: In part by grants R01-DK49302, M01-RR01066, and P32-DK07028 from the National Institutes of Health.

    • Requests for Single Reprints: Steven Grinspoon, MD, Neuroendocrine Unit, Bulfinch 457b, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

    • Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

    • Current Author Addresses: Dr. Grinspoon, Ms. Corcoran, Ms. Stanley, and Dr. Klibanski: Neuroendocrine Unit, Bulfinch 457b, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

    • Ms. Parlman and Ms. Costello: Physical Therapy Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

    • Dr. Rosenthal: Radiology Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

    • Ms. Anderson, Dr. Schoenfeld, and Mr. Hayden: General Clinical Research Center, White 13, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

    • Dr. Burrows: Radiology Department, Boston University School of Medicine and the Boston Veterans Administration Medical Center, 150 South Huntington Avenue, Boston, MA 02130.

    • Dr. Basgoz: Infectious Disease Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.

    • Author Contributions: Conception and design: S. Grinspoon, C. Corcoran, K. Parlman, M. Costello, D. Rosenthal, D. Schoenfeld, B. Burrows, D. Hayden, A. Klibanski.

    • Analysis and interpretation of the data: S. Grinspoon, C. Corcoran, K. Parlman, M. Costello, D. Rosenthal, T. Stanley, D. Schoenfeld, B. Burrows, D. Hayden, A. Klibanski.

    • Drafting of the article: S. Grinspoon, K. Parlman, M. Costello, D. Rosenthal, D. Schoenfeld, D. Hayden, N. Basgoz, A. Klibanski.

    • Critical revision of the article for important intellectual content: S. Grinspoon, C. Corcoran, K. Parlman, M. Costello, D. Rosenthal, D. Schoenfeld, B. Burrows, D. Hayden, N. Basgoz, A. Klibanski.

    • Final approval of the article: S. Grinspoon, C. Corcoran, K. Parlman, M. Costello, D. Rosenthal, D. Schoenfeld, B. Burrows, D. Hayden, N. Basgoz, A. Klibanski.

    • Provision of study materials or patients: S. Grinspoon, C. Corcoran, N. Basgoz.

    • Statistical expertise: D. Schoenfeld, D. Hayden.

    • Obtaining of funding: S. Grinspoon, A. Klibanski.

    • Administrative, technical, or logistic support: K. Parlman, M. Costello, E. Anderson, T. Stanley.

    • Collection and assembly of data: S. Grinspoon, C. Corcoran, D. Rosenthal, E. Anderson, T. Stanley, B. Burrows.

    Summary for Patients

    • Summaries for Patients:Effects of Testosterone Therapy and Weight Training in Men with Normal Testosterone Levels and AIDS Wasting Ann Intern Med September 5, 2000 133:I-40
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    1. Ann Intern Med September 5, 2000 vol. 133 no. 5 348-355
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