Exercise guide
Exercise is safe and helpful for people living with HIV (human immunodeficiency virus). In 44 trials, regular cardio and strength training improved fitness, strength, body shape, mood and quality of life, and didn't harm the immune system. With treatment, most people with HIV live long and healthy lives, and more than half of people in HIV care in England are now 50 or over, so heart health, muscle and bone matter more than ever.
Keep taking your HIV medicine exactly as prescribed: exercise works alongside it, never instead of it. You can't pass HIV on through sweat, gym equipment or pools.
This guide covers what the trials show, how much and what kind of exercise to do, the medicines and supplements that matter for exercise, the gym and sport, and the warning signs to act on.
In 24 trials with 936 people, aerobic exercise, or aerobic and strength training together, at least 3 times a week improved fitness, strength, body shape, low mood and quality of life in adults living with HIV. In 20 trials with 764 people, strength training improved fitness and strength. Neither lowered CD4 counts (the immune cells HIV attacks) or raised viral load (the amount of virus in the blood).
Combined cardio and strength training came out best for fitness and quality of life in a review of 40 trials. Aim for the same as everyone: at least 150 minutes of moderate activity a week, plus strength exercises on at least 2 days.
HIV medicine is what controls HIV and protects your immune system; exercise works alongside it, never instead of it. European guidelines say switching HIV medicine because of weight gain generally isn't recommended: lifestyle comes first.
People with HIV have about twice the risk of heart and circulation disease, and low bone density is more common. More than half of people in HIV care in England are 50 or over. Exercise improves fitness and waist size, and strength training protects muscle and bone as you get older.
Some HIV medicines need to be taken at a different time from antacids and from supplements containing magnesium, iron, zinc or calcium, and some can't be taken with St John's wort. If you take ritonavir or cobicistat, tell any doctor offering a steroid injection for a sports injury. Ask your HIV pharmacist.
HIV isn't passed on through sweat, shared equipment or pools, and there are no well-documented cases of HIV passing on during sport. With an undetectable viral load on effective treatment, you can't pass HIV on.
HIV "is a virus that weakens your immune system and increases your risk of serious illness". There's no cure, but daily medicines called antiretrovirals bring the virus down until it can no longer be measured, usually within about 6 months, and "with treatment most people with HIV can live a long and healthy life".
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HIV is passed on through blood, semen, vaginal fluids and mucus from inside the anus. It isn't passed on through sweat, saliva, tears, air or water, or through "healthy, unbroken skin", or by hugging, sharing toilets, food or drinks. Someone on effective treatment with an undetectable viral load can't pass it on.
In England, 95% of people with HIV have been diagnosed, 99% of them are on treatment, and 98% of those have the virus under control. Of the 103,689 people in HIV care in England in 2024, 52% were 50 or over, up from 26% in 2015.
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In 80 studies with 793,635 people living with HIV, the risk of heart and circulation disease was about twice that of people without HIV. European guidelines now recommend a statin for many people with HIV, even at low to moderate heart risk.
Low bone density is more common with HIV (older studies that didn't account for other factors), and tenofovir disoproxil, one HIV medicine, is linked with fractures. HIV raises the risk of losing muscle with age, and fitness is often lower, partly because of anaemia, nerve and muscle problems and lung problems. Only about half of people with HIV meet the activity guidelines.
During HIV treatment, weight, blood fats and blood sugar can rise, and your clinic checks them. European guidelines put lifestyle first for weight gain and say switching HIV medicine generally isn't recommended.
HIV is one cause of peripheral neuropathy: numbness, tingling or pain in the feet. If that affects you, choose steady footing, check your feet, and see our peripheral neuropathy guide.
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The trials are mostly small and mostly in men, and many people dropped out, so the size of the benefits is less certain than their direction.
Two reviews using the Cochrane method concluded that aerobic exercise for at least 5 weeks, or strength training for at least 6 weeks, at least 3 times a week, is safe for medically stable adults with HIV. Side effects were reported in a few studies; none was serious or caused by the exercise.
CD4 cells are the immune cells HIV attacks. Across the trials, exercise didn't lower CD4 counts or raise viral load, and the reviews agree on this.
The aerobic review found no difference in CD4 counts. The strength review's results table shows a rise of about 64 cells, although its summary reports no difference, and a 2022 review found a rise of about 55. The reviews disagree, so it's unclear. HIV medicine is what brings the virus down and protects your immune system.
Aerobic exercise raised peak fitness (the most oxygen the body can use, or VO2max) by about 2.9 ml/kg/min in 8 trials with 358 people, a meaningful amount, though the certainty was very low. Strength or combined training raised it by about 3.7 in 3 small trials (moderate certainty), and combined training by about 4.5 in 7 studies. Exercise also improved how far people could walk in 6 minutes.
Strength training raised chest press strength by about 12 kg in 2 small trials (low certainty), and combined training raised leg strength by about 25 kg in 7 studies.
In a network meta-analysis of 40 trials with 1,518 people, combined cardio and strength training ranked first for fitness and for physical function, general health, mental health and energy, ahead of cardio, strength training or yoga alone.
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In 10 trials with 479 people, exercise reduced depression and anxiety symptoms, with bigger effects at 3 or more sessions a week. A second review of 5 trials found the same for depression. The trials were small.
Aerobic exercise reduced waist size and body fat in 9 trials with 469 people, and strength training added muscle. Exercise at home or in the community, with little supervision, added about 1,100 steps a day and improved physical quality of life in 13 studies.
Exercise may raise HDL (high-density lipoprotein, the "good" cholesterol) and improve blood sugar, but its effect on LDL (low-density lipoprotein) cholesterol was inconsistent, while dietary counselling lowered LDL. Exercise helps alongside a statin, not instead of one.
In 7 trials with 210 people, exercise produced a small but real gain in bone density, with strength training possibly helping most at the hip. The studies were of poor to moderate quality.
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In adults over 50 who had lived with HIV for 9 to 25 years, exercise improved quality of life and fitness in 10 trials with 372 people, but not sleep. Combined strength and cardio training increases muscle mass, which HIV puts at risk.
HIV medicine controls the virus, and statins, now recommended for many people with HIV, lower heart risk. Exercise adds fitness, strength, mood and quality of life on top of them.
Doses are starting points, not prescriptions. Build up gradually.
At least 150 minutes of moderate activity a week, such as brisk walking (you can talk but not sing), or 75 minutes of vigorous activity, plus strength exercises for all the major muscles on at least 2 days. HIV.gov says regular activity is "helpful and strongly encouraged for people living with HIV".
Most used 3 sessions a week, building up to 20 to 60 minutes of cardio, such as cycling, walking or jogging, at a moderate to hard effort. Strength sessions used 3 or 4 sets of 8 to 12 repetitions on machines such as the leg press and chest press, made heavier over the weeks. One year-long trial started with 20 minutes of easy cycling and built to 30 minutes at a harder effort, followed by 30 minutes of strength training.
3 days a week: 20 to 30 minutes of brisk walking, cycling or rowing, then 5 or 6 strength moves for 2 sets of 8 to 12, stopping each set with 2 or 3 repetitions in reserve. Add a set, then weight, over 6 to 8 weeks, and walk on other days.
Across 36 trials, 29% of people dropped out, but fewer did with strength training, supervision and qualified staff. A gym induction, an exercise referral scheme or a physiotherapist can help you start (our suggestion).
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A sports medicine statement says people with a new, symptomatic infection should "limit exercise intensity based on their current health status". If you're recovering from an illness or injury, HIV.gov suggests starting with low-impact activity and building up gradually.
European guidelines recommend exercise with a strength component for frailty, and an exercise programme including strength and balance to prevent falls. Our older adults guide has the doses.
Build to 20 to 30 minutes at a talk-but-not-sing effort, 3 to 5 days a week, adding harder stretches as you get fitter (our editorial starting point, from the trials and the NHS guidelines).
2 or 3 sets of 8 to 12 on 2 or 3 days a week, stopping 2 or 3 repetitions short of failure, as each move's guide suggests. The trials used machines like the leg press and chest press.
3D demoLeg pressBeginner · Strength machine
3D demoChest press machineBeginner · Strength machine
3D demoLat pulldownBeginner · A cable machine
3D demoSeated cable rowBeginner · A cable machine
3D demoDumbbell goblet squatIntermediate · A dumbbell
3D demoDumbbell Romanian deadliftIntermediate · A dumbbell
3D demoPush-upIntermediate · No equipment
3D demoIncline push-upBeginner · A bench or box
3D demoSupported single-arm dumbbell rowIntermediate · A dumbbell + A bench or box
3D demoStep-upBeginner · A step
3D demoForearm plankIntermediate · No equipmentHeel drops for bone, building towards about 50 on most days as the UK osteoporosis consensus suggests, and sit-to-stands and balance holds for strength and falls prevention, near a counter if you're unsteady.
Combine a strength session with some cardio, 3 times a week, as the trials did. The neuropathy session suits numb feet.
A 45-minute full-body gym workout on machines: leg press, chest press, machine row, leg curl, shoulder press and arms, with sets, reps and rest.
45 minBeginner14 movesCardio machine, A bandA 20-minute full-body dumbbell workout: two supersets of squats, rows, Romanian deadlifts and push-ups. Twice a week covers the minimum dose.
20 minBeginner8 movesA dumbbell, A bench or boxStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 30-minute beginner run-walk session: a brisk walk, then 1-minute jogs with 1-minute walks, building to 3-minute runs over your first three weeks.
30 minBeginner5 movesCardio machine, A wallImpact, strength and balance for stronger bones, following UK osteoporosis consensus advice, with options for every level.
40 minBeginner14 movesA kettlebell, Other / check instructionsA 35-minute home routine for numb feet: seated ankle work, leg strength and balance at a counter, then a walk, with shoes on and a foot check before and after.
35 minBeginner13 movesA bench or box, Something with weightA 20-minute full-body workout with no equipment: squats, knee push-ups, bridges, lunges and planks.
20 minBeginner10 movesNo equipmentA plan with 3 sessions a week of cardio and strength matches the trials.
A beginner gym plan: three full-body sessions a week, alternating workouts A and B, with sets, reps, rest and an 8-week progression.
3 training days45 minBeginner2 days a weekYour first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginner6 days a weekA free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 9-week beginner plan with the same walk-to-run shape as Couch to 5K: three run-walk sessions a week, from 1-minute jogs to 30 minutes of running.
3 training days35 minBeginner3 days a weekA 3-day strength plan for men over 40 with power and bone work, two cardio days and mobility, built on research on ageing muscle.
3 training days45 minBeginner3 days a weekA weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginner3 days a weekA 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginnerNever stop or change an HIV medicine because of exercise. Ask your HIV clinic or pharmacist.
Some HIV medicines need to be taken at a different time from antacids containing aluminium or magnesium, and from supplements or vitamins containing magnesium, zinc or iron (and calcium in pregnancy). Some must never be taken with St John's wort, which can stop them working. That includes sports supplements and multivitamins: ask your HIV pharmacist before starting one.
Ritonavir and cobicistat, which boost some HIV medicines, can raise steroid levels from joint injections, inhalers and nasal sprays, causing Cushing's syndrome or switching off the body's own steroid hormones. If you take one, tell any doctor offering a steroid injection for a sports injury.
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Many people with HIV are now offered a statin. Keep taking it, and mention unexplained muscle aches: European guidelines keep blood tests for creatine kinase (CK), a muscle enzyme, for people with symptoms.
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The prescribing information for raltegravir lists muscle damage (myopathy and rhabdomyolysis). Severe muscle pain or weakness, with dark pee, needs medical help the same day: our rhabdomyolysis guide has the signs.
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One HIV medicine's leaflet says "If you feel dizzy ... do not drive or ride a bicycle". HIV medicines can rarely cause bone death from poor blood supply (osteonecrosis): tell your doctor about joint stiffness, aches and pains, especially in the hip, knee or shoulder, or difficulty moving.
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The NHS warns that sharing needles to inject steroids can spread HIV and hepatitis.
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HIV isn't passed on through sweat, saliva or tears, through water, or through healthy, unbroken skin, so gym equipment, changing rooms, showers and pools are no risk. Wipe equipment after use, as everyone should.
A sports medicine position statement says there are "no well-documented reports of HIV ... transmission during sport", and that HIV testing shouldn't be a condition of taking part. Deal with any bleeding using standard first aid, as for everyone.
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The NHS: "If you're having effective treatment for HIV and have an undetectable viral load ... you cannot pass the HIV virus onto someone else."
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In small trials, exercise reduced depression and anxiety symptoms in people with HIV, more so with 3 or more sessions a week. Our depression guide covers how much and how.
Depression is a common side effect of some HIV medicines, so tell your clinic if your mood drops. If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E (accident and emergency). For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.
The NHS lists the Terrence Higgins Trust helpline, 0808 802 1221, for information and support.
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HIV isn't passed on through sweat, saliva, tears, air or water, or through healthy, unbroken skin, or by sharing toilets, food, drinks or household items.
Across 44 trials, exercise didn't lower CD4 counts or raise viral load.
HIV medicine controls HIV. Whether exercise raises CD4 counts is unclear, because the reviews disagree.
There are "no well-documented reports of HIV ... transmission during sport", and testing isn't required to take part.
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Trials used 3 or 4 sets with moderate to heavy weights, 3 times a week, with no serious side effects caused by the exercise. Build up gradually, as anyone should.
Strength training built strength and muscle in trials without them. Some mineral supplements and antacids need to be taken at a different time from HIV medicines, and some can't be taken with St John's wort: ask your HIV pharmacist first.
Yes. In 44 trials, aerobic and strength training improved fitness, strength, body shape, mood and quality of life in people living with HIV, without harming the immune system. Combining cardio and strength worked best.
Yes. HIV isn't passed on through sweat, shared equipment, showers, toilets or pools, and someone on effective treatment with an undetectable viral load can't pass it on at all. Wipe equipment after use, as everyone should.
Exercise doesn't lower your CD4 count or raise your viral load. Whether it raises CD4 counts is unclear, because the reviews disagree. HIV medicine is what protects your immune system, by bringing the virus down.
Yes: strength training at least 3 times a week built strength and muscle in trials. Check any supplements, vitamins or antacids with your HIV pharmacist first, because some need taking at a different time from some HIV medicines, and never share needles for steroids.
Yes. There are no well-documented reports of HIV being passed on during sport, and a sports medicine position statement says testing shouldn't be required to take part. Deal with any bleeding using standard first aid, as for everyone.
The same as everyone: at least 150 minutes of moderate activity a week, such as brisk walking, plus strength exercises on at least 2 days. The trials mostly used 3 sessions a week of cardio and strength, built up over several weeks.
Exercise improves fitness, waist size and body fat, and European guidelines put lifestyle first for weight gain. They say switching HIV medicine because of weight gain generally isn't recommended, so keep taking it and talk to your clinic.
People with HIV have about twice the risk of heart and circulation disease, and low bone density is more common. Regular exercise helps with both, alongside treatments such as statins: our heart disease and osteoporosis guides have the detail.
In trials, exercise improved energy and quality of life in people with HIV. Start gently and build up, and see your clinic if tiredness is new or severe, as it can be a side effect of some medicines or a sign of another problem.
Yoga is safe and can help you relax, but in a review of 40 trials, combined cardio and strength training did more for fitness and quality of life. If you enjoy yoga, add some cardio and strength work too.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
