Die Bedeutung körperlicher Aktivität bei Anorexia nervosa: Dimensionen, Erfassung und Behandlungsstrategien aus Expertensicht

Hechler, Tanja; Beumont, P. J. V.; Touyz, Stephen; Marks, Peta; Vocks, Silja

doi:10.1159/000087374

Cited by 5 publications

(3 citation statements)

References 38 publications

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“…In the 1980s and 1990s, first treatment approaches applied response prevention techniques including one hour of supervised bed rest after meals to reduce compulsive exercise behavior [ 39 ]. A 2005 review by Hechler and colleagues [ 40 ] showed that unstructured psycho-education, self-monitoring of daily physical activity and cognitive restructuring were the most frequently used treatment approaches.…”

Section: Introductionmentioning

confidence: 99%

Specialized group intervention for compulsive exercise in inpatients with eating disorders: feasibility and preliminary outcomes

et al. 2018

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BackgroundPatients with eating disorders (ED) often suffer from compulsive exercise behavior, which is associated with lower short-term response to treatment and poorer long-term outcome. Evidence-based interventions specifically targeting compulsive exercise behavior have been scarce so far. We developed a manualized group therapeutic approach integrating cognitive-behavioral therapy, exercise therapy and exposure with response management to promote healthy exercise behavior. Our objective was to examine the feasibility and acceptance of this new approach as add-on to regular inpatient treatment in a pilot study. Additionally, we wanted to estimate preliminary effect sizes.MethodsThirty-two female, adolescent and adult eating disordered inpatients were recruited. According to the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), twenty-six patients met criteria for Anorexia nervosa (AN), two for Bulimia nervosa and four for eating disorder not otherwise specified. Semi-structured interviews were conducted for qualitative evaluation of feasibility and acceptance of the new intervention. Patients completed the Commitment to Exercise Scale (CES) and the Compulsive Exercise Test (CET) for assessment of compulsive exercise, the Eating Disorder Inventory-2 for assessment of eating disorder pathology, the Beck Depression Inventory-II and Brief Symptom Inventory for assessment of depressive and general psychopathology and the Emotion Regulation Skills Questionnaire for assessment of emotion regulation before the beginning and at the end of the group intervention. Additionally, weight gain was monitored.ResultsFeasibility of our approach was confirmed. All patients reported a high satisfaction with both structure and content of the group. Between pre- and post-intervention, patients showed significant reductions in compulsive exercise (effect size CES: 1.44; effect size CET total: 0.93), drive for thinness (effect size: 0.48), depressive symptoms (effect size: 0.36), general psychopathology (effect size: 0.29) and acceptance of emotions (effect size: − 0.62). Patients with AN also showed significant mean weight gain during the intervention (effect size: − 0.44).ConclusionsResults of our pilot study indicate that our integrative approach to compulsive exercise in ED patients might represent a promising new therapeutic option. Feasibility and acceptance of the intervention were confirmed. Preliminary effect sizes on most outcomes were promising. As improvements in Body-mass-index, eating disorder and general psychopathology are also to be expected by routine inpatient treatment, a large randomized trial is currently underway to evaluate the efficacy of this new intervention.

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Section: Introductionmentioning

confidence: 99%

Specialized group intervention for compulsive exercise in inpatients with eating disorders: feasibility and preliminary outcomes

et al. 2018

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“…228,229 In relation to treatment outcomes, commitment to exercise is a problem in inpatients and engagement in excessive sport in outpatients may be a barrier to treatment. 230 In addition, high PA may arise prior to illness 231,232 and remain following recovery. 225,233 Therefore, excessive exercise behaviours may also contribute to the aetiology of AN rather than simply being a symptom of the illness.…”

Section: Introductionmentioning

confidence: 99%

“…232,[234][235][236][237] Recently, a study reported increased PA in a subgroup of AN patients only, suggesting that high PA may not be universal in this patient group. 238 The hypothesised drivers of increased PA in AN are cognitive desire to lose weight, 225 to improve mood 230 and to reduce anxiety. 239,240 This is supported by the fact that women with AN are reported to value negative affect regulation as a motivator for exercise more than they value exercising to improve health and fitness.…”

Section: Introductionmentioning

confidence: 99%

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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Physical activity and the drive to exercise in anorexia nervosa

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Woerwag‐Mehta

Bartholdy

et al. 2014

Intl J Eating Disorders

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Die Bedeutung körperlicher Aktivität bei Anorexia nervosa: Dimensionen, Erfassung und Behandlungsstrategien aus Expertensicht

Cited by 5 publications

References 38 publications

Specialized group intervention for compulsive exercise in inpatients with eating disorders: feasibility and preliminary outcomes

Specialized group intervention for compulsive exercise in inpatients with eating disorders: feasibility and preliminary outcomes

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Physical activity and the drive to exercise in anorexia nervosa

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