Effectiveness of exercise‐based interventions in patients with anorexia nervosa: A systematic review

Abstract

Objective This study aimed to conduct a systematic review of research that has evaluated the outcomes of exercise‐based interventions in anorexia nervosa (AN) patients. Method We searched for studies in the MEDLINE, Embase, Web of Science, PsycInfo, Scopus and SPORTDiscus databases. We followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines throughout the selection process, and used Cochrane tools to assess the risk of bias in the primary studies. In cases where sufficient information was available, outcomes were pooled using meta‐analytic techniques. Results Ten studies were included in the review. Results showed similar changes in body mass index in both experimental and control conditions (difference in mean changes of −0.53, 95% CI −1.52 to 0.46). We found no differences in depression or anxiety as a result of implementing exercise programmes. Studies using resistance or strength exercise programmes reported an increase in lower and upper body strength and in skeletal muscle mass in the intervention groups. Conclusion The incorporation of a supervised physical exercise programme to the usual treatment may be appropriate for AN patients. Exercise interventions should only be performed when they are safe for AN patients and should be focused on resistance/strength or flexibility exercises. The results from this systematic review should be interpreted with caution because the studies reviewed showed serious methodological problems.

Inpatient Rehabilitation during Intensive Refeeding in Severe Anorexia Nervosa

“…On the other hand, muscle strength and endurance increased significantly in the trunk and limbs. Our results are difficult to compare with those of other studies due to different activities performed in populations of anorexic subjects of different ages and BMIs [47]. Only two medical teams were interested in developing strength during a physical activity program in anorexic patients [11,43,44].…”

“…Several studies have already shown that it is possible to perform physical activities for anorexic subjects while gaining weight or improving BMI [ 42 , 43 , 44 , 45 , 46 ]. However, no difference has been found compared to control anorexic subjects not performing physical activity [ 47 ]. Body fat increase had already been shown in patients with anorexia from Australia aged from 16 to 19 years old (BMI from 14.8 to 15.4 kg/m 2 ) who gained between 2.5 and 8% of body fat while they performed various anaerobic and aerobic physical activities [ 48 , 49 ].…”

Exercise therapy in the treatment of anorexia nervosa: Its effects depending on the type of physical exercise—A systematic review

“…Over the last two decades, some ET programs have been developed within specialized units for ED to promote better adherence to treatment and achieve more effective and sustainable reductions in the main symptoms of AN and associated disorders ( 17 , 32 , 34 ). Even if this remains a minority and no official recommendations exist, the development of ET in standard care is a growing phenomenon ( 32 , 35 ). Achamrah et al’s ( 32 ) review and Bratland-Sanda’s et al ( 34 ) publication both reported that different types of ET, including aerobic exercise, resistance exercise, and mind–body PE (MBPE), have been implemented for patients with AN and other ED.…”

“…Some studies have investigated the impact of ET interventions on AN patients and shown positive effects on the main symptoms of the disease, and physical and mental health, as well as better behavior toward the health care team ( 32 , 35 ). However, to our knowledge, there are still few studies assessing the effects of ET interventions in patients with AN.…”

“…This is partly due to the difficulty of conducting interventional studies in public health, but also to the fact that, as seen previously, ET has long been prohibited in the treatment of AN ( 34 , 40 , 41 ). This lack of studies was reported by reviews published in the last decade, which emphasized that more experimental studies were needed to explore the effects of ET interventions on AN ( 32 , 33 , 35 , 42 – 44 ). This lack of proof was particularly highlighted in the most recent review conducted by Quiles Marcos et al ( 35 ), which identified only twelve studies from 1970 to December 2019 ( 35 ).…”