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

Abstract

Background and purposeClinical research focusing on the effectiveness of exercise therapy (ET) in patients with anorexia nervosa (AN) shows increasing interest in the last decade. The aim of this systematic review was to provide an overview of quantitative studies that have examined the impact of ET in AN patients and to examine its specific effects on physical and mental health according to the type of physical exercise (PE) practiced.MethodsThe review was carried out based on the PRISMA 2020. Electronic databases PubMed, Web of Science, Embase, and Wiley were searched from inception to December 2021. Quantitative studies assessing the effects of ET interventions on AN patients were included and study quality was assessed using the PEDro scale.ResultsA total of 27 studies were selected, including 13 randomized controlled trials. Regarding outcomes measured, results showed that aerobic and resistance exercise improved muscle strength, that mind-body PE decreased main symptoms of AN and mental health, and that combined PE reduced dysfunctional exercise and improved weight gain.ConclusionThe findings suggest that ET intervention can induce benefits and has no deleterious effects on patients. In addition, specific effects on anorexia symptoms and physical and mental health have been observed according to the type of PE. However, this review reported several methodological weaknesses, including a lack of control group or randomization and statistical misconduct. Finally, ET intervention parameters were heterogeneous, and ET intervention generally lacked details, making reproducibility and comparability difficult. All these limitations underscore the need for a more rigorous methodology for further research.

How to address physical activity and exercise during treatment from eating disorders: a scoping review

“…The current literature review supports previous positive findings from studies on effects from psychoeducation and supervised PAE during treatment of different EDs. However, because the existing studies on safety and effects from use of PAE in treatment of EDs is limited in number, the same articles are cited and evaluated in reviews published the past decade [ 32 – 34 , 43 ▪ , 44 , 46 , 47 ▪ , 48 ▪ ]. Hence, the more recent original studies [ 45 ▪▪ , 50 ▪▪ , 51 , 52 , 53 ▪▪ ] bring important nuances and findings to the field, and the feasibility and safety of education and practical experience from PAE during treatment that they demonstrate are underlined by the positive experiences from those with lived experiences [ 54 , 55 ▪▪ , 56 ▪ ].…”

“…The three reviews (all of only anorexia nervosa) and one metanalysis (all EDs) that summarized findings on including supervised exercise to treatment, were similar in characterizing exercise programs as low-to-moderate in impact; that exercise gave no effect on body weight or –composition compared with a control condition; and, that exercise had either positive or neutral effects on psychopathology (Table 2) [46–49]. Importantly, no adverse outcomes were reported.…”

“…Two unique publications were identified by searches in Google Scholar (see figure). on body weight or -composition compared with a control condition; and, that exercise had either positive or neutral effects on psychopathology (Table 2) [46][47][48][49]. Importantly, no adverse outcomes were reported.…”

The Prospect of Focal Ultrasound in the Treatment of Mental Disorders

“…Anorexia nervosa (AN) refers to an eating disorder that leads to abnormal low body weight and anxiety related to gaining weight accompanied by distorted self-perception of one's own body. With regard to treatment, AN has been commonly targeted through psychotherapy, physical exercise, and pharmaceutical interventions as a joint intervention [37,38]. Interestingly, deep brain stimulation (DBS) of the subcallosal cingulate has been well tolerated and shown to be associated with improvements in mood and anxiety in patients with treatment-refractory AN [39].…”

Athletes with Eating Disorders: Analysis of Their Clinical Characteristics, Psychopathology and Response to Treatment

“…However, due to the high incidence of dysfunctional exercise in patients with ED, some specialists prefer to limit physical activity during treatment [78]. Nevertheless, a growing number of studies have shown that incorporating physical activity into the routine care of these patients can improve ED symptomatology and can be an effective intervention for the management of these disorders [79][80][81][82][83][84]. Experienced clinicians have reaffirmed the need to incorporate physical activity into ED treatment protocols within a psychotherapeutic approach, not only for the physical and mental health benefits but also to help patients learn how to engage in exercise in an adaptive manner [85].…”