High Levels of Physical Activity in Anorexia Nervosa: A Systematic Review

Abstract

High level physical activity is a frequent symptom in patients with anorexia nervosa (AN), influencing the development, maintenance, complications, treatment success, relapse rate and severity of the disease. Accelerometry is assumed to be an objective method to assess physical activity (PA) in AN. We aimed to review objectively measured levels of PA in AN and to give an overview for clinical practice and future research. Data were searched in PubMed and PsychINFO until April 2015 following the preferred reporting items for systematic reviews and meta-analyses statement. Twenty studies fulfilled the inclusion criteria. A notable heterogeneity of measurements, outcomes, participants and settings was found. Overall, HLPA is not adressed enough by current evidence. A common valid terminology of HLPA is not available, and accurate criteria of different levels of PA must be defined to create comparability of future studies. Further objective PA assessments are needed to improve treatment outcome and relapse rate.

Characterization and correlates of exercise among adolescents with anorexia nervosa and bulimia nervosa

“…Further, patients' perceptions of exercise activity and what was even considered exercise may have been distorted by their ED‐related cognitions (Bratland‐Sanda & Sundgot‐Borgen, ). We lacked direct collection of exercise data via methods such as accelerometry (Gummer et al, ), did not evaluate the role of exercise in ED psychopathology, did not have healthy controls, and did not have longitudinal exercise data so are only able to comment on exercise activity at the time of presentation. Although we calculated an estimated rate of weight loss, subjects' weight loss may not occur at a steady rate over the whole duration of illness.…”

“…Exercise behaviors among adolescents with AN, atypical AN, or BN (hereafter referred to as AN or BN for simplicity) are not well characterized and are relatively understudied compared to nutritional and food‐related aspects of EDs (Giel et al, ; Noetel, Dawson, Hay, & Touyz, ). For instance, using the criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) (American Psychiatric Association, ) exercise is not a listed diagnostic criterion in the diagnosis of AN whereas subtype classification is based on dietary behavior including restricting or binge eating (Gummer et al, ). There is a wide range in the reported prevalence of exercise among adolescents with EDs, from 16.7 to 85.3%, according to a recent systematic review (Fietz, Touyz, & Hay, ).…”

“…There is a wide range in the reported prevalence of exercise among adolescents with EDs, from 16.7 to 85.3%, according to a recent systematic review (Fietz, Touyz, & Hay, ). Controversy in the literature regarding how to define clinically significant exercise in EDs and what standard terminology to use (e.g., “excess exercise,” “compulsive exercise,” or “obligatory exercise”) may further contribute to the barriers for researching this topic (Gummer et al, ; Noetel et al, ).…”

Effectiveness Of Enhanced Cognitive Behavioral Therapy (cbt-e) In The Treatment Of Anorexia Nervosa – a Prospective Multidisciplinary Study

“…Dalle Grave and colleagues [39] found that compulsive exercise was performed by 80 % of patients with restrictive AN and by 43.3 % of patients with purging AN. Excessive exercise and high-level physical activity have not been widely studied in AN, and there are neither established terminologies nor criteria for their use in definitions or measurements [39,42]. Most studies rely on self-report measures of physical activity, and so new studies using objective measures are warranted [42].…”

“…Excessive exercise and high-level physical activity have not been widely studied in AN, and there are neither established terminologies nor criteria for their use in definitions or measurements [39,42]. Most studies rely on self-report measures of physical activity, and so new studies using objective measures are warranted [42]. Alberti and colleagues [43] compared a self-report measure and an objective measure of physical activity in AN patients, which revealed significant underreporting of physical activity level in this population.…”