Psychometric properties of instruments assessing exercise in patients with eating disorders: a systematic review

Abstract

Background: Research has identified factors specific to exercise in eating disorder patients such as affect regulation and compulsivity. Existing measures of exercise behaviour which were not originally designed for eating disorder patients may not adequately assess these factors. The aim of this systematic review is to identify and assess the psychometric properties of all self-report measures of exercise designed to be used with eating disorder patients. Method: A systematic review was conducted following the PRISMA guidelines. MedLine, Scopus and PsycINFO were systematically searched. A total of 12 studies examining two measures, the Exercise and Eating Disorders and the Compulsive Exercise Test, met inclusion criteria. Results: Validation studies showed promising results for both tests and established internal consistency, concurrent and convergent validity, and construct validity. The factor structure of the Compulsive Exercise Test was not confirmed in the majority of the studies included in this review, while there are only two studies conducting factor analysis on the Exercise and Eating Disorders. Conclusion: The two measures identified by this systematic review represent the current research on measures of compulsive exercise for eating disorder patients. Further research is needed to confirm a factor structure and validate both the Compulsive Exercise Test and the Exercise and Eating Disorders in more diverse clinical samples.

Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review

“…In summary, the psychosocial variables that demonstrated associations with later ME broadly comprise body concern, affect regulation, and compulsivity. Together, these domains support a definition of ME as "compulsive" (Harris et al, 2020); features of a "compulsive" psychosocial model of ME (Meyer et al, 2011); and an overarching framework from which we might experimentally examine other potential affect-regulatory mechanisms that may maintain this behavior (Kolar & Gorrell, 2020).…”

“…Four studies (~20%) earned a global rating of “strong” strength of evidence based on methodological rigor, but these studies used items only, and did not use a complete measure of ME. Of the remaining studies that used full measures or an adaptation, only four used a measure with psychometric validity in ED samples (e.g., CET; Harris et al, 2020; Meyer et al, 2016; Taranis et al, 2011). This limitation may be less important, as few samples in the current review were comprised of individuals with EDs; however, we are then limited in our ability to extend our findings across a broader conceptualization of ME within the context of more severe eating pathology.…”

“…A widely accepted definition of ME has yet to be harmonized across the literature, but a type of ME commonly identified among patients with EDs is referred to as “compulsive” (Adkins & Keel, 2005). Building on this construct, several criteria have been proposed that capture the compulsive nature of some ME (Dittmer, Jacobi, & Voderholzer, 2018), and a recent review of the assessment of exercise in ED patients (Harris, Hay, & Touyz, 2020) concluded that component characteristics across definitions of ME overlapped most closely with the American Psychiatric Association's account of compulsivity, defined by “repetitive behaviors that the person feels driven to perform” that are “aimed at preventing or reducing distress” (APA, 2013). This exercise behavior may be excessive with regards to intensity, duration, and frequency (Solenberger, 2001), and individuals with ME may feel compelled to engage in physical activity to control weight or shape; to prevent or reduce negative affect; or to avoid adverse health effects of a sedentary lifestyle (Dittmer et al, 2018).…”

Psychometric properties of the Compulsive Exercise Test in a large sample of female adolescent and adult inpatients with anorexia nervosa and bulimia nervosa

“…However, this dimensional structure of compulsive exercise does not map directly onto clinical samples, as a recent review on the psychometric properties of exercise assessments suggests. Evaluating nine studies that analyzed the validity of the CET, it concluded that “the factor structure […] was not confirmed in the majority of the studies” and that “further research is needed to confirm a factor structure and validate the […] in more diverse clinical samples” (Harris, Hay, & Touyz, 2020). For example, Swenne (2016), Limburg et al (2021), and Plateau et al (2014) discussed whether four factors, three factors, or a single factor better explained the factorial structure of the questionnaire.…”

AgRP neurons coordinate the mitigation of activity-based anorexia

“…Thus, there is a huge need for therapeutic alternatives that target the basic biology of AN. Strikingly, a large proportion (up to 80%) of AN patients also display hyperactivity, due to excessive exercise and/or general restlessness [14][15][16][17] . A number of these key features of AN, including many of the sex differences 18 , can be replicated in the activity-based anorexia (ABA) rodent model, in which some animals voluntarily become hyperactive in contexts of food restriction [19][20][21] .…”