Running on empty – a nationwide large-scale examination of compulsive exercise in eating disorders

Monell, Elin; Levallius, Johanna; Mantilla, Emma Forsén; Birgegård, Andreas

doi:10.1186/s40337-018-0197-z

Cited by 60 publications

(54 citation statements)

References 46 publications

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“…Table 1 presents a plethora of terms and definitions used by authors, as well as the instruments used to assess PPA and the time of assessment. [24]; Sharp et al (1994) [25]. b Blumenthal et al (1984) [19]; Higgins et al (2013) [26]; Long and Hollin (1995) [27].…”

Section: Resultsmentioning

confidence: 99%

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Physical Activity in Eating Disorders: A Systematic Review

et al. 2020

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Abnormally high levels of physical activity have been documented throughout the literature in patients with eating disorders (ED), especially those diagnosed with anorexia nervosa (AN). Yet no clear definition, conceptualization, or treatment of the problematic use of physical activity (PPA) in ED patients exists. The aim of this review is to propose a new classification of PPA, report the prevalence, triggers, predictors, maintainers and other related factors of PPA in ED patients, in addition to proposing a comprehensive model of the development of PPA in AN. A total of 47 articles, retrieved from Medline and Web of Science, met the inclusion criteria and were included in the analysis. As a result, the new approach of PPA was divided into two groups (group 1 and group 2) according to the dimension (quantitative vs qualitative approach) of physical activity that was evaluated. The prevalence of PPA in ED was reported in 20 out of 47 studies, the comparison of PPA between ED versus controls in 21 articles, and the links between PPA and psychological factors in ED in 26 articles, including depression (16/26), anxiety (13/26), obsessive–compulsiveness (9/26), self-esteem (4/26), addictiveness (1/26), regulation and verbal expression of emotions (1/26) and anhedonia (1/26). The links between PPA and ED symptomatology, PPA and weight, body mass index (BMI) and body composition in ED, PPA and age, onset, illness duration and lifetime activity status in ED, PPA and ED treatment outcome were reported in 18, 15, 7, 5 articles, respectively. All of the factors have been systematically clustered into group 1 and group 2. Results focused more on AN rather than BN due to the limited studies on the latter. Additionally, a model for the development of PPA in AN patients was proposed, encompassing five periods evolving into three clinical stages. Thus, two very opposite components of PPA in AN were suggested: voluntarily PPA increased in AN was viewed as a conscious strategy to maximize weight loss, while involuntarily PPA increased proportionally with weight-loss, indicating that exercise might be under the control of a subconscious biological drive and involuntary cognition.

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Section: Resultsmentioning

confidence: 99%

“…* Studies excluded for one or more reasons. a Blumenthal et al (1984) [19]; Crisp et al (1980) [20]; Davis et al (1994) [21]; Frey et al (2000) [22]; Kron et al (1978) [23]; Monell et al (2018) [24]; Sharp et al (1994) [25]. b Blumenthal et al (1984) [19]; Higgins et al (2013) [26]; Long and Hollin (1995) [27].…”

Section: Study Selectionmentioning

confidence: 99%

Physical Activity in Eating Disorders: A Systematic Review

et al. 2020

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“…Together, the combination of symptoms suggested here may put the individual at risk for developing an ED. Numerous studies have established that maladaptive perfectionism predicts CE, ED, and psychopathology in general (e.g., [ 20 , 28 , 29 , 30 , 45 , 46 ]). A prominent feature of maladaptive perfectionism is excessive and negative self-evaluation [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…We aimed to identify effective EDE-Q items for each gender that relate to CE and provide information about their psychological importance. Further, self-criticism is not assessed in the EDE-Q, but is important for CE [ 20 , 28 , 29 , 30 , 31 ]. Hence, we examined the association between self-criticism and CE.…”

Section: Introductionmentioning

confidence: 99%

Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard

Mantilla

Levallius

Monell

et al. 2018

IJERPH

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When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.

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“…The prevalence differs depending on the sample studied, the definition of unhealthy exercise and the measures used. Unhealthy exercising is regarded as a factor associated with poorer treatment outcome, e. g. higher relapse rates and a chronic course in anorexia nervosa, and longer hospital stays and a greater severity of eating pathology across ED diagnoses [4][5][6]. Although diagnostic criteria for anorexia and bulimia nervosa (DSM 5, ICD 10) refer primarily to the quantity of physical activity ("excessive"), its quality can be considered more characteristic [7,8].…”

Section: Introductionmentioning

confidence: 99%

The Freiburg sport therapy program for eating disorders: a randomized controlled trial

et al. 2020

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Background: Unhealthy attitudes towards sport and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg sport therapy program for eating disorders (FSTP). Methods: Outpatients with ED were randomized either to a 3 month sport therapy program (sport therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale, CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive Exercise Test, CET subscales) and exercise quantity (accelerometer). Results: Recruitment was challenging. Fifteen patients were randomized to the STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG. Improvements (STG) were maintained at follow up. Conclusions: There was no statistically significant difference in the reduction of unhealthy attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale. Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major limitation is the small sample size.

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Running on empty – a nationwide large-scale examination of compulsive exercise in eating disorders

Cited by 60 publications

References 46 publications

Physical Activity in Eating Disorders: A Systematic Review

Physical Activity in Eating Disorders: A Systematic Review

Exercise Caution: Questions to Ask Adolescents Who May Exercise Too Hard

The Freiburg sport therapy program for eating disorders: a randomized controlled trial

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