The assessment and treatment of unhealthy exercise in adolescents with anorexia nervosa: A Delphi study to synthesize clinical knowledge

Abstract

This study aimed to explore and synthesize expert clinical knowledge on defining and managing unhealthy exercise in adolescents with AN. The Delphi methodology was used. Clinicians (n = 25) considered experts in the treatment of AN in adolescents were recruited internationally to form the panel. The first round of the questionnaires was comprised of five open-ended questions regarding defining, assessing, and treating unhealthy exercise in adolescents with AN. Statements were derived from this data using content analysis, and included as Likert-based items in two subsequent rounds, in which panellists were required to rate their level of agreement for each item. All 25 respondents completed the three rounds of questionnaires. Consensus was achieved for 59.0% of the items included in the second and third round of questionnaires. Although consensus was not achieved, compulsive exercise was the preferred term for the panel when referring to unhealthy exercise in adolescents with AN. The panel clearly delineated features of unhealthy and healthy exercise, and endorsed a number of items considered important to assess for when evaluating exercise in this clinical population. A variety of treatment approaches and strategies reached consensus. Notably, for those who are medically stable and progressing toward recovery, the panel recommended initial exercise restriction practices and reintroducing healthy exercise behaviors, rather than exercise cessation practices. The current findings can serve as preliminary treatment guidelines. A unified approach to labeling and defining unhealthy exercise in the eating disorder literature and clinical settings is required to achieve further progress.

Is the neglect of exercise in anorexia nervosa research a case of “running out” of ideas or do we need to take a “LEAP” of faith into the future?

“…Although unhealthy exercise was documented in the earliest descriptions of the disorder [3], it remains a significant barrier to recovery [4]. There has been a dearth of research as to what is best practice to address over-exercise in both the inpatient and outpatient treatment of adolescents with AN [4].…”

“…Although unhealthy exercise was documented in the earliest descriptions of the disorder [3], it remains a significant barrier to recovery [4]. There has been a dearth of research as to what is best practice to address over-exercise in both the inpatient and outpatient treatment of adolescents with AN [4]. Despite calls to the broader research community for more action (e.g., the Meyer, Taranis and Touyz (2008) article entitled: “Excessive exercise in the eating disorders: A need for less activity from patients and more from researchers”) [5], such appeals appear to have been largely ignored.…”

“…On this front at least, there has been some progress. With an array of terminology (e.g., “excessive exercise, “compulsive exercise”, “obligatory exercise”, “driven exercise”) describing various aspects of physical activity in clinical and research settings, Noetel and colleagues [4] sought to canvass opinions from the leading clinicians/scientists in the field of adolescent eating disorders to settle on one term to describe this phenomenon. The authors undertook a Delphi study to explore whether consensus could be reached in the terminology used to describe unhealthy exercise in adolescents with AN [4].…”

Ejercicio físico como herramienta para el tratamiento de los trastornos de la conducta alimentaria

“…Es por ello, que si se impide realizar la actividad física, hay un aumento de la ansiedad y afecto negativo, que se modula mediante la reanudación del ejercicio . El ejercicio compulsivo puede ser una representación más precisa del perfil del ejercicio problemático en TCA Noetel et al, 2017;Sauchelli et al, 2016). Stiles-Shields et al, (2015), estudiaron a 201 adolescentes con AN y BN.…”

“…Se debe considerar la concienciación sobre la condición física actual del cuerpo del paciente, el reconocimiento y la aceptación de los cambios en el peso corporal y los sentimientos y las necesidades asociadas. Expertos en TCA recomiendan la restricción del ejercicio hasta que el adolescente esté médicamente estable, con un peso suficiente y ser capaz de compensar el ejercicio con una suficiente ingesta energética (Noetel et al, 2017). Se debe realizar una reintroducción y promoción del ejercicio saludable de manera graduada y supervisada, donde el ejercicio proporciona grandes beneficios: como mejorar y aumentar la confianza social y otorgar una herramienta para una vida sana (Cook et al, 2016;Moola et al, 2013;Ng et al 2013;Soundy et al, 2016).…”