The inpatient management of physical activity in young people with anorexia nervosa

Abstract

This study investigates the management of physical activity in young inpatients with anorexia nervosa. Through telephone interviews and postal surveys inpatient units across the UK were asked about written documents regarding physical activity management, how they viewed healthy exercise, how they assessed physical fitness to engage in activity, the management approaches taken, provision of education and support around this issue and range of activities provided. Results indicated that a variety of approaches were taken, with little consensus between units, although the majority of approaches did involve some form of restriction, frequently determined by weight criteria. There were few substantial written documents to guide practice and a range of interpretations of healthy exercise. The findings are discussed and suggestions made for research to explore this area further and to inform the development of effective interventions.

Speaking on behalf of the body and activity: Investigating the activity experiences of Canadian women living with anorexia nervosa

“…Although fear of weight loss drives activity restriction approaches, exercise interventions with appropriate nutritional support do not compromise weight gain. Eating disorder symptoms either stay the same or improve with activity (Beaumont, Arthur, Russell, & Touyz, 1994;Calogero & Pedrotty, 2004, Chantler, Szabo, & Green, 2006Davies, Parekh, Etelapaa, Wood, & Jaffa, 2007;Del Valle et al, 2010;Giordano, 2005;Hausenblas et al, 2008;Moola et al, 2013;Szabo & Green, 2002;Thien, Thomas, Markin, & Birmingham, 2000;Tokumura, Yoshiba, Tanaka, Nanri, & Watanabe, 2003;Zunker et al, 2011). Readers should refer to the reviews of literature indicated above for further information on AN and exercise.…”

The treatment of compulsive physical activity in anorexia nervosa lacks a conceptual base

“…All share common characteristics of describing an urge to be active, with resultant anxiety and depression when activity is restricted. However, they do not appear to have informed treatment practices, as evidenced by the varied approaches used, including restricted exercise, weight-determined programmes, resistance training, cardiovascular exercise and yoga (Davies et al, 2008). There appears to be little difference between them on physiological or psychological outcomes, such that weight increased (Carei et al, 2010;Szabo & Green, 2002;Thien et al, 2000) and depression, anxiety and eating disorder symptoms decreased (Carei et al, 2010;Szabo & Green, 2002) in similar ways across studies.…”

“…There appears to be widespread concern that allowing patients to exercise would adversely affect weight gain, hence the extreme restriction on movement in some units (Davies, Parekh, Etelpaa, Wood, & Jaffa, 2008). However, there is an emerging consensus that supporting patients with AN in taking part in a pre-designed exercise programme may be beneficial, for example, it may increase general treatment tolerance (Daubenmier, 2005;Ng, Ng, & Wong, 2013;Thien, Thomas, Markin, & Birmingham, 2000;Tokumura, Yoshiba, Tanaka, Nanri, & Watanabe, 2003) and nor does it lead to any less weight gain than those who do not participate in such programmes (Ng et al, 2013).…”

“…Currently, there are a variety of approaches across treatment units. Davies et al (2008) investigated management in inpatient units across the UK. The authors found that although most units adopted a weight-based approach to determine levels of activity, the figures used to set what activity could be allowed at which body mass index (BMI) or weight for height ratio varied enormously and were somewhat arbitrary.…”

“…The authors found that although most units adopted a weight-based approach to determine levels of activity, the figures used to set what activity could be allowed at which body mass index (BMI) or weight for height ratio varied enormously and were somewhat arbitrary. For example, in one unit normal activities would be resumed at a BMI of 15 kg/m 2 whereas in another such activity was restricted until a BMI of 18.5 kg/m 2 was achieved (Davies et al, 2008). (Thien et al, 2000) and cardiovascular (Tokumura et al, 2003).…”