Treatment of compulsive exercise in eating disorders and muscle dysmorphia: A systematic review and meta-analysis.

Abstract

A lack of consensus exists among the scientific and medical communities on how to treat compulsive exercise, a core feature of eating disorders (EDs) and muscle dysmorphia (MD). We systematically searched five electronic databases for treatment studies of compulsive exercise that sampled adolescents and/or adults with an ED or MD, assessed longitudinal changes in compulsive exercise and used a validated instrument to measure compulsive exercise or related constructs. We identified 777 papers, of which 18 met eligibility criteria. None of the included studies sampled people with MD and 15 of 18 evaluated multi-component interventions combining psychoeducation and/or psychotherapy and/or structured exercise. Results from meta-analyses indicated moderate-to-large prepost treatment changes in compulsive exercise (Cohen’s d = −.62), but small treatment effects between active and control treatments in randomized controlled trials (Cohen’s d = −.23). Multi-component interventions appear best suited to reduce compulsive exercise in people with EDs, but the optimal combination of treatment components is unknown. Further treatment research on MD is needed.

Better understanding change processes and mechanisms: A commentary on “treatment of compulsive exercise in eating disorders and muscle dysmorphia: A systematic review and meta-analysis”.

“…Martenstyn et al (2022) paved the way for important next steps in our field. Importantly, they highlighted the absence of muscle dysmorphia treatment studies.…”

“…Although Martenstyn et al (2022) focused on investigating outcome achievement among existing intervention studies, other intervention research strategies may allow us to understand how outcomes are achieved. Doss (2004) highlighted that change processes (i.e., the role of components of an intervention) and change mechanisms (i.e., client characteristic changes which lead to outcome achievement) are important considerations in evaluations of interventions.…”

“…For example, Scharmer et al (2020) distinguished compulsive exercise from exercise dependence, indicating that exercise dependence reflects a behavioral addiction mechanism and compulsive exercise reflects an anxiety/ affect regulation mechanism. Scharmer et al subsequently measured these constructs with different self-report questionnaires, on which the items align with each proposed mechanism-the Compulsive Exercise Test and the Exercise Dependence Questionnaire -both of which were also synthesized in Martenstyn et al's (2022) meta-analytic review. Although there may be some construct overlap between these measures, which Martenstyn et al noted, if these constructs represent varying mechanisms underlying problematic exercise behaviors, conflating them in the future may obscure important information about mechanisms of change within certain treatments.…”

“…Martenstyn et al (2022) contributed an important, comprehensive, and quantitative review of interventions targeting compulsive exercise in eating disorders as well as muscle dysmorphia. The authors found small effects of compulsive exercise interventions among a limited number of randomized controlled trials and medium-to-large pre–post improvements in compulsive exercise among all included interventions.…”

“…An important research question that emerged upon reading this review is how we can successfully enhance existing interventions by targeting treatment resistant components of body image disorder symptoms, such as compulsive exercise. Martenstyn et al (2022) demonstrated that among the few randomized controlled trials with an active control condition (e.g., cognitive behavioral therapy), there was limited incremental improvement in compulsive exercise or eating pathology when incorporating an additive compulsive exercise intervention. Although current eating disorder and body dysmorphic disorder evidence-based treatments, such as cognitive behavioral therapy, have demonstrated strong efficacy in symptom reduction, risk of lapse can be attributed to the treatment resistant nature of both body image disturbance and compulsive exercise.…”