What is the evidence for using bed rest as part of hospital treatment of severe anorexia nervosa?

Abstract

Bed rest is commonly used on medical and paediatric wards as part of nursing management of the physically compromised patient with severe anorexia nervosa. The aim of this study was to review the evidence base of bed rest as an intervention in the management of severe anorexia nervosa. We searched MEDLINE, PubMed, Embase, PsychInfo, CINAHL, HMIC, AMED, HBE, BNI and guidelines written in English until April 2018 using the following terms: bed rest and anorexia nervosa. After exclusion of duplicates, three guidelines and eight articles were included. The papers were methodologically heterogeneous, and therefore, quantitative summary was not possible. There have been no randomised controlled trials to compare the benefits and harms of bed rest as the focus of intervention in the treatment of anorexia nervosa. Several papers showed that patients have a strong preference for less restrictive approaches. These are also less intensive in nursing time. Negative physical consequences were described in a number of studies: these included lower heart rate, impaired bone turn over and increased risk of infection. We found no evidence to support bed rest in hospital treatment of anorexia nervosa. The risks associated with bed rest are significant and include both physical and psychological harm, and these can be avoided by early mobilisation. Given the established complications of bed rest in other critically ill patient populations, it is difficult to recommend the enforcement of bed rest for patients with anorexia nervosa. Future research should focus on safe early mobilisation, which would reduce complications and improve patient satisfaction.

How to address physical activity and exercise during treatment from eating disorders: a scoping review

“…The rationale behind the use of bed rest is understandable given the poor medical status and high mortality rates in persons with anorexia nervosa [5,6]. However, a recent review showed that this had no evidence in existing literature and most likely was not only ineffective but potentially counterproductive [4,7]. DEx is also prevalent in individuals with other EDs such as bulimia nervosa and binge-eating disorder (BED) [8][9][10][11], yet the management of this symptom has been insufficiently addressed in research concerning all EDs.…”

Metabolic Equivalents of Safe Physical Activity Levels at Anaerobic Threshold in Anorexia Nervosa Patients

“…It is not advisable to manage the range of activity of patients with AN only with bed rest. In a study by Ibrahim et al, bed rest was not supported for the inpatient treatment of patients with AN [33]. Other studies have shown that physical activity has a positive impact in the treatment of AN.…”

Physical Fitness—Not Physical Activity Levels—Influence Quality of Life in Anorexia Nervosa

“…It is often the first presenting and last remaining symptom in this population [ 2 , 3 , 4 ], and engagement in uPA after treatment is a relapse predicting eating disorder symptom [ 5 ]. For this reason and to reduce the metabolic demand, bed rest and exercise restriction has historically been the elected strategy in AN patients [ 6 ]. Bed rest has shown to negatively impact bone health during hospitalization [ 7 ], while low-mechanical stimulus (exercise) is able to prevent bone turnover decline in AN [ 8 ].…”

“…Incorporating exercise has been a challenge for health care teams due to a lack of guidelines and insufficient knowledge on safe and effective exercise in AN [ 13 ], therefore, resulting in decreased PA levels [ 12 , 22 ]. This has contributed to partial PFit recovery, even after weight or body mass index (BMI) restoration [ 6 ]. PFit, also referred to as “health status”, is affected by physical activity behaviors.…”

“…PFit, also referred to as “health status”, is affected by physical activity behaviors. In AN, PFit health-related components are negatively affected with reduced cardiorespiratory (CR) function, muscular fitness, decreased functional mobility—reduced performance in activities of daily living—and altered body composition (i.e., reduced skinfold thicknesses and circumferences at the extremities, low muscle mass, and bone mineral density at different stages of the treatment) that persists even after weight and BMI recovery and impacts negatively quality of life (QoL) [ 2 , 6 , 15 , 23 ].…”