Attitudes about Exercise During Treatment

Reprinted from Eating Disorders Review
January/February 2010 Volume 21, Number 1
©2010 Gürze Books

Physical activity can be a mixed blessing among patients with eating disorders. The benefits of regular exercise are well known, but excessive exercise is also one of the compensatory behaviors among patients with eating disorders. Results of a recent study pointed out differing attitudes about physical activity during treatment.

Scandinavian researchers sought to determine how thoroughly the balance between healthy and excess activity is maintained in specialty centers that treat patients with eating disorders (Eating Weight Disord 14:e106-e112, June-September, 2009). S. Bratland-Sanda, PhD and colleagues designed a questionnaire-based study of 49 treatment centers in Scandinavia and the United Kingdom to discover how centers that treat patients with eating disorders assess physical activity, the background and experience their staff have in evaluating excessive exercise, and whether regular exercise is integrated into the unit’s treatment program. In addition, the treatment units were asked to rate the role of physical activity in the treatment of eating disorders compared with other mental disorders.

Some areas needed improvement

Of the 49 treatment units assessed, 84% replied to the questionnaire. Overall, there was a universally fair agreement about excessive physical activity as an important and harmful clinical feature in eating disorders. Among 28 centers, (68%), physical activity was regularly assessed during treatment. Thirty-two units included physical activity in their treatment programs, and most units reported having guidelines to manage excessive exercise. Eleven centers reported that patients were given individual plans by an exercise specialist or physiotherapist once their weight was stabilized. Most centers included physical activity for treatment of obesity, depression, binge eating disorder, and to a lesser degree, anorexia nervosa. One interesting finding was that assessing physical activity was more common among units for younger patients. Six of the units reported use of group activities once or twice a week, including walking, bowling, ball games, horseback riding, Nordic walking, strength exercises, swimming, water, gymnastics and yoga, for example.

The authors suggest that assessment of activity levels should be done by staff members who are specifically educated about physical activity, and that the assessment should cover the types, motives, intensity, duration and frequency of such exercise. When patients have been active in sports, the assessment should be even more detailed. In additional, although the directors of the treatment centers generally agreed that excessive physical activity is a core eating disorder symptom, there was no consensus about how to define “excessive exercise” and the best way to manage it. Further research about the potentially beneficial effects of regular physical activity in various eating disorders is needed, according to Dr. Bratland-Sanda and colleagues.

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