Excessive Exercise Among Anorexia Nervosa Patients

Reprinted from Eating Disorders Review
May/June 2010 Volume 21, Number 3
©2010 Gürze Books

Researchers exploring excess exercise among patients with anorexia nervosa (AN) have added some new insights. For example, AN patients who use excessive exercise to manage their weight can be distinguished from the two DSM-IV categories of restricting-type and binge-purge type AN, according to the results of one of three studies (Eat Weight Disord. 2009; 14:199).

Researchers at the University of Abertary Dundee, Scotland, compared 428 AN patients with 19 age- and gender-matched controls. Those with AN were initially categorized according to DSM-IV subtype criteria into restricting (RAN, 198 patients) and binge-purge (BPAN, 230) AN. Dr. K. Kiezebrink and colleagues then administered a series of questionnaires selected to reflect key features of the diagnosis of eating disorders and characteristics of eating and food behavior. In addition, structured clinical interviews were carried out to identify the subgroup of patients who use excessive exercise in order to help control weight (EAN).

The RAN, EAN, and BPAN groups did not differ in age, body mass index, age of onset of AN, or in restrained eating. However, significant differences were noted on the Eating Attitude Test-26, including measures of emotional and external factors, disinhibition and hunger factors, extraversion and neuroticism and self-esteem. Subjects in the EAN group were similar to the RAN group on the majority of variables but showed significant differences in extraversion, neuroticism, self-esteem and disease pathology (EAT-26). Compared with the BPAN group, the EAN subjects had lower disease pathology (EAT-26) scores and scored higher on the Eynsenck Personality Inventory (EPI) , extraversion scale, lower on the neuroticism scale than the BPAN group, and had significantly lower disinhibition and hunger scores (Three-Factor Eating Questionnaire).

To the authors, these results suggested that the EAN group has a mixed profile of characteristics resembling both BPAN and RAN groups. When the EAN group was defined as a separate group, members appeared to be more similar to the RAN group than to the BPAN group. However, when the DSM-IV criteria were applied, the EAN group were almost exclusively classified as BPAN. The results suggest that EAN do constitute an identifiable group than can be distinguished from RAN and BPAN. Consequently, it is likely that excessive exercise should be considered as clinically relevant on the outcome of treatment.

Two other studies

In two Norwegian studies, S. Sanda-Bratland and colleagues examined the role of physical activity in patients with long-term eating disorders (Int J Eat Disord 2010 43: 88) and excessive and nonexcessive exercisers who receiving inpatient treatment (Int J Eat Disord 2010, e-pub ahead of print). The first study evaluated 39 female patients receiving inpatient treatment of AN, BN, or eating disorders not otherwise specified (EDNOS). The authors used accelerometer assessed physical activity, the ex4rcise Dependence Sale, Reasons for Exercise Inventory, Eating Disorders Examination, and the Eating Disorders Inventory.

Physical activity was significantly reduced in non-excessive exercisers during treatment; among excessive exercisers there was a trend toward a reduction of physical activity from admission to discharge. In excessive exercisers, reduced eating disorders psychopathology was correlated with a reduction in exercise affects but not with importance of exercise for weight/appearance. Such associations were not reported in non-excessive exercisers. The authors concluded that excessive exercise in an important issue in longstanding eating disorders and the excessive exercising patients need help to develop alternative strategies to regulate negative affects.

The same authors conducted a second study to examine self-reported versus objectively assessed moderate-to-vigorous physical activity and different reasons given for exercise in patients with longstanding eating disorders, compared to a group of controls. Fifty-nine female inpatients (mean age: 30.1 years) and 53 nonclinical age-matched controls (mean age: 31.3 years) participated in a cross-sectional study. Exercise patterns were measured with an accelerometer, ActiGraph (a small monitor worn by a client that measures physical activity for a given period), and a physical activity diary, Reasons for Exercise Inventory, and the EDE.

Self reports and objective reports of moderate-to-vigorous activity were higher across all patients with eating disorders diagnoses when compared with controls. Patients’ self-reported activity levels were lower than were the objectively assessed levels, and no difference was found among controls. Among patients, exercise was more important for regulating negative affects, not weight and appearance, than among controls. Fitness or health was a less important reason for exercise in patients than in controls.

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