Excessive Exercise, Anxiety, and Eating Disorder Symptoms

Two recent studies are focusing attention on the effects of excessive exercise among patients with eating disorders and those with symptoms of disordered eating.

LEAP: unraveling overreliance on exercise

Even with the best treatment available, only half of patients with anorexia nervosa (AN) currently have a good clinical outcome. A group at Loughborough University’s Centre for Research into Eating Disorders (LUCRED), Leicestershire, UK, are conducting a pilot program to tackle one element that interferes with treatment: AN patients’ reliance on excessive exercise. The new pilot program is termed LEAP, which stands for Loughborough Eating Disorders Activity TheraPy.

According to the researchers at the LUCRED program, AN patients often rely on excessive exercise as a way to control weight, shape, and even mood (Eur Eat Disord Rev 2008; 16:81). Those for whom exercise is a characteristic of their eating disorder are more likely to require hospitalization, have a longer inpatient stay for treatment, and are more likely to have a poor outcome or to relapse. Although previous reports suggest that as many as 80% of AN patients exercise excessively during the acute phase of their disorder, before the LEAP study, there were no focused attempts to find ways to reduce an individual patient’s reliance on excessive exercise.

As reported by Dr. Caroline Meyer, director of the Eating Disorders Centre, the University is collaborating with the University of Sydney and Leicester National Health Service Eating Disorders Service to understand exercise within the context of eating disorders and to identify barriers to successful treatment. This involves a large-scale study to look at factors that might predict pathological exercise behaviors among adolescents.

Risk of eating disorder symptoms is greater among athletes

Dr. Jill Holm-Denoma of the University of Vermont and her colleagues recently reported that female university undergraduates who actively participate in sports and exercise-related activities tend to have higher rates of attitudes and behaviors related to disordered eating compared to young women who do not regularly exercise (Int J Eat Disord 2009; 42:47).

The researchers concluded that women who have higher levels of anxiety about their sports or about exercise-related performance were even more likely to experience eating disorder symptoms and body dissatisfaction. This study is the first to document that women who participate in high levels of athletic competition and have sports anxiety are more likely to have eating disorders symptoms.

The study involved 274 female undergraduates from a large southeastern university. It examined whether differences in eating disorder symptoms exist between women who are varsity athletes (defined as exercising an average of 2 hours a day), club athletes (who practice their sport an average of 4 times a week), independent exercisers (people who exercise on their own 3 times a week), and non-exercisers (people who exercise 0-2 times a week, on average). All women completed the Eating Disorders Inventory, the Rosenberg Self Esteem Scale, and the Physical Activity and Sport Anxiety Scale.

The results suggest that coaches and athletic departments need to be alert for sports-related anxiety among young athletes because these athletes may be at greater risk of eating disorder symptoms, compared to women who are less anxious about their performance and those not involved in competition.