Attitudes toward physical activity as a treatment component for adolescents with anorexia nervosa: An exploratory qualitative study of patient perceptions

Abstract

Objective Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment. Method Seventeen adolescents 12–18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5‐day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi‐structured interviews that were audio‐recorded and transcribed. Results were analyzed deductively using qualitative techniques. Results Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group‐based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology. Discussion Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment.

Competing for perfection: A scoping review evaluating relationships between competitiveness and eating disorders or disordered eating behaviours

“…Most identified studies evaluating the relationship between competitiveness and ED treatment and recovery outcomes were qualitative in nature ( n = 12; Chubbs‐Payne et al., 2021; Colton & Pistrang, 2004; De Bois, 2020; Lavis, 2011; Lazerson, 1984; Moreno, 1998; Raulli, 2018; Rich, 2006; Stirling & Kerr, 2012; Warchol, 2013; Warin, 2006; Wasil et al., 2019). Among these, several authors interviewed ED inpatients who reported pressure to compete with others in the ED milieu (Chubbs‐Payne et al., 2021; Colton & Pistrang, 2004; Lavis, 2011; Warchol, 2013).…”

“…Most identified studies evaluating the relationship between competitiveness and ED treatment and recovery outcomes were qualitative in nature ( n = 12; Chubbs‐Payne et al., 2021; Colton & Pistrang, 2004; De Bois, 2020; Lavis, 2011; Lazerson, 1984; Moreno, 1998; Raulli, 2018; Rich, 2006; Stirling & Kerr, 2012; Warchol, 2013; Warin, 2006; Wasil et al., 2019). Among these, several authors interviewed ED inpatients who reported pressure to compete with others in the ED milieu (Chubbs‐Payne et al., 2021; Colton & Pistrang, 2004; Lavis, 2011; Warchol, 2013). For example, participants endorsed perceived competition to be the ‘best anorexic’ while inpatient and described how this disrupts ED recovery and harms relationships with other inpatients (Colton & Pistrang, 2004, p. 311) Additionally, participants reported increased motivation to engage in ED behaviours, such as maladaptive exercise and food restriction, resulting from competitiveness (Colton & Pistrang, 2004).…”

Eating disorders treatment experiences and social support: Perspectives from service seekers in mainland China

“…Participants who indicated that they sought ED treatment and left contact information were contacted for the semi-structured interview (n = 36); however, five were excluded after clarifying that they had not sought ED treatment when contacted. The size of the final interview sample (n = 31), representing all of our eligible respondents, is typical of qualitative studies (Guest, Bunce, & Johnson, 2006) and larger than, or on par with, recently published qualitative studies of EDs (Chubbs-Payne et al, 2021;Ortiz, Espel-Huynh, Felonis, & Scharff, 2020;Venturo-Conerly et al, 2020). Interviewees chose to provide their qualitative data via semi-structured telephone interviews (n = 19; 61.3%) or in writing (n = 12; 38.7%); interviewer prompts and clarification questions were identical for both response modalities.…”

Divergent trajectories of positive affect following maladaptive and non‐maladaptive exercise among individuals with binge‐spectrum eating disorders

“…However, even among individuals with binge‐spectrum EDs who exercise, there is considerable variability in the degree to which individuals engage in maladaptive exercise. For example, not all exercise episodes are necessarily maladaptive for a given individual (Chubbs‐Payne et al, 2021; Lampe, Forman, et al, 2021; Lampe, Trainor, et al, 2021). However, it is currently unknown to what extent exercise that is non‐maladaptive (i.e., not driven or compensatory) is overlapping with exercise that is adaptive (i.e., exercise promoting social or health benefits) in this population.…”