Measuring exercise in eating disorder patients: a Delphi study to aggregate clinical and research knowledge

Abstract

Background Exercise is a prominent feature of most eating disorders, and has been shown to have a number of detrimental effects on treatment outcome. There is some disagreement in the literature regarding the construct of compulsive exercise, and assessment and treatment varies significantly. This study therefore aimed to aggregate expert clinicians’ and researchers’ views on how to define and measure compulsive exercise in eating disorder patients. The expert panel was also asked about questionnaire design, and possible problems when measuring compulsive exercise. Method This study used the Delphi method to establish consensus amongst an expert panel. Three successive rounds of questionnaires were distributed to the panel over a period of six months. The first round consisted of four open-ended questions regarding the definition and measurement of compulsive exercise in eating disorder patients. For Round 2, 70 statements were derived from the answers, and panelists were asked to rate each item on a Likert-based scale. An 85% consensus level was chosen. In Round 3, 44 statements were re-rated by the panel. Results Seventeen of 24 participants completed all three rounds of the study. Consensus was achieved for 63% of the items, while 18.5% reached near consensus, and 18.5% did not reach consensus after Round 3. The panel agreed on a number of important aspects of compulsive exercise. Several suggestions regarding the format of a questionnaire assessing this behavior were also endorsed. The panel further identified common difficulties when assessing compulsive exercise in eating disorder patients, notably a lack of consensus still apparent in the literature. Conclusion The current findings constitute a further step towards a unified definition of compulsive exercise, and contribute important suggestions to the measurement of this behavior.

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

“…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. Notable as well are the many definitions and understandings of DEx [12][13][14][15][16], leading to a variety of methods to evaluate symptom severity [17,18].…”

Adolescent leisure-time physical activity and eating disorders: a longitudinal population-based twin study

“…However, the panel of experts have recently recommended that in addition to qualitative aspects of physical activity, also the frequency of physical activity should be assessed when studying physical activity behavior in individuals with ED [ 15 ]. The reason for this is that physical activity frequency may give more information on how compulsive exercise manifests in different types of EDs.…”

“…Still, persons with non-restrictive EDs may display high scores on compulsive exercise instruments despite their objectively assessed low volume of physical activity [ 16 ]. However, in restrictive EDs (e.g., anorexia nervosa), compulsive exercise may more likely include increased levels of physical activity [ 15 ].…”

“…Defining and measuring physical activity and exercise in EDs is difficult due to patients with EDs engaging in a variety of physical activity they may not see as exercise [ 15 ]. Based on the general agreement of researchers and professionals, physical activity that is not required as an essential physical activity of daily living, is not done during working hours and is performed at the person’s discretion is called leisure-time physical activity.…”

“…Exercise is a subcategory of leisure-time physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective [ 17 , 18 ]. It has been suggested that it would be beneficial to assess for all types and levels of physical activity in EDs (e.g., walking for errands or standing), not just those typically considered exercise (e.g., running to improve fitness or weightlifting) [ 15 ].…”