Physical Therapy Interventions in Patients with Anorexia Nervosa: A Systematic Review

Abstract

Objective: Assess the effectiveness of physical therapy, including supervised physical exercise for body mass index (BMI) restoration; improving muscle strength and the psychological, behavioural, cognitive symptoms and quality of life in patients with anorexia nervosa (AN). Methods: A Systematic Review (SR) was conducted in the following scientific databases: Medline, PubMed, PEDro, PsychInfo, Cochrane Library plus, Nursing and Allied Health database, Scopus and Web of Science databases, from inception until November 2021. An assessment of the risk of bias and the certainty of evidence across studies was conducted. Articles were eligible if they followed randomized and non-randomized control trial designs with treatments based on physical therapy or exercise or physical activity in AN patients. Results: 496 records were screened, and after eligibility assessment, 6 studies from 8 articles were finally analysed. The studies, involving 176 AN patient (85.02% of patients), reported improvements in muscle strength, eating behaviour, eating attitude, mood and quality of life. Three studies included nutritional co-interventions and four studies included psychological therapy. None of the studies reported adverse effects. Conclusions: In two of the RCTs included in this SR, strength training and high intensity resistance improved the muscle strength of patients with AN. In addition, in two RCTs, improvements were observed in patients’ attitudes towards their bodies after basic body awareness therapy or after full body massage and instruction to relax. In addition, quality of life improved in two studies, with stretching, isometrics, endurance cardiovascular and muscular exercising.

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

“…The current literature review supports previous positive findings from studies on effects from psychoeducation and supervised PAE during treatment of different EDs. However, because the existing studies on safety and effects from use of PAE in treatment of EDs is limited in number, the same articles are cited and evaluated in reviews published the past decade [ 32 – 34 , 43 ▪ , 44 , 46 , 47 ▪ , 48 ▪ ]. Hence, the more recent original studies [ 45 ▪▪ , 50 ▪▪ , 51 , 52 , 53 ▪▪ ] bring important nuances and findings to the field, and the feasibility and safety of education and practical experience from PAE during treatment that they demonstrate are underlined by the positive experiences from those with lived experiences [ 54 , 55 ▪▪ , 56 ▪ ].…”

“…Two unique publications were identified by searches in Google Scholar (see figure). on body weight or -composition compared with a control condition; and, that exercise had either positive or neutral effects on psychopathology (Table 2) [46][47][48][49]. Importantly, no adverse outcomes were reported.…”

“…The three reviews (all of only anorexia nervosa) and one metanalysis (all EDs) that summarized findings on including supervised exercise to treatment, were similar in characterizing exercise programs as low-to-moderate in impact; that exercise gave no effect on body weight or –composition compared with a control condition; and, that exercise had either positive or neutral effects on psychopathology (Table 2 ) [ 46 – 49 ]. Importantly, no adverse outcomes were reported.…”

Avoidant Restrictive Food Intake Disorder: A Narrative Review of Types and Characteristics of Therapeutic Interventions

“…By sequentially relaxing different muscles of the body (legs, arms, head, neck, shoulders, chest and stomach), an increasingly deeper level of relaxation is achieved [ 58 ]. Finally, the subject implements the learned techniques towards the stimulus causing anxiety or phobia, proceeding according to the hierarchy initially identified [ 28 , 65 , 66 ]. Generally, one moves from even imaginary exposure to an in vivo but controlled exposure.…”

Beliefs and Self-Perceptions of Spanish Mental Health Professionals about Physical Therapy in Mental Health: An Observational Survey Study

“…Additionally, the notion of "necessary" may be attributed to the substantial body of scientific evidence supporting various mental health therapies, such as therapeutic exercise and body awareness therapies. This evidence includes numerous meta-analyses demonstrating the effectiveness of therapeutic exercise in various mental health conditions, including anxiety [27,28], depression [29], schizophrenia [30], eating disorders [31], and body awareness therapies [32].…”