Problematic Exercise in Anorexia Nervosa: Testing Potential Risk Factors against Different Definitions

Abstract

“Hyperactivity” has a wide prevalence range of 31% to 80% in the anorexia nervosa literature that could be partly due to the plethora of definitions provided by researchers in this field. The purpose of this study was two-fold: 1) To assess the variance across prevalence rates of problematic exercise encountered in patients with anorexia nervosa, in relation to seven different definitions found in the literature. 2) To examine how core eating disorder symptoms and the dimensions of emotional profile are associated with these different definitions and the impact of these definitions on the assessment of patients’ quality of life. Exercise was evaluated in terms of duration, intensity, type and compulsion using a semi-structured questionnaire administered to 180 women suffering from severe anorexia nervosa. Seven different definitions of problematic exercise were identified in the literature: three entailing a single dimension of problematic exercise (duration, compulsion or intensity) and four combining these different dimensions. Emotional profile scores, obsessive-compulsive symptoms, eating disorder symptomatology, worries and concerns about body shape, self-esteem and quality of life were assessed using several established questionnaires. The prevalence of problematic exercise varied considerably from, 5% to 54%, depending on the number of criteria used for its definition. The type and level of eating disorder symptomatology was found to be associated with several definitions of problematic exercise. Surprisingly, a better self-reported quality of life was found among problematic exercisers compared to non-problematic exercisers in three of the definitions. The different definitions of problematic exercise explain the broad prevalence ranges and the conflicting associations generally reported in the literature between problematic exercise and eating disorder-related psychological parameters. There is an urgent need for a valid consensus on the definition of problematic exercise in anorexia nervosa. This will support the development of further research on the etiology and treatment of problematic exercise.

High‐intensity exercise is associated with a better nutritional status in anorexia nervosa

“…Participants were interviewed by trained evaluators, using a semistructured questionnaire (Rizk et al, ). This questionnaire was designed to determine at what level patients were engaging in a given type of exercise in the month preceding hospitalization.…”

Restless activation and drive for activity in anorexia nervosa may reflect a disorder of energy homeostasis

“…Numerous studies in recent decades have focused on the frequency of behavior, termed variously “hyperactivity” or “excessive exercise” by interviewing patients, through self‐rating scales and through retrospective reviews of medical records. Differences in methodologies and patient populations which have resulted in inconsistent findings of excessive exercise in AN with prevalence rates ranging from 30 to 80% were recently critically reviewed . From a developmental perspective, a reported predisposition to greater than average activity levels in childhood in nearly half of adolescents with AN is relevant.…”

“…Differences in methodologies and patient populations which have resulted in inconsistent findings of excessive exercise in AN with prevalence rates ranging from 30 to 80% were recently critically reviewed. 3 From a developmental perspective, a reported predisposition to greater than average activity levels in childhood in nearly half of adolescents with AN is relevant.…”

Exercise in Anorexia Nervosa: Complexity of Pathology and Health

“…Health status may be estimated by the level of functional or metabolic efficiency of living organisms; in this context, the type, duration and extent of physical exercise may be an essential issue in determining its interventional status. For example, the influence of physical activity upon subjective well-being was studied through an analysis of individuals' participation intensity and duration of sports activities [20].…”

“…Health status may be estimated by the level of functional or metabolic efficiency of living organisms; in this context, the type, duration and extent of physical exercise may be an essential issue in determining its interventional status. For example, the influence of physical activity upon subjective well-being was studied through an analysis of individuals' participation intensity and duration of sports activities [20].The issue or whether or not physical exercise serves patients presenting AN optimally remains a markedly complicated issue since the prevalence of problematic exercise fluctuates to a great extent from 5% to 54%, depending upon the number of criteria applied for its definition [21]. The enduringly, but disturbingly, high level of variation depicting the physical exercise/activity profiles of AN patients that is attributed to the, either low or very high, patterns of these behaviors presents a highly relevant issue in AN [22].…”