ABSTRACT
BACKGROUND: Compulsive exercise is common in eating disorders (EDs), but a systematic treatment model is lacking. The CompuLsive Exercise Activity TheraPy (LEAP) is a cognitive behavioral therapy treatment for compulsive exercise in EDs, delivered by trained therapists in groups over four consecutive weeks (8 groupsessions and 1 individual session), aiming to promote healthy physical activity. LEAP is currently evaluated in a randomized efficacy trial. In parallel, it is crucial to learn more about how it is perceived by qualitatively investigating participants' subjective experiences. METHODS: Nine patients with various EDs participating in the LEAP trial were interviewed about their experiences of taking part in LEAP and about compulsive exercise as an ED symptom using a semi-structured interview guide. The interview transcripts were analyzed according to thematic analysis. RESULTS: The informants expressed that compulsive exercise had not been addressed in their standard ED treatment and that LEAP as such provided an important complement, spurring reflection, awareness, and changed feelings and behaviors in relation to compulsive exercise. Initially, increased PA was triggered for some, but this side effect was transitory. A wish for more treatment time, in terms of longer or additional sessions, was expressed. CONCLUSIONS: Overall, LEAP seemed to fill an important treatment need and seemed both acceptable and feasible to patients. However, treatment time and the initial increase in PA may need further investigation and attention in order to optimize this treatment. TRIAL REGISTRATION: The trial is registered with the ISRCTN registry (registration date 20200325), trial ID ISRCTN80711391.
Compulsive exercise (CE) is very common in individuals with eating disorders (EDs) often tightly connected with the eating pathology. Even so, most standard treatments do not specifically target CE, leaving patients without strategies to normalize their exercise. The CompuLsive Exercise Activity TheraPy (LEAP) is delivered as an adjunctive treatment to standard ED treatment (targeting CE in patients with EDs. In this study, nine former LEAP patients were interviewed about their experiences of taking part in LEAP and about CE as an ED symptom. The informants were in general satisfied with LEAP and indicated that participation had positive effects on their exercise-related thoughts and attitudes, as well as actual exercise behaviors. They all experienced that CE was not addressed in their standard treatment, although they were motivated to work towards changing it. LEAP was therefore viewed as an important complement. Participating in LEAP initially triggered some informants to exercise more, which fortunately ceased over time and is similar to the temporal negative effect (increased food occupation) often observed initially in cognitive behavioral therapy for eating disorders. The content of LEAP was experienced as valid, informative, and eye-opening, and being able to discuss CE-related topics in a group setting was for many a positive experience. The experiences expressed in this study are very useful for continued development of LEAP. Although preliminary, the results also suggest that LEAP may be a valuable add-on treatment within ED care.