ABSTRACT
BACKGROUND: To investigate the frequency of compulsive exercise among early adolescents, and determine the associated impact of sex, physical activity level, exercise habits, motivational regulation, dieting behaviour and health-related quality of life (HRQoL) on compulsive exercise. METHODS: Cross-sectional design with 8th grade adolescents (n = 572, mean ± SD age 13.9 ± 0.3 yrs). Outcome assessment was compulsive exercise (Compulsive Exercise Test, CET). Total CET score ≥ 15 was defined as clinical CET score. Further assessment included exercise motivation (Behavioural Regulation of Exercise Questionnaire-2), HRQoL (KIDSCREEN 27), accelerometer-assessed physical activity and Andersen test for cardiorespiratory fitness. Exercise obsession was defined as clinical CET score and < 60 min/day with moderate-to-vigorous objectively assessed physical activity. RESULTS: Small sex differences were found for CET total score. Seven percent of the adolescents were classified with clinical CET score, and four percent with exercise obsession. Adolescents with clinical CET score had higher body mass index, more weight loss attempts, and lower physical fitness compared to adolescents with non-clinical CET score. Being a boy, higher scores on introjected motivational regulation and HRQOL subscale parent relation and autonomy, use of exercise monitoring tool, and number of weight loss attempt the past 12 months explained 39% of the total CET score variance. Physical activity level did not predict compulsive exercise. CONCLUSIONS: Compulsive exercise in early adolescents was predicted by exercise motivation, exercise habit, and dieting, but not physical activity level. This implicates a distinction of obsessive cognitions about physical activity from performed physical activity in adolescents, and that such cognitions must be addressed in future initiatives that aim to improve adolescents' general physical activity level, health, and wellbeing. Trial registration ClinicalTrials.gov: NCT03906851. Although there is a huge concern about adolescents being insufficiently physically active, there are also adolescents who struggle with issues of compulsive exercise. The issues of compulsive exercise have been rarely studied in adolescents. We therefore aimed to describe compulsive exercise and factors that were associated with and could explain presence of compulsive exercise. A total of 572 8th graders (age 13.9 ± 0.3 yrs) responded to this study. We found that the score on compulsive exercise was higher in boys than in girls, and that adolescents with high score on compulsive exercise had higher body mass index, more weight loss attempts, and lower physical fitness compared to adolescents with low score on compulsive exercise. Also, we found that exercise obsessions, i.e., thinking of exercise without actually exercising, was present in four percent of the respondents. Being a boy, attempting weight loss, exercising to avoid shame/guilt, and exercising for the perceived value of exercise predicted compulsive exercise. Awareness of the compulsive exercise and exercise obsessions is important in public health initiatives that aim to increase adolescents' physical activity level.
ABSTRACT
BACKGROUND: Excessive exercise is recognized as a predictor of poor outcome in eating disorders. However, little is known about how excessive exercise might affect the treatment process. The aim of this study was to describe process of weekly changes in eating disorder psychopathology, general psychopathology and exercise, and the possible interactive effects of excessive exercise on these changes during inpatient treatment of longstanding eating disorders. METHODS: Eighty-four patients meeting the DSM-IV criteria for Anorexia Nervosa, Bulimia Nervosa, or Eating Disorders Not Otherwise Specified received inpatient cognitive-behavioural therapy including, physical activity and nutritional counselling treatment over 12 weeks. Excessive exercise was defined as having ≥6 episodes of driven exercise during week 1 of treatment. Excessive exercisers received one additional session of individual counseling with the clinical exercise physiologist. The study used repeated measurements during treatment and collected measures of eating disorders: psychopathology (EDE-Q), general psychopathology (SCL-5), and frequencies of exercise and body mass index (BMI). Statistical analysis was performed using repeated measures ANOVA. RESULTS: Both eating disorders and general psychopathology were reduced from admission to discharge in excessive exercisers and non-exercisers. There was an overall interaction effect between time (week) and excessive exercise for the process of exercise and eating disorders psychopathology reduction. This interaction effect was also found in week 10 vs 11 regarding general psychopathology. The excessive exercisers showed steep reduction at first, followed by a smaller increase towards the end of treatment in both eating disorder and general psychopathology; this pattern was not found among the non-exercisers. CONCLUSION: The process of change in exercise and psychopathology during inpatient treatment of longstanding eating disorders differs across excessive and non-excessive exercisers. Although excessive exercisers were given special attention for their exercise cognition and behavior during treatment, it is apparent that this part of treatment must be further developed.
ABSTRACT
OBJECTIVE: Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders. METHODS: Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire. RESULTS: In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED. CONCLUSION: PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED.
