Accuracy of self-reported physical activity in patients with anorexia nervosa: links with clinical features

Louise Bezzina,Nasim Foroughi,Jon Arcelus,Kathleen M Pike,Phillipa Hay,Stephen Touyz,Caroline Meyer,Evelyn Attia,Stacy Clemes,Sarah Young,Sloane Madden

doi:10.1186/s40337-019-0258-y

Abstract

BackgroundHigh levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN). Despite the importance of measuring PA in this population, there are two important factors that remain unknown. First, it is not clear how accurate self-report measures of PA are among patients. Second, little is known about how clinical characteristics are associated with the accuracy of self-reported PA. Therefore, this study aimed to examine the accuracy of self-reported PA compared to an objective measure of PA in patients with AN. It also investigated whether levels of accuracy/inaccuracy were associated with compulsive exercise, motivation to change, and psychological distress.MethodData were analysed from 34 adult outpatients with AN. Patients wore an accelerometer device (ActiGraph) for 4 days and completed a retrospective self-report measure of exercise (Exercise Participation Screening Questionnaire). They also completed measures of compulsive exercise (Compulsive Exercise Test), motivation to change (The Anorexia Nervosa Stages of Change Questionnaire), and psychological distress (Kessler-10).ResultsOn the self-report measure, patients accurately reported their time spent in moderate and vigorous intensity PA, however, they significantly under-reported their light physical activity (compared to the accelerometer data). Accurate reporting of total PA was positively associated with higher levels of compulsive exercise. There was evidence to suggest that clinical features, such as motivation to change and psychological distress, may be associated with inaccurate reporting at some levels of PA intensity and not others.ConclusionsResults indicate that patients with AN are likely to under-report their light intensity PA. We also found preliminary evidence for how compulsive exercise, motivation to change, and distress are associated with self-reported PA accuracy. Clinical implications and directions for future research are considered.Trial registrationACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.

Highlights

High levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN)
There was evidence to suggest that clinical features, such as motivation to change and psychological distress, may be associated with inaccurate reporting at some levels of PA intensity and not others
We found preliminary evidence for how compulsive exercise, motivation to change, and distress are associated with self-reported PA accuracy

Summary

Introduction

High levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN). Despite the importance of measuring PA in this population, there are two important factors that remain unknown It is not clear how accurate self-report measures of PA are among patients. This study aimed to examine the accuracy of self-reported PA compared to an objective measure of PA in patients with AN. It investigated whether levels of accuracy/inaccuracy were associated with compulsive exercise, motivation to change, and psychological distress. These signals can be converted to units of energy expended, and / or summarised as time spent in different intensities of PA, using standardised cut points such as sedentary, light, moderate, and vigorous PA [17]

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Conclusion