Abstract
In persons with anorexia nervosa (AN), compulsive exercise and osteopenia are common symptoms. Although treatment of osteopenia besides weight regain is lacking, maximal strength training (MST) has been found to be effective in other populations. Such training has not been prescribed to those with AN due to uncertainty of tolerance. We therefore examined use of MST in a woman with long-standing AN, osteopenia, menstrual dysfunction, and compulsive exercise. The MST intervention consisted of four exercises: three sets of five repetitions maximum (RM), 3 times per week for 16 weeks. We examined muscle strength, bone mineral density (BMD), AN psychopathology, and compulsive exercise at baseline, posttest, and 6-month follow-up. Attendance rate was 100%. The subject improved muscle strength by 20% to 40%. BMD in lumbar spine improved by 4% to posttest, and by 8% from baseline to 6-month follow-up. The BMD T-scores shifted from values classified as osteopenic to normal values throughout the course of the intervention, despite continuance of menstrual dysfunction and lack of weight gain. No changes in AN psychopathology or levels of compulsive exercise were detected. Perceived psychological benefits including new bodily experiences were self-reported by the subject, emphasizing the importance of close follow-up by competent instructors.
Highlights
Theoretical and Research Basis for Treatment Anorexia nervosa (AN) ensues a state of malnutrition that is strongly associated with medical complications such as sarcopenia, myopathy, and osteoporosis (Mehler, Krantz & Sachs, 2015)
Osteopenia is defined as reduced bone mineral density (BDM) and a precursor to osteoporosis
A weight gain of 1.1-2.2 lbs. (0.5-1.0 kg)/week until the achievement of a body mass index (BMI) of 20 is recommended (Lund et al, 2009), a recent study showed that restoring approximate BMI to 17.5 or higher through the current method of treatment is difficult (Halvorsen, Tollefsen, & Rø, 2016)
Summary
Theoretical and Research Basis for Treatment Anorexia nervosa (AN) ensues a state of malnutrition that is strongly associated with medical complications such as sarcopenia, myopathy, and osteoporosis (Mehler, Krantz & Sachs, 2015). Each week in the intervention period, she was asked to report changes in energy intake, habitual exercise, and/or other compensatory behavior such as purging, the use of laxatives, and use of diuretics. Course of Treatment and Assessment of Progress The MST was performed under supervision from an instructor with competence in clinical exercise physiology and AN psychopathology.
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