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.
Highlights
Anorexia Nervosa (AN) is a severely debilitating eating disorder (ED) with considerable morbidity [1] and mortality [2]
We identified seven definitions of problematic exercise” (PE) based on the quantitative or qualitative dimensions implemented by studies in the literature and the instruments they used to evaluate these dimensions [25, 46,47,48,49,50,51,52,53,54,55,56,57,58,59] (S1 Table)
There were no statistically significant differences between excluded patients and patients retained for further analyses for age (p = 0.745), BMI (p = 0.817), illness duration (p = 0.296), AN subtype (p = 0.314), EDE-Q scores, total hours of exercise per week (p = 0.982), and Hospital Anxiety and Depression scale (HADS) anxiety (p = 0.236) or depression (p = 0.211)
Summary
Anorexia Nervosa (AN) is a severely debilitating eating disorder (ED) with considerable morbidity [1] and mortality [2]. Patients suffering from ED have been found to have the highest frequency of physical activity and participation in sports compared to all other psychiatric disorders [6]. This “hyperactivity”, affecting 31% to 80% of AN patients [7], has been identified as a complex and multifaceted feature commonly present in AN. This wide range in prevalence range could be partly due to the plethora of definitions provided by researchers for patients with AN. General physical activity includes any body movement that contracts the muscles to burn more calories than the body would normally do at rest [9]
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