Quand bouger n’est plus synonyme de santé : une recension des traitements de l’exercice physique pathologique en troubles des conduites alimentaires

Abstract

IntroductionPathological physical exercise is a central feature of eating disorder and is related to a poor prognosis. Only few evidence-based recommendations are currently available to guide caregivers in the management of “exerciser” patients. Objective. The purpose of this paper is to present the current state of knowledge regarding proposed treatments targeting specifically the management of pathological physical exercise in patients with any type of eating disorder. MethodThe literature search took place in March 2020 and has been updated in February 2021 in databases (PsycINFO, PubMed, MEDLINE, SPORTDiscuss, etc.). English keywords encompassing concepts associated with pathological physical exercise, any type of eating disorder, and treatment were used in various combinations. To be included in the study, the publications identified must be written in English or French and be quantitative or qualitative empirical articles, systematic reviews of the literature or meta-analyses, case studies or syntheses of clinical guidelines. ResultsThe synthesis of the studies highlights four main classes of pathological physical exercise treatment: adapted physical exercise treatment (n=6), cognitive-behavioral therapy (n=4), thermoregulation (n=1) and pharmacotherapy (n=1). The summary of currently available treatments for pathological exercise indicates benefits of adapted physical exercise and cognitive-behavioral therapy treatments, primarily. These treatments demonstrate efficacy in improving principally the qualitative components of pathological exercise (decrease of compulsion towards exercise, dysfunctional attitude towards exercise, rigidity towards exercise, exercise to regulate emotions and lack of pleasure during exercise and rule-based exercise) in addition to a favorable effect on other symptoms associated with eating disorder (increase of the body mass index, quality of life, motivational change stage and emotional acceptance as well as decrease of the global eating disorder severity, drive for thinness, perfectionism, depression symptoms and psychological distress). Treatments aimed at reducing pathological exercise should include adapted physical exercise combined with cognitive-behavioral therapy principles, principally. Also, pathological physical exercise treatment should (1) promote the benefit of group and pleasure to avoid ascetic and compulsive behaviors as well as provide a variety of movement, (2) include relaxation/rest intervals to reconnect with bodily sensations, (3) include psychoeducational interventions to learn to identify pathological physical exercise and (4) address emotions and cognitions related to exercise to change the function of behavior. Pharmacological treatments should be used only in specific cases and with great caution. ConclusionWhile this review points to a predominantly uni- or multi-disciplinary approach to the management of pathological physical exercise, the multidimensionality and complexity of this phenomenon dictates that it be managed holistically through a transdisciplinary team. In this regard, transdisciplinary programs that consider physical exercise as a complex phenomenon transcending sectors of activity must be seriously considered.