Treatment effects on compulsive exercise and physical activity in eating disorders

Therese Fostervold Mathisen,Jan H Rosenvinge,Oddgeir Friborg,Kari Anne Vrabel,Jorunn Sundgot-Borgen,Solfrid Bratland-Sanda,Gunn Pettersen

doi:10.1186/s40337-018-0215-1

Abstract

BackgroundDysfunctional thoughts- and use of physical activity (PA) are core symptoms of the eating disorders (ED) bulimia nervosa (BN) and binge eating disorder (BED). The compulsive desire for PA complicates a favourable treatment outcome; hence, regular, adapted PA led by personnel with competence in exercise science is rarely part of treatment of BN and BED. The present study compared cognitive behaviour therapy (CBT) with a new treatment combining physical exercise and dietary therapy (PED-t) with respect to the short- and long-term changes in the level of compulsive exercise and actual level of PA in women with BN or BED.MethodsWe enrolled 187 women with BN or BED, aged 18–40 years, with BMI 17.5–35, in an outpatient randomised controlled therapy trial. Participants were randomised to PED-t or CBT, while waitlist participants served as a control group during the treatment period. The treatment covered 16 weeks, with 6- and 12 months follow-up, and outcomes included self-reported compulsive exercise (CE) and objectively measured PA, analysed by linear mixed regression models.ResultsBoth CBT and PED-t reduced CE from baseline (P < 0.01, Hedges g ~ 0.4), but with no difference to control group. Compared to baseline, only PED-t significantly reduced the number of patients who scored above cut-off rating for CE, but with no between-group differences. The proportion of participants complying with the official recommendation for PA neither changed following treatment, nor emerged different between the treatment arms.ConclusionBoth therapies resulted in significant improvements in compulsive exercise, a change not found in the control group, however there were no between-group differences. The findings are tempered by the low statistical power due to a small control group size. The number of participants complying with the recommendation for PA were stable throughout the study, and no change in total PA was found. Presence and intensity of CE decline with treatment, but a need to increase PA towards healthy levels remains unsolved.Trial registrationApproved by the Norwegian Regional Committee for Medical and Health Research Ethics (ID: 2013/1871, 16th of December 2013); registered in Clinical Trials (ID: NCT02079935, 17th of February 2014).

Highlights

Dysfunctional thoughts- and use of physical activity (PA) are core symptoms of the eating disorders (ED) bulimia nervosa (BN) and binge eating disorder (BED)
This paper reports on the short- and long-term effects of a 16-week outpatient treatment-intervention with physical exercise- and dietary therapy (PED-t) or cognitive behaviour therapy (CBT) on compulsive exercise and objectively measured PA in women with BN or BED [29]
Compared to the physical exercise and dietary therapy (PED-t) group, more in the CBT group was lost to follow up at Follow up months (T3) (P = 0.026) and Follow up months (T4) (P = 0.002). Those lost to follow up at T4 were less physically active at baseline compared to the completers at T4

Summary

Introduction

Dysfunctional thoughts- and use of physical activity (PA) are core symptoms of the eating disorders (ED) bulimia nervosa (BN) and binge eating disorder (BED). Practising regular PA has rarely been part of treatment of BN and BED [4,5,6], because of the excessive and compulsive exercise reported in about 20–80% of patients with eating disorders (EDs) [7,8,9,10]. Excessive or compulsive physical exercise is one of the compensatory symptoms of bulimia nervosa (BN), and described in the diagnostic criteria as being “excessive and recurrent” in nature [11]. Compulsive exercise (CE) includes the maintenance of rigid exercise regimens, exercising despite physical injuries, prioritising exercise before other important activities, feelings of anxiety if unable to exercise, or rigidly imposing exercise regimens before meals, or after binge eating [12, 13]. With the high prevalence of obesity in BED [14, 15], it has been found that individuals with BED do have concerns about their body weight, figure and appearance [16] that may trigger CE

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