Compulsive Exercise Test Research Articles

Assessment of eating disorder symptoms, compulsive exercise, body dissatisfaction and depression in Swedish national team gymnasts, with a one-year follow-up

PurposeThe purpose of this study was to explore changes in symptoms of eating disorders, compulsive exercise, and depression, between two assessments 12 months apart, among elite gymnasts.MethodFactors related to the development of mental health symptoms in male and female Swedish national team gymnasts were investigated using baseline and 1-year follow-up scores in two subscales of the Eating Disorders Inventory 3; drive for thinness and body dissatisfaction, two subscales of the Compulsive Exercise Test; avoidance and rule-driven behavior and exercise for weight control, and the Montgomery-Åsberg Depression Rating Scale-Self report (MADRS-S). Linear mixed models were used to investigate the influence of drive for thinness, exercise for weight control, avoidance and rule-driven behavior, and MADRS-S on body dissatisfaction.ResultsBody dissatisfaction increased from baseline to the follow-up assessment, while drive for thinness and depression remained stable. Symptoms of eating disorders and depression were generally low in this group of elite gymnasts at both assessments. Drive for thinness, exercise for weight control, and symptoms of depression were associated with body dissatisfaction.DiscussionOur findings indicate that there were no significant changes over time in eating disorders and depression symptoms but significant associations with body dissatisfaction. Furthermore, we found independent effects of drive for thinness, exercise for weight control and symptoms of depression for body dissatisfaction.

The Arabic Version of Compulsive Exercise Test among Saudi Population; Translation and Validation.

Compulsive exercise is a condition characterized by uncontrollable exercise behaviour that may lead to severe and harmful physical and psychological consequences. Indeed, compulsive exercise is among the early symptoms of eating disorders that may affect different age groups. Globally and among Arab countries, compulsive exercise is common, while the screening methods used to assess compulsive exercise are limited. Thus, the Compulsive Exercise Test (CET) has emerged as a tool to assess cognitive, behavioural, and emotional factors related to compulsive exercise. The CET is a self-report, Likert-type scale comprising five distinct subscales. The increase in the CET scores is more likely associated with worsened pathology. Since the Arab countries lack such an assessment tool, we aimed to translate the CET into Arabic, validate the translated version, confirm the factor structures, and assess the internal consistency of the different subscales. Herein, we used the forward-backward translation method as recommended by the World Health Organization (WHO). The overall validity index of the translated version showed a score higher than 0.78, while the scale-level content validity index based on the average calculating method (S-CVI/Ave) and the agreement method (S-CVI/UA) were 0.91 and 0.58, respectively. Moreover, we recruited 399 Arabs living in Saudi to measure the internal consistency, and the value of the substantive internal consistency with Cronbach's α was 0.81. Subsequently, four of the Arabic-CET subscales had substantive internal consistency with Cronbach's α values higher than or equal to 0.70. Furthermore, the exploratory factor analysis results supported the substantial use of the five-subscale model. Taken together, our study supports using the Arabic-CET version to measure exercise compulsiveness among Arabs.

EXERCISE PROGRAM WITHIN ADULT PSYCHIATRIC INPATIENT SERVICES FOR THOSE WITH DISORDERED EATING

INTRODUCTION & AIMS Over one million Australians live with an eating disorder, with 40 – 80% reported to undertake dysfunctional exercise practices (e.g., compulsive exercise, exercise dependence). Dysfunctional exercise can be the first symptom to appear and the last symptom to resolved in eating disorder patients, with 41% of eating disorders patients relapsing into dysfunctional exercise patterns 4 to 9 months post inpatient treatment. We evaluated an accredited exercise physiology led program implemented for adult mental health inpatients with disordered eating and exercise behaviours to support patient outcomes and safe exercise participation. METHODS Data was collected as part of service evaluation and included patient characteristics, session data (e.g., mood and enjoyment via Exercise Enjoyment Scale) and patient outcomes (e.g., Compulsive Exercise Test (CET); Exercise Dependence Scale (EDS-21)). Characteristics of the cohort was reported and compared to clinical cut-offs, along with program feasibility measures. RESULTS Between Sep 2022 and Nov 2023, 20 female patients engaged in the program (mean age= 26 years). Of those 15 were diagnosed with Anorexia Nervosa, 16 with a co-occurring Personality Disorder and 9 with a Trauma Related Disorder. EDS-21 results showed 56% were symptomatic, and 33% exercise dependent, with 80% also presenting with suicidal ideation/self-harm. Across 137 service interactions, patients engaged 65% of the time, and 25% of the time deemed inappropriate. Pre-session mood was low (mean= -2.13 ± 1.46) with an average post-session mood improvement of + 4.46 Session enjoyment was high (mean=3.6±1.20) and no adverse events were recorded. CONCLUSIONS & IMPLICATIONS Exercise supported by AEPs is safe for inpatients with disorder eating, with patients valuing engagement in services focused on supporting positive exercise relationships and behaviours. A tailored and evidence-based approach to exercise can improve acute mood of consumers.

Validation and measurement invariance of the Compulsive Exercise Test among Brazilian and American young adults

PurposeTo evaluate compulsive exercise, researchers often rely on the widely used Compulsive Exercise Test (CET). However, the measure has shown unstable factor structure in several validation studies and is not available in Portuguese for use in Brazil. We aimed to describe the translation and cultural adaptation of the CET to Brazilian Portuguese, to test several factor structures among Brazilian and US samples of men and women, to test measurement invariance across countries, and to evaluate its internal consistency. Furthermore, we sought to evaluate convergent validity, correlating the CET with a measure of eating disorder symptoms, and to compare compulsive exercise symptoms between countries.MethodsFour models of the latent structure of the CET were tested using confirmatory factor analyses (CFAs), three-factor structure with 15 items, three-factor structure with 18 items, four-factor structure with 21 items, and the original five-factor structure with 24 items, in a sample of 1,531 young adults (601 Brazilians and 930 Americans), aged 18–35 years.ResultsA series of CFAs demonstrated that the three-factor structure with 15 items showed a better fit to the data. This model demonstrated good convergent validity and internal consistency. Results from the CET multigroup CFA showed evidence for the invariance at the configural, metric, and scalar levels across Brazilians and Americans. Furthermore, significant differences were found between Brazilians and Americans, with Brazilians demonstrating higher scores on the Avoidance and rule-driven behavior and Mood improvement subscales, whereas US participants scored higher on the Weight control exercise subscale.ConclusionsResults support the three-factor structure with 15 items to be used as a measure of compulsive exercise among Brazilians and Americans, allowing cross-cultural comparisons between these countries.Level of evidence Level V, Cross-sectional, Psychometric study.

Assessment and treatment of compulsive exercise in anorexia nervosa – A combined investigation of Compulsive Exercise Activity Therapy (LEAP) and Compulsive Exercise Test subscales

IntroductionCompulsive exercise is a transdiagnostic feature of eating disorders which adversely affects aspects of recovery, such as length of hospitalisation, risk of a chronic outcome, and risk of relapse. CompuLsive Exercise Activity TheraPy (LEAP) aims to reduce compulsive exercise through a cognitive behavioural approach. This study aims to investigate the effect of LEAP on compulsive exercise behaviour using subscales of the Compulsive Exercise Test (CET), a measure of exercise in individuals with eating disorders. Predictive validity of the CET's subscales and its ability to predict eating psychopathology are investigated. MethodThis study used data from a randomized controlled trial of LEAP (1). Linear mixed modelling was used to investigate the effect of LEAP on compulsive exercise behaviour, and the predictive ability of CET subscales on various outcomes. The CET was compared to other exercise measures to assess its superiority in predicting eating psychopathology. ResultsLEAP was superior in reducing the scores of the CET's Avoidance and Rule Driven Behaviour and Exercise Rigidity subscales. All subscales made a contribution to the respective models. The CET was superior to other measures in predicting eating pathology. ConclusionThe results lend credibility to LEAP's ability to reduce core parts of compulsive exercise. The CET has been found to target important aspects of compulsive exercise behaviour, and has was superior to other exercise measures in predicting eating psychopathology.

Too healthy for their own good: orthorexia nervosa and compulsive exercise in the community

BackgroundThe similarities and differences between orthorexia nervosa symptoms (ONs) and the symptoms and correlates of eating disorders listed in the DSM-5 need to be elucidated. ONs were examined in a volunteer community sample in conjunction with compulsive exercise, disordered eating, as well as emotional and behavioral correlates of eating disorders.MethodsParticipants were 561 adult volunteers (93 men, 17.09%) aged 19–72 (M = 32.7 ± 11), recruited via social media networks. Participants self-reported on the following measures online: Düsseldorf Orthorexia Scale, Compulsive Exercise Test, Retrospective Child Feeding Questionnaire, Experiences in Close Relationships, Difficulties in Emotional Regulation Scale, Toronto Alexithymia Scale, and Eating Disorder Examination Questionnaire 13. Data were downloaded and analyzed in SPSS26 and Amos26.ResultsA theoretical model of the connections between the study variables was tested via SEM and confirmed. The profiles of participants with high, average and low levels of ONs were compared. Participants with the highest levels also scored highest for compulsive exercise, insecure attachment, alexithymia, emotion regulation difficulties, weight and shape concerns, body dissatisfaction, restriction, bingeing, purging and parental feeding practices of concern about child’s weight and restricting and monitoring the child’s intake of calorie-rich foods.DiscussionHigh levels of ONs are related to disordered eating attitudes and behaviors, as well as to emotional and behavioral correlates of eating disorders. It is unclear to what extent these ONs are distinguishable from symptoms of other eating disorders listed in the DSM-5. Longitudinal studies may help to elucidate distinct trajectories and risk factors for ON.Level of evidence: Level III, case–control analytic study.

Gender differences in compulsive exercise facets and their associations with eating disorder symptoms

Compulsive exercise (CE) is a core symptom of eating disorders (EDs) that is common in undergraduate men and women. Importantly, CE is a multidimensional construct, and certain facets of CE (i.e., exercise to control weight or to avoid negative affect associated with missed exercise) are more strongly associated with ED symptoms in undergraduate women than others. However, less is known about how CE facets relate to ED symptoms in men. This study examined: 1) gender differences in levels of CE facets, assessed using the Compulsive Exercise Test (CET); 2) whether specific CE facets independently relate to ED symptoms; and 3) whether gender moderates these relationships. Five hundred and ninety-one university students (58.5 % men) completed the CET and Eating Pathology Symptoms Inventory. Women reported significantly greater weight control exercise, exercise for mood improvement, lack of exercise enjoyment, body dissatisfaction, and purging than men, while men reported more muscle building than women. CE motivated by avoidance of negative emotions and performed in a rule-driven manner and weight control CE were associated with the greatest number of ED symptoms. Further, rigid exercise routines were associated with greater muscle building. Women with greater weight control CE experienced more body dissatisfaction, and women with more CE motivated by avoidance of negative emotions experienced more restriction, compared to men. Overall, specific CE facets relate to ED symptoms in men and women. Findings highlight the importance of interventions designed to target unhealthy exercise motivations and of cultivating healthy attitudes towards exercise across genders.

Predictive Factors for Compulsive Exercise in Adolescent Athletes: A Cross-Sectional Study

Although exercise is generally considered a healthy lifestyle habit, it may be problematic for some people. This has led to growing research on compulsive exercise—an uncontrollable urge for physical activity despite its deleterious effects. A maintenance model of compulsive exercise has been developed for adults exhibiting weight and shape concerns, weight control behaviors, and specific psychological states (including depression and anxiety) as predictive factors. We identified predicting factors for compulsive exercise in adolescent athletes using the same model framework. These athletes completed the compulsive exercise test and several well-validated psychometric measures. Gender-specific multiple regression models identified stronger drive for thinness, perfectionism, and body image investment in sport as significant predictors of compulsive exercise in boys and girls. Among girls, asceticism and bulimia symptoms were also significantly associated with compulsive exercise. These findings support the relevance of the model for clinical intervention and research on compulsive exercise in adolescent athletes.

Under pressure to exercise: a cross-sectional study of characteristics and predictors of compulsive exercise in early adolescents

BackgroundTo investigate the frequency of compulsive exercise among early adolescents, and determine the associated impact of sex, physical activity level, exercise habits, motivational regulation, dieting behaviour and health-related quality of life (HRQoL) on compulsive exercise.MethodsCross-sectional design with 8th grade adolescents (n = 572, mean ± SD age 13.9 ± 0.3 yrs). Outcome assessment was compulsive exercise (Compulsive Exercise Test, CET). Total CET score ≥ 15 was defined as clinical CET score. Further assessment included exercise motivation (Behavioural Regulation of Exercise Questionnaire—2), HRQoL (KIDSCREEN 27), accelerometer-assessed physical activity and Andersen test for cardiorespiratory fitness. Exercise obsession was defined as clinical CET score and < 60 min/day with moderate-to-vigorous objectively assessed physical activity.ResultsSmall sex differences were found for CET total score. Seven percent of the adolescents were classified with clinical CET score, and four percent with exercise obsession. Adolescents with clinical CET score had higher body mass index, more weight loss attempts, and lower physical fitness compared to adolescents with non-clinical CET score. Being a boy, higher scores on introjected motivational regulation and HRQOL subscale parent relation and autonomy, use of exercise monitoring tool, and number of weight loss attempt the past 12 months explained 39% of the total CET score variance. Physical activity level did not predict compulsive exercise.ConclusionsCompulsive exercise in early adolescents was predicted by exercise motivation, exercise habit, and dieting, but not physical activity level. This implicates a distinction of obsessive cognitions about physical activity from performed physical activity in adolescents, and that such cognitions must be addressed in future initiatives that aim to improve adolescents’ general physical activity level, health, and wellbeing.Trial registration ClinicalTrials.gov: NCT03906851.Plain English summaryAlthough there is a huge concern about adolescents being insufficiently physically active, there are also adolescents who struggle with issues of compulsive exercise. The issues of compulsive exercise have been rarely studied in adolescents. We therefore aimed to describe compulsive exercise and factors that were associated with and could explain presence of compulsive exercise. A total of 572 8th graders (age 13.9 ± 0.3 yrs) responded to this study. We found that the score on compulsive exercise was higher in boys than in girls, and that adolescents with high score on compulsive exercise had higher body mass index, more weight loss attempts, and lower physical fitness compared to adolescents with low score on compulsive exercise. Also, we found that exercise obsessions, i.e., thinking of exercise without actually exercising, was present in four percent of the respondents. Being a boy, attempting weight loss, exercising to avoid shame/guilt, and exercising for the perceived value of exercise predicted compulsive exercise. Awareness of the compulsive exercise and exercise obsessions is important in public health initiatives that aim to increase adolescents’ physical activity level.

Compulsive Exercise, Exercise Identity, and Coping Styles

Abstract: Compulsive exercise occurs among the general exercise population and is associated with adverse mental and physical health outcomes. The current study explored compulsive exercise behavior regarding coping styles and its relationship to identity to improve our understanding of compulsive exercise among the general exercise population. A community sample of 1,209 adults (aged 18 – 89) with varied exercise levels completed an online survey. We examined the relationships between engagement and disengagement coping styles (as assessed by the Coping Strategy Inventory) and exercise identity (Exercise Identity Scale) with compulsive exercise (Compulsive Exercise Test) using correlation, regression, and moderation analyses. Emotion-focused engagement (β = .075, p &lt; .01) and emotion-focused disengagement (β = .212, p &lt; .001) coping styles significantly predicted compulsive exercise, as did exercise identity (β = .514, p &lt; .001). Coping styles did not moderate the relationship between exercise identity and compulsive exercise behaviors. The results indicate that both adaptive and maladaptive emotion-based coping styles are associated with greater compulsive exercise behavior.

Compulsive exercise in eating disorders: Validation of the Italian scale and evaluation of its relationships with body image concerns and quality of life

BackgroundCompulsive exercise (CE) has been proposed as one of the maladaptive elements that might concur to developing and maintaining an eating disorder (ED), even if no conclusive consensus is yet available. This study evaluates the psychometric properties of the Compulsive Exercise Test (CET), the questionnaire most frequently discussed in the literature. Our second aim is to evaluate the relationships between CE, quality of life, and different body concerns in a group of individuals. MethodsTwo different studies are performed. In the first study, we evaluate the psychometric properties of the Italian CET with a sample of 272 individuals (157 with different diagnoses of ED). In the second study, a group of 75 ED patients is compared to 68 of their peers looking for specific differences and relationships between CE, quality of life, and body concerns. ResultsThe CET shows optimal psychometric proprieties, and a five-factors structure. CE is linked to more severe specific psychopathology in ED patients, including increased thoughts of restraint and concerns about weight and shape. Moreover, weight phobia and quality of life are predictors of CE in patients. ConclusionThe specific role of CE is discussed according to its connections with a core psychopathological element like weight phobia. Specific profiles of CE emerged for each clinical subgroup, and they corroborate the presence of different cognitive/physical approach to exercise. The CE showed to be a dysfunctional element with a disruptive role in patients' quality of life. Future directions and possible applications of the CET are also discussed.

Preliminary evaluation of the online course “I Care” targeting eating disorder knowledge and attitudes among sports coaches and fitness instructors

BackgroundFitness instructors, coaches and trainers are often looked up to and seen as role-models within their sporting community. Since problematic exercise is a common symptom of eating disorders, they are also highly likely to meet individuals at risk for developing eating disorders within their profession. Thus, educating coaches about how to promote healthy ideals within their sports/training context and equipping them with knowledge to be able to detect and approach individuals at risk, is of great importance.MethodWe studied the pre-to-post effects of the I Care online psychoeducational intervention in 150 coaches, trainers, and fitness instructors. Variables included the Compulsive Exercise Test, as well as knowledge of eating disorders, and confidence and awareness regarding approaching, talking to, and referring individuals whose observed behavior raised concerns.ResultsResults showed significant and large improvements in coaches’ confidence and knowledge regarding warning signs and how to approach an at-risk person, and a decrease in their perceived ability to recognize eating disorders by sight, e.g., insight about EDs not being recognizable just by looking at a person. Also, significant positive change in attitudes about their own rule-driven exercise behavior and lack of enjoyment of exercise was observed.ConclusionsAlthough the lack of a control group compels caution, the study suggests that I Care may have positive effects in terms of a “declaration of intent” toward more positive role-modeling and interactions with clients.

Examining the reliability of the scores of self-report instruments assessing problematic exercise: A systematic review and meta-analysis.

Background and aimsProblematic exercise (PE) has mainly been assessed with self-report instruments. However, summarized evidence on the reliability of the scores derived from such instruments has yet to be provided. The present study reports a reliability generalization meta-analysis of six well-known self-report measures of PE (Commitment to Exercise Scale, Compulsive Exercise Test, Exercise Addiction Inventory, Exercise Dependence Questionnaire, Exercise Dependence Scale, and Obligatory Exercise Questionnaire).MethodsPooled effect sizes were computed using a random-effect model employing a restricted maximum likelihood estimation method. Univariable and multivariable meta-regressions analyses were employed for testing moderator variables.ResultsData retrieved from 255 studies (741 independent samples, N = 254,174) identified three main groups of findings: (i) pooled alpha values that, ranging from 0.768 to 0.930 for global scores and from 0.615 to 0.907 for subscale scores, were found to be sensitive to sociodemographic and methodological characteristics; (ii) reliability induction rates of 47.58%; and (iii) the virtually non-existent testing of the assumptions required for the proper applicability of alpha. Data unavailability prevented the provision of summarized reliability estimates in terms of temporal stability.DiscussionThese findings highlight the need to improve reliability reporting of the scores of self-reported instruments of PE in primary studies. This implies providing both prior justification for the appropriateness of the index employed and reliability data for all the subpopulation of interest. The values presented could be used as a reference both for comparisons with those obtained in future primary studies and for correcting measurement-related artefacts in quantitative meta-analytic research concerning PE.

Psychometric properties of the Compulsive Exercise Test in a large sample of female adolescent and adult inpatients with anorexia nervosa and bulimia nervosa.

The Compulsive Exercise Test (CET) was developed to assess compulsive exercise in patients with eating disorders (EDs), but originally validated in a nonclinical sample, and psychometric properties were only investigated in small clinical samples. Therefore, the aim of this study was to examine its psychometric properties in a large clinical sample of adolescent and adult inpatients with anorexia nervosa and bulimia nervosa. A sample of 2,535 German female inpatients with EDs completed the CET and other instruments at admission and discharge. Factor structure (confirmatory [CFA] and exploratory factor analyses [EFA]), internal consistency and construct validity, measurement invariance across age and diagnostic groups, group comparisons of means, as well as sensitivity to change during treatment were assessed. The CET showed high internal consistency, very good construct validity, and sensitivity to change. CFA indicated a better fit of four-factor and three-factor solutions compared to the original five-factor model. However, subsequent EFA identified an optimum for a five-factor model. Only three subscales were satisfactorily invariant to measurement, but not the CET total score. Only small differences in scores between patient groups were observed. Results support internal consistency, construct validity, and sensitivity to change, whereas factor structure remains inconclusive, questioning the theoretical basis of the CET. There is limited support for using the lack of enjoyment subscale, and only moderate support for using the rigidity subscale in patients with EDs. It is recommended to further explore and/or revise the original CET, including investigation in other samples, for example, male samples.

Compulsive exercise and mental health challenges in fitness instructors; presence and interactions

BackgroundSome physically active people exercise compulsively, which can be associated with several mental health challenges. Fitness instructors are considered important role models for an active, healthy lifestyle; yet little is known about their exercise motives and mental health. The aim of this study was to examine the presence of compulsive exercise and mental health challenges, and their interaction, in fitness instructors.MethodsA total of 270 fitness instructors from Norwegian fitness clubs were recruited for this cross-sectional study. Inclusion criteria were operating as instructors within the current year and understanding Norwegian language. Data were collected by an electronic questionnaire and included demographic information, hours of classes instructed and of personal physical activity, Compulsive Exercise Test (CET), Symptom Check List – 10 (SCL-10), Beck Depression Inventory (BDI), and Eating Disorder Examination Questionnaire (EDE-Q)).ResultsFemales had higher CET scores than males, and 9% of all respondents had CET score above clinical cutoff. Respondents with clinical CET score had higher SCL-10, BDI and EDE-Q global- and subscale scores compared with their counterparts. Although CET was positively and significantly associated with BDI, SCL-10, and EDE-Q, only the latter explained the CET score (ß = 1.23, 99% CI = 0.87, 1.59).ConclusionAbout one out of eleven instructors were above clinical CET cut-off, revealing symptoms of compulsive exercise. EDE-Q significantly contributed in a model explaining 43% of the variation of compulsive exercise.

Psychological changes in young people with anorexia nervosa during an inpatient treatment: exploration of optimal length of stay predictors.

The current study aimed to monitor psychological changes in young people (YP) with anorexia nervosa (AN) during aspecialist inpatient treatment in order to explore possible predictors of an optimal length of stay. Outcome measures were analysed to determine if significant changes occur earlier or later on during the treatment. Eating Disorder Examination Questionnaire (EDE-Q), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory (STAI) and Compulsive Exercise Test (CET) measures administered to YP (n = 42) at three time points-admission, 85% ideal body weight (IBW) and discharge-were analysed using linear mixed effects model and regression analysis to determine change between the time points and possible predictors in length of stay. Significant improvements occurred between admission and the mid time point of 85% IBW in the eating disorder (ED) symptomology outcome measures of EDE‑Q (mean difference [MD] = 1.066 ± 0.259) and CET (MD = 1.743 ± 0.627). Asignificant improvement occurred in the CDI (MD = 7.714 ± 2.343), and STAI (MD = 5.292 ± 2.121) measures between admission and discharge. Psychological changes occur at different stages of treatment. Although it was difficult to determine what factors may predict the length of stay from the variables explored, it was observed that alower weight at admission impacted negatively on the improvement of ED and anxiety symptoms, which may lead to stay in treatment for longer. Also, higher levels of compulsive exercise and depression were associated to worse outcomes. Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

Dimensions of unhealthy exercise and their associations with restrictive eating and binge eating

Unhealthy exercise is a core symptom of eating disorders that predicts greater chronicity and risk of relapse. A detailed conceptualization of unhealthy exercise in the context of eating disorders is only beginning to emerge, and associations between specific dimensions of unhealthy exercise and eating disorder symptoms have received little attention. The aim of the current study was to examine associations between three key dimensions of unhealthy exercise – compulsive exercise (i.e., rule-driven exercise to avoid negative affect), exercise to control weight/shape, and exercise to compensate for recent food intake – with restrictive eating and binge eating. Participants were 239 women drawn from two separate studies of emotions and eating behavior; 126 (52.7%) endorsed restrictive eating and/or objective binge eating episodes in the past three months. Unhealthy exercise dimensions were measured using the Compulsive Exercise Test and investigator-designed items, and eating disorder symptoms were assessed using the Eating Pathology Symptoms Inventory. Restrictive eating was only associated with avoidance and rule-driven exercise, whereas binge eating was significantly correlated with all unhealthy exercise variables. Multiple regression results revealed that only compensatory exercise was uniquely associated with binge eating. Unhealthy exercise consists of partially distinct dimensions with differential relations to core eating disorder symptoms. Future research should examine unhealthy exercise dimensions in patients with eating disorder diagnoses and consider whether treatments for specific unhealthy exercise forms might be beneficial.

The influence of social networks within sports teams on athletes’ eating and exercise psychopathology: A longitudinal study

Teammates have been found to have an impact on athletes’ eating and exercise psychopathology via multiple influence mechanisms (e.g., modelling, making critical comments). However, far less is known about the role of the team social network (i.e. the pattern and strength of relationships between teammates). This novel longitudinal study aimed to explore how athletes’ eating and exercise psychopathology becomes more (convergence) or less (divergence) similar to their teammates’ over time and to explore how this varies for male and female athletes. A second aim was to identify the role of team social network variables (e.g., popularity) in determining individuals’ levels of eating and exercise psychopathology. Athletes (N = 199, mean age 18 years, n = 123 female) from 20 teams/training groups completed a survey regarding their teammate relationships and eating/exercise psychopathology (Eating Disorder Inventory-2; Athlete Compulsive Exercise Test) at three time points over a 7-month period. Significant interaction effects between time and gender were noted for athlete team variability in eating and exercise psychopathology, where both convergence and divergence of eating and exercise psychopathology was evident. In addition, being well connected to teammates, acting as the bridge between groups of teammates or being part of a cohesive team were longitudinally associated with reduced exercise psychopathology. Disordered eating and exercise prevention strategies should look to harness the behavioural convergence effect demonstrated here, by encouraging healthy eating/exercise practices among teammates. Furthermore, coaches should foster cohesive teammate relationships and be aware of how an athlete’s social positioning within their team may affect their susceptibility to exercise psychopathology.

The Freiburg sport therapy program for eating disorders: a randomized controlled trial

BackgroundUnhealthy attitudes towards sport and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg sport therapy program for eating disorders (FSTP).MethodsOutpatients with ED were randomized either to a 3 month sport therapy program (sport therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale, CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive Exercise Test, CET subscales) and exercise quantity (accelerometer).ResultsRecruitment was challenging. Fifteen patients were randomized to the STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG. Improvements (STG) were maintained at follow up.ConclusionsThere was no statistically significant difference in the reduction of unhealthy attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale. Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major limitation is the small sample size.Trial registrationStudy register: ISRCTN 14776348 (registered 26 January, 2015.

Morbid exercise behaviour and eating disorders: A meta-analysis

Background and aimsThis study examined the relationship between self-reported symptoms of morbid exercise behaviour (MEB) and eating disorders (ED) using meta-analytic techniques.MethodsWe systematically searched MEDLINE, PsycINFO, Web of Science, SciELO and Scopus. Random effects models were used to compute pooled effect sizes estimates (r). The robustness of the summarized estimates was examined through sensitivity analyses by removing studies one at a time.ResultsSixty-six studies comprising 135 effect-sizes (N = 21,816) were included. The results revealed: (a) small-sized relationship in the case of bulimic symptoms (r = 0.19), (b) small- (r = 0.28) to medium-sized relationships (r = 0.41) in the case of body/eating concerns, and (c) medium-sized relationships in the case of overall ED symptoms (r = 0.35) and dietary restraint (r = 0.42). Larger effect sizes were observed in the case of overall ED symptoms in clinical, younger, and thinner populations, as well as when employing a continuously-scored instrument for assessing ED or the Compulsive Exercise Test for assessing MEB. Larger effect sizes were also found in female samples when the ED outcome was dietary restraint.ConclusionsThe identified gaps in the literature suggest that future research on the topic may benefit from: (a) considering a range of clinical (in terms of diagnosed ED) and non-clinical populations from diverse exercise modalities, (b) addressing a wide range of ED symptomatology, and (c) employing longitudinal designs that clarify the temporal direction of the relationship under consideration.