Compulsive Exercise Research Articles

"Racial variations in binge eating, body image concerns, and compulsive exercise among men": Correction to Kelly, Cotter, Tanofsky-Kraff, and Mazzeo (2014).

"Racial variations in binge eating, body image concerns, and compulsive exercise among men": Correction to Kelly, Cotter, Tanofsky-Kraff, and Mazzeo (2014).

Overvaluation of body shape/weight and engagement in non-compensatory weight-control behaviors in eating disorders: is there a reciprocal relationship?

Overvaluation of body shape/weight is thought to be the core psychopathology underlying eating disorders, which propels engagement in non-compensatory weight-control behaviors. In turn, these behaviors lead to binge eating and/or maintenance of low weight thereby reinforcing overvaluation. The present study investigated the reciprocal relationship between overvaluation and engagement in non-compensatory weight-control behaviors (defined in two ways: restrictive eating and compulsive exercise) among women diagnosed with anorexia nervosa or bulimia nervosa (N = 237). Participants completed clinical interviews in which weekly eating disorder symptoms and behaviors were assessed over 2 years. Overvaluation on a given week was associated with greater engagement in non-compensatory weight-control behaviors during the following week. Further, engagement in non-compensatory weight-control behaviors on a given week was associated with greater overvaluation during the following week. These findings held true regardless of participants' shape/weight concerns (feelings of fatness and fat phobia), and eating disorder diagnosis. Our data provide empirical support for key aspects of the transdiagnostic cognitive-behavioral model of eating disorders and suggest that targeting non-compensatory weight-control behaviors in treatment may help alleviate overvaluation and shape/weight concerns.

Stress fracture injury in female endurance athletes in the United Kingdom: A 12-month prospective study.

Studies of stress fracture (SF) incidence are limited in number and geographical location; this study determined the incidence of SF injury in female endurance athletes based in the United Kingdom. A total of 70 athletes aged between 18 and 45 years were recruited and prospectively monitored for 12 months. Questionnaires at baseline and 12 months assessed SF, menstrual and training history, eating psychopathology, and compulsive exercise. Peak lower leg muscle strength was assessed in both legs using an isometric muscle rig. Bone mineral density (BMD) of total body, spine, hip, and radius was assessed using dual X-ray absorptiometry. Among the 61 athletes who completed the 12-month monitoring, two sustained a SF diagnosed by magnetic resonance imaging, giving an incidence rate (95% confidence intervals) of 3.3 (0.8, 13.1) % of the study population sustaining a SF over 12 months. The SF cases were 800 m runners aged 19 and 22 years, training on average 14.2 h a week, eumenorrheic with no history of menstrual dysfunction. Case 1 had a higher than average energy intake and low eating psychopathology and compulsive exercise scores, while the reverse was true in case 2. BMD in both cases was similar to mean values in the non-SF group. The incidence of SF in our female endurance athlete population based in the United Kingdom was 3.3%, which is lower than previously reported. Further work is needed to confirm the current incidence of SF and evaluate the associated risk factors.

The role of exercise across the lifespan in patients with anorexia nervosa: a narrative inquiry

The current study explored the role of exercise across the lifespan in patients with anorexia nervosa (AN). Twenty-four female participants were recruited: 10 currently in treatment for AN, 7 partially recovered and 7 fully recovered, according to stringent criteria. Participants completed the eating disorder examination (EDE) and a semi-structured interview where they were invited to share their story of their illness, with a specific focus on exercise. A qualitative analysis using narrative inquiry methodology was conducted. We found that exercise can be a significant part of the individual's life in various stages – premorbidly, and in treatment and recovery processes. Important themes across stages included: rapid transformation into compulsive exercise during AN; importance of containment processes during treatment; appropriate limit setting and accountability in early stages of recovery; and the gradual transformation into healthy exercise in full recovery. Results were developed into a model of exe...

Eating Disorders: a Diagnosis to Consider in Male Population. a Case Report and Review of Current Data

Background Although Eating Disorders (ED) are more prevalent among female population, in the last decades they are gaining importance among males. Aims The aim was to review prevalence, specific characteristics, comorbidity, diagnosis, treatment and prognosis of ED in male population. Methods We searched in MEDLINE selecting studies from 2000 until the present related to ED among males. We report a case of an 18-year old male who was hospitalized with a severe hyponatremia in the context of potomania and abuse of diuretics and laxatives and who was diagnosed with purgative Anorexia nervosa. Results Males with ED have higher rates of family history of ED and higher percentages of Substance Use Disorders and Alcohol Use Disorders. They tend to have more medical complications and comorbidity. Levels of previous overweight and subsequent malnutrition are higher, and purgative behaviours and compulsive exercise more frequent. They show significantly less desire to lose weight, express dissatisfaction with the upper rather than the lower body, and they are more concerned of muscle development. Conclusions The prevalence of ED among male population has increased in the last decades, probably due to the clinician´s underdiagnosis of malnutrition related symptoms in this group. In addition, scales and diagnostic criteria are adapted to female population, which increases the difficulty at he time of diagnosing. The clinical debut in males tends to be later and it is associated with more and severe physical complications. Clinicians should be aware of loss of weight in men and consider ED as a possible diagnosis.

Validation of the exercise and eating disorders questionnaire.

ABSTRACTObjectiveCompulsive exercise is a well‐known feature in eating disorders. The Exercise and Eating Disorder (EED) self‐report questionnaire was developed to assess aspects of compulsive exercise not adequately captured by existing instruments. This study aimed to test psychometric properties and the factor structure of the EED among women with eating disorders and a control group.MethodThe study included 449 female participants, including 244 eating disorders patients and 205 healthy controls. The patient group consisted of 32.4% (n = 79) AN patients, 23.4% (n = 57) BN, 34.4% (n = 84) EDNOS and 9.8% (n = 24) with BED diagnosis.ResultsThe analyses confirmed adequate psychometric properties of the EED, with a four‐factor solution: (1) compulsive exercise, (2) positive and healthy exercise, (3) awareness of bodily signals, and (4) weight and shape exercise. The EED discriminated significantly (p < .001) between patients and controls on the global score, subscales, and individual items. Test‐retest reliability was satisfactory (r = 0.86). Convergent validity was demonstrated by high correlations between the EED and the Eating Disorder Examination Questionnaire (EDE‐Q; r = 0.79).DiscussionThe EED is the first clinically derived, self‐report questionnaire to assess compulsive exercise among ED patients. The EED offers assessment that has broader clinical utility than existing instruments because it identifies treatment targets and treatment priorities. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:983–993).

A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries.

Research into the detrimental effects of excessive exercise has been conceptualized in a number of similar ways, including ‘exercise addiction’, ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Among the most currently used (and psychometrically valid and reliable) instruments is the Exercise Addiction Inventory (EAI). The present study aimed to further explore the psychometric properties of the EAI by combining the datasets of a number of surveys carried out in five different countries (Denmark, Hungary, Spain, UK, and US) that have used the EAI with a total sample size of 6,031 participants. A series of multigroup confirmatory factor analyses (CFAs) were carried out examining configural invariance, metric invariance, and scalar invariance. The CFAs using the combined dataset supported the configural invariance and metric invariance but not scalar invariance. Therefore, EAI factor scores from five countries are not comparable because the use or interpretation of the scale was different in the five nations. However, the covariates of exercise addiction can be studied from a cross-cultural perspective because of the metric invariance of the scale. Gender differences among exercisers in the interpretation of the scale also emerged. The implications of the results are discussed, and it is concluded that the study’s findings will facilitate a more robust and reliable use of the EAI in future research.

Too much of a good thing: compulsive exercise in children and adolescents with eating disorders.

Compulsive exercising is the most common compensatory behaviour amongst children and adolescents with eating disorders. The Compulsive Exercise Test is a self-report measure that has been recently developed to assess the cognitive, behavioural and affective features of compulsive exercise. The aim of the current study was to validate the measure using a paediatric eating disorder sample presenting for treatment at a specialist eating disorder service. Confirmatory factor analysis was conducted and correlations with eating disorder symptoms were examined. The study failed to confirm a factor structure, although there was still clear evidence of the multidimensionality of the measure. CET scores were significantly related to measures of eating pathology, perfectionism and exercise frequency to control shape and weight. This suggests a need for further investigation into the construct of compulsive exercise in clinical populations, given the strong association with eating pathology.

Crossing the finish line: a narrative inquiry into the role of exercise in patients with anorexia nervosa

The current study explored the role of exercise in the treatment and recovery process of Anorexia Nervosa (AN). 24 female participants completed the study: 10 women currently in treatment for AN; 7 partially recovered and 7 fully recovered, according to strict criteria. Participants undertook a structured interview assessing eating disorder psychopathology and a semi-structured interview where they were invited to share their story of their illness, with a focus on exercise. Narrative inquiry analyses revealed exercise can be a significant part of the individual’s life in various stages - premorbidly, during the illness, in treatment and recovery processes. Analyses demonstrated important themes including: rapid transformation into compulsive exercise during AN; importance of containment processes during treatment, appropriate limit setting and accountability in early stages of recovery; and the resumption of healthy exercise in full recovery. Results were developed into a model of exercise depicting these themes. Clinical implications to support re-integrating healthy exercise in treatment include the use of psycho-education and structured exercise interventions in treatment services. The findings emphasize the need for further clinical guidelines to ensure consistency in management of compulsive exercise in AN patients. Ongoing interpersonal and therapeutic support is required for patients to re-establish healthy exercise in recovery. This abstract was presented in the Peter Beumont Young Investigator award finalist stream of the 2014 ANZAED Conference.

Physiotherapy management in eating disorders

The Paediatric Unit at Flinders Medical Centre in South Australia launched an Eating Disorder Program in February 2013. The presentation of an eating disorder patient varies among consumers, and treatment requires a sustained, flexible and multidisciplinary approach. Physiotherapy was asked to be involved in the multi-disciplinary team to deliver an inpatient exercise class to provide education on posture and provide a safe environment for healthy exercise. The class began and consisted of two half an hour sessions a week. To increase the knowledge of Physiotherapy management in Eating Disorders a study tour was undertaken to observe the role of physiotherapists at the leading children's hospitals. The hospitals visited include Westmead Children's Hospital, Princess Margaret Hospital and the Starship Children's Hospital in Auckland. On completion of the study tour it was identified that to progress Physiotherapy involvement with the Eating Disorder population we should incorporate an initial physiotherapy assessment when new patients are admitted, provide discharge information for exercise and an information sheet for parents for compulsive exercise. It was also identified that there were no guidelines for Physiotherapy Management in Eating Disorders and this would be beneficial to standardise the role of physiotherapy across Australia.

Activity-related parenting practices: development of the Parenting Related to Activity Measure (PRAM) and links with mothers' eating psychopathology and compulsive exercise beliefs.

This is a two-study paper that developed a measure to assess parenting practices related to children's physical activity and explored maternal predictors of such parenting practices. Study 1: A self-report measure of parents' activity-related practices (the Parenting Related to Activity Measure) was developed, and a principal component analysis was carried out using data from 233 mothers of 4.5- to 9-year-old children. The results supported a six-factor model and yielded the following subscales: Responsibility/monitoring; Activity regulation; Control of active behaviours; Overweight concern; Rewarding parenting; and Pressure to exercise. Study 2: Mothers (N = 170) completed the Parenting Related to Activity Measure, alongside measures of eating psychopathology and compulsive exercise, to identify predictors of activity-related parenting practices. Mothers' eating psychopathology and exercise beliefs predicted activity parenting practices with their sons and daughters, but different predictors were seen for mothers of daughters versus sons. Mothers' eating and exercise attitudes are important predictors of their activity-related parenting practices, particularly with girls. Identifying early interactions around activity/exercise could be important in preventing the development of problematic beliefs about exercise, which are often a key symptom of eating disorders. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Emotion regulation styles as longitudinal predictors of compulsive exercise: A twelve month prospective study

Exercise can be used as a mood regulator but, in the eating disorder literature, exercise has sometimes been found to be compulsive, detrimental to physical health, and regarded as one maladaptive strategy used to regulate emotions. This study examined longitudinal associations between emotion regulation styles and this compulsive exercise in 572 adolescents who completed measures of compulsive exercise and emotion regulation. Twelve months later they completed measures of compulsive exercise. Compulsive exercise was predicted by Internal Dysfunctional emotion regulation in girls and boys, even after controlling for initial levels of compulsive exercise. Adolescents displaying compulsivity to exercise may require intervention programmes to alter their emotion regulation strategies.

Physical activity recommendations for adolescents with anorexia nervosa: An existing protocol based on physical activity risk

AimThere is a critical gap between the literature pertaining to physical activity (PA) in eating disorders and directives regarding the management of PA. There is evidence that managed PA in eating disorders is beneficial, as long as it accounts for compulsive exercise. The goal of this paper is to encourage future research to test the efficacy and safety of the existing protocol, leading to the development of clinical practice guidelines to optimize care. MethodA protocol developed for the purpose of individual prescription of PA for adolescents receiving inpatient treatment for AN is described. The protocol uses primary complications related to PA and AN to categorize an adolescents level of PA risk as high, moderate or low. The risk factors assessed include; vital sign instability, percentage of Ideal Body Weight and an evaluation of compulsive exercise. PA recommendations are implemented according to the level of PA risk. Two case studies are presented to illustrate the application of the protocol. DiscussionCritical limitations of the research to date regarding managed PA in eating disorders are numerous and a model of compulsive exercise has only recently been proposed, thus restricting the evaluation of existing research. The applicability of the protocol may be limited within Family Based Treatment in outpatient care, where the management of PA is the responsibility of the parents. ConclusionCategorization of PA risk is assessed by the eating disorders team. A physical therapist should be considered for the implementation and management of the proposed PA recommendations according to the level of PA risk.

Psychometric properties of the Compulsive Exercise Test in an adolescent eating disorder population

The objective of this study was to evaluate the factor structure, validity, and reliability of the Compulsive Exercise Test (CET) in an adolescent clinical eating disorder population. The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project, a prospective ongoing registry study comprising consecutive pediatric tertiary eating disorder referrals. Adolescents (N=104; 12–17years) with eating disorders completed the CET and other measures. Factor structure, convergent validity, and internal consistency were evaluated. Despite failing to identify a factor structure, the study provided clear evidence of the multidimensionality of the measure. The total score correlated significantly with measures of eating pathology, perfectionism, and frequency of exercise for shape and weight control (r=0.32–0.70, ps<0.05). More research into the multidimensional nature of compulsive exercise in clinical populations is needed. Further, research into compulsive exercise offers promise as an addition to existing cognitive behavioral models and treatments for eating disorders.

Sociocultural risk factors for compulsive exercise: a prospective study of adolescents.

The risk factors for compulsive exercise are unknown. This study aims to explore longitudinal sociocultural risk factors for compulsive exercise, using a 12-month prospective design. A sample of 332 male and female adolescents (aged 13-15 years at baseline) completed self-report measures of sociocultural risk factors and compulsive exercise at baseline and eating disorder psychopathology and compulsive exercise at 12-month follow-up assessment. Hierarchical regressions found that family and peer messages to become more muscular predicted compulsive exercise in boys, whereas feeling pressure from the media to be thin was a significant predictor of compulsive exercise in girls. These relationships remained significant when controlling for eating disorder psychopathology but became nonsignificant when initial levels of compulsive exercise were entered into the model. The findings suggest that sociocultural risk factors may contribute to the development of compulsive exercise but future research should utilise a younger sample and employ a longer follow-up period to identify true longitudinal effects.

Psychological risk factors for compulsive exercise: A longitudinal investigation of adolescent boys and girls

Compulsive exercise is associated with unhealthy outcomes and is common among eating disorder populations. This study aimed to replicate previous cross-sectional work by considering psychological characteristics as longitudinal predictors of compulsive exercise. A sample of 369 adolescents (n=221 female, n=148 male) completed measures of compulsive exercise, eating disorder psychopathology, obsessive–compulsiveness, perfectionism, anxiety, and depression at baseline, and a measure of compulsive exercise twoyears later. For boys, greater obsessive–compulsiveness and self-oriented perfectionism predicted compulsive exercise, whilst among girls only baseline compulsive exercise was a significant predictor. Compulsive exercise prevention work among boys may benefit from targeting their levels of obsessive–compulsiveness and self-perfectionism. For girls, further risk factor research into compulsive exercise is required.

Use of the Compulsive Exercise Test With Athletes: Norms and Links With Eating Psychopathology

This study assessed the 5-factor structure of the Compulsive Exercise Test (CET) and explored the relationship between compulsive exercise and eating psychopathology in athletes. Confirmatory and exploratory factor analyses of the CET were conducted with 689 competitive athletes (18–35 years of age). Convergent validity with the Eating Disorders Examination Questionnaire (EDE-Q) was explored. The 5-factor structure showed a poor fit; an alternative 3-factor structure is proposed. Exercising for weight control and exercising to avoid a negative mood were strongly associated with eating psychopathology. Implications for using the CET with athletes are discussed.

Poster #M216 LONG-TERM IMPROVEMENTS IN AVHS: CLINICIAN VS. PATIENT PERSPECTIVES

Despite the substantial role of compulsive exercise in the development and maintenance of anorexia nervosa, and despite associated risks of medical complications, longer length of hospitalization and higher relapse rates, little is understood about the personal experience and meaning of compulsive exercise in this context. This study explored the experiences of compulsive exercise in women with anorexia nervosa, restrictive type, and the sense they make of these experiences in the context of their daily lives and treatment programme.Semi-structured interviews were conducted with six females, four of whom were former athletes. Transcripts were subjected to interpretative phenomenological analysis (IPA).This paper reports on the first superordinate theme, paradoxical functions of exercise. An account of the participants' perspectives regarding their engagement with compulsive exercise as a means of emotion regulation is presented first. Secondly, the manner in which participants experience the embodiment of emotional states is explored. Thirdly, the ability of exercise to offer participants a sense of time-out is presented. Finally, the meaning of exercise in relation to the participants' sense of self and identity are analysed.The study demonstrates how compulsive exercise represents an essential means of emotion distraction and management for individuals with anorexia nervosa. The finding that feelings are echoed in the participants' bodies is significant, as this gives participants a sense of connecting with their emotions. The time outs offered by exercise provide a degree of structure, control and stability for the participants' sense of self, helping them commit to the demands of treatment. However, this control and stability is short lived, as it may lead to a subsequent loss of control if underlying concerns and emotions are not addressed. It is suggested that interventions should aim to increase recognition and tolerance of negative feelings. Body-oriented and physical therapy interventions tailored specifically to individuals with anorexia nervosa may provide a fresh way of addressing emotions that is complementary to other therapies.

A risk profile of compulsive exercise in adolescents with an eating disorder: a systematic review

This review aims to critically examine and summarise the existing research that has studied the prevalence and psychopathological correlates of compulsive exercise in adolescents with eating disorders. A systematic electronic database search (PsycINFO, Medline, and Web of Science) of published studies was completed in May 2013. A search strategy was developed to identify all studies of adolescents with eating disorders, in which the prevalence and/or psychological correlates of compulsive exercise had been formally assessed through clinical interview or reliable and valid clinical measures. A total of 11 studies met the inclusion criteria for the review, of which 10 studies provided comparable prevalence estimates and 4 studies identified psychopathological correlates of compulsive exercise. For the relevant data, the prevalence of compulsive exercise in adolescents with eating disorders ranged from 16.7% to 85.3%. There is some evidence to suggest that compulsive exercise is associated with increased eating disorder symptomology and anxiety; however, other relationships remain unclear with studies producing disparate results. The results from the studies reviewed suggest that compulsive exercise is an evident problem within adolescent eating disorders; however, the specific psychopathological risks associated with this behaviour cannot be reliably summarised.

Exercise reinforcement, stress, and β-endorphins: An initial examination of exercise in anabolic–androgenic steroid dependence

BackgroundAnabolic–androgenic steroids (AASs) are abused primarily in the context of intense exercise and for the purposes of increasing muscle mass as opposed to drug-induced euphoria. AASs also modulate the HPA axis and may increase the reinforcing value of exercise through changes to stress hormone and endorphin release. To test this hypothesis, 26 adult males drawn from a larger study on AAS use completed a progressive ratio task designed to examine the reinforcing value of exercise relative to financial reinforcer. MethodSixteen experienced and current users (8 on-cycle, 8 off-cycle) and 10 controls matched on quantity×frequency of exercise, age, and education abstained from exercise for 24h prior to testing and provided 24-h cortisol, plasma cortisol, ACTH, β-endorphin samples, and measures of mood, compulsive exercise, and body image. ResultsBetween group differences indicated that on-cycle AAS users had the highest β-endorphin levels, lowest cortisol levels, higher ACTH levels than controls. Conversely, off-cycle AAS users had the highest cortisol and ACTH levels, but the lowest β-endorphin levels. Exercise value was positively correlated with β-endorphin and symptoms of AAS dependence. ConclusionThe HPA response to AASs may explain why AASs are reinforcing in humans and exercise may play a key role in the development of AAS dependence.