Exercise for the compulsive exercisers? An exploratory study in adolescent inpatients with anorexia nervosa

ABSTRACT

Objective: This study aimed to explore whether exercise produced acute psychological benefits for adolescent inpatients receiving treatment for anorexia nervosa (AN). Specifically, the study examined whether a supervised inpatient exercise programme resulted in negative or positive affective changes over time, and if the participant’s reported level of compulsive exercise influenced such changes. Method: Forty-seven adolescent female inpatients with a DSM-5 diagnosis of AN completed a measure of compulsive exercise at admission to an eating-disorder inpatient programme. Participants routinely attended physiotherapy sessions (exercise condition) and school lessons (school condition) throughout their admission, and completed visual analogue scales assessing anxious, depressed, and positive affect immediately prior to and after both conditions. Results: Participants reported a significant decrease in anxious and depressed affect, and an increase in positive affect after the exercise condition compared to the school condition. Participants with higher levels of compulsive exercise features reported significantly greater decreases in anxious affect following exercise. Discussion: The current study provides promising results in terms of the acute psychological benefits supervised exercise can offer adolescent inpatients with AN. Research and clinical efforts are required to develop standardised treatment guidelines for exercise programmes and the management of compulsive exercise in this population during active treatment.

KEYWORDS:

• Adolescent
• anorexia nervosa
• inpatient
• exercise
• mood

Acknowledgements

The authors thank the staff of the Eating Disorder Service, the Hospital School, and the Physiotherapy Department at The Children’s Hospital at Westmead for providing support surrounding recruitment and data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Temperature >35.5°C; heart rate >50 beats/min; and blood pressure >80 mmHg systolic and >50 mmHg diastolic (Hay et al., 2014).

2. Due to the variability in the number of observations collected over time for each participant, sensitivity analyses were conducted in which participants limited to only one, two, and three observations were consecutively excluded from the overall model. When analyses were re-run under such conditions, the change in the interpretation of the final results was negligible, and therefore, all observations were included in the final model. Furthermore, although there were some missing data points due to the participant’s absence from a session, the modelling framework chosen for analysis does not necessitate that each participant’s data set be equivalent in terms of the quantity of observations and the intervals between observations (Goldstein, 2003).

3. Satisfaction ratings as assessed by the participant were not included within the overall model as a control variable. Enjoyment and satisfaction ratings were highly correlated (r = .68, p < .001) and to ensure that power was not reduced by including redundant covariates, satisfaction ratings were excluded. Furthermore, the level of participation (1 = did not participate to 5 = participated excessively) as assessed at each observation by the facilitator of each condition, did not significantly differ between the exercise condition (M = 3.02, SD = .17) and school condition (M = 3.01, SD = .13), t(366) = .739, p = .46.

4. Degrees of freedom noted for the MLM analyses are Sattherthwaite approximations.

Additional information

Funding

ST and PH receive royalties from Hogrefe, and Huber and McGraw-Hill publishers for contributions on eating disorders. ST received an honorarium from Shire Pharmaceuticals. PH received royalties from Oxford University Press and received sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry.