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Khoshro S, Abbasalizad Farhangi M. Major Dietary Patterns, Exercise Addiction, and Eating Disorders Among a Sample of Physically Active Young Adults. Nutr Metab Insights 2024; 17:11786388241258938. [PMID: 39070982 PMCID: PMC11273586 DOI: 10.1177/11786388241258938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 05/16/2024] [Indexed: 07/30/2024] Open
Abstract
Background Regular exercise has been widely acknowledged for its numerous health benefits, including improvements in physical fitness, body function, and mental well-being. However, excessive exercise and unhealthy dietary patterns can lead to adverse effects on individuals' physical and psychological well-being. This study aimed to examine the association of dietary patterns, exercise addiction, and eating disorders among physically active young adults. Method In this cross-sectional study, a total of 200 physically active young adults aged 18-35 years were included. The participants' dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ) consisting of 80 food items. To determine dietary patterns, factor analysis was employed. Exercise addiction was evaluated using The Exercise Addiction Inventory (EAI) and Exercise Dependence Questionnaire (EDQ), and eating disorders were assessed using The Eating Disorder Examination-Questionnaire Short (EDE-QS). Result Three main dietary patterns were identified: western, healthy, and traditional dietary patterns. The western dietary pattern was associated with increased waist-to-hip ratio (P = .01) that remained significant after adjustment for confounders (eg, age, gender, BMI, and physical activity P = .03), while the adherence to traditional dietary pattern was linked to higher waist circumference and body shape index (P < .05). Participants that followed the healthy dietary pattern showed a higher score of EAI and body shape concern (P = .04). Furthermore, in structural equation modelling (SEM), eating disorder was identified as a significant positive predictor of exercise addiction (r = .17, P < .05). Conclusion According to our finding, those with the higher adherence to healthy dietary pattern had higher scores of exercise addiction and body shape concern. Also, eating disorder was a potential predictor of exercise addiction among young physically active individuals. Further research and targeted interventions are needed to better understand these complex relationships and develop effective strategies to promote healthy behaviors and mitigate the risk of adverse outcomes.
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Affiliation(s)
- Sahar Khoshro
- Faculty of Nutrition, Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
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2
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Schaumberg K, Pictor L, Frank M. Adaptive and Maladaptive Exercise in Eating Disorders. Curr Top Behav Neurosci 2024. [PMID: 39042250 DOI: 10.1007/7854_2024_499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
While exercise is generally associated with positive health outcomes, in the context of eating disorders, exercise has high potential to become maladaptive. Maladaptive exercise is compelled or compulsive in nature for the purposes of weight and shape control or to obtain/avoid other eating disorder-relevant consequences. A transdiagnostic eating disorder feature with moderate-to-high prevalence across restrictive- and bulimic-spectrum eating disorders, maladaptive exercise is often associated with negative mental and physical health sequalae. Several proposed threat- and reward-related biobehavioral mechanisms may initiate or perpetuate maladaptive exercise. While exercise is generally contraindicated during periods of acute medical concern, adaptive forms of exercise are also present among those with eating disorders, and facilitation of adaptive exercise has potential to promote physical and mental health benefits during eating disorder recovery. Detailed assessment and targeted interventions are needed to address the clinical conundrum of how and when to integrate exercise into eating disorder treatment.
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Affiliation(s)
| | - Lauren Pictor
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Max Frank
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
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Alghamdi NA, Aldhwayan MM, Albassam RS, Asseri RF, Alyousef AF, Naaman RK, Alzuman MA, Almukhlifi AJ, Alquraishi MI. The Arabic Version of Compulsive Exercise Test among Saudi Population; Translation and Validation. Sports (Basel) 2024; 12:176. [PMID: 39058067 PMCID: PMC11280584 DOI: 10.3390/sports12070176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 07/28/2024] Open
Abstract
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.
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Affiliation(s)
- Nouf A. Alghamdi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Madhawi M. Aldhwayan
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Reem S. Albassam
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Rana F. Asseri
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Aljouhara F. Alyousef
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Reem K. Naaman
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, Madinah 42353, Saudi Arabia
| | - Manar A. Alzuman
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Aseel J. Almukhlifi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Mohammed I. Alquraishi
- Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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4
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Khoshro S, Farhangi MA, Jahangiry L. Psychometric properties of the exercise addiction inventory (EAI) questionnaire among physically active young adults. BMC Res Notes 2024; 17:76. [PMID: 38486222 PMCID: PMC10941438 DOI: 10.1186/s13104-024-06722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Exercise addiction (EA) is a pathological behavior pattern in which a person loses control over his exercise habits and exercises excessively and suffers negative consequences for his health and even his social life. One of the best tools to measure EA is EAI. The aim of this study was to examine the psychometric properties of the EAI among Iranian physically active young adults. METHODS Participants were randomly selected from sports clubs in Tabriz, Iran. A total of 200 questionnaires were completed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted along with tests of convergent validity. Reliability was assessed using Cronbach's alpha and test-retest methods. RESULTS EFA indicated a one-factor structure explaining 40.43% of variance. CFA confirmed the one-factor model with good fit (Root Mean Square Error of Approximation [RMSEA] = 0.076; Comparative Fit Index [CFI] = 0.968). Internal consistency was acceptable (Cronbach's alpha = 0.71) and convergent validity was adequate. Test-retest reliability was also adequate (intraclass correlation coefficient [ICC] = 0.71). CONCLUSION The results of our study show that the Persian EAI has satisfactory psychometric properties and can be used as a valid tool to assess EA.
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Affiliation(s)
- Sahar Khoshro
- Department of Community Nutrition, Faculty of Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Leila Jahangiry
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Tang CSK, Gan KQ, Lui WK. The Associations between Obsessive Compulsive Personality Traits, Self-Efficacy, and Exercise Addiction. Behav Sci (Basel) 2023; 13:857. [PMID: 37887507 PMCID: PMC10603988 DOI: 10.3390/bs13100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Exercise addiction refers to maladaptive exercise patterns involving compulsivity and addiction-like behaviors. Exercise addiction has been found to relate to negative physical and mental health outcomes such as heart abnormalities, physical injuries, and interpersonal conflicts. Based on the social cognitive theory, this study investigated the extent to which the interplay of obsessive compulsive personality disorder (OCPD) traits and self-efficacy beliefs would influence the development and maintenance of exercise addiction. A total of 1228 college students in the United States responded to an online survey. Based on cut-off scores of the Revised Exercise Addiction Inventory, the prevalence estimates of exercise addiction were 4.0% for males and 1.8% for females. Results showed that males are more prone to exercise addiction than females. Also, OCPD traits and self-efficacy significantly predicted exercise addiction after controlling for age and sex. Self-efficacy acted as a moderator in influencing the relationship between OCPD traits and exercise addiction, especially for females. At high levels of self-efficacy, more OCPD traits were significantly associated with a higher risk of exercise addiction. However, at low levels of self-efficacy, there was no association between OCPD traits and exercise addiction. The findings suggest that public education and intervention for exercise addiction should attend to the interplay between personality factors and sex.
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Affiliation(s)
- Catherine So Kum Tang
- Department of Counselling & Psychology, Hong Kong Shue Yan University, 10 Wai Tsui Crescent, Braemar Hill, North Point, Hong Kong, China
| | - Kai Qi Gan
- Department of Psychology, National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Wai Kin Lui
- Department of Counselling & Psychology, Hong Kong Shue Yan University, 10 Wai Tsui Crescent, Braemar Hill, North Point, Hong Kong, China
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6
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Schüler J, Stähler J, Wolff W. Mind-over-body beliefs in sport and exercise: A driving force for training volume and performance, but with risks for exercise addiction. PSYCHOLOGY OF SPORT AND EXERCISE 2023; 68:102462. [PMID: 37665904 DOI: 10.1016/j.psychsport.2023.102462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 04/04/2023] [Accepted: 05/05/2023] [Indexed: 09/06/2023]
Abstract
We assume that athletic success is associated with certain beliefs that on the one hand promote performance-enhancing behavior (training volume), but on the other hand can also be detrimental to health (sports addiction). These beliefs are succinctly characterized by the title of the 9-item "Mind-over-Body" scale presented here. They are the three beliefs that 1) athletic performance requires a high level of effort, 2) that willpower plays an important role in athletic success, and 3) that athletic success requires pain tolerance. A total of six web-survey-based studies with a total of 1121 participants (approximately gender parity), including individuals with different levels of athletic performance (no competition; amateur sport; regional, national, or international competition), examined the psychometric network and construct and criterion validity of the MoB scale. Exploratory graph analyses, which included the studies with the largest sample sizes, showed that the three belief components (effort, willpower, pain) form separable communities within the MoB network and that the MoB items form communities distinct from self-control and self-efficacy. Meta-analyzed correlations across all six studies showed low positive correlations with self-control and self-efficacy. In terms of criterion validity, MoB beliefs were positively correlated with training volume and exercise addiction. We discuss MoBs as "on the edge of unhealthy" and place MOBs within a framework of related but distinct concepts.
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Affiliation(s)
| | | | - Wanja Wolff
- University of Konstanz, Germany; University of Bern, Switzerland
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7
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Lev Arey D, Sagi A, Blatt A. The relationship between exercise addiction, eating disorders, and insecure attachment styles among recreational exercisers. J Eat Disord 2023; 11:131. [PMID: 37550767 PMCID: PMC10408237 DOI: 10.1186/s40337-023-00855-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Exercise addiction (EA) and eating disorders (ED) frequently co-occur in both professional and amateur athletes, with up to 48% of individuals with EA also exhibiting symptoms of ED. Furthermore, pathological attachment styles have been linked to both EA and ED. The current study aimed to explore the unique association between types of insecure attachment styles (i.e., anxiety or avoidance) and EA and ED. METHOD Four hundred and five Israelis (199 women, 206 men) who were recreational exercisers (i.e., exercised at least four hours a week for at least one year) with ages ranging from 18 to 78 (M = 38, SD = 12.31) completed a set of questionnaires, including the Eating Attitudes Test (EAT-26), Exercise Addiction Inventory, and the Experiences in Close Relationship Scale. Path analysis was used to simultaneously examine the associations of attachment anxiety and avoidance with EA and ED symptoms. Attachment anxiety and avoidance were specified as independent variables predicting ED and EA symptoms and were entered into the analysis as two parallel dependent variables. RESULTS The results of the study indicate that attachment anxiety is positively associated with symptoms of EDs, while the association between attachment anxiety and symptoms of EA is not significant. On the other hand, attachment avoidance shows a positive association with symptoms of exercise addiction, but no significant association with symptoms of EDs is found. CONCLUSIONS These results imply that the anxious attachment regulation strategy is highly associated with body image concerns. Furthermore, individuals characterized by avoidance attachment manifest regulation strategies through excessive exercise. Scholars and practitioners could use these results to examine dispositional risk factors for insecure attachment styles and to assess specific pathologies among the population of recreational exercisers. The study also discusses limitations, future directions, and implications in detail.
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Affiliation(s)
- Dalit Lev Arey
- School of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
| | - Adi Sagi
- School of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Asaf Blatt
- School of Behavioral Sciences, College of Management Academic Studies, Rishon LeZion, Israel
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Miller ML, Sanzari CM, Timko CA, Hormes JM. Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report. Int J Eat Disord 2023; 56:1449-1460. [PMID: 37464977 DOI: 10.1002/eat.23942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and cost-effective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin. METHOD We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n = 42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points. RESULTS We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain. DISCUSSION Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings. PUBLIC SIGNIFICANCE Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological markers of the inflexible thinking style thought to be characteristic of anorexia nervosa and exercise dependence.
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Affiliation(s)
- McKenzie L Miller
- Department of Psychology, University at Albany, Albany, New York, USA
| | | | - C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Philadelphia, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, Albany, New York, USA
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Clemente-Suárez VJ, Ramírez-Goerke MI, Redondo-Flórez L, Beltrán-Velasco AI, Martín-Rodríguez A, Ramos-Campo DJ, Navarro-Jiménez E, Yáñez-Sepúlveda R, Tornero-Aguilera JF. The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions. Nutrients 2023; 15:2594. [PMID: 37299557 PMCID: PMC10255390 DOI: 10.3390/nu15112594] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Maria Isabel Ramírez-Goerke
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Ana Isabel Beltrán-Velasco
- Psychology Department, Facultad de Ciencias de la Vida y la Naturaleza, Universidad Antonio de Nebrija, 28240 Madrid, Spain;
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
| | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
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10
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Granziol U, Griffiths MD, Zou L, Yang P, Herschel HK, Junker A, Akimoto T, Stoll O, Alpay M, Aydın Z, Zandonai T, Di Lodovico L, Lichtenstein MB, Trott M, Portman RM, Schipfer M, Cook B, Cerea S, Egorov AY, Cantù-Berrueto A, de la Vega Marcos R, Fernandes PT, Landolfi E, Demetrovics Z, Tóth EE, Solmi M, Szabo A. The Expanded Exercise Addiction Inventory (EAI-3): Towards Reliable and International Screening of Exercise-Related Dysfunction. Int J Ment Health Addict 2023:1-27. [PMID: 37363769 PMCID: PMC10171173 DOI: 10.1007/s11469-023-01066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
Exercise addiction (EA) refers to excessive exercise, lack of control, and health risks. The Exercise Addiction Inventory (EAI) is one of the most widely used tools in its assessment. However, the cross-cultural psychometric properties of the EAI could be improved because it misses three pathological patterns, including guilt, exercise despite injury, and experienced harm. Therefore, the present study tested the psychometric properties of the expanded EAI (EAI-3) in a large international sample. The EAI-3 was administered to 1931 physically active adult exercisers speaking five languages (Chinese, German, Italian, Japanese, and Turkish) and other measures for obsessive-compulsive behavior, eating disorders, and personality traits. The assessment structure and reliability of the EAI-3 were tested with factorial analyses and through measurement invariance across languages and sex. Finally, a cutoff point for dysfunction-proneness was calculated. The EAI-3 comprised two factors, reflecting the positive and pathological sides of exercise. The structure had excellent reliability and goodness-of-fit indices and configural and metric invariances of the scale were supported. However, three items caused violations in scalar invariance. The results of partial measurement invariance testing suggested an adequate fit for the data. Following sensitivity and specificity analysis, the EAI-3's cutoff score was 34 out of a maximum score of 48. This preliminary study suggests that the EAI-3 is a promising tool for screening EA in an international sample, with a robust and reliable structure comparable across languages and sex. In addition, the proposed cutoff could pave the way toward a consensus on a threshold to screen for EA.
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Affiliation(s)
- Umberto Granziol
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padua, Italy
| | - Mark D. Griffiths
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Liye Zou
- Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, China
| | - Peiying Yang
- Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, China
| | - Hannah K. Herschel
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padua, Italy
| | - Annika Junker
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padua, Italy
| | | | - Oliver Stoll
- Martin-Luther University Halle-Wittenbergn, Halle (Saale), Germany
| | - Merve Alpay
- Physical Education and Sports, Institute of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - Zeynep Aydın
- International School of Advanced Studies, University of Camerino, Camerino, Italy
| | - Thomas Zandonai
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Alicante, Spain
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Laura Di Lodovico
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, Paris, France
| | - Mia Beck Lichtenstein
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Mike Trott
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Robert M. Portman
- Centre for Applied Psychological Science and School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK
| | - Melanie Schipfer
- Martin-Luther University Halle-Wittenbergn, Halle (Saale), Germany
| | | | - Silvia Cerea
- Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padua, Italy
- Department of Biomedical Science, University of Padova, Padua, Italy
| | - Aleksei Y. Egorov
- Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences, St. Petersburg, Russia
| | | | - Ricardo de la Vega Marcos
- Department of Physical Education, Sport & Human Movement, Autonomous University of Madrid, Madrid, Spain
| | - Paula Texeira Fernandes
- Department of Sport Science and GEPEN - Physical Education Faculty, State University of Campinas/UNICAMP, Campinas, Brazil
| | - Emilio Landolfi
- School of Kinesiology, University of the Fraser Valley, British Columbia, Canada
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
| | - Eliza E. Tóth
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- On track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, ON Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Attila Szabo
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
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Wons O, Lampe E, Patarinski AG, Schaumberg K, Juarascio A. Change in adaptive and maladaptive exercise and objective physical activity throughout CBT for individuals with eating disorders. Eat Weight Disord 2023; 28:40. [PMID: 37079117 PMCID: PMC10115602 DOI: 10.1007/s40519-023-01566-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
Maladaptive exercise (i.e., exercise that compensates for binge eating or is used to avoid negative consequences of not exercising-like weight gain) is a common eating disorder (ED) behavior, yet, some individuals with EDs only engage in adaptive exercise. CBT for EDs targets reducing maladaptive exercise but does not address adaptive exercise. Thus, research is limited on how adaptive and maladaptive exercise are impacted during CBT for EDs. The current study examined how assessor-rated adaptive and maladaptive exercise and objectively measured physical activity changed over a 12-week CBT treatment among adults with transdiagnostic binge eating and restrictive eating that did and did not engage in maladaptive exercise at the start of treatment (n = 13 non-maladaptive exercise group, n = 17 maladaptive exercise group). The overall amount of adaptive and maladaptive exercise was measured via the Eating Disorder Examination Interview and objectively measured physical activity (e.g., step count, minutes of moderate-to-vigorous physical activity [MVPA]) was measured via a wrist-worn fitness tracker. Throughout treatment, the overall amount of adaptive exercise did not significantly change for both groups, but the overall amount of maladaptive exercise significantly decreased in the maladaptive exercise group. Step count did not significantly change for both groups, but minutes of MVPA significantly increased over treatment for the non-maladaptive exercise group. Increases in step count and minutes of MVPA were not associated with ED symptom changes in either group. These results enhance an understanding of exercise changes during transdiagnostic CBT-based ED treatment for individuals with varying baseline exercise profiles.Level of evidence: Level 1, randomized controlled trial.
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Affiliation(s)
- Olivia Wons
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA.
| | - Elizabeth Lampe
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Anna Gabrielle Patarinski
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
| | - Katherine Schaumberg
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI, 53719, USA
| | - Adrienne Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA, 19104, USA
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12
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Remilly M, Mauvieux B, Drigny J. Personality Traits Associated with the Risk of Exercise Dependence in Ultraendurance Athletes: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1042. [PMID: 36673797 PMCID: PMC9858902 DOI: 10.3390/ijerph20021042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023]
Abstract
Exercise dependence (ED) is common in endurance athletes and can lead to physical and psychological distress with various health effects. We designed a prospective cross-sectional study to investigate the personality traits associated with ED among ultraendurance athletes. A total of 507 participants (41.6 (9.8) years, men: 73.7%) completed (1) a screening questionnaire about sociodemographic data, sporting habits, and healthcare data, (2) the Exercise Dependence Scale-Revised (EDS-R, 21 items scored from 1 (never) to 6 (always), 7 subscales), (3) the Big Five Inventory (BFI), and (4) 2 items of the SCOFF (Sick-Control-One Stone-Fat-Food) questionnaire regarding possible eating disorders. Based on the EDS-R scores, 37 (7.3%) participants were at risk for ED (scores ≥ 5/6 on ≥3 subscales), 366 (72.2%) were nondependent but symptomatic (scores ≥ 3/6 on ≥3 subscales), and 104 (20.5%) were asymptomatic. Participants with ED had a greater training volume and a higher prevalence of possible eating disorders. A higher level of neuroticism was associated with increased EDS-R scores (r = 0.294; p < 0.001), with significantly higher scores in the ED group (F = 14.50, p < 0.001). The association between neuroticism and ED was not moderated by the presence of eating disorders. These findings will help to screen ultraendurance athletes at risk for ED and optimize their care.
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Affiliation(s)
- Marion Remilly
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Médecine du Sport, 14000 Caen, France
| | - Benoit Mauvieux
- Normandie Univ, UNICAEN, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
| | - Joffrey Drigny
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Normandie University, Service de Médecine du Sport, Service de Médecine Physique et de Réadaptation, INSERM, COMETE, GIP CYCERON, 14000 Caen, France
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13
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Weinstein A, Szabo A. Exercise addiction: A narrative overview of research issues. DIALOGUES IN CLINICAL NEUROSCIENCE 2023; 25:1-13. [PMID: 36698618 PMCID: PMC9869993 DOI: 10.1080/19585969.2023.2164841] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This narrative overview summarises the work on exercise addiction (EA) over the past 12 years and exposes critical conceptual and methodological issues. More than 1000 articles exist on EA, conceptualised as uncontrolled training harming the individual. Still, EA has no clinical diagnosis criteria at this time. Research is increasing continuously, but it is stale in advancing knowledge. Scalar measurement and lack of differentiation between addictive and instrumental exercise could be reasons for insufficient progress. Exercise addiction fits in the framework of behavioural addictions, but excessive exercise patterns also co-occur with other morbidities, including eating or body-image disorders. In these cases, exercise is instrumental; it functions to achieve a non-exercise-related goal. Therefore, it is essential to separate primary from secondary EA. Based on the interactional model, significant stress and capacity-exceeding ambitions fuel primary EA, while chief motives behind secondary EA embed body image dissatisfaction and eating disorders. Few reports exist on EA's brain mechanisms, which could delay its classification as a distinct psychiatric dysfunction. Treatment of EA involves cognitive-behavioural approaches, but we know little about their effectiveness. Conceptually focussed psychophysiological research and in-depth interviews, complementing scalar data, could answer several open questions in this widely studied but relatively stagnant scholastic field.
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Affiliation(s)
- Aviv Weinstein
- The Isadore and Ruth Kastin Chair for Brain Research, Department of Psychology, University of Ariel, Ariel, Israel
| | - Attila Szabo
- Institute of Psychology, and Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
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14
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Assessing Metacognitions in Compulsive Exercising: The Construction and Evaluation of the Metacognitions About Exercise Questionnaire. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022. [DOI: 10.1007/s10942-022-00493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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15
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Roberts CJ, Hurst HT, Hardwicke J. Eating Disorders and Disordered Eating in Competitive Cycling: A Scoping Review. Behav Sci (Basel) 2022; 12:bs12120490. [PMID: 36546973 PMCID: PMC9774887 DOI: 10.3390/bs12120490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
This article reports on the findings from a scoping review on eating disorders and disordered eating in competitive cycling. The review was informed by a scoping review methodological framework as well as the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) reporting guidelines. PubMed, SPORTDiscus and Web of Science were used to identify relevant literature for review. Fourteen studies met the eligibility criteria and were included in the full review. A narrative synthesis was used to summarise the main findings and themes across the included literature. Findings from the review are presented under the following themes: cycling as an 'at-risk' discipline; power to weight ratio; energy requirements and risk of low energy availability; the social environment of cycling; nutrition support provision; relationship between eating disorders/disordered eating and exercise addiction; and recommendations made in identified literature. Overall, the literature suggests competitive cycling is a sport with a high prevalence of disordered eating and/or eating disorders and a sport with unique risk factors that contribute to this. Crucially, more research is needed in this area. The article concludes with the gaps in the literature highlighted, implications for future research, and applications to policy and practice suggested.
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Affiliation(s)
- Charlie Jon Roberts
- Centre for Physical Activity and Life Sciences, University of Northampton, Northampton NN1 5PH, UK
- Correspondence:
| | - Howard Thomas Hurst
- Centre for Applied Sport Physical Activity and Performance, University of Central Lancashire, Preston PR1 2HE, UK
| | - Jack Hardwicke
- Centre for Physical Activity and Life Sciences, University of Northampton, Northampton NN1 5PH, UK
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16
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Yang P, Wang T, Herold F, Müller NG, Taylor A, Szabo A, Granziol U, Cook B, Landolfi E, Solmi M, Zou L. Relationships between personality traits and disordered eating among Chinese female exercisers: the role of symptoms of exercise dependence and obsessive-compulsiveness. J Eat Disord 2022; 10:169. [PMID: 36397179 PMCID: PMC9670462 DOI: 10.1186/s40337-022-00679-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although numerous studies have examined associations between personality traits and eating disorders in females, few studies have been conducted on female exercisers. Given the high risk of disordered eating in female exercisers, this study investigated the associations between the Big Five personality traits and disordered eating in female exercisers, and further explored the potential mediators, namely exercise dependence symptoms, and obsessive-compulsive symptoms underlying this association. METHODS A total of 295 female exercisers aged between 18 to 67 years (M = 22.11, SD = 6.65) participated in this study. RESULTS Negative and statistically significant correlations between conscientiousness (r = - 0.17, p < 0.01), emotional stability (r = - 0.27, p < 0.001) and agreeableness (r = - 0.18, p < 0.01) and disordered eating were observed in our sample of female exercisers. The multiple mediation analyses revealed that exercise dependence symptoms and obsessive-compulsive symptoms mediate the relationship between conscientiousness (β = 0.016, CI = [0.003, 0.031]), emotional stability (β = -0.012, CI = [- 0.028, - 0.002]), and disordered eating in female exercisers, whereas obsessive-compulsive symptoms (β = - 0.041, CI = [- 0.088, - 0.001]) but not exercise dependence symptoms are a mediator of the relationship between agreeableness and disordered eating. CONCLUSIONS Our findings can be used to improve the screening procedures for eating disorders in female exercisers as they contribute to a better understanding of the psychological mechanisms that underlie the associations between the Big Five personality traits and disordered eating.
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Affiliation(s)
- Peiying Yang
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ting Wang
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Alyx Taylor
- School of Rehabilitation, Sport and Psychology, AECC University College, Bournemouth, BH5 2DF, UK
| | - Attila Szabo
- Institute of Health Promotion and Sport Science, ELTE, Eötvös Loránd Unbiversity, Budapest, Hungary
| | - Umberto Granziol
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Emilio Landolfi
- Faculty of Health Sciences, School of Kinesiology, University of the Fraser Valley, Abbotsford, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Department of Child and Adolescent Psychiatry, Charité, Universitätsmedizin, Berlin, Germany
| | - Liye Zou
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China.
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17
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Measurement Invariance of the Exercise Addiction Inventory According to Eating Disorder Risk Status. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00936-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Haltom CE, Halverson TF. Relationship between college lifestyle variables, eating disorder education, and eating disorder risk. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-9. [PMID: 36194243 DOI: 10.1080/07448481.2022.2122720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Objective: This study examined relationships between eating disorder risk (EDR), lifestyle variables (e.g., exposure to healthy eating media), and differences among male and female college students. Participants: College students (N = 323) completed survey questionnaires (Fall, 2016). Fifty-three participants retook the survey at a later time. Methods: Participants completed a survey measuring EDR using EDI-3 subscales and 10 college lifestyle variables. Female and male EDR and Time 1 and Time 2 EDR were compared. Relationships between EDR and college life-style variables were examined. Results: Exercise, fewer daily meals, less face-to-face interactions, more digital interactions, less exposure to healthy eating media, and having conversations about body image were associated with EDR risk. Male college students showed an increase in EDR over time. Conclusions: Several lifestyle factors predicted EDR in college females and males. These lifestyle factors are modifiable and may be addressed by colleges during orientation and within the campus environment.
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Affiliation(s)
- Cris E Haltom
- Department of Psychology, Ithaca College, Ithaca, New York, USA
| | - Tate F Halverson
- Durham VA Health Care System, Durham, North Carolina, USA
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
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19
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Sas-Nowosielski KJ, Gutek M. Prevalence of risk for exercise dependence in rock climbers and mountaineers. MEDICAL SCIENCE PULSE 2022. [DOI: 10.5604/01.3001.0015.9811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Research on physical activity has extensively shown that regular exercise produces many physical and psychological benefits. However, excessively practiced physical activities can also have negative effects, both physical and psychological. One of them is the risk of becoming dependent on exercise, similar to substances such as drugs or alcohol. Most studies on exercise dependence have focused on runners and strength athletes. Aim of the study: This study aimed to explore the prevalence of exercise dependence in climbers. Material and methods: A group of 272 climbers (32.3 ± 8.7 years old) participated in the study. They were divided into three groups: sport/rock climbers (59.6%), boulderers (30.2%), and mountaineers (10.3%). Data was collected using the Exercise Dependence Scale (EDS). Results: Based on EDS scores, 44 climbers (16.2%) were classified as at-risk for exercise dependence, 183 (67.3%) as nondependent-symptomatic, and 45 (16.5%) as asymptomatic. Competitive and non-competitive climbers significantly differed in tolerance, and boulderers scored significantly higher than rock climbers and mountaineers. Conclusions: Climbers are at risk of developing exercise dependence, especially those who participate in climbing competitions and who are boulderers. However, more research is needed to further characterize this phenomenon in the climbing community.
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Affiliation(s)
| | - Mateusz Gutek
- Polish School of Mountaineering TDMA, Bielsko-Biała, Poland
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20
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Axelsson KF, Woessner MN, Litsne H, Wheeler M, Flehr A, King AJ, Kalén M, Vandenput L, Lorentzon M. Eating disorders are associated with increased risk of fall injury and fracture in Swedish men and women. Osteoporos Int 2022; 33:1347-1355. [PMID: 35088102 PMCID: PMC9106600 DOI: 10.1007/s00198-022-06312-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED In this retrospective cohort study, men and women with eating disorders (n = 8867) had higher risk of injurious falls and hip fractures than age, sex, and county-matched controls (n = 88670). INTRODUCTION Eating disorders have been associated with decreased bone mineral density and increased fracture risk, but the association with fall injuries without fracture has not previously been investigated. Furthermore, fracture risk in men with eating disorders has been insufficiently studied. METHODS In the present study, 8867 patients (9.4% men) with a diagnosed eating disorders and 88670 age-, sex-, and county-matched controls were investigated. RESULTS The mean (standard deviation) age of the patients and controls was 41.6 (13.7) years and the follow-up time 9.6 (5.2, 14.4) years (median, interquartile range) for patients and 10.1 (5.5, 14.2) years for controls. The proportions of injurious falls without fracture (17.3% vs. 9.0%) and of hip fracture (1.6% vs. 0.7%) were substantially greater in patients with an eating disorder than in their corresponding population controls. In an unadjusted Cox proportional hazards model, individuals with an eating disorder had a higher risk of injurious falls without fracture (Hazard ratio (HR) 95% confidence interval (CI): 2.07 (1.96-2.18), and hip fracture (HR 2.30 (1.92-2.75)) than the risk observed in the controls. The HR for any investigated outcome associated with an eating disorder did not differ by sex or age (interaction term p > 0.10). The risk of injurious falls without fracture and hip fracture was increased in both women (HR 2.07 (1.95-2.19) and HR 2.41 (1.98-2.93), respectively) and men (HR 2.09 (1.76-2.49) and HR 1.84(1.12-3.02), respectively), with an eating disorder. CONCLUSION The risk of injurious falls without fracture and of hip fracture is increased in both women and men with eating disorders, indicating measures to prevent both falls and fractures are important in these patients, regardless of age and sex.
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Affiliation(s)
- K F Axelsson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Norrmalm Health Centre, Skövde, Sweden
| | - M N Woessner
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Australia
| | - H Litsne
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Wheeler
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - A Flehr
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - A J King
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - M Kalén
- Region Västra Götaland, Department of Psychiatry, Skaraborgs Hospital, Skövde, Sweden
| | - L Vandenput
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - M Lorentzon
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Building K, 6th Floor, 431 80, Mölndal, Sweden.
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21
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Trott M, Johnstone J, McDermott DT, Mistry A, Smith L. The development and validation of the secondary exercise addiction scale. Eat Weight Disord 2022; 27:1427-1436. [PMID: 34370271 DOI: 10.1007/s40519-021-01284-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Exercise addiction can be secondary to eating disorders, or a primary condition in the absence of another disorder. Currently, to determine secondary exercise addiction, two screening tools must be administered. The aim of this study was to validate a novel screening tool able to stratify between primary and secondary exercise addiction, called the secondary exercise addiction scale (SEAS). METHODS Phase 1 (n = 339) described the statistical reduction of an initial pool of scale items. Phase 2 (n = 382) used a confirmatory factor analysis (CFA) to examine the robustness of the latent structure. Phase 3 (n = 721) determined cut off scores for the eating disorder and exercise addiction sections of the SEAS and determine concurrent reliability with the exercise addiction inventory (EAI) and the SCOFF questionnaires. Phase 4 (n = 45) determined test-retest reliability. RESULTS Phase 1 extracted two components: exercise addiction and eating disorder symptomology, with 11 items retained. The CFA in Phase 2 showed an acceptable fit to the proposed model (comparative fit index = 0.93, Tucker Lewis Index = 0.91). Phase 3 determined cut off scores of ≥ 28 (specificity = 91.97%), and ≥ 20 (specificity = 96.27%) in the respective exercise addiction and eating disorders sections of the SEAS. The respective sections also correlated well with the EAI (r = 0.70, p = < 0.001) and the SCOFF (r = 0.72, p = < 0.001). Phase 4 showed excellent test-retest reliability (exercise addiction r = 0.95, p = < 0.001, eating disorders r = 0.93, p = < 0.001). CONCLUSION The SEAS appears to be a valid and reliable tool for measuring primary and secondary exercise addiction. Further studies are warranted to further validate this tool amongst clinical populations. LEVEL OF EVIDENCE Level III: evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- M Trott
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, CB1 1PT, England. .,Vision and Eye Research Institute, Anglia Ruskin University, Young Street, Cambridge, England.
| | - J Johnstone
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, CB1 1PT, England
| | - D T McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, England
| | - A Mistry
- Cygnet Healthcare, Ealing, London, W5 2HT, England.,Royal College of Psychiatrists Sport and Exercise Special Interest Group, 21 Prescot Street, London, E1 8BB, England
| | - L Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, CB1 1PT, England
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22
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Colledge F, Meyer M. Exercise Addiction - Status, Identification and Treatment. PRAXIS 2022; 111:317-321. [PMID: 35473333 DOI: 10.1024/1661-8157/a003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The term "exercise addiction" has been used in the scientific literature since the late 1970s. It is used to refer to persistent excessive exercise despite negative physical, psychological and social consequences, with unsuccessful attempts to reduce or stop the behavior. In this article, the evidence for exercise addiction as a behavioral addiction is presented. Symptoms and psychiatric comorbidities are explained, and recommendations for identification and treatment of exercise addiction are presented.
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Affiliation(s)
- Flora Colledge
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Maximilian Meyer
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
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23
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Akbari M, Zamani E, Seydavi M, Griffiths MD, Pakpour AH. The Persian Exercise Addiction Inventory—Adult and Youth Versions: Psychometric Properties Based on Rasch Analysis Among Iranians. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00797-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Smith A, Broom D, Murphy M, Biddle S. A Manifesto for exercise science - a vision for improving the health of the public and planet. J Sports Sci 2022; 40:1110-1115. [PMID: 35262464 DOI: 10.1080/02640414.2022.2049083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this manifesto, we make the case that Exercise Science can and must do more to improve the health of the public and the planet. Post pandemic, our vision for Exercise Science is one of a maturing scientific discipline reaching outwards from a base of strong empirical evidence to have a profound and sustained positive global impact on health. In each of the three main areas of the discipline - research, teaching, and professional practice - a new and distinctive approach is needed. We propose 12 points of action, in no particular order, for a). quality, rigour, and professional standing, and b). reach, relevance, and public engagement and make numerous suggestions for action and change. We encourage the teachers, researchers and practitioners of Exercise Science to consider and act on these recommendations. We hope that this manifesto can help create a shared sense of purpose amongst the global Exercise Science community and further the principles of equality, diversity and inclusion. To act on these principles, we need to cultivate a discipline that encourages more women, people who experience racism and other forms of discrimination, and people with a disability to become involved in the discipline.
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Affiliation(s)
- Andy Smith
- Independent, Unaffiliated Sport and Exercise Scientist, UK
| | - David Broom
- Centre for Sport Exercise and Life Sciences, Coventry University, Coventry, UK
| | - Marie Murphy
- Doctoral College, Ulster University, Co. Antrim, Northern Ireland
| | - Stuart Biddle
- Centre for Health Research, University of Southern Queensland, Toowoomba, QL, Australia
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25
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Colledge F, Buchner U, Schmidt A, Wiesbeck G, Lang U, Pühse U, Gerber M, Walter M. Individuals at Risk of Exercise Addiction Have Higher Scores for Depression, ADHD, and Childhood Trauma. Front Sports Act Living 2022; 3:761844. [PMID: 35156014 PMCID: PMC8825800 DOI: 10.3389/fspor.2021.761844] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/22/2021] [Indexed: 12/16/2022] Open
Abstract
Background Exercise addiction is increasingly being recognized as a psychologically and physically burdensome set of symptoms. However, little is known about the psychiatric profiles of individuals who are at risk. It is well-established that individuals affected by substance use disorders frequently suffer from depression, attention deficit hyperactivity disorder (ADHD), and experiences of childhood trauma. The aim of this study is to determine whether this pattern of psychiatric disturbance is also present in individuals at risk for exercise addiction. Methods Individuals exercising for 10+ h/week were divided into those at risk and not at risk for exercise addiction based on their scores on the Exercise Dependence Scale (EDS). Demographic data and scores on the Beck Depression Inventory (BDI), a measure for ADHD in adults and the Childhood Trauma Questionnaire (CTQ) were also gathered. Results One hundred and twenty-three individuals agreed to participate in the study, and completed the questionnaires. Twenty-nine (23.6%) of these individuals were classed as at risk for exercise addiction. There was a statistically significant difference between the at-risk and not at-risk groups on the combined dependent variable after controlling for hours of exercise per week, F(3, 95)= 10.198, p = 0.00, Wilk's Λ = 0.756, partial η2 = 0.244. Compared to those not at risk, individuals at risk for exercise addiction had significantly higher scores for symptoms of depression [t(121) = 4.944, p = 0.000], ADHD [t(121) = 2.915, p = 0.004], and childhood trauma [t(121) = 2.297, p = 0.024]. Conclusion Our results suggest that exercise addiction may be accompanied by a disturbed psychiatric profile consistent with other addictive disorders. Clinical interviewing in individuals at risk for exercise addiction is a valuable and worthwhile next step in characterizing this phenomenon.
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Affiliation(s)
- Flora Colledge
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- *Correspondence: Flora Colledge
| | - Ursula Buchner
- Deutsche Hochschule für Gesundheit und Sport GmbH, Ismaning, Germany
| | - André Schmidt
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Gerhard Wiesbeck
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Undine Lang
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Marc Walter
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
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Ertl MM, Pazienza R, Cannon M, Cabrera Tineo YA, Fresquez CL, McDonough AK, Bozek DM, Ozmat EE, Ladouceur GM, Planz EK, Martin JL. Associations between Impulsivity and Exercise Addiction, Disordered Eating, and Alcohol Use Behaviors: A Latent Profile Analysis. Subst Use Misuse 2022; 57:886-896. [PMID: 35321617 PMCID: PMC9019863 DOI: 10.1080/10826084.2022.2052095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BackgroundDespite the known negative consequences of exercise addiction and preliminary evidence suggesting that it may co-occur with other health risk behaviors, no studies to date have examined exercise addiction among college students in conjunction with disordered eating behaviors and alcohol use. The aim of this study was to describe which college students are most at-risk for co-occurring health risk behaviors to enhance the efficiency of health risk prevention efforts. Method: Guided by multidimensional theories of impulsivity and substance use models of comorbidity, this study used latent profile analysis to examine whether separate, conceptually meaningful profiles of risk for exercise addiction, disordered eating behaviors, and alcohol use would emerge among 503 college students from a large public university. Results: The best-fitting model supported three profiles. MANOVA results revealed significant profile differences based on exercise addiction, binge eating, purging, laxative/pill/diuretic use, exercising longer than 60 minutes, negative urgency, and problematic alcohol use. Profile 3 students (n = 29), labeled the Affect Driven Health Risk-Takers, demonstrated the highest levels of impulsivity (i.e., negative urgency, lack of premeditation, lack of perseverance, and sensation seeking) and the most risk behaviors compared to the other two profiles. Profile membership was associated with distinct levels of negative urgency, exercise addiction, disordered eating behaviors, and problematic alcohol use. A small proportion of undergraduates demonstrated co-occurring exercise addiction, disordered eating behaviors, and problematic alcohol use. Profile membership also predicted the health outcomes of clinically significant exercise addiction and hazardous alcohol use. Conclusions: Findings illuminated how patterns of risk behavior engagement were associated with clinically significant exercise addiction and hazardous alcohol use and will inform prevention efforts and clinical interventions with at-risk college students.
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Affiliation(s)
- Melissa M Ertl
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA
| | - Rena Pazienza
- Clover Educational Consulting Group, Austin, Texas, USA
| | - Margeaux Cannon
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Yajaira A Cabrera Tineo
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Cara L Fresquez
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Alicia K McDonough
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Dana M Bozek
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Evan E Ozmat
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Guy M Ladouceur
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Emily K Planz
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
| | - Jessica L Martin
- Department of Educational and Counseling Psychology, University at Albany-State University of New York, Albany, New York, USA
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Patsalos O, Dalton B, Kyprianou C, Firth J, Shivappa N, Hébert JR, Schmidt U, Himmerich H. Nutrient Intake and Dietary Inflammatory Potential in Current and Recovered Anorexia Nervosa. Nutrients 2021; 13:nu13124400. [PMID: 34959952 PMCID: PMC8708616 DOI: 10.3390/nu13124400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023] Open
Abstract
Anorexia nervosa (AN) is characterised by disrupted and restrictive eating patterns. Recent investigations and meta-analyses have found altered concentrations of inflammatory markers in people with current AN. We aimed to assess nutrient intake in participants with current or recovered AN, as compared to healthy individuals, and explore group differences in dietary inflammatory potential as a possible explanation for the observed alterations in inflammatory markers. We recruited participants with current AN (n = 51), those recovered from AN (n = 23), and healthy controls (n = 49). We used the Food Frequency Questionnaire (FFQ), to calculate a Dietary Inflammatory Index (DII®) score and collected blood samples to measure serum concentrations of inflammatory markers. In current AN participants, we found lower intake of cholesterol, compared to HCs, and lower consumption of zinc and protein, compared to HC and recovered AN participants. A one-way ANOVA revealed no significant group differences in DII score. Multivariable regression analyses showed that DII scores were significantly associated with tumour necrosis factor (TNF)-α concentrations in our current AN sample. Our findings on nutrient intake are partially consistent with previous research. The lack of group differences in DII score, perhaps suggests that diet is not a key contributor to altered inflammatory marker concentrations in current and recovered AN. Future research would benefit from including larger samples and using multiple 24-h dietary recalls to assess dietary intake.
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Affiliation(s)
- Olivia Patsalos
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (B.D.); (C.K.); (U.S.); (H.H.)
- Correspondence:
| | - Bethan Dalton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (B.D.); (C.K.); (U.S.); (H.H.)
| | - Christia Kyprianou
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (B.D.); (C.K.); (U.S.); (H.H.)
| | - Joseph Firth
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK;
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M25 3BL, UK
| | - Nitin Shivappa
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (N.S.); (J.R.H.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - James R. Hébert
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (N.S.); (J.R.H.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (B.D.); (C.K.); (U.S.); (H.H.)
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (B.D.); (C.K.); (U.S.); (H.H.)
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
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Abstract
AbstractExercise addiction (EA) involves excessive concerns for exercise routines, an abusive practice, and the inability to control one’s own behavior, as well as the presence of psychological processes that are typical of behavioral addictions such as abstinence. EA is further associated with an alteration of the individual’s personal, social, and professional functioning and a higher risk for several pathologies, including physical injury, psychological distress, and eating disorders. The present work presents a narrative scoping review of the state of the art and the main findings of the research on EA, with a focus in the athletic population. The prevalence of EA risk, between 1 and 52% and up to 80% when co-occurring with eating disturbances, is also reviewed. Additionally, some of the explanatory models proposed to date and their power and limitations in terms of their capacity for a consensual operationalization and characterization of EA, and thus for the optimal exploration and management of this condition, are discussed. Finally, some deficiencies in the research on EA are noted which are to be addressed to successfully respond to the intervention and prevention needs that occur both in the general context of exercise-sports practice and the specific context of competitive athletes.
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Protective and Risk Factors in Exercise Addiction: A Series of Moderated Mediation Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189706. [PMID: 34574631 PMCID: PMC8467293 DOI: 10.3390/ijerph18189706] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
Abstract
For a minority of individuals, exercise may become excessive and lead to an addictive behaviour. To better understand the processes by which exercise could become an addiction, the present study examined the risk and protective factors of exercise addiction among regular exercisers, by investigating the role of drive for thinness, bulimia, body dissatisfaction, body image concerns, and self-esteem. A sample of 319 Italian regular exercisers (Mage = 30.78 years, SD = 11.98) completed the Italian versions of the Exercise Addiction Inventory, Eating Disorder Inventory-3 Referral Form, Body Image Concern Inventory, and Rosenberg Self-Esteem Scale. Data were analyzed by implementing a series of moderated mediations. Drive for thinness, bulimia, and body dissatisfaction were positively associated with exercise addiction. An indirect path was found in each of these relationships, which included the mediation of body image concerns, as well as a significant moderation of self-esteem in the associations between drive for thinness, bulimia, body dissatisfaction, and the mediator. High self-esteem appeared to be a protective factor. The higher the level of self-esteem, the less indirect the effects of thinness drive, bulimia, body dissatisfaction, and body image concerns were on exercise addiction. Such findings contribute to a better understanding concerning the risk and protective factors of excessive exercise, and may have important practical implications in structuring interventions to reduce risk of developing exercise addiction, as well as orienting future research.
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Godoy-Izquierdo D, Ramírez MJ, Díaz I, López-Mora C. A Systematic Review on Exercise Addiction and the Disordered Eating-Eating Disorders Continuum in the Competitive Sport Context. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00610-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractExercise addiction (EA) affects a considerable number of individuals who regularly perform exercise-sport activities. The co-occurrence of EA manifestations and the continuum of disordered eating-eating disorders (EDs) is so common in sports that a deeper understanding of them as comorbidities is warranted. The aim of this review is to provide an up-to-date overview and synthesis of the research on the relationship between maladaptive exercise and dysfunctional eating in the sport context. A systematic review was conducted following the PRISMA guidelines. A total of 22 empirical studies (23 articles) with young and adult female and male athletes from several sports and competition levels was included. EA in conjunction with eating disturbances is frequent among athletes, yet the prevalence rates are inconsistent. Existing evidence suggests that EA is a relevant outcome of ED pathology among athletes, supporting the classical secondary type of EA. However, research also reveals that excessive exercising plays a central role in the psychopathology of disordered eating. There is a need for further quantitative research addressing the features and correlates of the EA-EDs dyad, qualitative research on the subjective experiences of athletes with disordered exercise and eating, longitudinal and experimental research to establish possible causal paths and attempts to develop comprehensive conceptual models of EA and its co-occurrence with EDs, in order to improve the identification, prevention, and management of this dyadic condition in the sport context.
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31
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Mond J, Gorrell S. "Excessive exercise" in eating disorders research: problems of definition and perspective. Eat Weight Disord 2021; 26:1017-1020. [PMID: 33389704 PMCID: PMC8068596 DOI: 10.1007/s40519-020-01075-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia.,School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA.
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32
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Trott M, Johnstone J, Firth J, Grabovac I, McDermott D, Smith L. Prevalence and correlates of body dysmorphic disorder in health club users in the presence vs absence of eating disorder symptomology. Eat Weight Disord 2021; 26:1169-1177. [PMID: 32965636 DOI: 10.1007/s40519-020-01018-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Body dysmorphic disorder (BDD) has been consistently linked with eating disorders, however studies that stratify associations between BDD in subjects with and without eating disorder symptomology are sparse. It was, therefore, the aim of this study to assess correlates of BDD (including social media use, motivations for exercise, exercise addiction, and sexuality) stratified by eating disorder symptomology. METHODS Cross-sectional study of 1665 health club users recruited online completed a battery of surveys. BDD prevalence rates were calculated and logistic regression models were created in two sub-samples: indicated or no-indicated eating disorder symptomology. RESULTS The key findings showed the prevalence of BDD in participants with indicated-eating disorder symptomology was significantly higher than in participants without indicated-eating disorder symptomology, yielding an odds ratio of 12.23. Furthermore, several correlates were associated with BDD only participants with an absence of eating disorder symptomology (gender, BMI, exercise addiction, exercising for mood improvement, attractiveness and tone), with others being significantly associated with BDD in participants in the presence of indicated eating disorders symptomology (exercising for health and enjoyment, relationship status, and ethnicity). CONCLUSIONS This study provides more evidence of the complex relationship that exists between BDD and eating disorders. Furthermore, it is recommended that practitioners working with BDD subjects should screen for eating disorders due to the high morbidity associated with eating disorders. LEVEL OF EVIDENCE Level III: case-control analytic study.
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Affiliation(s)
- Mike Trott
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, CB1 1PT, UK.
| | - James Johnstone
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, CB1 1PT, UK
| | - Joe Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.,NICM Health Research Institute, Western Sydney University, Westmead, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Daragh McDermott
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Compass House, Cambridge, CB1 1PT, UK
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33
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Martenstyn JA, Touyz S, Maguire S. Treatment of compulsive exercise in eating disorders and muscle dysmorphia: protocol for a systematic review. J Eat Disord 2021; 9:19. [PMID: 33568203 PMCID: PMC7877054 DOI: 10.1186/s40337-021-00375-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/29/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Compulsive exercise is a core feature of both eating disorders and muscle dysmorphia. Earlier models of treatment recommended complete abstinence from exercise in eating disorder populations, but recent guidelines advocate for the gradual inclusion of healthier forms of exercise into an overall treatment plan where appropriate. Given the association between problematic exercise behaviour and poorer prognosis, there has been a recent upsurge in the number of treatment interventions for compulsive exercise in eating disorders. However, no systematic review has been published summarising this existing treatment literature. The aim of this review is to determine the efficacy of existing treatments for compulsive exercise in eating disorders and muscle dysmorphia. METHODS A systematic review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five electronic databases (PsycInfo, MEDLINE, Embase, Web of Science, and Scopus) will be searched from database inception until November 2020. We will include studies that: (a) sampled adolescents and/or adults with either an eating disorder or muscle dysmorphia; (b) assessed changes in compulsive exercise from pre- to post-intervention; and (c) used a standardised instrument to measure compulsive exercise or related constructs. We will include studies with a comparison group (e.g., randomised controlled trials) and without a comparison group (e.g., pilot studies and case studies) to provide a comprehensive overview of the literature. One reviewer will screen all titles and abstracts against eligibility criteria, with 20% of excluded articles cross-referenced by another reviewer. Full texts will be obtained for articles deemed relevant or where inclusion was uncertain, and will be screened by both reviewers. We will also evaluate the quality of the included studies using a modified Downs and Black (J Epidemiol Community Health 52:377-384, 1998) assessment checklist. DISCUSSION Results from this review will help to determine the most efficacious treatment components for compulsive exercise in eating disorders and muscle dysmorphia. We hope that our results will help inform clinical practice guidelines in recommending targeted interventions for the treatment of compulsive exercise.
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Affiliation(s)
- Jordan Andre Martenstyn
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia.
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia.
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, St Leonards, Australia
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Stockwell S, Trott M, Tully M, Shin J, Barnett Y, Butler L, McDermott D, Schuch F, Smith L. Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review. BMJ Open Sport Exerc Med 2021; 7:e000960. [PMID: 34192010 PMCID: PMC7852071 DOI: 10.1136/bmjsem-2020-000960] [Citation(s) in RCA: 621] [Impact Index Per Article: 207.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE In March 2020, several countries banned unnecessary outdoor activities during COVID-19, commonly called 'lockdowns. These lockdowns have the potential to impact associated levels of physical activity and sedentary behaviour. Given the numerous health outcomes associated with physical activity and sedentary behaviour, the aim of this review was to summarise literature that investigated differences in physical activity and sedentary behaviour before vs during the COVID-19 lockdown. DESIGN DATA SOURCES AND ELIGIBILITY CRITERIA Electronic databases were searched from November 2019 to October 2020 using terms and synonyms relating to physical activity, sedentary behaviour and COVID-19. The coprimary outcomes were changes in physical activity and/or sedentary behaviour captured via device-based measures or self-report tools. Risk of bias was measured using the Newcastle-Ottawa Scale. RESULTS Sixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions. CONCLUSION Given the numerous physical and mental benefits of increased physical activity and decreased sedentary behaviour, public health strategies should include the creation and implementation of interventions that promote safe physical activity and reduce sedentary behaviour should other lockdowns occur.
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Affiliation(s)
- Stephanie Stockwell
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University - Cambridge Campus, Cambridge, UK
| | - Mike Trott
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University - Cambridge Campus, Cambridge, UK
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - Mark Tully
- Institute of Mental Health Sciences, School of Health Sciences, University of Ulster, Newtownabbey, UK
| | - Jae Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Republic of Korea
| | - Yvonne Barnett
- Anglia Ruskin University - Cambridge Campus, Cambridge, UK
| | - Laurie Butler
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Daragh McDermott
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Felipe Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University - Cambridge Campus, Cambridge, UK
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de la Vega R, Almendros LJ, Barquín RR, Boros S, Demetrovics Z, Szabo A. Exercise Addiction During the COVID-19 Pandemic: an International Study Confirming the Need for Considering Passion and Perfectionism. Int J Ment Health Addict 2020; 20:1159-1170. [PMID: 33293905 PMCID: PMC7714253 DOI: 10.1007/s11469-020-00433-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/28/2022] Open
Abstract
Various levels of lockdown due to COVID-19 limit people's habitual physical activity. Individuals addicted to exercise, health-oriented, and team-exercisers could be the most affected. We examined the COVID-19-related changes in exercise volume in 1079 exercisers from eight Spanish-speaking nations based on exercise addiction categories, primary reasons for exercise, and forms of exercise. The COVID-19-related decrease in exercise volume was 49.24% in the sample. The proportion of the risk of exercise addiction was 15.2%. Most (81.7%) of the participants exercised for a health-related reason. These exercisers reported lesser decrease in their exercise volume than those exercising for social reasons. The risk of exercise addiction was inversely related to changes in exercise volume, but after controlling for passion and perfectionism the relationship vanished. The reported effect of COVID-19 on training did not differ between the exercise addiction groups. The findings also confirm that exercise addiction research should control for passion and perfectionism.
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Affiliation(s)
- Ricardo de la Vega
- Department of Physical Education, Sport and Human Movement, Autonomous University of Madrid, Madrid, Spain
| | - Lucia Jiménez Almendros
- Department of Physical Education, Sport and Human Movement, Autonomous University of Madrid, Madrid, Spain
| | - Roberto Ruíz Barquín
- Department of Developmental and Educational Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Szilvia Boros
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Bogdánfy u. 10/B, Budapest, 1117 Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Attila Szabo
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Bogdánfy u. 10/B, Budapest, 1117 Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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36
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Levallius J, Monell E, Birgegård A, Clinton D, Forsén Mantilla E. Binge Eating and Addictive-Like Behaviours in Males and Females. Psychol Rep 2020; 125:148-166. [PMID: 33174818 DOI: 10.1177/0033294120971750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Binge eating is a common behaviour that is strongly linked to both obesity and eating disorder. There is evidence that binge eating commonly co-occurs with other problematic and addictive-like behaviours; however, this has not been explored systematically. The present study aimed to examine the relationship between binge eating, body weight, disordered eating behaviours and associated addictive-like behaviours, with particular attention paid to gender differences. METHOD A community sample (N = 500; 75% female, Mage = 32.5 years) reported disordered eating behaviours (i.e. binge eating, purging, restriction of eating, compulsive exercise), body mass index (BMI), food addiction, starvation addiction, exercise dependence, tobacco use and alcohol consumption. RESULTS 42% of females and 21% of males reported binge eating during the past four weeks. Binge eating was significantly associated with all investigated behaviours in females, and with purging, compulsive exercise and overweight/obesity in males. Controlling for BMI, self-starvation predicted binge eating in males (OR = 1.07), while food addiction (OR = 1.73) and alcohol dependence (OR = 1.11) predicted binge eating in females. CONCLUSIONS The multiple associations between binge eating and addictive-like behaviors supports broad screening and generalized prevention efforts. Prevention efforts should reflect gender differences.
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Affiliation(s)
- Johanna Levallius
- Department of Medical Epidemiology and Biostatistics, Center for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden
| | - Elin Monell
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Center for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden
| | - David Clinton
- Department of Medical Epidemiology and Biostatistics, Center for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Institute for Eating Disorders, Oslo, Norway
| | - Emma Forsén Mantilla
- Department of Medical Epidemiology and Biostatistics, Center for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Leme ACB, Haines J, Tang L, Dunker KLL, Philippi ST, Fisberg M, Ferrari GL, Fisberg RM. Impact of Strategies for Preventing Obesity and Risk Factors for Eating Disorders among Adolescents: A Systematic Review. Nutrients 2020; 12:nu12103134. [PMID: 33066501 PMCID: PMC7602154 DOI: 10.3390/nu12103134] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023] Open
Abstract
An effective behavior change program is the first line of prevention for youth obesity. However, effectiveness in prevention of adolescent obesity requires several approaches, with special attention paid to disordered eating behaviors and psychological support, among other environmental factors. The aim of this systematic review is to compare the impact of two types of obesity prevention programs, inclusive of behavior change components, on weight outcomes. "Energy-balance" studies are aimed at reducing calories from high-energy sources and increasing physical activity (PA) levels, while "shared risk factors for obesity and eating disorders" focus on reducing disordered eating behaviors to promote a positive food and eating relationship. A systematic search of ProQuest, PubMed, PsycInfo, SciELO, and Web of Science identified 8825 articles. Thirty-five studies were included in the review, of which 20 regarded "energy-balance" and 15 "shared risk factors for obesity and eating disorders". "Energy-balance" studies were unable to support maintenance weight status, diet, and PA. "Shared risk factors for obesity and eating disorders" programs also did not result in significant differences in weight status over time. However, the majority of "shared risk factors for obesity and eating disorders" studies demonstrated reduced body dissatisfaction, dieting, and weight-control behaviors. Research is needed to examine how a shared risk factor approach can address both obesity and eating disorders.
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Affiliation(s)
- Ana Carolina B. Leme
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
- Correspondence:
| | - Jess Haines
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
| | - Lisa Tang
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
| | - Karin L. L. Dunker
- Department of Psychiatric, Federal University of São Paulo, São Paulo 04038-000, Brazil;
| | - Sonia T. Philippi
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
| | - Mauro Fisberg
- Nutrition and Feeding Difficulties Excellence Center, PENSI Institute, Sabará Children’s Hospital, São Paulo 01228-200, Brazil;
- Department of Pediatrics, Escola Paulista, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Gerson L. Ferrari
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320000, Chile;
| | - Regina M. Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
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Trott M, Yang L, Jackson SE, Firth J, Gillvray C, Stubbs B, Smith L. Prevalence and Correlates of Exercise Addiction in the Presence vs. Absence of Indicated Eating Disorders. Front Sports Act Living 2020; 2:84. [PMID: 33345075 PMCID: PMC7739814 DOI: 10.3389/fspor.2020.00084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Abstract
Despite the many benefits of regular, sustained exercise, there is evidence that exercise can become addictive, to the point where the exerciser experiences negative physiological and psychological symptoms, including withdrawal symptoms upon cessation, training through injury, and the detriment of social relationships. Furthermore, recent evidence suggests that the etiology of exercise addiction is different depending on the presence or absence of eating disorders. The aim of this study was to explore to what extent eating disorder status, body dysmorphic disorder, reasons for exercise, social media use, and fitness instructor status were associated with exercise addiction, and to determine differences according to eating disorder status. The key findings showed that the etiology of exercise addiction differed according to eating disorder status, with variables including social media use, exercise motivation, and ethnicity being uniquely correlated with exercise addiction only in populations with indicated eating disorders. Furthermore, body dysmorphic disorder was highly prevalent in subjects without indicated eating disorders, and could be a primary condition in which exercise addiction is a symptom. It is recommended that clinicians and practitioners working with patients who present with symptoms of exercise addiction should be screened for eating disorders and body dysmorphic disorder before treatments are considered.
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Affiliation(s)
- Mike Trott
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, AB, Canada.,Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.,NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Claire Gillvray
- Cognitive Sports Therapy, Cambridge, United Kingdom.,Cambridge Private Doctors, Nuffield Hospital, Cambridge, United Kingdom.,RC Psych Sports and Exercise Psychiatry Special Interest Group, London, United Kingdom
| | - Brendon Stubbs
- Positive Ageing Research Institute (PARI), Anglia Ruskin University, Cambridge, United Kingdom.,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
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