An investigation of the process of change in psychopathology and exercise during inpatient treatment for adults with longstanding eating disorders

Recovery Trajectories in Adolescent Girls with Anorexia Nervosa

Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p < 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.

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

BACKGROUND

Unhealthy attitudes towards sport and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg sport therapy program for eating disorders (FSTP).

METHODS

Outpatients with ED were randomized either to a 3 month sport therapy program (sport therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale, CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive Exercise Test, CET subscales) and exercise quantity (accelerometer).

RESULTS

Recruitment was challenging. Fifteen patients were randomized to the STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG. Improvements (STG) were maintained at follow up.

CONCLUSIONS

There was no statistically significant difference in the reduction of unhealthy attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale. Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major limitation is the small sample size.

TRIAL REGISTRATION

Study register: ISRCTN 14776348 (registered 26 January, 2015.