Physical activity behaviors and attitudes among women with an eating disorder: a qualitative study

Longitudinal description and prediction of physical inactivity among patients with borderline personality disorder and personality-disordered comparison subjects

BACKGROUND

The physical and psychological benefits of physical activity are well-known, and physical activity has been proven to be a helpful adjunct to psychotherapeutic treatment for many symptomatic disorders, including mood and anxiety disorders. The current study explores physical inactivity levels in patients with borderline personality disorder (BPD). The first aim of this study is to describe the 12-year course of physical inactivity in patients with BPD. The second aim is to examine predictors of physical inactivity, including adversity experiences, comorbid symptomatic (formerly axis I) disorders, medical disorders, and demographic factors.

METHODS

Two hundred and forty-five patients with BPD were interviewed seven times over 12-years of prospective follow-up as part of the McLean Study of Adult Development (MSAD). Patients were categorized as ever-recovered (i.e., patient had experienced a symptomatic and psychosocial recovery from BPD) or never-recovered. At each follow-up, patients reported physical activity levels (minutes of exercise per week) via a semi-structured interview- the Medical History and Services Utilization Interview (MHSUI). Data was collected from June 1992 to December 2018.

RESULTS

Never-recovered patients with BPD were significantly more inactive than their ever-recovered counterparts (p < 0.001). These rates of inactivity remained stable over time for both groups. Two significant multivariate predictors of inactivity were found: obesity (p = 0.003) and PTSD (p < 0.001).

CONCLUSIONS

Non-recovered BPD patients are more likely to be inactive than patients who have recovered. Both clinical and medical factors appear to contribute to inactivity levels in patients with BPD.

How to address physical activity and exercise during treatment from eating disorders: a scoping review

PURPOSE OF REVIEW

This scoping review aimed to provide a recent update on how to address dysfunctional physical activity and exercise (DEx), and on effects and experiences from including supervised and adapted physical activity or exercise (PAE), during treatment of eating disorders.

RECENT FINDINGS

A systematic search for peer-reviewed publications in the period 2021-2023 generated 10 original studies and 6 reviews, including one meta-analysis (reporting according to PRISMA and SWiM). Findings showed that DEx was effectively managed by use of psychoeducation and/or PAE. Inclusion of PAE as part of treatment showed low-to-moderate impact on health and positive or neutral effects on eating disorder psychopathology. There were no reports of adverse events. For individuals with anorexia nervosa, PAE improved physical fitness with no influence on body weight or body composition unless progressive resistance training was conducted. For individuals with bulimia nervosa, DEx was reduced simultaneously with increased functional exercise and successful implementation of physical activity recommendations during treatment. Experiences by individuals with eating disorders and clinicians, including accredited exercise physiologists, pointed to positive benefits by including PAE in treatment.

SUMMARY

Lack of consensus about DEx and of recommendations for PAE in official treatment guidelines hinder adequate approaches to these issues in eating disorder treatment.

Learned industriousness as a translational mechanism in anorexia nervosa

It remains unexplained why some behaviours persist despite being non-hedonic and ostensibly aversive. This phenomenon is especially baffling when such behaviours are taken to excess in the form of psychopathology. Anorexia nervosa is one psychiatric disorder in which effortful behaviours that most people find unpleasant (suchas restrictive eating) are persistently performed. We propose thatthe social psychology theory of learned industriousness providesa novel mechanistic account for such phenomena. This theoryposits that high-effort behaviour can be conditioned to acquire secondary reinforcing properties through repeated pairing with reward. Accordingly, effort sensations become less aversive andmore appetitive, increasing willingness to engage in effortful behaviour. In this Perspective, we review pre-clinical behaviouraland biological data that support learned industriousness, contrast learned industriousness with other models of non-hedonic persistence (such as habit learning), highlight evidence that supports learned industriousness in individuals with anorexia nervosa and consider implications of the model, including translation to other psychiatric presentations.

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

BACKGROUND

Compulsive exercise (CE) has been proposed as one of the maladaptive elements that might concur to developing and maintaining an eating disorder (ED), even if no conclusive consensus is yet available. This study evaluates the psychometric properties of the Compulsive Exercise Test (CET), the questionnaire most frequently discussed in the literature. Our second aim is to evaluate the relationships between CE, quality of life, and different body concerns in a group of individuals.

METHODS

Two different studies are performed. In the first study, we evaluate the psychometric properties of the Italian CET with a sample of 272 individuals (157 with different diagnoses of ED). In the second study, a group of 75 ED patients is compared to 68 of their peers looking for specific differences and relationships between CE, quality of life, and body concerns.

RESULTS

The CET shows optimal psychometric proprieties, and a five-factors structure. CE is linked to more severe specific psychopathology in ED patients, including increased thoughts of restraint and concerns about weight and shape. Moreover, weight phobia and quality of life are predictors of CE in patients.

CONCLUSION

The specific role of CE is discussed according to its connections with a core psychopathological element like weight phobia. Specific profiles of CE emerged for each clinical subgroup, and they corroborate the presence of different cognitive/physical approach to exercise. The CE showed to be a dysfunctional element with a disruptive role in patients' quality of life. Future directions and possible applications of the CET are also discussed.

What my body looks like and what my body can do: A self-perception explanation of excessive exercise in young adults with anorexia and/or bulimia

The present study examined the relationships between quantitative and qualitative dimensions of excessive exercise (EE) with the physical self-perception’s dimensions and perceptual perspectives of body image (i.e., allocentric/3rd person and egocentric/1st person perspectives). The eLoriCorps Immersive Body Rating Scale 1.1, the very short form version of the Physical Self-Inventory and the Exercise and Eating Disorder test were used. The study includes 36 people with anorexia and/or bulimia seeking an external and specialized transdisciplinary program for eating disorders. Results show a different correlational profile of physical self-perceptions depending on the dimension (qualitative or quantitative) used to define EE. Differences in the perspectives used to assess body dissatisfaction (allocentric or egocentric) were also found. Perceived physical appearance was the key predictor of the qualitative dimension of excessive exercise. Findings suggest that EE in patients with an eating disorder could be explained by the feeling of competence not only related to physical appearance but also to physical abilities.

Inpatient Rehabilitation during Intensive Refeeding in Severe Anorexia Nervosa

Severe forms of anorexia nervosa are responsible for weight loss and life-threatening consequences. Refeeding represents a real psychiatric and somatic challenge. Physical activities are usually not recommended during intensive refeeding in order to avoid energy expenditure. This study assessed the interest in an early return to controlled physical activities, during a hospitalization in a Physical Medicine and Rehabilitation (PMR) department, including continuous nasogastric refeeding and psychiatric care. A total of 37 subjects aged 32 ± 11 years old performed inpatient physical activities during nasogastric refeeding initiated after intensive care. The physical activity program was adapted according to the hyperactivity of the patients. Evaluation parameters were weight, body mass index (BMI), body composition (fat, lean, and bone masses), and function (strength, balance, walking, ventilation). Patient satisfaction, re-hospitalizations, and physical activities continuation were assessed at 12 months of follow-up. Weight, BMI, and body fat increased significantly (+2.7 ± 1.7 kg; +1.0 ± 0.6 kg/m²; +1.7 ± 2.5 kg, respectively). Muscle strength increased even if the lean mass did not. Walking distance, balance, and respiratory function were significantly improved. Weight and fat mass gains did not differ according to the presence or absence of hyperactivity. At 12 months, 46% of the patients continued to be physically active, but 21% of the patients had been re-hospitalized. The early return to controlled physical activities in PMR hospitalization does not compromise the efficiency of intensive refeeding in severe anorexia nervosa patients.

Consumer Knowledge and Acceptance of "Algae" as a Protein Alternative: A UK-Based Qualitative Study

Overconsumption of meat has been recognised as a key contributing factor to the climate emergency. Algae (including macroalgae and microalgae) are a nutritious and sustainable food source that may be utilised as an alternative to animal-based proteins. However, little is known about the consumer awareness and acceptance of algae as a protein alternative. The aim of this qualitative study was to develop a rich and contextualised understanding of consumer beliefs about the use of algae in novel and innovative food products. A total of 34 participants from the UK assisted with our study. Each participant engaged in one focus group, with six focus groups conducted in total. Existing consumer knowledge of algae was discussed before participants explored the idea of algae-based food products. Reflexive (inductive) thematic analysis was used to analyse these data. Results showed that consumers have limited pre-existing knowledge of algae as a food source; however, participants were open to the idea of trying to consume algae. This anticipated acceptance of algae was influenced by several product attributes, including perceived novelty, edibility, healthiness, sustainability, and affordability. These findings highlight algae as a promising protein alternative to support plant-forward diets in the UK and identify key attributes to consider in future product development and marketing strategies.

Orthorexia Nervosa and Disordered Eating Attitudes, Self-Esteem and Physical Activity among Young Adults

A relation between Orthorexia Nervosa (ON) and increased frequency of physical activity has been put in evidence by recent studies. It is well known that intense physical exercises are typically related to eating disorders, but its relationship with ON is still a subject of debate. Other transdiagnostic features could be necessary to conceptualize and understand ON; in this way, low self-esteem is related to eating behavior but is not still extensively investigated in ON, and, to date, data are so heterogeneous that they do not allow us to understand if this is a psychological feature somehow associated with ON. The current study aimed to assess whether disordered eating attitudes, self-esteem, and physical activity are associated with ON in young adults from Poland and Italy. Moreover, we investigated the differences by comparing lower and higher ON levels related to disordered eating attitudes, self-esteem, and physical activity. Our results indicated that a great concern about dieting significantly predicted problems associated with healthy eating, knowledge about healthy eating, and feeling positive about healthy eating. In addition, young adults with a high level of ON demonstrated higher levels of disordered eating attitudes and vigorous-intensity physical activity than young adults with a low level of ON. Future studies are needed to assess the direct effect of physical activity and self-esteem on ON.

Relationship between Negative Running Addiction and Eating Disorder Patterns in Runners

Current studies show an increase in the risk of eating disorders in runners. Since it is known that abusive exercise can be both a cause and a consequence of such developments, the main objective of the present study was to examine the risk and possible relationships between negative running addiction (NRA), as measured by the reduced and validated SAS-40 scale, and the tendency to be a compulsive eater (measured by YFAS 2.0), anorexia nervosa (AN), and/or bulimia nervosa (BN) (measured by EAT-40). This study highlights the novelty of researching the level of influence of NRA on each defined eating disorder.

METHOD

A total of 167 Spanish-speaking federated runners in cross-country and track running (42% women and 58% men), with an average age of 24 years and an average BMI of 21 kg/m2, responded to an online questionnaire that asked about sociodemographic data and the Spanish versions of the SAS-40, YFAS 2, YFAS 3, and YFAS 4. Through a quantitative methodology using logistic regressions-the coefficient of determination and Pearson's correlation coefficient-we created a sample analysis that related the significant items of the DSM-V to the results of the questionnaires administered, as well as their relationship with the practice of the sport in question and various variables of the environment.

RESULTS

The rates of CE, AN, and BN were 65, 11.4, and 16.2%, respectively. The tendency towards CE increased with a lower weight (r = 0.156, p < 0.05), not having been overweight in childhood (r = 0.151, p < 0.05), and being a long-distance runner (r = 0.123 p < 0.05). The risk of AN increased with the absence of menstruation for more than 3 months (r = 0.271 p < 0.01), having suffered from childhood obesity (r = 0.213 p < 0.05), and being underweight (r = 0.064 p < 0.05). The risk of BN increased with having suffered from childhood obesity (r = 0.194 p < 0.05), having a higher weight (r = 0.140, p < 0.05), and practicing athletics, especially the relay modality (r = 0.044 p < 0.05).

CONCLUSIONS

A considerable number of runners are at risk of suffering from some type of eating disorder. A significant relationship was observed between long-distance runners and the risk of eating disorders (AN, BN, and CE), and the association is stronger for CE than for AN and BN. Lastly, childhood experiences (such as being obese/a healthy weight) were notorious for increasing the risk of eating disorders. Further studies are needed to research each particular parameter and the relationships between the possible levels of dependence on exercise.

LEVEL OF EVIDENCE

Level III, cohort analytic study.