Physical activity in treatment units for eating disorders: Clinical practice and attitudes

  • S. Bratland-Sanda
  • J. H. RosenvingeEmail author
  • K. A. R. Vrabel
  • C. Norring
  • J. Sundgot-Borgen
  • Ø. Rø
  • E. W. Martinsen
Original Research Paper


Objective: Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders. Methods: Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire. Results: In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED. Conclusion: PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED.

Key words

Eating disorders physical activity exercise treatment clinical practice 


  1. 1.
    Caspersen C.J., Powell K.E., Christenson G.M.: Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep., 100, 126–131, 1985.PubMedCentralPubMedGoogle Scholar
  2. 2.
    Haskell W.L., Lee I.M., Pate R.R., Powell K.E., Blair S.N., Franklin B.A., Macera C.A., Heath G.W., Thompson P.D., Bauman A.: Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci. Sports Exerc., 39, 1423–1434, 2007.PubMedCrossRefGoogle Scholar
  3. 3.
    Martinsen E.W.: Exercise and depression. Int. J. Sport Exerc. Psychol., 4, 469–483, 2005.CrossRefGoogle Scholar
  4. 4.
    Meyer T., Broocks A.: Therapeutic impact of exercise on psychiatric diseases: guidelines for exercise testing and prescription. Sports Med., 30, 269–279, 2000.PubMedCrossRefGoogle Scholar
  5. 5.
    Sundgot-Borgen J., Rosenvinge J.H., Bahr R., Schneider L.S.: The effect of exercise, cognitive therapy, and nutritional counselling in treating bulimia nervosa. Med. Sci. Sports Exerc., 34, 190–195, 2002.PubMedCrossRefGoogle Scholar
  6. 6.
    Fossati M., Amati F., Painot D., Reiner M., Haenni C., Golay A.: Cognitive-behavioral therapy with simultaneous nutritional and physical activity education in obese patients with binge eating disorder. Eat. Weight Disord., 9, 134–138, 2004.PubMedCrossRefGoogle Scholar
  7. 7.
    Levine M.D., Marcus M.D., Moulton P.: Exercise in the treatment of binge eating disorder. Int. J Eat. Disord., 19, 171–177, 1996.PubMedCrossRefGoogle Scholar
  8. 8.
    Pendleton V.R., Goodrick G.K., Poston W.S., Reeves R.S., Foreyt J.P.: Exercise augments the effects of cognitive- behavioral therapy in the treatment of binge eating. Int. J Eat. Disord., 31, 172–184, 2002.CrossRefGoogle Scholar
  9. 9.
    Duesund L., Skårderud F.: Use the body and forget the body: treating anorexia nervosa with adapted physical activity. Clin. Child. Psychol. Psychiatry, 8, 53–72, 2003.CrossRefGoogle Scholar
  10. 10.
    Tokumura M., Yoshiba S., Tanaka T., Nanri S., Watanabe H.: Prescribed exercise training improves exercise capacity of convalescent children and adolescents with anorexia nervosa. Eur. J Pediatr., 162, 430–431, 2003.PubMedGoogle Scholar
  11. 11.
    Thien V., Thomas A., Markin D., Birmingham C.L.: Pilot study of a graded exercise program for the treatment of anorexia nervosa. Int. J. Eat. Disord., 28, 101–106, 2000.PubMedCrossRefGoogle Scholar
  12. 12.
    Carraro A., Cognolato S., Bernardis A.L.F.: Evaluation of a programme of adapted physical activity for ED patients. Eat.Weight Disord., 3, 110–114, 1998.PubMedCrossRefGoogle Scholar
  13. 13.
    Szabo C.P., Green K.: Hospitalized anorexics and resistance training; Impact on body composition and psychological well-being. A preliminary study. Eat. Weight Disord., 7, 293–297, 2002.PubMedCrossRefGoogle Scholar
  14. 14.
    American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Wasington, DC, APA, 1994.Google Scholar
  15. 15.
    World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva, WHO, 1993.Google Scholar
  16. 16.
    Kron L., Katz J.L., Gorzynski G., Weiner H.: Hyperactivity in anorexia nervosa: a fundamental clinical feature. Compr. Psychiatry, 19, 433–440, 1978.PubMedCrossRefGoogle Scholar
  17. 17.
    Vansteelandt K., Pieters G., Vandereycken W., Claes L., Probst M., Van Mechelen I.: Hyperactivity in anorexia nervosa: a case study using experience sampling methodology. Eat. Behav., 5, 67–74, 2004.PubMedCrossRefGoogle Scholar
  18. 18.
    Holtkamp K., Hebebrand J., Herpertz-Dahlmann B.: The contribution of anxiety and food restriction on physical activity levels in acute anorexia nervosa. Int. J. Eat. Disord., 36, 163–171, 2004.CrossRefGoogle Scholar
  19. 19.
    Solenberger S.E.: Exercise and eating disorders: a 3- year inpatient hospital record analysis. Eat. Behav., 2, 151–168, 2001.PubMedCrossRefGoogle Scholar
  20. 20.
    Brewerton T.D., Stellefson E.J., Hibbs N., Hodges E.L., Cochrane C.E.: Comparison of eating disorder patients with and without compulsive exercising. Int. J. Eat. Disord., 17, 413–416, 1995.CrossRefGoogle Scholar
  21. 21.
    Kaye W.H., Gwirtsman H., Ebert G.T., Peterson R.: Caloric consumption and activity levels after weight recovery in anorexia nervosa: a prolonged delay in normalization. Int. J. Eat. Disord., 5, 489–502, 1986.CrossRefGoogle Scholar
  22. 22.
    Davis C., Woodside D.B., Olmsted M.P., Kaptein S.: Psychopathology in the eating disorders: the influence of physical activity. J. Appl. Biobehav. Res., 4, 139–156, 1999.CrossRefGoogle Scholar
  23. 23.
    Ro O., Martinsen E.W., Rosenvinge, J.H.: [Treatment of bulimia nervosa—results from Modum Bads Nervesanatorium]. Tidsskr. Nor Laegeforen., 122, 260–265, 2002.PubMedGoogle Scholar
  24. 24.
    Adkins E.C., Keel P.K.: Does “excessive” or “compulsive” best describe exercise as a symptom of bulimia nervosa? Int. J. Eat. Disord., 38, 24–29, 2005.PubMedCrossRefGoogle Scholar
  25. 25.
    Bamber D., Cockerill I.M., Rodgers S., Carroll D.: “It’s exercise or nothing”: a qualitative analysis of exercise dependence. Br. J. Sports Med., 34, 423–430, 2000.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Mond J.M., Hay P.J., Rodgers B., Owen C.: An update on the definition of “excessive exercise” in eating disorders research. Int. J. Eat. Disord., 39, 147–153, 2006.PubMedCrossRefGoogle Scholar
  27. 27.
    Hausenblas H.A., Symons Downs, D.: Exercise dependence: a systematic review. Psychol. Sports Exerc., 3, 89–123, 2002.CrossRefGoogle Scholar
  28. 28.
    Ng B., Maginot K.R.: Sudden cardiac death in young athletes: trying to find the needle in the haystack. W.M.J., 106, 335–342, 2007.Google Scholar
  29. 29.
    Long C., Hollin C.R.: Assessment and management of eating disordered patient who over-exercise: a fouryear follow-up of six single case studies. J. Mental Health, 4, 309–316, 1995.CrossRefGoogle Scholar
  30. 30.
    Long C., Smith J.: Treatment of compulsive over-exercising in anorexia nervosa: a case study. Behav. Psychother., 18, 295–306, 1990.CrossRefGoogle Scholar
  31. 31.
    Calogero R.M., Pedrotty K.N.: The practice and process of healthy exercise: an investigation of the treatment of exercise abuse in women with eating disorders. Eat. Disord., 12, 273–291, 2004.PubMedCrossRefGoogle Scholar
  32. 32.
    Hechler T., Beumont P., Marks P., Touyz S.: How do clinical specialists understand the role of physical activity in eating disorders? Eur. Eat. Disorders Rev., 13, 125–132, 2005.CrossRefGoogle Scholar
  33. 33.
    Davies S., Parekh K., Etelapaa K., Wood D., Jaffa T.: The inpatient management of physical activity in young people with anorexia nervosa. Eur. Eat. Disord. Rev., 16, 334–340, 2008.PubMedCrossRefGoogle Scholar

Copyright information

© Editrice Kurtis 2009

Authors and Affiliations

  • S. Bratland-Sanda
    • 1
    • 2
  • J. H. Rosenvinge
    • 3
    Email author
  • K. A. R. Vrabel
    • 1
  • C. Norring
    • 4
    • 7
  • J. Sundgot-Borgen
    • 2
  • Ø. Rø
    • 1
  • E. W. Martinsen
    • 5
    • 6
  1. 1.Research InstituteModum Bad Psychiatric CentreVikersundNorway
  2. 2.Department of Sports MedicineNorwegian School of Sports SciencesOsloNorway
  3. 3.Department of PsychologyUniversity of TromsøTromsøNorway
  4. 4.Department of Behavioural, Social and Legal Sciences (Psychology)Örebro UniversityStokholmSweden
  5. 5.Institute of PsychiatryUniversity of OsloNorway
  6. 6.Clinic and Mental HealthAker University HospitalOsloNorway
  7. 7.Stockholm Centre for Eating DisordersStokholmSweden

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