Effect of dronabinol therapy on physical activity in anorexia nervosa: a randomised, controlled trial
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The level of physical activity is inappropriately high in up to 80 % of the patients suffering of anorexia nervosa (AN), as a result of conscious efforts to lose weight, affect regulation and biological adaptive changes to starvation induced by hypothermia and neuroendocrine mechanisms. The purposes of this paper were to (1) assess the effect of dronabinol—a synthetic cannabinoid agonist—on physical activity in patients with chronic and stable AN, and to (2) unravel the role of leptin and cortisol in this process.
This prospective, randomised, double-blind, crossover study was conducted at a specialised care centre for eating disorders. Twenty-four adult women with AN of at least 5-year duration received either the dronabinol-placebo or placebo-dronabinol sequence. Physical activity was monitored during the fourth week of each intervention. Body weight, leptin and urinary free cortisol excretion were measured repeatedly during the trial. Changes in behavioural dimensions related to AN were assessed by Eating Disorder Inventory-2.
The total duration of physical activity did not change, while its average intensity increased by 20 % (P = 0.01) during dronabinol therapy, resulting in an increased energy expenditure with 68.2 kcal/day (P = 0.01) above placebo.
This randomised, double-blind study revealed that cannabinoid agonist treatment was associated with a modest increase in physical activity in adult women with severe and longstanding AN. Additionally, we detected a strong relationship between the circulating levels of leptin and physical activity in these chronically undernourished patients.
KeywordsAnorexia nervosa Physical activity Urinary free cortisol Leptin Dronabinol
We thank the patients who participated in the trial; Charlotte Olsen, Lone Hansen and Merete Møller are thanked for helping with collecting samples and the leptin measurements. We would like to kindly thank to the team at the Department of Exercise epidemiology, University of Southern Denmark who developed the software Propero used for compiling accelerometer data. Claire Gudex is thanked for language editing of the manuscript.
Conflict of interest
- 5.Bratland-Sanda S, Sundgot-Borgen J, Ro O, Rosenvinge JH, Hoffart A, Martinsen EW (2010) Physical activity and exercise dependence during inpatient treatment of longstanding eating disorders: an exploratory study of excessive and non-excessive exercisers. Int J Eat Disord 43(3):266–273. doi: 10.1002/eat.20769 PubMedGoogle Scholar
- 12.Focker M, Timmesfeld N, Scherag S, Buhren K, Langkamp M, Dempfle A, Sheridan EM, de Zwaan M, Fleischhaker C, Herzog W, Egberts K, Zipfel S, Herpertz-Dahlmann B, Hebebrand J (2011) Screening for anorexia nervosa via measurement of serum leptin levels. J Neural Transm 118(4):571–578. doi: 10.1007/s00702-010-0551-z CrossRefPubMedGoogle Scholar
- 14.Holtkamp K, Herpertz-Dahlmann B, Mika C, Heer M, Heussen N, Fichter M, Herpertz S, Senf W, Blum WF, Schweiger U, Warnke A, Ballauff A, Remschmidt H, Hebebrand J (2003) Elevated physical activity and low leptin levels co-occur in patients with anorexia nervosa. J Clin Endocrinol Metab 88(11):5169–5174CrossRefPubMedGoogle Scholar
- 16.Pi-Sunyer FX, Aronne LJ, Heshmati HM, Devin J, Rosenstock J (2006) Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial. JAMA J Am Med Assoc 295(7):761–775CrossRefGoogle Scholar
- 29.Garner DM (1991) Eating Disorder Inventory-2: professional manual. Psychological Assessment Resources, Inc., Odessa, FLGoogle Scholar
- 32.Practice guideline for the treatment of patients with eating disorders (revision). American Psychiatric Association Work Group on Eating Disorders. Am J Psychiatry 157(1 Suppl):1–39Google Scholar
- 42.Bissada H, Tasca GA, Barber AM, Bradwejn J (2008) Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry 165(10):1281–1288. doi: 10.1176/appi.ajp.2008.07121900 CrossRefPubMedGoogle Scholar