An evaluation of efficacy and acceptability of a novel manualised JuniorLEAP group programme for compulsive exercise, for children and adolescents with anorexia nervosa, within an inpatient setting

Abstract

Purpose

Compulsive exercise is a symptom and a maintenance factor of eating disorders, which increases the risk of relapse. It has been considered a target for treatment, particularly for anorexia nervosa (AN). This audit aims to review the efficacy and acceptability of a new seven-week JuniorLEAP group therapy programme, for children and adolescents with anorexia nervosa. JuniorLEAP was adapted by the authors and based on the Loughborough Eating Disorder Activity Programme (LEAP) for adults.

Methods

32 children and adolescents with anorexia nervosa were allocated to the group in an in-patient setting using entry criteria. All children and adolescents completed seven weekly sessions of the JuniorLEAP programme, as well as pre- and post-treatment questionnaires, including the Eating Disorder Examination Questionnaire (EDE-Q) and the Compulsive Exercise Test (CET). The children and adolescents were also asked to provide qualitative responses about the acceptability of the group. A paired t test was conducted to review the efficacy of the JuniorLEAP programme.

Results

Significant changes in eating disorder psychopathology was observed, as measured by the EDE-Q, with total mean scores reducing from 3.53 to 2.77 (p = 0.001). Compulsive exercise attitudes were also observed to reduce, as measured by the CET, with total mean scores reducing from 15.39 to 10.90 (p ≤ 0.001). Furthermore, there was a significant reduction in all five subscales of the CET following completion of the group. Qualitative results also demonstrate the group to be acceptable to the patients.

Conclusion

This study finds that a new manualised JuniorLEAP group therapy, specifically adapted for adolescents and children with AN, when used as an adjuvant with other therapies in a residential setting, significantly reduces their compulsive exercise, as measured by CET. The patients reported that the treatment was acceptable. Further research testing the new treatment in a randomised controlled trial is now needed, particularly to disentangle the impact of other aspects of standard treatment in reducing compulsive exercise.

Level of evidence

II.

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Acknowledgements

The authors would like to thank Caroline Meyer for generously sharing her manual with us and supporting this project. We would also like to thank the children and adolescents who attended the JuniorLEAP group and acknowledge support and contributions from colleagues, including Philippa McQuilton and Emma Giles.

Funding

Funding was provided by Schoen-UK in the form of time by the authors. Additional small sums were paid for incidentals.

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Correspondence to Hubert Lacey.

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The authors declare there are no conflict of interest.

Ethical approval

All procedures in this study were in accordance with the ethical standards of Newbridge House Research & Ethics Committee and have been performed with the ethical standards as laid down by the 1964 Declaration of Helsinki. The West Midlands-Black Country NHS Ethics Committee did not consider formal ethics were required because this was a paper-based study on therapy routinely provided for every patient.

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Prior written informed consent was gained from all patients and their parents.

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Mang, L., Garghan, A., Grant, J. et al. An evaluation of efficacy and acceptability of a novel manualised JuniorLEAP group programme for compulsive exercise, for children and adolescents with anorexia nervosa, within an inpatient setting. Eat Weight Disord 26, 591–597 (2021). https://doi.org/10.1007/s40519-020-00884-w

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Keywords

  • Compulsive exercise
  • Adolescents
  • Eating disorders
  • Anorexia nervosa
  • Group therapy