Management of Over Activity and Compulsive Exercise in the Treatment of People with Eating Disorders

  • Yvonne Swainson
  • Sandra Philip-RaffertyEmail author


  • The so-called ‘eating disorders’ are in fact disorders of compulsive weight losing, or body image shaping. Pursuit of physical activity to burn calories or build muscle is as fundamental and characteristic as better known features such as food restriction and purging behaviours.

  • Over exercise and over activity are powerful in maintaining an eating disorder. People who continue to over exercise have poorer prognosis

  • At healthy weight, healthy levels of activity confer many benefits, but if the balance is lost between activity and nutritional status, or if activity becomes compulsive, there is physical and psychosocial damage.

  • Compulsive exercise means physical activity driven by unhealthy beliefs, with inability to moderate exercise levels when they are physically or socially detrimental. There is a neurochemical basis for this.

  • Assessment and management of exercise and activity levels from the outset is vital to address the disorder in its entirety and prevent sabotage of treatment.

  • Overall benefits for patients go beyond improved weight gain, to include awareness of what constitutes healthy, balanced exercise and activity levels. This improves quality of life and reduces the risks of relapse and chronicity.


Yvonne Swainson

is a Physiotherapist with a specialist interest in eating disorders at the Royal Cornhill Hospital, Aberdeen.

Sandra Philip-Rafferty

is a Physiotherapist with a specialist interest in eating disorders at the Royal Cornhill Hospital, Aberdeen.


  1. 1.
    Davis C, Kennedy SH, Ravelski E, Dione M. The role of physical activity in the development and maintenance of eating disorders. Psychol Med. 1994;24(4):957–67.CrossRefPubMedGoogle Scholar
  2. 2.
    Davis C, Katzman DK, Kaptein S, Kirsh C, Brewer H, Kalmbach K, Olmsted MF, Woodside DB, Kaplan AS. The prevalence of high-level exercise in the eating disorders: Etiological implications. Compr Psychiatry. 1997;38(6):321–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Touyz SW, Beumont PJV, Hook S. Exercise anorexia: a new dimension in anorexia nervosa. In: Handbook of eating disorders: Part 1. Amsterdam: Elsevier; 1987. p. 143–57.Google Scholar
  4. 4.
    Davis C. Body image and weight preoccupation: a comparison between exercising and non-exercising women. Appetite. 1990;15(1):13–21.CrossRefPubMedGoogle Scholar
  5. 5.
    Ackard DM, Brehm BJ, Steffen JJ. Exercise and eating disorders in college-aged women: profiling excessive exercisers. Eat Disord. 2002;10(1):31–47.CrossRefPubMedGoogle Scholar
  6. 6.
    Steffen JJ, Brehm BJ. The dimensions of obligatory exercise. Eat Disord. 1999;7(3):219–26.CrossRefGoogle Scholar
  7. 7.
    Kron L, Katz JL, Gorzynski G, Weiner H. Hyperactivity in anorexia nervosa: a fundamental clinical feature. Comprehens Psychol. 1978;19(5):433–40.CrossRefGoogle Scholar
  8. 8.
    Strober M, Freeman R, Morrell W. The long-term course of severe anorexia nervosa in adolescents: Survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord. 1997;22(4):339–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Solenberger S. Exercise and eating disorders: A 3-year inpatient hospital record analysis. Eat Behav. 2001;2(2):151–68.CrossRefPubMedGoogle Scholar
  10. 10.
    Beumont PJV, Arthur B, Russell JD, Touyz SW. Excessive physical activity in dieting disorder patients: proposals for a supervised exercise program. Int J Eat Disord. 1994;15(1):21–36.CrossRefPubMedGoogle Scholar
  11. 11.
    Davis C, Kaptein S. Anorexia nervosa with excessive exercise: a phenotype with close links to obsessive-compulsive disorder. Psychiatry Res. 2006;142(2-3):209–17.CrossRefPubMedGoogle Scholar
  12. 12.
    Epling WF, Pierce WD. Activity anorexia: theory, research and treatment. Mahwah NJ: Lawrence Erlbaum Associates; 1996.Google Scholar
  13. 13.
    Taranis L, Touyz S, Meyer C. Disordered eating and exercise: development and preliminary validation of the Compulsive Exercise Test (CET). Eur Eat Disord Rev. 2011;19(3):256–68.CrossRefPubMedGoogle Scholar
  14. 14.
    Hechler T, Beumont P, Marks P, Touyz S. How do clinical specialists understand the role of physical activity in eating disorders? Eur Eat Disord Rev. 2005;13(2):125–32.CrossRefGoogle Scholar
  15. 15.
    Long C. Assessment and management of eating disordered patients who over-exercise: a four-year follow-up of six single case studies. J Ment Health. 1995;4(3):309–16.CrossRefGoogle Scholar
  16. 16.
    Thein V, Thomas D, Markin CL. Pilot study of a graded exercise program for the treatment of anorexia nervosa. Int J Eat Disord. 2000;28(1):101–6.CrossRefGoogle Scholar

Further Reading

  1. Prochaska JO, Diclemente CC. Toward a comprehensive model of change. New York, NY: Springer; 1986. p. 3–27.Google Scholar
  2. Body Composition changes with Anorexia and weight re-gain. Dr Shaun Phillips, Edinburgh University, May 2015.Google Scholar
  3. Managing Activity and Exercise with an Eating Disorder – Service User Booklet, Physiotherapy Eating Disorder Professional Network by Kate Brown, Advanced Specialist Physiotherapist, February 2016.
  4. Managing Activity and Exercise in Adolescents with and Eating Disorder. Physiotherapy Eating Disorder Professional Network, February 2015.Google Scholar
  5. Exercise and Management of Osteoporosis with and Eating Disorder. Physiotherapy Eating Disorder Professional Network by Lynn Hammond and Kate Brown, Advanced Specialist Physiotherapists, August 2015.Google Scholar
  6. Physiotherapy Guidance Notes for Osteoporosis and Exercise in Anorexia Nervosa and Bulimia Nervosa, Lynn Hammond, Advanced Specialist Physiotherapist, February 2015
  7. UK physical activity guidelines - Publications - GOV.UK.Google Scholar
  8. Taranis L, Touyz S, La Puma M, Meyer C. Loughborough eating-disorders activity programme “LEAP” group cognitive-behavioural therapy for compulsive exercise in the eating disorders: therapist manual. Loughborough University.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Highly Specialist Physiotherapist, Eating Disorders ServicesRoyal Cornhill HospitalAberdeenUK

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