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Agne A, Olmedillas H, Pérez Ruiz M, del Valle Soto M, Fernandez-del-Valle M. Physical Fitness-Not Physical Activity Levels-Influence Quality of Life in Anorexia Nervosa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2678. [PMID: 35270370 PMCID: PMC8910610 DOI: 10.3390/ijerph19052678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
Abstract
Background: Incorporating physical activity (PA) has been a challenge for health care professionals working with anorexia nervosa (AN) patients. This has contributed to partial physical fitness (PFit) recovery that persists after weight restoration. Objective: This cross-sectional study aimed to examine the relationships between PA, sedentary behaviors, PFit, and quality of life (QoL) in a group of adolescents after hospitalization. Methods: QoL, PA, and sedentary behaviors were measured using the Health-Questionnaire Short-Form 36 (SF-36) and accelerometers, while PFit was assessed through cardiorespiratory fitness, body composition (anthropometry), and strength (six repetition maximum) tests in a total of 63 patients. Results: Light-PA (LPA), moderate-PA (MPA), moderate-to-vigorous-PA (MVPA), and relative sedentary time (%ST) did not meet the recommendations (p < 0.001). Only 22% of the patients met MVPA criteria, and ~82% exceeded %ST. SF-36 scores were lower than normative values except the physical component scale. Absolute cardiorespiratory fitness was reduced (p < 0.001) in 84% of the patients, and was positively associated to body weight, body mass index (BMI), circumferences, and muscle areas. Additional positive significant relationships were found between QoL, muscular strength, and body composition, and negative associations between vigorous-to-very vigorous PA and BMI, skinfolds, and percent body fat. Regression analyses revealed lower body strength as an explanatory factor for improved QoL (OR 1.03, 95%CI 1.00−1.07). Conclusions: PFit and QoL scores are poor after hospitalization. LPA, MPA, and MVPA do not meet recommendations. PFit management—with emphasis on improving muscular fitness—may be a valuable strategy for QoL improvement in AN after hospitalization.
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Affiliation(s)
- Alexa Agne
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, IL 62026, USA;
| | - Hugo Olmedillas
- Department of Functional Biology, Campus del Crito B, University of Oviedo, 33006 Oviedo, Spain;
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain;
| | - Margarita Pérez Ruiz
- Grupo de Investigación de Investigación en Nutrición, Ejercicio y Estilo de Vida Saludable (ImFINE), Departamento de Salud y Rendimiento, Facultad de Ciencias de la Actividad Física y del Deporte–Instituto Nacional de Educación Física (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Miguel del Valle Soto
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain;
- Department of Morphology and Cellular Biology, Anatomy, Campus del Crito B, University of Oviedo, 33006 Oviedo, Spain
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Ibrahim A, Cutinha D, Ayton A. What is the evidence for using bed rest as part of hospital treatment of severe anorexia nervosa? EVIDENCE-BASED MENTAL HEALTH 2019; 22:77-82. [PMID: 31003978 PMCID: PMC10270425 DOI: 10.1136/ebmental-2018-300064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 11/04/2022]
Abstract
Bed rest is commonly used on medical and paediatric wards as part of nursing management of the physically compromised patient with severe anorexia nervosa. The aim of this study was to review the evidence base of bed rest as an intervention in the management of severe anorexia nervosa. We searched MEDLINE, PubMed, Embase, PsychInfo, CINAHL, HMIC, AMED, HBE, BNI and guidelines written in English until April 2018 using the following terms: bed rest and anorexia nervosa. After exclusion of duplicates, three guidelines and eight articles were included. The papers were methodologically heterogeneous, and therefore, quantitative summary was not possible. There have been no randomised controlled trials to compare the benefits and harms of bed rest as the focus of intervention in the treatment of anorexia nervosa. Several papers showed that patients have a strong preference for less restrictive approaches. These are also less intensive in nursing time. Negative physical consequences were described in a number of studies: these included lower heart rate, impaired bone turn over and increased risk of infection. We found no evidence to support bed rest in hospital treatment of anorexia nervosa. The risks associated with bed rest are significant and include both physical and psychological harm, and these can be avoided by early mobilisation. Given the established complications of bed rest in other critically ill patient populations, it is difficult to recommend the enforcement of bed rest for patients with anorexia nervosa. Future research should focus on safe early mobilisation, which would reduce complications and improve patient satisfaction.
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Affiliation(s)
- Ali Ibrahim
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, London, UK
| | - Darren Cutinha
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, London, UK
| | - Agnes Ayton
- Cotswold House, Oxford Health NHS Foundation Trust Adult Mental Health Services, Oxford, Oxfordshire, UK
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Hoskins JI, Blood L, Stokes HR, Tatham M, Waller G, Turner H. Patients' experiences of brief cognitive behavioral therapy for eating disorders: A qualitative investigation. Int J Eat Disord 2019; 52:530-537. [PMID: 30741438 DOI: 10.1002/eat.23039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Although it is important to analyze the effectiveness of new therapies, it is also necessary to consider how patients experience them. This is particularly important if we are to maximize treatment acceptability and reduce attrition. This study examined patient experiences of a new 10-session cognitive-behavioral therapy (CBT-T), using a qualitative approach. METHOD The sample was 17 patients with a diagnosis of bulimia nervosa who had received CBT-T (including treatment completers and non-completers) within the previous 2 years. Sample size was determined by saturation of the emergent themes. Responses were analyzed using a six-step thematic analysis process. RESULTS Rated acceptability and effectiveness of CBT-T were high. Five themes emerged, with subthemes. The key elements of patient experience of the therapy were: the therapeutic relationship; the nature of the therapy; its challenging but beneficial aspects; ending therapy; and the overall experience of CBT-T (including comparison with other therapies). DISCUSSION The findings build on the effectiveness research for CBT-T, suggesting that it is an acceptable therapy that addresses many of the same themes that matter to patients as other therapies. The findings show that patients were positive about CBT-T relative to other therapies, and offer suggestions as to how CBT-T might be delivered to emphasize the importance of the time-limited nature of the therapy.
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Affiliation(s)
- Jessica I Hoskins
- Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Lauren Blood
- Norfolk Community Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, United Kingdom
| | - Holly R Stokes
- Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Madeleine Tatham
- Norfolk Community Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, United Kingdom
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Hannah Turner
- Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, United Kingdom
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Ziser K, Resmark G, Giel KE, Becker S, Stuber F, Zipfel S, Junne F. The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2018; 26:379-393. [PMID: 29577487 DOI: 10.1002/erv.2590] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 11/08/2022]
Abstract
Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa.
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Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Becker
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
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Gueguen J, Piot MA, Orri M, Gutierre A, Le Moan J, Berthoz S, Falissard B, Godart N. Group Qigong for Adolescent Inpatients with Anorexia Nervosa: Incentives and Barriers. PLoS One 2017; 12:e0170885. [PMID: 28152083 PMCID: PMC5289494 DOI: 10.1371/journal.pone.0170885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 01/12/2017] [Indexed: 01/28/2023] Open
Abstract
Background Qigong is a mind-body intervention focusing on interoceptive awareness that appears to be a promising approach in anorexia nervosa (AN). In 2008, as part of our multidimensional treatment program for adolescent inpatients with AN, we began a weekly qigong workshop that turned out to be popular among our adolescent patients. Moreover psychiatrists perceived clinical benefits that deserved further exploration. Methods and findings A qualitative study therefore sought to obtain a deeper understanding of how young patients with severe AN experience qigong and to determine the incentives and barriers to adherence to qigong, to understanding its meaning, and to applying it in other contexts. Data were collected through 16 individual semi-structured face-to-face interviews and analyzed with the interpretative phenomenological analysis method. Eleven themes emerged from the analysis, categorized in 3 superordinate themes describing the incentives and barriers related to the patients themselves (individual dimension), to others (relational dimension), and to the setting (organizational dimension). Individual dimensions associated with AN (such as excessive exercise and mind-body cleavage) may curb adherence, whereas relational and organizational dimensions appear to provide incentives to join the activity in the first place but may also limit its post-discharge continuation. Once barriers are overcome, patients reported positive effects: satisfaction associated with relaxation and with the experience of mind-body integration. Conclusions Qigong appears to be an interesting therapeutic tool that may potentiate psychotherapy and contribute to the recovery process of patients with AN. Further analysis of the best time window for initiating qigong and of its place in overall management might help to overcome some of the barriers, limit the risks, and maximize its benefits.
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Affiliation(s)
- Juliette Gueguen
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
- * E-mail:
| | - Marie-Aude Piot
- Univ. Paris-Descartes, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Massimiliano Orri
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
| | - Andrea Gutierre
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | | | - Sylvie Berthoz
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Bruno Falissard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Univ. Paris-Descartes, Paris, France
| | - Nathalie Godart
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
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Eli K. Between difference and belonging: configuring self and others in inpatient treatment for eating disorders. PLoS One 2014; 9:e105452. [PMID: 25210886 PMCID: PMC4161313 DOI: 10.1371/journal.pone.0105452] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/24/2014] [Indexed: 11/18/2022] Open
Abstract
Dedicated inpatient care for eating disorders has profound impact on patients' embodied practices and lived realities. Analyses of inpatients' accounts have shown that participants endorse complex and conflicting attitudes toward their experiences in eating disorders wards, yet the apparent ambivalence that characterizes inpatient experiences has not been subject to critical examination. This paper examines the narrated experiences of 13 participants (12 women and one man; age 18–38 years at first interview) with past or present anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified, who had been hospitalized in an inpatient eating disorders ward for adults in central Israel. The interviews, which took place in 2005–2006, and again in 2011, were part of a larger longitudinal study exploring the subjective experiences of eating disorders and recovery among Israeli adults. Employing qualitative analysis, this study finds that the participants' accounts were concerned with dynamics of difference and belonging, as they played out in various aspects of inpatient care, including diagnosis, treatment, relationships with fellow patients and staff, and everyday life in hospital. Notably, participants simultaneously defined themselves as connected to, but also distinct from, the eating disordered others who formed their reference group at the ward. Through negotiating a protectively ambivalent positioning, participants recognized their eating disordered identities and connected with others on the ward, while also asserting their non-disordered individuality and distancing themselves from the potential dangers posed by ‘excessive’ belonging. The paper suggests that this ambivalent positioning can usefully be understood through the anthropological concept of liminality: being both a part of and apart from one's community.
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Affiliation(s)
- Karin Eli
- Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Vandereycken W. The place of inpatient care in the treatment of anorexia nervosa: questions to be answered. Int J Eat Disord 2003; 34:409-22. [PMID: 14566928 DOI: 10.1002/eat.10223] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The chance that an anorexia nervosa patient will be hospitalized depends more on circumstantial rather than on scientifically based factors. Although there is a lot of information on the treatment of anorexia nervosa patients in a residential setting, answers to questions relating to the "when," "where," and "how" of treatment are subjective. There is no clinical consensus and the paucity of controlled research is hampering the development of an evidence-based practice. RESULTS Increasing economic restraints through managed care policies limit the length of inpatient treatment, which leads to early discharge at a lower body weight, which leads to a higher likelihood of readmissions, which leads to increasing costs. DISCUSSION We will highlight important issues in the ongoing debate between economic demands and clinical challenges. Our goal is to stimulate critical reflections and systematic research.
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Bell L. What can we learn from consumer studies and qualitative research in the treatment of eating disorders? Eat Weight Disord 2003; 8:181-7. [PMID: 14649780 DOI: 10.1007/bf03325011] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this paper is to review all qualitative research and questionnaire surveys with people who have experienced an eating disorder or received treatment for it. Studies were identified on PubMed and PsychInfo. Twenty-three studies were identified and key findings are reviewed. Support and understanding are critical aspects of treatment perceived as helpful. Empathic relationships, whether professional or non-professional, were reported as essential to recovery. Psychological interventions (counselling and therapy) are the most popular and perceived as the most helpful. Many patients report that "medical interventions" were unhelpful. Interventions which focus exclusively on weight are reported negatively and many studies identify the importance of addressing wider issues than food and weight in treatment.
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Affiliation(s)
- L Bell
- Eating Disorders Team, Park Way Centre, Havant, UK.
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Le Heuzey M. Faut-il encore isoler les jeunes anorexiques mentales ? ANNALES MEDICO-PSYCHOLOGIQUES 2002. [DOI: 10.1016/s0003-4487(02)00177-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Swain-Campbell NR, Surgenor LJ, Snell DL. An analysis of consumer perspectives following contact with an eating-disorders service. Aust N Z J Psychiatry 2001; 35:99-103. [PMID: 11270465 DOI: 10.1046/j.1440-1614.2001.00855.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The views of consumers following contact with treatment for eating disorders represent an underresearched aspect of service provision. The aim of this paper is to examine patterns of consumer satisfaction following contact with a specialist eating-disorders service. METHOD Using both a structured and an open-ended questionnaire format, consumer perspectives were sought routinely through postal survey 3 months after the point of first contact. Responses were analysed from 120 patients who returned their questionnaires during the 2-year period ending in December 1998. RESULTS Although the structured response format indicated high rates of satisfaction, the open-ended format revealed five categories describing the perceived best and worst aspects following consultation with the service. The category of therapeutic alliance drew the majority of positive comments, while the most frequently cited worst aspect of consultation was the category of treatment type. CONCLUSIONS People with eating disorders form a unique group of mental health consumers to survey for satisfaction. While approval ratings prompted by both structured and open-ended questions were high, and centred around the theme of therapeutic alliance, the most frequent source of negative commentary was activities and structures considered essential by traditional treatment modalities. This provides important insights into the predicaments of people with eating disorders presenting for treatment, and the importance of developing satisfaction surveys to accommodate such predicaments and concerns.
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Affiliation(s)
- N R Swain-Campbell
- Eating Disorders Service, HealthLink South, The Princess Margaret Hospital, Christchurch, New Zealand
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Newton T. Consumer involvement in the appraisal of treatments for people with eating disorders: a neglected area of research? EUROPEAN EATING DISORDERS REVIEW 2001. [DOI: 10.1002/erv.435] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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