Relationships between exercise behaviour, eating-disordered behaviour and quality of life in a community sample of women: when is exercise‘excessive’?

The 'not-so-healthy' appearance pursuit? Disentangling unique associations of female drive for toned muscularity with disordered eating and compulsive exercise

Today, many women are driven to subscribe to a more athletically oriented appearance ideal hallmarked by muscle tone (referred to as athletic- or fit-looking). However, the constellation of unhealthy eating and exercise behaviors that may accompany the pursuit of toned muscularity among women is not yet well characterized. To address this knowledge gap, our study evaluated the associations among the female drive for toned muscularity and both thinness-oriented disordered eating behaviors (e.g., dietary restriction) and muscularity-oriented disordered eating behaviors (e.g., excessive scrutiny of macro-nutrient values of food), as well as dimensions of compulsive exercise. Participants were 388 Australian undergraduate women who completed an online questionnaire including self-report measures of said constructs. Hierarchical regression models were used to determine whether the drive for toned muscularity accounted for unique variance in eating and exercise behaviors after adjusting for theoretically relevant covariates. Results indicated independent relationships between the drive for toned muscularity and several facets of thinness- and muscularity-oriented disordered eating, as well as compulsive exercise (e.g., exercise rigidity). Our findings further contribute to an emerging literature illustrating that women driven to attain a toned appearance may be vulnerable to engaging in a wide range of maladaptive eating and exercise practices.

Prospective Associations Between Driven Exercise and Other Eating Disorder Behaviors in Adolescence: A Longitudinal Cohort Study

PURPOSE

Dysfunctional exercise is a common, debilitating symptom across eating disorders (ED). We examined the cross-sectional and longitudinal associations between experiences of exercise and ED behaviors and cognitions in an adolescent, population-based sample.

METHODS

Adolescents (n = 4,054) self-reported whether they exercised to control shape and weight (exercise for weight loss [EWL]), and, if so, whether they exercised even when injured, and whether exercise interfered with life functioning (driven exercise) at age 14 years, allowing delineation of three exercise-based groups: no-EWL, EWL, and driven exercise. Participants also reported ED cognitions at age 14 years along with other ED behaviors (fasting, purging, binge eating) at ages 14 and 16 years. Sex-stratified regression approaches were employed to examine relationships between these exercise categories at age 14 and ED behaviors and cognitions at ages 14 and 16.

RESULTS

Cross-sectionally, those in the driven exercise group, compared to the no-EWL group, consistently reported higher levels of ED cognitions and behaviors, with those in the EWL group also reporting higher levels of some ED cognitions and behaviors relative to the no-EWL group. Those in the EWL and driven exercise groups at age 14 also demonstrated a higher prospective likelihood of fasting (boys and girls) and purging (girls only) at age 16, relative to those in the no-EWL group at age 14.

DISCUSSION

Results inform our understanding of EWL and driven exercise and the developmental timing of ED behaviors in adolescence and point toward the potential utility of targeted prevention for young people who report EWL.

The Relationship between Compulsive Exercise, Self-Esteem, Body Image and Body Satisfaction in Women: A Cross-Sectional Study

Purpose: In this study, we aimed to test the relationship between compulsive exercise and self-esteem, body image, and body satisfaction as potential predictors of eating disorders. Methods: Self-report measures of compulsive exercise beliefs and behaviors, self-esteem, body image, and body satisfaction, were completed by 120 female participants through an online questionnaire. Factor analyses with varimax rotation were performed to create exercise-frequency groups. ANOVA’s were performed on Body Mass Index (weight adjusted for height squared, BMI), current minus ideal weight, self-esteem, body image, and body satisfaction to determine if there were differences depending on these exercise groups. Results: Factor analysis revealed two factors for compulsive exercise beliefs and behaviors: (1) Exercise Fixation, and (2) Exercise Frequency and Commitment. Based on those factors, participants were subdivided into four clusters: (1) pathological obligatory exercisers, (2) exercise fixators, (3) committed exercisers, and (4) non-exercisers. No differences were found between these groups for BMI or current minus ideal weight. Pathological obligatory exercisers and committed exercisers spend significantly more hours on exercise weekly compared to exercise fixators or non-exercisers. No differences between pathological obligatory exercisers, exercise fixators, and non-exercisers were found on self-esteem or body satisfaction, where the committed exercisers scored significantly better. Both committed exercisers and non-exercisers scored significantly better on body image flexibility compared to pathological obligatory exercisers and exercise fixators. Conclusion: Compulsive exercise has both an exercise volume and an emotional component. The level of compulsive exercise is linked to one’s self-esteem, body image, and body satisfaction and those factors could be a target for future interventions.

Characterizing reasons for exercise in binge-spectrum eating disorders

Although 40-60% of individuals with eating disorders (EDs) report engaging in maladaptive exercise, self-reported reasons for engaging in exercise vary. Further, no studies have examined momentary reasons for exercise and whether reasons for exercising could be both adaptive and maladaptive for any episode. Examining reasons for exercise can inform interventions which more effectively target maladaptive exercise. The current study recruited adults with binge-spectrum EDs (N = 58, 89.2% Female) and assessed self-reported reasons for exercise using ecological momentary assessment over 7-14 days. Exercise episodes were categorized as maladaptive if the participant endorsed exercising to compensate for eating or feeling driven to exercise. On average, participants reported exercising 8 times (SD = 8) over the 7-14 days. On average, 73% of exercise episodes were maladaptive. Participants most frequently stated exercising to control shape or weight (67.2% of episodes), feeling driven (62.9%), and exercising as part of a routine (52.9%). Participants least endorsed exercising so that they could eat more later (9.8%). Participants reported a mean of 3.6 reasons for exercising at each episode (SD = 1.85, mode = 1.0). As hypothesized, individuals with EDs were exercising for several reasons at each exercise episode. Further, the extent to which each exercise episode is maladaptive varied between participants and even within a single participant's exercise episodes. These findings underscore the importance of research evaluating when, and for whom, exercise becomes maladaptive, as well as research examining other characteristic features of maladaptive and adaptive exercise in EDs.

Understanding risk factors for disordered eating symptomatology in athletes: A prospective study

Disordered eating and eating disorders have huge impact on athletic health and performance. Understanding risk factors for disordered eating development is paramount to protecting the health and performance of these athletes. This project tested a model longitudinally to test whether body dissatisfaction (mediated by negative affect) and societal pressures (mediated by internalisation) predicted bulimic symptomatology at 1 year. The study recruited 1017 male and female athletes in a range of sports at three time points over a year. Cross-lag meditation modelling in MPLUS was utilised to test the hypothesised model. Results indicated that societal pressures mediated by general internalisation led to bulimic symptomatology and that gender and sport type do moderate the relationships. However, measurement issues indicate that scales not originally created for athletes may not reliably measure athletes' experience. This research highlights how understanding how to better assess risk factors and disordered eating related concepts in athletes is a key next step. The study is unique in its longitudinal design and in its sampling of a wide range of sports in both male and female athletes.

Body-related self-conscious emotions and reasons for exercise: A latent class analysis

Body-related self-conscious emotions are important predictors of exercise motivation, yet the association between body-related self-conscious emotions and reasons for exercise has not been explored. Researchers have typically examined body-related emotions (e.g., shame, guilt, pride, embarrassment, envy) in isolation, but they may interact in unique ways to predict reasons for exercise. The present study examined how patterns of body-related emotions were associated with exercise reasons. In an online survey, participants (N = 520; M_age = 35.43 ± 10.09; 57.5 % men) reported their experience of body-related self-conscious emotions and exercise reasons over the past week. Latent class analysis revealed a three-class model of emotions, resulting in a High Emotionality class (i.e., experiencing positive and negative emotions), a Negative Emotions class, and a Pride class. Individuals who experienced negative emotions about their bodies engaged in exercise for appearance reasons, while individuals who felt proud about their bodies and did not report the negatively valenced emotions reported exercising for health reasons. These findings underscore the importance of investigating how multiple body-related self-conscious emotions influence reasons for exercising. Understanding how patterns of body-related self-conscious emotions are experienced could inform future research on factors that may precede exercise motivation and increase exercise behavior.

Efficacy of a Specialized Group Intervention for Compulsive Exercise in Inpatients with Anorexia Nervosa: A Randomized Controlled Trial

INTRODUCTION

Treatment of compulsive exercise is recognized as a key unmet challenge in the treatment of anorexia nervosa (AN). To address this challenge, we developed the manualized group intervention "healthy exercise behavior" (HEB). This study evaluates the efficacy of HEB for the reduction of compulsive exercise as add-on to routine inpatient treatment (treatment as usual [TAU]) in a randomized controlled trial.

METHODS

Two hundred and seven adolescent and adult female inpatients with (atypical) AN were randomly allocated to TAU or to additional participation in HEB (TAU + HEB). HEB integrates elements of exercise-based therapy into a cognitive-behavioral approach. Assessments took place at admission, pre-intervention, post-intervention, discharge, and 6 months follow-up. Primary outcome was the severity of compulsive exercise assessed by the Commitment to Exercise Scale between pre- and post-intervention; secondary outcomes were additional aspects of compulsive exercise, assessed by the Compulsive Exercise Test, weight gain, eating disorder and general psychopathology, and emotion regulation.

RESULTS

In intention-to-treat analysis for the primary outcome, the TAU + HEB group showed significantly stronger reductions in the severity of compulsive exercise compared to the TAU group (z = -2.81; p = 0.005; effect size [ES] = -0.3). We also found significantly stronger reductions from admission to discharge (z= 2.62; p = 0.009; ES = -0.43), and from admission to follow-up (z = 2.1; p = 0.035; ES = -0.39). Regarding secondary outcomes, we found significant group differences between pre- and post-intervention in additional aspects of compulsive exercise (z = -2.55; p = 0.011; ES = -0.27). We did not find significant differences regarding weight gain, eating disorder and general psychopathology, and emotion regulation.

CONCLUSIONS

Our intervention proved efficacious in reducing compulsive exercise in inpatients with (atypical) AN.

Obsessive healthy eating and orthorexic eating tendencies in sport and exercise contexts: A systematic review and meta-analysis

BACKGROUND

Orthorexia Nervosa (ON) and exercise addiction (ExAdd) are two phenomena believed to overlap. We conducted a meta-analysis exploring the link between ON and (addictive) exercise behaviors.

METHODS

A systematic review of major databases and gray literature was carried out for studies reporting on ON and (addictive) exercise behaviors. Random effects meta-analyses were undertaken calculating correlations between ON and (addictive) exercise behaviors. A sub-group analysis investigated gender differences.

RESULTS

Twenty-five studies with 10,134 participants (mean age = 25.21; 56.4% female) were included. Analyses showed a small overall correlation between ON and exercise (21 studies, r = 0.12, 95% CI |0.06-0.18|) and a medium overall correlation between ON and ExAdd (7 studies, r = 0.29, 95% CI |0.13-0.45|). Gender differences were negligible.

CONCLUSIONS

Orthorexic eating correlated slightly and moderately with exercise and ExAdd, respectively, expressing some unique and shared variance of these behaviors. While this does not suggest ON and addictive exercising to be independent, it does not indicate substantial comorbidity. Future research should focus on clinical relevance, underlying mechanisms, vulnerability, and risk factors.

Increased rates of eating disorders and their symptoms in women with major depressive disorder and anxiety disorders

BACKGROUND

Individuals with eating disorders (EDs) have increased rates of major depressive disorder (MDD) and anxiety disorders. Yet, few studies have investigated rates of EDs and their symptoms in individuals presenting with MDD/anxiety disorders. Identifying potential disordered eating in people with MDD/anxiety disorders is important because even subclinical disordered eating is associated with reduced quality of life, and undiagnosed eating pathology may hinder treatment progress for both MDD/anxiety disorders and comorbid EDs.

METHOD

We compared rates of EDs (anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding and eating disorders) and their symptoms in 130 women with, and 405 women without, lifetime MDD or an anxiety disorder (generalized anxiety disorder, obsessive-compulsive disorder, social phobia, specific phobia, panic disorder, agoraphobia, or post-traumatic stress disorder) recruited from the population-based Michigan State University Twin Registry. Lifetime ED and MDD/anxiety diagnoses, and lifetime clinically significant disordered eating behaviors (e.g., binge eating, excessive exercise) were assessed using the Structured Clinical Interview for DSM-IV (SCID).

RESULTS

Among participants with lifetime MDD or any anxiety disorder, 13% met criteria for a lifetime ED and 39% reported engaging in at least one lifetime clinically significant disordered eating behavior (e.g., binge eating) on the SCID. In contrast, only 3% of participants without a history of MDD/an anxiety disorder met criteria for a lifetime ED, and only 11% reported lifetime clinically significant disordered eating behavior.

DISCUSSION

Our findings suggest that women with MDD and anxiety disorders have elevated rates of EDs, and it is therefore imperative to screen for disordered eating in these populations.

Morbid exercise behaviour and eating disorders: A meta-analysis

BACKGROUND AND AIMS

This study examined the relationship between self-reported symptoms of morbid exercise behaviour (MEB) and eating disorders (ED) using meta-analytic techniques.

METHODS

We systematically searched MEDLINE, PsycINFO, Web of Science, SciELO and Scopus. Random effects models were used to compute pooled effect sizes estimates (r). The robustness of the summarized estimates was examined through sensitivity analyses by removing studies one at a time.

RESULTS

Sixty-six studies comprising 135 effect-sizes (N = 21,816) were included. The results revealed: (a) small-sized relationship in the case of bulimic symptoms (r = 0.19), (b) small- (r = 0.28) to medium-sized relationships (r = 0.41) in the case of body/eating concerns, and (c) medium-sized relationships in the case of overall ED symptoms (r = 0.35) and dietary restraint (r = 0.42). Larger effect sizes were observed in the case of overall ED symptoms in clinical, younger, and thinner populations, as well as when employing a continuously-scored instrument for assessing ED or the Compulsive Exercise Test for assessing MEB. Larger effect sizes were also found in female samples when the ED outcome was dietary restraint.

CONCLUSIONS

The identified gaps in the literature suggest that future research on the topic may benefit from: (a) considering a range of clinical (in terms of diagnosed ED) and non-clinical populations from diverse exercise modalities, (b) addressing a wide range of ED symptomatology, and (c) employing longitudinal designs that clarify the temporal direction of the relationship under consideration.

Compulsive exercise and weight suppression: Associations with eating pathology in distance runners

Some athletes, particularly those who participate in activities that emphasize leanness such as competitive running, are at greater risk for eating disorder (ED) pathology. Compulsive exercise (CE) is linked with ED pathology among female athletes, with evidence that CE for weight control is most strongly correlated with ED thoughts and behaviors. Weight suppression (WS), the discrepancy between highest adult weight and current weight, is also linked with ED symptoms. Taken together, runners with greater WS may be more likely to engage in CE to influence their weight or shape and may subsequently report other associated ED symptoms. As such, the current study investigated associations between CE and ED pathology in a mixed-gender sample of adult distance runners (N = 277, 51% female), and tested the impact of WS on this association. Results indicated that females reported greater CE and ED pathology, whereas males reported greater WS. A significant interaction effect for CE x WS, (p < .05) indicated that the relation between CE and ED scores was stronger among male runners who reported higher WS. In contrast, WS did not impact the association between CE and ED pathology for female runners. Results from the current study have important implications for the assessment and treatment of ED in athletes, specifically runners, and suggest that WS is an important factor to consider when working with male athletes.

The role of depression, eating disorder symptoms, and exercise in young adults' quality of life

OBJECTIVE

Eating disorder (ED) symptoms are negatively associated with quality of life (QOL), while exercise is typically positively associated with QOL. Past studies have not examined the relative contribution of depression to this outcome. This study examined the influence of ED symptoms, exercise frequency, and exercise motivation on global QOL in undergraduates while accounting for the shared relationship between ED symptoms and depression.

METHOD

Students (N = 851) completed the EDE-Q, Reasons for Exercise Inventory, BDI-II, Quality of Life Inventory, and a 1-month exercise timeline followback calendar. Hierarchical regression analyses were conducted to examine the relative contributions of ED symptoms, depression, and exercise variables to QOL.

RESULTS

Shape concern and BDI-II scores accounted for significant variance in QOL scores. Depressive symptoms, however, accounted for 9.55% of the unique variance in QOL, while shape concern accounted for only 0.77%. Exercise frequency did not explain significant variance in QOL. The motivations of exercising for mood improvement and for enjoyment explained significant variance in QOL. No interactions between exercise frequency and exercise motivations were significant. In the final model, identifying as a woman was associated with decreased QOL.

DISCUSSION

Results suggest that studies examining the impact of disordered eating and exercise on QOL should account for depression due to depression's high comorbidity with EDs and its influence on exercise behavior and motivation. Additionally, results support findings that factors such as exercise motivation may better account for differences in QOL than exercise frequency.

Monitoring eating and activity: Links with disordered eating, compulsive exercise, and general wellbeing among young adults

OBJECTIVE

To explore the relationships between the use of food intake and activity monitoring tools with compulsive exercise, eating psychopathology, and psychological wellbeing.

METHOD

Participants (N = 352; mean age 21.90 years) indicated their use of activity and food intake monitoring tools, and completed the Compulsive Exercise Test (CET), Eating Disorders Examination Questionnaire (EDE-Q), and the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS).

RESULTS

Users of monitoring tools reported significantly higher CET and EDE-Q scores than nonusers. Positive associations were detected between the frequency of activity monitoring tool use with CET and EDE-Q scores. Participants who reported using monitoring tools primarily to manage weight and shape reported higher levels of eating and compulsive exercise psychopathology than those who reported using tools to improve health and fitness.

DISCUSSION

Features of compulsive exercise and eating psychopathology are elevated among users of food intake and activity monitoring tools; and particularly among those who report using the tools for weight and shape purposes. Longitudinal and experimental research is needed to further our understanding of these observed associations, and specifically to explore the prospective relationships between monitoring tool use, eating psychopathology, and compulsive exercise.

Obligatory exercise and coping in treatment-seeking women with poor body image

PURPOSE

Obligatory exercise is characterized by continued exercise despite negative consequences, and intense negative affect when unable to exercise. Research suggests psychosocial differences between individuals that exercise in an obligatory manner and those that do not. It also has been speculated that obligatory exercise may serve coping and affect regulation functions, yet these factors have not been routinely examined in community women with poor body image. The purpose of the current study was to investigate psychosocial differences between obligatory and non-obligatory exercisers, and to examine the use of obligatory exercise as an avoidant coping strategy in a sample of women with poor body image.

METHODS

Women (n = 70) seeking treatment for body dissatisfaction were divided into obligatory and non-obligatory exercise groups based on their scores on the Obligatory Exercise Questionnaire. Participants then completed an assessment battery about eating pathology, body image, reasons for exercise, coping strategies, and negative affect.

RESULTS

Independent t test analyses indicated that obligatory exercisers had significantly greater eating disorder symptomatology, avoidant coping, and appearance- and mood-related reasons for exercise than non-obligatory exercisers. Multiple regression analyses revealed that eating disorder symptomatology and avoidant coping were significant predictors of obligatory exercise.

CONCLUSIONS

There are distinct psychosocial differences between women with poor body image who exercise in an obligatory fashion and those who do not. The current study suggests that obligatory exercise may serve as an avoidant coping strategy for women with poor body image. Enhancing healthy coping strategies may be an important addition to body image improvement programs.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa

BACKGROUND

For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN.

METHOD

A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change.

RESULTS

Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL.

CONCLUSIONS

These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients' engagement in treatment.

TRIAL REGISTRATION

ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.

Stress is associated with exercise differently among individuals with higher and lower eating disorder symptoms: An ecological momentary assessment study

OBJECTIVE

Stress is associated with the maintenance of eating disorders and exercise behaviors. However, it is unclear how stress is associated with exercise and vice-versa among individuals with higher levels of eating disorder symptoms in daily life. The current study tested the moderating effect of eating disorder symptoms on the relationships between (1) daily stress and later exercise behavior and (2) daily exercise behavior and later stress.

METHOD

Female college students [N = 129, mean age = 19.19 (SD = 1.40)] completed the Eating Disorder Inventory-2. Participants then completed measures of stress and exercise four times daily across seven days using an automated telephone ecological momentary assessment system. Data were analyzed using multilevel models.

RESULTS

Drive for thinness, bulimic symptoms, and body dissatisfaction significantly moderated the relationship between daily stress and later exercise (ps = .01-.05), such that higher daily stress predicted higher later exercise only in individuals who were low (but not average or high) in drive for thinness, bulimic symptoms, and body dissatisfaction symptoms.

DISCUSSION

Stress is associated with exercise differentially depending on individuals' eating disorder symptoms. Our findings suggest that only individuals with lower levels of eating disorder symptoms exercise when stressed.

Validity of Exercise Measures in Adults with Anorexia Nervosa: The EDE, Compulsive Exercise Test and Other Self-Report Scales

OBJECTIVE

Compulsive exercise is a prominent feature for the majority of patients with Anorexia Nervosa (AN), but there is a dearth of research evaluating assessment instruments. This study assessed the concurrent validity of the exercise items of the Eating Disorder Examination (EDE) and Eating Disorder Examination-Questionnaire (EDE-Q), with the Compulsive Exercise Test (CET) and other self-report exercise measures in patients with AN. We also aimed to perform validation of the CET in an adult clinical sample.

METHODS

The sample consisted of 78 adults with AN, recruited for the randomized controlled trial "Taking a LEAP forward in the treatment of anorexia nervosa." At baseline, participants completed the EDE, EDE-Q, CET, Reasons for Exercise Inventory (REI), Commitment to Exercise Scale (CES) and Exercise Beliefs Questionnaire (EBQ). Correlational and regression analyses were performed.

RESULTS

EDE exercise days and exercise time per day were positively correlated with each other and with all CET subscales (except Lack of exercise enjoyment), CES mean, EBQ total and REI total. Exercise time per day was associated with a higher EDE global score. The CET demonstrated good concurrent validity with the CES, the REI and the EBQ. Of the self-reports, the CET explained the greatest variance in eating disorder psychopathology and demonstrated good to excellent reliability in this sample.

DISCUSSION

The EDE and EDE-Q demonstrated good concurrent validity with the CET. Further research is required to evaluate the CET's factor structure in a large clinical sample. However, the CET has demonstrated strong clinical utility in adult patients with AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:533-541).

Evaluation of the Compulsive Exercise Test (CET) in Adolescents with Eating Disorders: Factor Structure and Relation to Eating Disordered Psychopathology

OBJECTIVE

The aims of this study were to explore the factor structure of the Compulsive Exercise Test (CET) in a clinical sample of Swedish adolescents with eating disorders (ED) and to study the relationship of CET with ED cognitions, body weight and exercise frequency.

METHODS

The compulsive Exercise Test, the Eating Disorders Examination-Questionnaire, body mass index (BMI) and exercise frequency were available at assessment of 210 adolescents (age 14.4 ± 1.6 years) with ED.

RESULTS

Factor analysis generated four factors with close similarity to factors previously obtained in a community sample of adolescents samples and supported the use of the original version of CET. Exercise for weight control was strongly related to ED cognitions but less to exercise frequency and BMI. Exercise for regulation of mood was related to ED cognitions and exercise frequency but not to BMI.

DISCUSSION

In adolescents with ED, different aspects of exercise are related to ED cognitions. This needs addressing in the treatment of adolescents with ED. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Using implicit attitudes of exercise importance to predict explicit exercise dependence symptoms and exercise behaviors

OBJECTIVES

"Fast" (i.e., implicit) processing is relatively automatic; "slow" (i.e., explicit) processing is relatively controlled and can override automatic processing. These different processing types often produce different responses that uniquely predict behaviors. In the present study, we tested if explicit, self-reported symptoms of exercise dependence and an implicit association of exercise as important predicted exercise behaviors and change in problematic exercise attitudes.

DESIGN

We assessed implicit attitudes of exercise importance and self-reported symptoms of exercise dependence at Time 1. Participants reported daily exercise behaviors for approximately one month, and then completed a Time 2 assessment of self-reported exercise dependence symptoms.

METHOD

Undergraduate males and females (Time 1, N = 93; Time 2, N = 74) tracked daily exercise behaviors for one month and completed an Implicit Association Test assessing implicit exercise importance and subscales of the Exercise Dependence Questionnaire (EDQ) assessing exercise dependence symptoms.

RESULTS

Implicit attitudes of exercise importance and Time 1 EDQ scores predicted Time 2 EDQ scores. Further, implicit exercise importance and Time 1 EDQ scores predicted daily exercise intensity while Time 1 EDQ scores predicted the amount of days exercised.

CONCLUSION

Implicit and explicit processing appear to uniquely predict exercise behaviors and attitudes. Given that different implicit and explicit processes may drive certain exercise factors (e.g., intensity and frequency, respectively), these behaviors may contribute to different aspects of exercise dependence.

The Compulsive Exercise Test: confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders

BACKGROUND

This study aimed to determine the psychometric properties of the Compulsive Exercise Test (CET) among an adult sample of patients with eating disorders.

METHOD

Three hundred and fifty six patients and 360 non-clinical control women completed the CET and the Eating Disorders Examination questionnaire (EDE-Q).

RESULTS

A confirmatory factor analysis revealed that the clinical data showed a moderate fit to the previously published five factor model derived from a community sample (Taranis L, Touyz S, Meyer C, Eur Eat Disord Rev 19:256-268, 2011). The clinical group scored significantly higher than the non-clinical group on four of the five CET subscales, and logistic regression analysis revealed that the CET could successfully discriminate between the two groups. A Receiver Operating Curve analysis revealed that a cut-off score of 15 on the CET resulted in acceptable values of both sensitivity and specificity.

CONCLUSIONS

The CET appears to have a factor structure that is acceptable for use with an adult sample of patients with eating disorders. It can identify compulsive exercise among patients with eating disorders and a cut-off score of 15 is acceptable as indicating an appropriate cut-off point.

Problematic Exercise in Anorexia Nervosa: Testing Potential Risk Factors against Different Definitions

“Hyperactivity” has a wide prevalence range of 31% to 80% in the anorexia nervosa literature that could be partly due to the plethora of definitions provided by researchers in this field. The purpose of this study was two-fold: 1) To assess the variance across prevalence rates of problematic exercise encountered in patients with anorexia nervosa, in relation to seven different definitions found in the literature. 2) To examine how core eating disorder symptoms and the dimensions of emotional profile are associated with these different definitions and the impact of these definitions on the assessment of patients’ quality of life. Exercise was evaluated in terms of duration, intensity, type and compulsion using a semi-structured questionnaire administered to 180 women suffering from severe anorexia nervosa. Seven different definitions of problematic exercise were identified in the literature: three entailing a single dimension of problematic exercise (duration, compulsion or intensity) and four combining these different dimensions. Emotional profile scores, obsessive-compulsive symptoms, eating disorder symptomatology, worries and concerns about body shape, self-esteem and quality of life were assessed using several established questionnaires. The prevalence of problematic exercise varied considerably from, 5% to 54%, depending on the number of criteria used for its definition. The type and level of eating disorder symptomatology was found to be associated with several definitions of problematic exercise. Surprisingly, a better self-reported quality of life was found among problematic exercisers compared to non-problematic exercisers in three of the definitions. The different definitions of problematic exercise explain the broad prevalence ranges and the conflicting associations generally reported in the literature between problematic exercise and eating disorder-related psychological parameters. There is an urgent need for a valid consensus on the definition of problematic exercise in anorexia nervosa. This will support the development of further research on the etiology and treatment of problematic exercise.

Body-related sport and exercise motives and disturbed eating attitudes and behaviours in adolescents

Motives underlying sport and exercise involvement have recently been hypothesized as potential factors influencing the positive association between sports/exercises involvement and disturbed eating attitudes and behaviours (DEAB) among adolescents. Nevertheless, very few studies have examined this hypothesis or the moderating role of gender, context of practice, performance levels and sport type on these relationships. In this study, these questions were addressed among 168 male and 167 female French adolescents involved in various types, contexts and performance levels of sport and exercise. Participants were asked to indicate their main motives for involvement in sport practice and to self-report DEAB (generic DEAB, vomiting-purging behaviours, and eating-related control) on a French adaptation of the Eating Attitudes Test-26. The results shared positive associations between body-related sport and exercise motives and most of the DEAB subscales. Furthermore, they show that the relationship between body-related sport and exercise motives and Vomiting-Purging Behaviours differs according to involvement in individual and competitive sports and exercises.

DSM-5 unspecified feeding and eating disorders in adolescents: what do they look like and are they clinically significant?

OBJECTIVE

The recent DSM-5 categorization of eating disorders introduces a new category of eating disorders, Unspecified Feeding and Eating Disorders (UFED), where symptoms do not meet criteria for any other diagnostic category, but cause clinically significant distress or impairment. The aim of the current study was to explore what disorders in UFED might look like in an adolescent population.

METHOD

We examined a large cohort of adolescent female twins (N = 699) who were assessed on three occasions and who did not meet a DSM-5 eating disorder diagnosis but who reported threshold levels of either fasting and/or driven exercise (N = 33; 4.7%). This group of girls was compared to girls who reported no eating disorder over the three waves, and girls who met a diagnosis of either anorexia nervosa (AN) or atypical AN.

RESULTS

The UFED group was characterized as being in the overweight range while striving to lose weight, and placing a high degree of importance on weight and shape in their self-evaluation. This group was indistinguishable from the two eating disorder groups on measures of global eating disorder severity, and demonstrated significantly elevated impairment and distress compared to the no eating disorder group commensurate with the eating disorder groups.

DISCUSSION

Further research of this group is necessary to ensure that these individuals are not overlooked, and that treatment options are appropriate and available.

A content analysis of healthy living blogs: evidence of content thematically consistent with dysfunctional eating attitudes and behaviors

OBJECTIVE

"Healthy" living blogs are a recent addition to internet media that offer advice on improving physical and mental health. Often, these sites include information on eating, exercise, and self-image. This study was a content analysis designed to evaluate the information included on these sites.

METHOD

A sample of 21 blogs was selected from a larger sample for evaluation. These blogs were chosen based on two criteria: they had won an award for healthy blogs and they had a large number of pageviews (pageviews were calculated using a web analytics website). Two raters (kappa reliability = 0.82) rated these blogs on multiple variables related to the blogger's characteristics, the content provided by the blogger, and entries posted on the blog.

RESULTS

Five of the bloggers self-identified as having had an eating disorder; seven mentioned difficulties with either menstruation or fertility; 11 referenced being on a diet; five indicated that they were using some form of dietary restraint; and 11 included some form of written negative/guilt-inducing message about food. Blog entries and About Me sections contained a variety of content indicative of problematic eating and body image information.

DISCUSSION

These findings suggest the content of healthy living blogs might be problematic for viewers who have eating or body image issues. The content does not approach the inflammatory nature of pro-eating disorder websites, yet information promoted clearly indicates that future research should further evaluate these sites.

Effects of perfectionism and exercise on disordered eating in college students

PURPOSE

This study examined two dimensions of perfectionism (Standards and Discrepancy), two aspects of exercise (cardiovascular and strength), and the interaction of these variables as predictors of disordered eating in female and male college students.

METHODS

Recruited participants (N=314; n=204 women) completed self-report measures of disordered eating (Eating Attitudes Test), perfectionism (Almost Perfect Scale-Revised; Standards and Discrepancy subscales), and exercise (strength and cardiovascular).

RESULTS

Among women, there was a significant three-way interaction between the two dimensions of perfectionism (Standards and Discrepancy) and cardiovascular exercise. Also among women, there was a significant two-way interaction between the Standards dimension and strength exercise and between the Discrepancy dimension and strength exercise. There were no significant main effects or interactions among men.

CONCLUSIONS

We found some support for the hypotheses that adaptive perfectionism (higher Standards coupled with lower Discrepancy) is a protective factor for disordered eating and that maladaptive perfectionism (higher Standards coupled with higher Discrepancy) is a risk factor, although, only among women who engaged in lower, but not higher, levels of cardiovascular exercise. The findings also suggest that it may be beneficial to consider dimensions of perfectionism and exercise separately when studying disordered eating.

Defining Features of Unhealthy Exercise Associated with Disordered Eating and Eating Disorder Diagnoses

OBJECTIVES

The current study sought to compare different features of unhealthy exercise on associations with disordered eating and their ability to identify individuals with eating disorders. A secondary aim of the study was to compare prevalence and overlap of different aspects of unhealthy exercise and potential differences in their gender distribution.

DESIGN

Cross-sectional epidemiological study.

METHODS

A community-based sample of men (n=592) and women (n=1468) completed surveys of health and eating patterns, including questions regarding exercise habits and eating disorder symptoms.

RESULTS

Compulsive and compensatory features of exercise were the best predictors of disordered eating and eating disorder diagnoses compared to exercise that was excessive in quantity. Further, compulsive and compensatory aspects of unhealthy exercise represented overlapping, yet distinct qualities in both men and women.

CONCLUSIONS

Including the compulsive quality among the defining features of unhealthy exercise may improve identification of eating disorders, particularly in men. Results suggest that the compensatory aspect of unhealthy exercise is not adequately captured by the compulsive aspect of unhealthy exercise. Thus, interventions that target unhealthy exercise behaviors among high-risk individuals, such as athletes, may benefit from addressing both the compulsive and compensatory aspects of unhealthy exercise. Future prospective longitudinal studies will aid in determining the direction of the association between these features of unhealthy exercise and the onset of eating pathology.

The expression of excessive exercise co-segregates with the risk of developing an eating disorder in women

Excessive exercise (EE) is an important symptom of eating disorders (ED) and is a likely risk factor for developing ED, however, no population-based studies have been performed on the relationship between EE and obtaining ED diagnosis. The aim of this study was to examine the co-occurrence of EE and ED diagnosis in a general population of women. Data for 778 females (age min=30, max=55) from the Saint Thomas Twin Registry, London were used. Phenotypes analyzed included self-reported time spent on physical activity per week, ED diagnosis, Eating Disorder Inventory results (EDI-III), age, BMI and kinship (twin pair). Generalized Estimating Equation analysis showed that only EE (>5 h of exercise per week) and Bulimia Subscale of EDI-III were significantly associated with obtaining ED diagnosis throughout the life. These data revealed that the odds of ever being diagnosed with an ED are more than 2.5 times higher for excessive exercisers compared to individuals with lower activity levels. These data support the notion that EE may be an important risk factor for developing an ED in women.

Quality of life impairment associated with body dissatisfaction in a general population sample of women

Background

In order to elucidate the individual and community health burden of body dissatisfaction (BD), we examined impairment in quality of life associated with BD in a large, general population sample of women.

Methods

Self-report measures of BD, health-related quality of life (SF-12 Physical and Mental Component Summary scales) and subjective quality of life (WHOQOL-BREF Psychological Functioning and Social Relationships subscales) were completed by 5,255 Australian women aged 18 to 42 years.

Results

Most participants (86.9%) reported some level of dissatisfaction with their weight or shape and more than one third (39.4%) reported moderate to marked dissatisfaction. Higher levels of BD were associated with poorer quality of life for all items of both quality of life measures, the degree of impairment being proportional to the degree of BD. Associations were strongest for items tapping mental health and psychosocial functioning, although greater BD was associated with substantially increased risk of impairment in certain aspects of physical health even when controlling for body weight. Post-hoc analysis indicated that the observed associations between BD and quality of life impairment were not accounted for by an association between BD and eating disorder symptoms.

Conclusions

In women, BD is associated with marked impairment in aspects of quality of life relating to mental health and psycho-social functioning and at least some aspects of physical health, independent of its association with body weight and eating disorder symptoms. Greater attention may need to be given to BD as a public health problem. The fact that BD is “normative” should not be taken to infer that it is benign.

Beliefs about exercise: relationship to eating psychopathology and core beliefs among young female exercisers

OBJECTIVE

This study had two objectives. First, to determine links between levels of eating psychopathology and beliefs about exercise among young women. Second, to determine the predictive effects of unhealthy core beliefs on exercise beliefs.

METHOD

A convenience sample of 185 young female exercisers completed the Eating Disorders Inventory (EDI), the Exercise Beliefs Questionnaire (EBQ) and the Young Schema Questionnaire (YSQ).

RESULTS

The participants' mean scores on the EDI were as follows: drive for thinness=0.69 (SD=0.82); body dissatisfaction=1.30 (SD=0.86); and bulimia=0.33 (SD=0.42). There were significant, positive correlations of all three EDI scales with EBQ social and EBQ appearance subscales. In addition, YSQ Defectiveness/Shame beliefs predicted EBQ social scores, while YSQ Unrelenting Standards predicted EBQ appearance scores.

DISCUSSION

Those women with relatively unhealthy eating attitudes are likely to believe that exercise will prevent negative social consequences, and are likely to be motivated to exercise in order to preserve or enhance their physical appearance. These same types of exercise belief (regarding social consequences and appearance) are predicted by feelings of defectiveness and shame and by unrelenting high personal standards.

The effect of exercise absence on affect and body dissatisfaction as moderated by obligatory exercise beliefs and eating disordered beliefs and behaviors

AIM: Research suggests that exercise absence is frequently associated with greater guilt and negative affect, particularly when obligatory exercise beliefs and eating disordered psychopathology are considered. Two separate studies used ecological momentary assessment (EMA) to examine differences in mood on exercise and non-exercise days and the moderating impact of obligatory exercise beliefs and eating disordered beliefs and behaviors. METHOD: Both studies recruited female university students who endorsed frequent exercise behavior and study two also recruited based on level of eating disordered psychopathology. Participants completed the Obligatory Exercise Questionnaire at baseline and EMA measures of affect and exercise behavior for approximately one week. Study two participants also completed measures of body dissatisfaction and cognitions. RESULTS: Results of study one suggest that obligation to exercise appears to have a greater impact on general level of affect than does exercise absence or the interaction of these two. In addition, in study two, eating disorder symptomatology was significantly associated with affect and cognition while exercise absence and obligatory exercise beliefs were not. CONCLUSIONS: The present studies suggest that the absence of exercise is not associated with significant changes in affect or cognitions. However, obligation to exercise and eating disorder symptomatology do impact affect and cognitions.

Do exercise motives predict obligatory exercise?

Few studies have examined whether factors predicting obligatory exercise differ by gender. 303 participants completed the Obligatory Exercise Questionnaire and the Reason for Exercise Inventory. All variables correlated significantly. However, the correlation between exercising for fitness and obligatory exercise was significantly stronger in women than men. In women, obligatory exercise was predicted by exercising to improve body tone, fitness, and to enhance mood; in men, obligatory exercise was predicted by exercising to improve body tone, enjoyment, and perceived attractiveness. Implications for treatment are discussed.

The relationship between compulsive exercise and emotion regulation in adolescents

OBJECTIVE

Compulsive exercise is suggested to be a strategy to regulate emotions. This suggestion has never been studied in adolescents. Therefore, this study examined the cross-sectional association between emotion regulation and compulsive exercise attitudes in adolescents.

DESIGN

A cross-sectional design was employed for this study.

METHOD

A sample of 1,630 adolescent boys and girls completed self-report measures of compulsive exercise, emotion regulation, and disordered eating attitudes, as part of ongoing research into exercise and eating attitudes in adolescents.

RESULTS

Compulsive exercise was significantly associated with emotion regulation, after controlling for disordered eating attitudes. Among boys, compulsive exercise was associated with internal functional, internal dysfunctional, and external functional emotion regulation strategies. In girls, internal functional and internal dysfunctional emotion regulation strategies predicted compulsive exercise.

CONCLUSIONS

Adolescents' compulsivity towards exercise is positively associated with different emotion regulation strategies. More work is needed to identify whether emotion regulation strategies longitudinally predict compulsive exercise.

Psychometric evaluation of the compulsive exercise test (CET) in an adolescent population: links with eating psychopathology

OBJECTIVE

Compulsive exercise describes a rigid, driven urge to exercise that has been reported in different populations, including eating disorder patients. This compulsion can develop at an early age and yet the measurement of compulsive exercise in adolescents is limited by inappropriate assessment techniques. This study aimed to psychometrically evaluate the Compulsive Exercise Test (CET) in a sample of adolescents.

METHODS

The sample consisted of 1012 adolescents aged 12-14 years old, who completed the CET, the Commitment to Exercise Scale (CES), and selected subscales from the Eating Disorder Inventory-2 (EDI-2).

RESULTS

Results confirmed the original five-factor solution of the CET. The CET's concurrent validity with the CES, as well as the convergent validity with the EDI-2, was established. The CET was not strongly related to exercise frequency.

CONCLUSION

The CET appears to be valid and reliable for use with adolescents. Replication with an adolescent clinical eating disorder sample is now required.

Disordered eating and exercise: development and preliminary validation of the compulsive exercise test (CET)

OBJECTIVE

The Compulsive Exercise Test (CET) was developed to assess the primary factors operating in the maintenance of excessive exercise.

METHODS

A total of 367 young female exercisers were recruited from University campuses. Across three separate studies, the participants completed either the CET alone, or the CET and other standard self-report measures of excessive exercise and eating psychopathology.

RESULTS

Factor analyses yielded five factors from which a final 24-item, five subscale measure was constructed. The CET demonstrated high internal consistency across the three samples. Supporting the concurrent and convergent validity of the scale, the CET correlated in the expected direction with existing measures of excessive exercise and eating pathology. As expected, the CET explained greater variance in eating pathology than existing measures of excessive exercise.

DISCUSSION

The resulting subscales of the CET are consistent with a cognitive-behavioural maintenance model of excessive exercise and support the multidimensionality of the excessive exercise construct. Further research is required to validate the instrument within a sample of eating disordered women.

Beliefs about excessive exercise in eating disorders: the role of obsessions and compulsions

OBJECTIVE

This study aimed to develop an understanding of excessive exercise in eating disorders by exploring the role of exercise beliefs, obsessive beliefs and obsessive-compulsive behaviours.

METHOD

Sixty-four women were recruited from eating disorder services and 75 non-clinical women were recruited from a university. Exercise beliefs and behaviours, obsessive beliefs and behaviours and eating disorder psychopathology were assessed using self-report questionnaires.

RESULTS

There was an association between exercise beliefs, obsessive beliefs and obsessive-compulsive behaviours in the eating-disordered group, but not in the non-eating-disordered group. In the eating-disordered group obsessive beliefs and obsessive-compulsive behaviours were associated with a significant proportion of variance in exercise beliefs after controlling for eating disorder psychopathology and BMI. In the non-eating-disordered group obsessive beliefs and behaviours were associated with beliefs about exercise as a method of affect regulation after controlling for BMI.

CONCLUSION

The results are compatible with a model in which obsessive beliefs and exercise beliefs could maintain exercise in eating disorders. This has implications for the assessment and treatment of excessive exercise. Further research is necessary to determine the causality of these relationships.

Compulsive exercise and eating disorders

The aim of this review was to develop an empirically supported cognitive behavioural model of compulsive exercise within the context of the eating disorders. A systematic review of the correlates and predictors of compulsive exercise among eating disordered patients identified four key correlates. These were subsequently validated by a second review, incorporating both the clinical and non-clinical as well as the exercise science literatures. A proposed model is presented which is both evidence-based and testable.

Quality of life in relation to psychosocial risk variables for eating disorders in women and men

This study examined health-related quality of life in relation to psychosocial variables associated with eating disorders. A sample of 266 women and 114 men from a Midwestern university completed questionnaires asking about both generic and eating disorder-specific health-related quality of life, as well as body dissatisfaction, objectified body consciousness, internalization of sociocultural ideals, and restrained eating. Results revealed that women reported significantly higher levels of psychosocial risk variables than men. In addition, for women, all but one of the psychosocial risk variables was found to be associated with lower quality of life. Gender moderated the relationship between quality of life and objectified body consciousness, but not the other psychosocial risk variables. Finally, comparisons between a generic and an eating disorder-specific quality of life scale revealed that the eating disorder-specific scale had higher sensitivity for use in a college student population. These results suggest that women who are at higher risk for developing an eating disorder suffer from lower quality of life, and that eating disorder-specific quality of life scales are useful in understanding women and men in a general population.

Eating disorder-specific health-related quality of life and exercise in college females

OBJECTIVE

Although eating disorder (ED) symptoms result in reduced quality of life (QOL), research is needed to examine variables that influence this relationship. The purpose of our study was to conceptually examine the relationship among ED-specific QOL, ED symptoms, and exercise behavior.

METHOD

Female university students (N = 387) completed ED-specific QOL, exercise behavior, ED symptoms, and exercise dependence symptoms measures.

RESULTS

We found support for the beneficial association of psychological QOL on ED symptoms as well as the detrimental association of exercise dependence on ED symptoms.

DISCUSSION

Our results suggest that improvements in psychological aspects of QOL resulting from exercise may mediate ED symptoms when exercise motivations are not pathological. We discuss further research and intervention implications of our findings.

Predictors of excessive exercise in anorexia nervosa

OBJECTIVE

The aim of the present study was to replicate and amalgamate findings from previous research into a comprehensive regression model predicting excessive exercise in individuals with anorexia nervosa (AN).

METHOD

Participants were 153 patients admitted to an inpatient treatment program for AN. Excessive exercise status was defined as a minimum of 1 hour of obligatory exercise aimed at controlling shape and weight, 6 days per week in the month before admission.

RESULTS

Thirty-four percent (n = 52) of participants met criteria for excessive exercise. A logistic regression was conducted with excessive exercise status as the dependent variable and a number of variables previously found to be predictors of excessive exercise entered as independent variables on the same step. The overall regression model was statistically significant (P < .0005) and explained 31% of the variance in exercise status. Higher levels of dietary restraint (P = .03), depression (P = .04), and self-esteem (P = .02); lower levels of obsessive-compulsive symptomatology (P = .04); and the restricting subtype of AN (P = .03) were significantly associated with excessive exercise.

CONCLUSIONS

Excessive exercise is associated with a number of independent psychologic and behavioral variables, some that suggest a negative impact and others that suggest positive effects.

Examination of a sociocultural model of excessive exercise among male and female adolescents

There is substantial evidence that sociocultural pressures and body image disturbances can lead to disordered eating, yet few studies have examined their impact on excessive exercise. The study adapted a sociocultural model for disordered eating to predict excessive exercise using data from boys and girls in early adolescence (N=421). Perceived sociocultural pressures to lose weight and build muscle, body image disturbance and appearance investment were associated with a compulsive need to exercise. Adolescents' investment in appearance and body image disturbance fully mediated the relationship between sociocultural pressures and a compulsive need for exercise. There was no support for the meditational model in predicting adolescents' frequency or duration of exercise. Results support the sociocultural model as an explanatory model for excessive exercise, but suggest appearance investment and body image disturbance are important mediators of sociocultural pressures.

Qualidade de vida e transtornos alimentares: uma revisão sistemática

O objetivo foi fazer uma revisão sistemática dos estudos que avaliam qualidade de vida em pessoas com transtornos alimentares. Foram realizadas buscas bibliográficas em seis bases de dados e buscas manuais em duas revistas, abrangendo o período de janeiro de 1975 até junho de 2008. As estratégias de busca forneceram um total de 29.537 referências. Quarenta e um estudos preencheram os critérios de inclusão desta revisão e 36 foram analisados no presente trabalho. De modo geral, os estudos revelam prejuízos na qualidade de vida de pacientes com transtornos alimentares quando comparados a grupos normais ou outras patologias psiquiátricas. O aspecto mental da qualidade de vida mostra-se mais prejudicado. A avaliação da qualidade de vida em sujeitos com transtorno da compulsão alimentar periódica revela prejuízos nos aspectos físico e mental da qualidade de vida. Há pouca evidência e discussão para indivíduos com bulimia nervosa isoladamente. Em sujeitos com anorexia nervosa, a avaliação requer cautela, já que o aparente menor impacto físico pode ser reflexo da psicopatologia específica deste transtorno e não do funcionamento saudável.

The effects of exercise on body satisfaction and affect

This research used ecological momentary assessment to examine the effects of exercise on state body dissatisfaction and affect in 33 undergraduate females with high trait body dissatisfaction and 28 with low trait body dissatisfaction who exercised at least three times weekly. Trait body dissatisfaction was investigated as a moderator of the effects of exercise as well as different motivations for exercise. Results indicated all participants experienced lower state body dissatisfaction and negative affect and greater positive affect post-exercise. Trait body dissatisfaction moderated the association between motivations and exercise effects. Appearance and weight motivations were related to higher state body dissatisfaction for all individuals. Fitness and health motivations were related to higher state body dissatisfaction for high trait body dissatisfied individuals and lower state body dissatisfaction for low trait body dissatisfied individuals. Thus, although exercise has positive effects on body dissatisfaction and affect for high frequency exercisers, their exercise motivations impact these effects.

Health-related quality of life and eating disorders: a review and update

OBJECTIVE

The aim of this article is to provide a narrative review of empirical studies related to health-related quality of life (HRQOL) and eating disorders and to report recent changes in the measurement of HRQOL in eating disorders.

METHOD

Twenty-five articles of central importance to the topic were identified in a systematic search of six databases. All articles were selected based on a consensus relevancy rating process. Key themes were extracted from the articles and validated by all authors.

RESULTS

We identify six themes in the extant empirical literature.

DISCUSSION

We discuss these six themes and review them in light of the fact that they are identified in studies using only generic measures of HRQOL. Four recently developed disease-specific HRQOL measures specific to patients with eating disorder are discussed.