Medical and physiological complications of exercise for individuals with an eating disorder: A narrative review

Individuals with eating disorders (ED) experience prolonged malnutrition, binge episodes, and compensatory behaviours that affect every organ system. Psychological and physiological symptoms are worsened with comorbid dysfunctional exercise, seen in up to 80% of those with an ED. Although return to exercise is an important component of treatment and recovery, little is known about the contraindications and risks of exercise engagement specific to those with an ED. This paper provides a comprehensive narrative review of the medical and physiological complications of engaging in exercise during ED treatment and outlines when exercise may be contraindicated or used in modified or cautionary ways. We conducted a literature search on MEDLINE, PubMed, and PsychArticles to identify relevant articles, which yielded six categories of medical and physiological complications of ED that may be exacerbated by exercise: energy availability, cardiovascular health, electrolyte abnormalities, biomedical function markers, sex hormones, and body composition. We summarize the evidence for these complications for readers and offer an initial set of recommendations for incorporating exercise during ED treatment based on our findings. This review may serve as a resource for members of ED treatment teams to help evaluate more readily and confidently whether exercise is safe for individual patients and when modifications and caution may be warranted.

Compulsive exercise and mental health challenges in fitness instructors; presence and interactions

BACKGROUND

Some physically active people exercise compulsively, which can be associated with several mental health challenges. Fitness instructors are considered important role models for an active, healthy lifestyle; yet little is known about their exercise motives and mental health. The aim of this study was to examine the presence of compulsive exercise and mental health challenges, and their interaction, in fitness instructors.

METHODS

A total of 270 fitness instructors from Norwegian fitness clubs were recruited for this cross-sectional study. Inclusion criteria were operating as instructors within the current year and understanding Norwegian language. Data were collected by an electronic questionnaire and included demographic information, hours of classes instructed and of personal physical activity, Compulsive Exercise Test (CET), Symptom Check List - 10 (SCL-10), Beck Depression Inventory (BDI), and Eating Disorder Examination Questionnaire (EDE-Q)).

RESULTS

Females had higher CET scores than males, and 9% of all respondents had CET score above clinical cutoff. Respondents with clinical CET score had higher SCL-10, BDI and EDE-Q global- and subscale scores compared with their counterparts. Although CET was positively and significantly associated with BDI, SCL-10, and EDE-Q, only the latter explained the CET score (ß = 1.23, 99% CI = 0.87, 1.59).

CONCLUSION

About one out of eleven instructors were above clinical CET cut-off, revealing symptoms of compulsive exercise. EDE-Q significantly contributed in a model explaining 43% of the variation of compulsive exercise.