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. 2018 Jun 12:6:11.
doi: 10.1186/s40337-018-0197-z. eCollection 2018.

Running on empty - a nationwide large-scale examination of compulsive exercise in eating disorders

Elin Monell  1   2 , Johanna Levallius  1   2 , Emma Forsén Mantilla  1   2 , Andreas Birgegård  1   2
Affiliations

Running on empty - a nationwide large-scale examination of compulsive exercise in eating disorders

Elin Monell et al. J Eat Disord. .

Abstract

Background: Compulsive exercise (CE) has been the neglected "Cinderella" among eating disorder (ED) symptoms, even though it seems to impact severity, treatment and outcome. This prompted a large-scale and systematic examination of the impact of CE in a representative ED sample.

Methods: CE was examined in over 9000 female and male patients from a clinical ED database (covering out-patient, day and/or residential treatment) with respect to prevalence, ED diagnosis, ED symptoms, clinical features, patient characteristics, and outcome at 1-year follow-up. Relationships between changes in CE behavior and remission were also examined.

Results: CE was a transdiagnostic symptom, present in nearly half of all patients (48%). It was associated with greater overall ED pathology, particularly dietary restraint, and negative perfectionism. Initial CE did not impact remission rate, but patients continuing or starting CE during treatment had considerably lower remission rates compared to patients who never engaged in, or ceased with, CE. Results were comparable for females and males.

Conclusions: At baseline, there were few differences between patients with and without CE, except a somewhat higher symptom load for patients with CE, and CE did not predict ED outcome. However, how CE developed during treatment to 1-year follow-up considerably impacted remission rates. We strongly recommend CE to be systematically assessed, addressed, and continuously evaluated in all ED patients seeking treatment.

Keywords: Compulsive exercise; Eating disorder; Females; Males; Outcome.

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Conflict of interest statement

Patients who decline being included in research when they are registered in the Stepwise database are removed prior to analysis. Ethical approval was granted by the regional review board (No. 2009/1298-31/1, EPN Stockholm).The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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