Compulsive exercise and physical activity in eating disorders

Abstract

Compulsive exercise and extensive physical activity are significant symptoms of eating disorders. Compulsive exercise is one of the most persistent symptoms associated with a higher risk of relapse, chronicity, and prolonged hospitalisation. However, a deeper understanding of the progression of compulsive exercise symptoms during sickness and recovery is lacking. This research aimed to investigate the role of compulsive exercise and physical activity in eating disorders before and after day-care treatment. A longitudinal mixed design assessed symptoms at admission, discharge, and follow-up, with a primary focus on qualitative data providing a deep understanding of participants' experiences, while the quantitative data served a complementary role in contextualising and supporting the qualitative findings. Eight women diagnosed with eating disorders undergoing day-care treatment were assessed by the Exercise and Eating Disorders questionnaire and interviews. Following treatment and discharge, a positive change in compulsive exercise attitudes and behaviour was found. Individuals with anorexia nervosa showed higher symptoms of compulsive exercise at admission and discharge compared to clients with bulimia nervosa. Thematic analysis revealed five broad themes that defined physical activity in eating disorders throughout sickness and recovery: (1) eating pathology, (2) compulsivity and obsessiveness, (3) exercise commitment, (4) affect regulation, and (5) perfectionism. These findings provided substantial evidence for the progression and multidimensionality of compulsive exercise symptoms, supporting Meyer's model of compulsive exercise in eating disorders, and highlighting the importance of this factor in eating disorders treatment.