Exercise Intervention for Women with AN

For from 40% to 80% of women with AN, excessive exercise is a proverbial dual-edged sword: it brings guilt but also provides relief about not gaining weight. Most of these patients also have a great aversion to fat, and report the major reason to exercise is to retain their shape and keep weight off. Also, many AN patients are at high risk for a variety of serious medical complications, such as bone fractures, electrolyte imbalances, and sudden death, which can be caused by or exacerbated by excessive exercise.

Christie Zunker, PhD and colleagues at the Neuropsychiatric Institute, Fargo, ND, evaluated six exercise intervention programs in clinical settings, including three that were conducted in hospitals (Int J Eat Disord 2011; 7:579) identified in the medical literature.

In one controlled study, by Calogero and Pedrotty (Eat Disord 2004; 112:273), designed to decrease excessive exercise among women in a residential eating disorders treatment center, a 60-minute exercise session was conducted four times a week and included a combination of stretching, posture, yoga, Pilates, partner exercises, strength training, balance, exercise balls, aerobic activity, and recreational games. Women with AN in the exercise group gained 33% more weight compared to women in the control group. In another study, 16 outpatients diagnosed with AN were randomized to either an exercise group with a 3-month graded exercise program or to a control group where patients were encouraged to limit their exercise (Int J Eat Disord 2000; 28:101). The graded exercise protocol consisted of seven levels, depending on the patient’s percent ideal body weight (% IBW) and percent body fat (% BF).For example Level 1 exercise included stretching three times a week for patients who were less than 75% IBW or 19% IBW, compared to Level 7, where the patient protocol included stretching, resistive strengthening exercises, and low-impact cardiovascular exercise three times a week for those at 100% IBW or 25% body weight. Both those in the exercise and control groups increased their BMI and % BF. The slight differences found between groups may have been due to the small sample size because four patients dropped out and only 12 participants completed the study.

According to Dr. Zunker and her co-workers, limited empirical findings demonstrate a positive correlation between responsible physical activity and weight restoration in patients with AN. It seems important to develop comprehensive treatments to promote weight restoration, including gradually encouraging healthy amounts of physical activity, for patients with AN who exercise excessively despite injuries and contrary to medical advice.