Is Exercise a Good Treatment for Anorexia Nervosa?

One to two percent of North American girls and women suffer from anorexia nervosa (AN). This psychological disorder mainly affects women and is characterized by caloric restriction and the unrelenting pursuit of thinness. Without treatment, AN contributes towards significant morbidity and may be fatal. Although only a small proportion of women meet clinical criteria for AN, body image dissatisfaction and unhealthy dieting are prevalent within North American culture and are normative features of the social interaction between women. Thus, efforts are also being made to consider AN as a social and political problem.

Historically, the notion of prescribing exercise for patients with AN was considered preposterous, if not dangerous. Conventional wisdom at the time advocated for complete activity restriction and "bed rest." Conceptualizing exercise as a "pathological symptom" of the disorder, professionals proposed that it was simply another mechanism in which to expend calories. Drawing upon studies conducted with rats, researchers proposed a model of hyperactivity in AN; mediated by neuro-chemicals, overactivity and under-nutrition mutually reinforce one another in an addictive cycle. Furthermore, aesthetic sporting cultures, such as gymnastics, place a great deal of emphasis on physical appearance. Thus, researchers and clinicians were concerned that features associated with competitive sports may contribute towards and maintain disordered eating.


How Exercise Can Help
However, an emerging body of literature has emphasized that safe, nutritionally-supported, and supervised exercise programs may facilitate recovery in patients with AN. Engaging in exercise enhances patient quality of life and eating disorder program adherence; there are no adverse effects on weight restoration. And exercise improves the quality of the interaction between health providers and patients during treatment and enhances patient compliance with treatment.

As well, in a population that is susceptible to osteoporosis, exercise may also maintain the integrity of the musculo-skeletal system and prevent bone deterioration. In addition to improved body image, physical activity may contribute towards positive identity development, in which patients develop new interests outside of the disorder. Importantly, by incorporating exercise as an integral component of treatment, patients are able to change their attitudes and beliefs and learn to perceive it as an enjoyable pursuit.

Patients with anorexia may not be attuned to important bodily sensations, such as hunger or pain. Exercise may help patients to re-engage with their bodies in new and healthy ways. Lastly, since most patients with AN were highly active prior to the onset of the disorder, discontinuing activity all together is an unrealistic approach to the management of activity overtime.

In exercise studies conducted in the AN population, patients were medically cleared for participation in the program, and the type, intensity, and duration of the activity was tailored to suit the patient's stage of recovery. Thus far, engaging in activities such as yoga, walking, weight-lifting, horseback riding, and social team sports such as volleyball, appear to afford the greatest benefit. Solitary aerobic activities, such as running, cycling, and swimming, should be avoided.

Key Messages

* The issue of exercise in AN is controversial and different researchers have debated whether or not it is a "friend or foe."

* However, it appears that safe, medically supervised, and nutritionally-supported exercise may facilitate recovery in medically stable girls and women with AN.