# Exercise as it relates to Disease/Anorexia Nervosa and Exercise Abuse

Anorexia nervosa (AN) refers to an eating disorder where an individual, in order to maintain a below average body weight, either severely limits their food intake, or goes through binging and purging cycles. The latter is generally achieved by means of vomiting or laxative abuse. Some research has found strong links between AN and obsessive-compulsive disorder (OCD), specifically that both share obsessive ritual-like behaviours, including but not limited to cleaning and counting. Due to most AN patients being obsessed with their weight and body image, it seems logical that they subsequently could turn to exercise as a means of achieving their goal(s). The term "excessive exercise" (or "hyperactivity") in association with AN pertains to sufferers' overriding need to exercise, rather than the sheer quantity of exercise performed. Someone who exercises excessively is recognised as prioritising exercise above other actions, keeping an exercise schedule and irritable when they cannot complete any exercise. The combination of these two factors - caloric restriction and calorie burning, can have detrimental effects on the body.

## By The Numbers

* Anorexia Nervosa is seen as a chronic illness, due to a mean duration of five to seven years
* Has the highest death rate of all mental illnesses (20% in 20 years)
* 10x more common in females than males
* Hyperactivity presence in AN patients estimated to be between 40-81%

## Signs of AN

* Physical
* Lack of Menstruation
* Inexplicable weight loss
* Psychological
* Obsession with weight
* Self-perception of being overweight when they are not
* Fear of weight gain/eating
* Behavioural
* Excessive exercise
* Vomiting and laxative abuse
* Eating separately

## Symptoms of AN

* Psychological
* Depression
* Moodiness
* Lack of attentiveness
* Distortion of self-perception
* Physical
* Loss of consciousness
* Cessation of menstruation (females)
* Anaemia
* Slowed metabolism
* Reduced resting energy expenditure (REE)

## Associated With

While there is no single factor which can cause an individual to develop Anorexia Nervosa, there are recurring trends among AN patients with hyperactivity:
* High levels of Obsessive Compulsive Personality Disorder (OCPD) characteristics
* High anxiety and depression scores
* High self-esteem but low body esteem
* Lower lifetime Body Mass Indexes (BMI)

## The Effects

Hyperactivity and AN together make for a lethal combination. Considering the lack of carbohydrates and subcutaneous fat in a patient with AN, further depleting energy stores through excessive exercise can create new health concerns:
* Osteopenia (low Bone Mineral Density)
* Decreased heart size
* Hypotension
* Arrhythmia (irregular heartbeat)
* Peripheral Edema (swelling)
With regard to recovery, AN patients who exercise excessively generally take longer to rid themselves of the condition. Hyperactivity has been linked to high levels of relapse, lengthier spells in hospitals and more general physical problems, including a requirement for higher energy intake levels to gain weight.

## Treatment

In a normal course of events, exercise can be prescribed to aid in the management of an abundance of mental health issues. Herein lies the dilemma - how could we reap the benefits that come from exercise in patients who need to exercise less? One study by Beumont et. al. suggested using exercise as a reward for the patients continued compliance with their treatment. Through therapy, diet restoration, and exercise, the overall well-being of the individual can be significantly improved, and their treatment completed. Beumont et. al. prescribed an exercise regime consisting of:
* Stretching
* Postural exercises
* Weight training
* Social/Team Sports
* Aerobic Exercise

## Benefits of Exercising

* Enjoyment
* Anxiety reduction
* Improved moods
* Increased sense of well-being

## Final Recommendations

The biggest hurdle in the fight against Anorexia Nervosa and hyperactivity is the mental side of things. Whilst a patient suffers from such severe body image distortion, very little can be achieved in terms of restoring them to good health. One study suggested an exercise where patients stand in front of a full-length mirror without criticising their body, but rather accepting the body as it appears in that instant. This method has proved effective in obese binge eaters and body dysmorphic individuals. Exercise (in healthy levels) should be implemented in conjunction with a balanced diet and therapy, as the positive effects of exercise cannot be actively replicated using any other means. The most important of these for AN patients, is the regulation of metabolism. The emphasis of their treatment needs to be from an overall health perspective, rather than appearance. They need to be shown that they can balance nutrition and exercise, leading them to become healthier. At this point, perhaps they will see that the appearance of their body in a healthy state is more attractive than a dilapidated skeleton wrapped in skin.

## References

* 1 2 3 4 5 6 Bewell-Weiss, CV, Carter, JC (2010). "Predictors of Excessive Exercise in Anorexia Nervosa", Comprehensive Psychiatry, 51, pp. 566-571.
* ↑ Davis, C, Kaptein, S (2006). "Anorexia Nervosa with Excessive Exercise: A Phenotype With Close Links to Obsessive-Compulsive Disorder", Psychiatry Research, 142, pp.209-217.
* ↑ Dalle Grave, R, Calugi, S, Marchesini, G (2008). "Compulsive Exercise to Control Shape or Weight in Eating Disorders: Prevalence, Associated Features, and Treatment Outcome", Comprehensive Psychiatry, 49, pp. 346-352.
* 1 2 3 4 Australian Government, Department of Health. "Anorexia nervosa: Australian treatment guide for consumers and carers", 2005. http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-a-anorex-toc~mental-pubs-a-anorex-int (accessed 27th of September, 2014).
* ↑ Serpell, L, Livingstone, A, Neiderman, M, Lask, B (2002). "Anorexia Nervosa: Obsessive-compulsive disorder, obsessive-compulsive personality disorder, or neither?", Clinical Psychology Review, 22, pp.647-669.
* 1 2 Zipfel, S, Mack, I, Baur, LA, Hebebrand, J, Touyz, S, Herzog, W, Abraham, S, Davies, PSW, Russell, J (2013). "Impact of Exercise on Energy Metabolism in Anorexia Nervosa", Journal of Eating Disorders, 1:37, pp. 1-9.
* 1 2 3 4 Beumont, PJV, Arthur, B, Russell, JD, Touyz, SW (1994). "Excessive Physical Activity in Dieting Disorder Patients: Proposals for a Supervised Exercise Program", International Hournal of Eating Disorders, 15:1, pp. 21-36.
* ↑ Wilson, GT (1999). "Cognitive Behaviour Therapy for Eating Disorders: Progress and Problems", Behaviour Research and Therapy, 37, pp. S79-S95.