Solfrid Bratland-Sanda

Fitness clubs may be environments where abnormal eating behaviors and excessive exercise are socially accepted, potentially putting individuals at risk for disordered eating (DE). This study examined the DE risk prevalence among gym members, comparing body appreciation, exercise motivation, frequency, BMI, and age across DE risk levels, and assessed the associated factors. A sample of 232 gym members (age: 39.6 ± 13.7) completed an online survey measuring DE risk (Eating Disorder Screen for Primary Care (ESP)), body appreciation (Body Appreciation Scale version 2), and exercise motivation (Behavioral Regulation in Exercise Questionnaire-2). One out of five (19.4%) were at risk of DE, while 15.5% and 11.6% reported having secretive eating behaviors and a history of eating disorders, respectively. Body weight impacted self-perception for 62.5% of the respondents. Those at DE risk had a higher mean BMI (26.23 ± 4.36 vs. 24.68 ± 3.61, p = 0.032) with a higher proportion of those with a BMI of 25–29.9 (46.67% vs. 29.41%, p = 0.027) compared to non-at-risk individuals. DE risk was associated with lower body appreciation (3.00 ± 3.60 versus 4.00 ± 3.70, p = ≤0.001), with body appreciation being the only factor associated with DE risk (OR = 0.24, 95% CI = 0.15, 0.39, p = ≤0.001).

Purpose: This study aimed to examine changes in compulsive exercise among adults with eating disorders (ED) admitted for inpatient treatment in a randomized controlled trial comparing cognitive behavioral therapy (CBT) and compassion‐focused therapy (CFT) and whether such changes were influenced by treatment condition, childhood trauma, or level of compulsive exercise.Method: A total of 130 adults admitted to inpatient treatment for EDs mean (SD) age 30.9 (9.7) years, mean illness duration 14.2 (8.9) years, were randomized to receive CBT or CFT and analyzed using multilevel modeling. Assessments included Eating Disorders Examination – Interview, Compulsive Exercise Test and Childhood Trauma Questionnaire.Results: Mean total CET score at baseline was 14.7 (4.0) with no difference between the treatment groups. A total of 63 (48.5%) had CET score ≥ 15, indicating clinical levels. There was an overall time effect on reduction in CET total and all CET subscale scores except Lack of enjoyment, and CFT provided greater reduction compared to CBT on the CET subscale Mood improvements. Patients with clinical CET score levels showed greater reduction on CET total and the subscales Avoidance, Weight, and Rigidity across time compared to persons with non‐clinical CET score. Childhood trauma did not predict changes in CET total or subscale scores.Discussion: Both CBT and CFT improve overall compulsive exercise. The greater effect of CFT than CBT on exercise as a maladaptive mood regulator calls for further research on how affective oriented psychotherapies can not only reduce compulsive exercise but also promote functional exercise among persons with EDs.Public Significance Statement: Understanding and addressing compulsive exercise in adults with eating disorders is crucial. This study comparing cognitive‐behavioral therapy and compassion‐focused therapy shows both improve compulsive exercise. Importantly, compassion‐focused therapy has a greater impact as an emotion‐focused regulator. This emphasizes the need for further exploration into how emotion‐focused therapies can reduce compulsive exercise and promote healthier, functional physical activity for individuals with eating disorders.

The purpose of the study was to compare methods for estimating energy expenditure (EE) and physical activity (PA) intensity during a 30 min session of active virtual reality (VR) gaming. Eight individuals (age = 25.4 ± 2.0 yrs) participated, with a maximal oxygen consumption (VO_2max) of 41.3 ± 5.7 mL∙kg⁻¹∙min⁻¹. All tests were conducted over two days. An incremental test to determine the VO_2max when running was performed on day 1, while 30 min of active VR gaming was performed on day 2. The instruments used for EE estimations and PA measurements were indirect calorimetry, a heart rate (HR) monitor, and waist- and wrist-worn accelerometer. Compared to indirect calorimetry, waist-worn accelerometers underestimated EE (mean difference: −157.3 ± 55.9 kcal, p < 0.01) and PA levels. HR-based equations overestimated EE (mean difference: 114.8 ± 39.0 kcal, p < 0.01 and mean difference: 141.0 ± 81.6 kcal, p < 0.01). The wrist-worn accelerometer was the most accurate in estimating EE (mean difference: 23.9 ± 45.4 kcal, p = 0.95). The large variations in EE have implications for population-based surveillance of PA levels and for clinical studies using active VR gaming.

Background: Body appreciation might serve as a protective factor for developing eating disorders and is associated with participation in physical activity. Less is known about whether various arenas for physical activity may be linked to body appreciation. Therefore, the current study sought to (1) identify potential associations between physical activity level and arenas for physical activity, connectedness with nature, self-compassion, and body appreciation in adults, and (2) explore physical activity level and arenas, connectedness with nature, and self-compassion as explanatory factors for body appreciation. Methods: A total of 360 adult Norwegian inhabitants (75% women, mean (SD) age 42.58 (12.30) yrs) responded to an online questionnaire. Instruments included the Body Appreciation Scale, the Connectedness with Nature Scale, and the Self-Compassion Scale. Results: The percentage of participants who engaged in various physical activity arenas were 98.5% for nature, 57.5% for fitness centers, and 43.0% for organized sports. Small, positive associations were found between body appreciation and the frequency of using fitness centers and nature as physical activity arenas. Self-compassion, connectedness with nature, and frequency of using fitness centers and nature as physical activity arenas explained 39% of the variance in body appreciation. Discussion: The importance of both fitness centers and nature as arenas for physical activity to explain body appreciation was surprising and might reflect different use of fitness centers among adults compared to younger age groups. Conclusion: Physical activity at fitness centers and in nature were positively associated with body appreciation in adults. Self-compassion, connectedness with nature, and using fitness centers and nature as arenas for physical activity, were found to explain variation in body appreciation in adults.

Background: To investigate the frequency of compulsive exercise among early adolescents, and determine the associated impact of sex, physical activity level, exercise habits, motivational regulation, dieting behaviour and health-related quality of life (HRQoL) on compulsive exercise.Methods: Cross-sectional design with 8th grade adolescents (n = 572, mean ± SD age 13.9 ± 0.3 yrs). Outcome assessment was compulsive exercise (Compulsive Exercise Test, CET). Total CET score ≥ 15 was defined as clinical CET score. Further assessment included exercise motivation (Behavioural Regulation of Exercise Questionnaire—2), HRQoL (KIDSCREEN 27), accelerometer-assessed physical activity and Andersen test for cardiorespiratory fitness. Exercise obsession was defined as clinical CET score and < 60 min/day with moderate-to-vigorous objectively assessed physical activity.Results: Small sex differences were found for CET total score. Seven percent of the adolescents were classified with clinical CET score, and four percent with exercise obsession. Adolescents with clinical CET score had higher body mass index, more weight loss attempts, and lower physical fitness compared to adolescents with non-clinical CET score. Being a boy, higher scores on introjected motivational regulation and HRQOL subscale parent relation and autonomy, use of exercise monitoring tool, and number of weight loss attempt the past 12 months explained 39% of the total CET score variance. Physical activity level did not predict compulsive exercise.Conclusions: Compulsive exercise in early adolescents was predicted by exercise motivation, exercise habit, and dieting, but not physical activity level. This implicates a distinction of obsessive cognitions about physical activity from performed physical activity in adolescents, and that such cognitions must be addressed in future initiatives that aim to improve adolescents’ general physical activity level, health, and wellbeing.Trial registrationClinicalTrials.gov: NCT03906851.Plain English summary: Although there is a huge concern about adolescents being insufficiently physically active, there are also adolescents who struggle with issues of compulsive exercise. The issues of compulsive exercise have been rarely studied in adolescents. We therefore aimed to describe compulsive exercise and factors that were associated with and could explain presence of compulsive exercise. A total of 572 8th graders (age 13.9 ± 0.3 yrs) responded to this study. We found that the score on compulsive exercise was higher in boys than in girls, and that adolescents with high score on compulsive exercise had higher body mass index, more weight loss attempts, and lower physical fitness compared to adolescents with low score on compulsive exercise. Also, we found that exercise obsessions, i.e., thinking of exercise without actually exercising, was present in four percent of the respondents. Being a boy, attempting weight loss, exercising to avoid shame/guilt, and exercising for the perceived value of exercise predicted compulsive exercise. Awareness of the compulsive exercise and exercise obsessions is important in public health initiatives that aim to increase adolescents’ physical activity level.