Physical Activity and Exercise Dependence During Inpatient Treatment of Longstanding Eating Disorders: An Exploratory Study of Excessive and Non-Excessive Exercisers Solfrid Bratland-Sanda, MSc 1,2 * Jorunn Sundgot-Borgen, PhD 2 Øyvind Rø, MD, PhD 1 Jan H. Rosenvinge, PhD 3 Asle Hoffart, PhD 1 Egil W. Martinsen, MD, PhD 4,5 ABSTRACT Objective: To describe changes in phys- ical activity (PA) and exercise dependence score during treatment of eating disor- ders (ED), and to explore correlations among changes in PA, exercise motiva- tion, exercise dependence score and ED psychopathology in excessive and non- excessive exercisers. Method: Thirty-eight adult females receiving inpatient treatment for ano- rexia nervosa, bulimia nervosa or ED not otherwise specified participated in this prospective study. Assessments included accelerometer assessed PA, Exercise De- pendence Scale, Reasons for Exercise In- ventory, ED Examination, and ED Inven- tory. Results: Amount of PA was significantly reduced in non-excessive exercisers dur- ing treatment, in excessive exercisers there was a trend towards reduced amount of PA from admission to dis- charge. In excessive exercisers, reduced ED psychopathology was correlated with reduction in exercise dependence score and perceived importance of exercise to regulate negative affects, but not with importance of exercise for weight/ appearance. These associations were not found in non-excessive exercisers. Discussion: Excessive exercise is an im- portant issue in longstanding ED, and the excessive exercising patients need help to develop alternative strategies to regu- late negative affects. V V C 2009 by Wiley Periodicals, Inc. Keywords: adult; female; humans; psychiatry; exercise; sports (Int J Eat Disord 2010; 43:266–273) Introduction Excessive physical activity (PA) has been viewed as a common feature affecting upto 80% of patients with eating disorders (ED). 1,2 Although this feature has been shown to be most frequent in the acute phases of the ED, 1–4 it has also been reported as a persistent behavior associated with more severe psychopathology, poorer treatment outcome and higher risk of relapse. 5–10 Unfortunately previous studies are hard to interpret due to the lack of a common definition of excessive PA. 2–4,6,7 Moreover, the validity of the data may be influenced by retro- spective recall biases commonly observed with self reported assessment of PA. 11 Although excessive PA is recognized as a malad- aptive behavior, adequate dosed PA might be a beneficial part of treatment for patient across the various ED diagnoses. 12 There is also good evi- dence for the positive effect of PA in treatment of depression and anxiety, 13 which are common comorbid conditions in ED. 14 In spite of this, devel- opment in PA behavior during ED treatment is poorly described. Blinder 15 reported an increase in weekly duration of PA parallel with weight restora- tion in patients with anorexia nervosa, and this in- crease did not interfere with the weight restoration. Similar studies have confirmed this finding 16,17 Rø et al. 18 reported no change in reported number of days with vigorous PA from admission to discharge in patients with bulimia nervosa. However, the pre- vious studies have used self reported PA only. They Accepted 25 August 2009 1 Research Institute, Modum Bad Psychiatric Center, Vikersund, Norway 2 Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway 3 Department of Psychology, University of Tromsø, Tromsø, Norway 4 Institute of Psychiatry, University of Oslo, Oslo, Norway 5 Department of Mental Health, Oslo University Hospital Aker, Oslo, Norway *Correspondence to: Solfrid Bratland-Sanda, Modum Bad Psychiatric Center, Research Institute, Badeveien, N-3370 Vikersund, Norway. E-mail: solfrid.bratland-sanda@nih.no Published online 16 October 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.20769 V V C 2009 Wiley Periodicals, Inc. 266 International Journal of Eating Disorders 43:3 266–273 2010 CE ACTIVITY