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Background: The link between compulsive exercise and eating disorders is well known, but research with clinical samples has been limited. The purpose of the study was to investigate changes in attitudes towards compulsive exercise and its impact on outcome at follow-up in female adult hospitalised patients with eating disorders. Methods: The sample consisted of 78 patients: Diagnostic distribution: anorexia nervosa 59% (n = 46), approximately 22% (n = 16) in bulimia nervosa, and Eating Disorder not Otherwise Specified respectively. The average follow-up period was 26 months (SD =15 months). Compulsive exercise was measured by the Exercise and Eating Disorder (EED) questionnaire. Other measures were the Eating Disorder Inventory (EDI-2), Body Attitude Test (BAT), Symptom Checklist (SCL-90), Inventory of Interpersonal Problems (IIP 64), Beck Depression Inventory (BDI), and body mass index (BMI). Outcome measures were EDI-2 and BMI (patients with admission BMI = 18.5). Paired sample t-tests and mixed model regression analysis were conducted to investigate changes in compulsive exercise and predictors of outcome respectively. Results: All measures revealed significant improvements (p < .01 - p < .001) from admission to follow-up. EED scores significantly predicted changes in EDI-2 scores and BMI (p < .01 and p < .001 respectively). Other significant predictors were BAT, SCL-90, IIP-64, BMI (p < .01-.001) (EDI-2 as outcome measure), and BAT and BDI (p < .001) (BMI as outcome measure). Conclusions: The results demonstrated significant improvements in attitudes towards compulsive exercise during treatment and follow-up. The change in compulsive exercise scores predicted the longer-term course of eating disorder symptoms and BMI. [ABSTRACT FROM AUTHOR]

Background Despite the substantial role of compulsive exercise in the development and maintenance of anorexia nervosa, and despite associated risks of medical complications, longer length of hospitalization and higher relapse rates, little is understood about the personal experience and meaning of compulsive exercise in this context. This study explored the experiences of compulsive exercise in women with anorexia nervosa, restrictive type, and the sense they make of these experiences in the context of their daily lives and treatment programme. Methodology Semi-structured interviews were conducted with six females, four of whom were former athletes. Transcripts were subjected to interpretative phenomenological analysis (IPA). Findings This paper reports on the first superordinate theme, paradoxical functions of exercise. An account of the participants' perspectives regarding their engagement with compulsive exercise as a means of emotion regulation is presented first. Secondly, the manner in which participants experience the embodiment of emotional states is explored. Thirdly, the ability of exercise to offer participants a sense of time-out is presented. Finally, the meaning of exercise in relation to the participants' sense of self and identity are analysed. Conclusions The study demonstrates how compulsive exercise represents an essential means of emotion distraction and management for individuals with anorexia nervosa. The finding that feelings are echoed in the participants' bodies is significant, as this gives participants a sense of connecting with their emotions. The time outs offered by exercise provide a degree of structure, control and stability for the participants' sense of self, helping them commit to the demands of treatment. However, this control and stability is short lived, as it may lead to a subsequent loss of control if underlying concerns and emotions are not addressed. It is suggested that interventions should aim to increase recognition and tolerance of negative feelings. Body-oriented and physical therapy interventions tailored specifically to individuals with anorexia nervosa may provide a fresh way of addressing emotions that is complementary to other therapies. [ABSTRACT FROM AUTHOR]

Perfectionism has a strong association with eating disorders. Research in non-clinical adults has suggested that perfectionism has both direct and indirect effects on eating disorder symptoms, and that compulsive exercise is a potential mediator. The aim of this study was to understand whether perfectionism is associated with eating disorder symptoms, both directly and indirectly through compulsive exercise in underweight adolescents with eating disorders. Participants were 149 female adolescents (M = 14.90 years, age range 13-17) with eating disorders from the Helping to Outline Paediatric Eating Disorders (HOPE) Project, an ongoing, registry study of individuals consecutively referred individuals to a statewide eating disorder service. The majority had a diagnosis of anorexia nervosa restricting type (66 %), followed by unspecified feeding or eating disorder (21 %), and anorexia nervosa binge-eating purging type (13 %). To test the model, path analyses with bootstrapping were conducted. All paths were statistically significant, including the indirect effect from perfectionism to eating disorder pathology via the mediator of compulsive exercise, and the direct effect of perfectionism on eating disorder pathology. Overall, this research provides further evidence that compulsive exercise may be one factor that can explain the relationship between perfectionism and eating disorder symptoms. Future research should seek to determine the relative efficacy of approaches for the treatment of eating disorders in adolescents which target perfectionism and compulsive exercise. [ABSTRACT FROM AUTHOR]

Understanding the mechanisms through which internalisation of societal body standards lead to negative outcomes for women is important to inform prevention and treatment strategies targeting female body image issues and problematic eating and exercise behaviours. This study investigated the mediating roles of body surveillance and social comparison on the relationship between fit-ideal internalisation and a range of negative eating and body image related outcomes. Participants were 448 females, aged 16-25 years who completed self-report measures of fit-ideal internalisation, body surveillance, social comparison, body dissatisfaction, dieting, bulimic behaviours and compulsive exercise. Consistent with hypotheses, the results of parallel mediation analyses suggested that both body surveillance and social comparison mediated the relationship between fit-ideal internalisation and body dissatisfaction, dieting and bulimic behaviours. However, only social comparison was found to mediate the relationship between fit-ideal internalisation and compulsive exercise. The results suggest both body surveillance and social comparison are mechanisms by which fit internalisation detriments women's body image, making them potentially useful treatment targets for future research. [ABSTRACT FROM AUTHOR]

Background: Compulsive exercise (CE) has been proposed as one of the maladaptive elements that might concur to developing and maintaining an eating disorder (ED), even if no conclusive consensus is yet available. This study evaluates the psychometric properties of the Compulsive Exercise Test (CET), the questionnaire most frequently discussed in the literature. Our second aim is to evaluate the relationships between CE, quality of life, and different body concerns in a group of individuals.Methods: Two different studies are performed. In the first study, we evaluate the psychometric properties of the Italian CET with a sample of 272 individuals (157 with different diagnoses of ED). In the second study, a group of 75 ED patients is compared to 68 of their peers looking for specific differences and relationships between CE, quality of life, and body concerns.Results: The CET shows optimal psychometric proprieties, and a five-factors structure. CE is linked to more severe specific psychopathology in ED patients, including increased thoughts of restraint and concerns about weight and shape. Moreover, weight phobia and quality of life are predictors of CE in patients.Conclusion: The specific role of CE is discussed according to its connections with a core psychopathological element like weight phobia. Specific profiles of CE emerged for each clinical subgroup, and they corroborate the presence of different cognitive/physical approach to exercise. The CE showed to be a dysfunctional element with a disruptive role in patients' quality of life. Future directions and possible applications of the CET are also discussed. [ABSTRACT FROM AUTHOR]

To provide quantitative summarized evidence on gender-related differences in self-reported problematic exercise (PE) symptoms. Eligible studies were searched up to December 31, 2021 in the databases MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global. Studies were considered eligible if they included information that allowed the calculation of the differences of interest as expressed by either the aggregate or subscales scores of the main self-reported instruments of PE identified by previous research (i.e., Commitment to Exercise Scale, Compulsive Exercise Test, Exercise Addiction Inventory, Exercise Dependence Questionnaire, Exercise Dependence Scale-Revised, and Obligatory Exercise Questionnaire). Data were analysed using three-level meta-analytic models. Potential moderator variables were examined using meta-regressions. A total of 168 effect-sizes from 117 studies (N = 65,718) were retrieved. Results showed (i) small overall differences favouring males for the aggregate scores of the instruments (g = 0.105), (ii) small-to-moderate differences favouring females for symptoms involving withdrawal (g = 0.169 and 0.118), lack of exercise enjoyment (g = 0.226), and the employment of exercise as a means to ends such as health improvement (g = 0.222), mood management (g = 0.158 and 0.226), and body weight control (g = 0.453 and 0.465); and (iii) small differences favouring males for symptoms involving spending considerable amount of time in the activity (g = 0.250), exercising with greater volume/intensity than planned (g = 0.254), a need for increased amounts of exercise to achieve the desired effect (g = 0.291), loss of control over the behaviour (g = 0.101), reduction or cessation of other activities because of exercise (g = 0.323), and continue to exercise despite physical and/or psychological issues being caused or exacerbated by this behaviour (g = 0.243). Adopting a gender-informed perspective may be needed both in the professional praxis of exercise and health practitioners prescribing and guiding exercise practice and in the design of prevention and treatment efforts aimed at avoiding the occurrence of PE. • Inconsistent results on gender-related differences in problematic exercise symptoms (PES) have been reported. • For the first time, meta-analytic techniques are employed to examine gender-related differences in PES. • Females are more likely to report PES involving exercise for weight control and mood modification purposes. • Males are more likely to report PES involving harms derived from exercise over-involvement. [ABSTRACT FROM AUTHOR]

Objective: Little is known about psychosocial variables that may be differentially associated with compulsive exercise versus adaptive exercise. The current study simultaneously examined associations of exercise identity, anxiety, and body dissatisfaction with both compulsive and adaptive exercise behaviors and investigated which construct may account for the most unique variance in compulsive and adaptive exercise. Hypotheses were that: 1) body dissatisfaction, anxiety, and exercise identity would be significantly associated with compulsive exercise and 2) exercise identity would be significantly associated with adaptive exercise., Method: A total of 446 individuals (50.2 % female) completed reports of compulsive exercise, adaptive exercise, body dissatisfaction, exercise identity, and anxiety via an online survey. Multiple linear regression and dominance analyses were used to test hypotheses., Results: Exercise identity, body dissatisfaction, and anxiety were all significantly associated with compulsive exercise. Only exercise identity and anxiety were significantly associated with adaptive exercise. Dominance analyses suggested that exercise identity accounted for the largest proportion of variance in compulsive (Dominance R 2  = 0.27) and adaptive exercise (Dominance R 2  = 0.45)., Conclusion: Exercise identity emerged as the strongest predictor of both compulsive and adaptive exercise. The simultaneous presence of exercise identity, body dissatisfaction, and anxiety may contribute to high risk for engagement in compulsive exercise. Incorporating exercise identity into established eating disorder preventions and treatments may contribute to the reduction of compulsive exercise behaviors., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Anorexia nervosa is the most deadly mental disorder. Early detection is crucial. Most patients engage in compulsive exercise, often in an early stage. Compulsive exercise has a deleterious impact on the course of the disease. It can manifest in extreme forms with rigid rules and an inevitable urge. Three different subtypes exist: intensive sports, increased movement in everyday life, and motor restlessness. Besides the underlining motives, neurobiological mechanisms play a role. Moreover, cold ambient temperature increases compulsive exercise, while many patients intentionally expose themselves to cold. Compulsive exercise disappears only partly after weight recovery. Therefore, it needs specific treatment. Psycho-education is indispensable: to learn the difference between healthy and compulsive exercise. Besides decreasing excessive exercising, supervised exercise training is helpful. In short, think of AN in case of compulsive exercise and think of compulsive exercise of case of AN. Pose the right questions to get an impression of the severity.

Purpose: Limited research has examined recovery processes and conceptualisations of recovery within orthorexia nervosa (ON). This study harnessed Instagram data to examine how people who self-identify with ON use the hashtag #OrthorexiaRecovery and how recovery is represented within this online space., Methods: 500 textual posts containing #OrthorexiaRecovery were extracted from Instagram. Co-occurring hashtags were analysed descriptively to determine whether this online space is specific to ON, and textual data were analysed using reflexive thematic analysis., Results: The hashtag analysis indicated that #OrthorexiaRecovery is being used within a wider context of eating disorder recovery and awareness, but also provides deep insights into experiences of recovery from ON. The thematic analysis generated five themes: the invisibility of orthorexia; a turbulent and continuous process; finding food freedom; from compulsive exercise to intuitive movement; a community of support. Our findings suggest that people with self-reported ON experience recovery as a continuous process and the current invisibility of ON within diagnostic criteria and wider society impedes recovery. While working towards recovery, users aimed to be free from diet culture, become more attuned to their bodies, and develop more adaptive relationships with food and fitness. Users noted a general lack of support for people with ON and so used this online space to create a supportive community, though some content was potentially triggering., Conclusion: Our findings highlight the importance of increased recognition of ON and the potential value of targeting societal norms and harnessing social identity resources within therapeutic interventions for ON., (© 2023. The Author(s).)

Background and aims: Exercise and physical activity are beneficial both physically and psychologically but a few individuals use exercise excessively resulting in physical and even psychological damage. There is evidence for bidirectional relationship between exercise with depression and anxiety showing that exercise can reduce anxiety and depression, whereas a lack of exercise is associated with higher levels of anxiety and depression. Methods: This study used questionnaires assessing compulsive exercise, anxiety and depression among 20 professional regular exercisers and 51 recreational regular exercisers. Results: Results showed that ratings of compulsive exercise were associated with ratings of anxiety and depression among individuals who exercise for professional and recreational purpose. Secondly, individuals who exercise for professional purpose were more depressed than individuals who exercise for recreational purpose, but did not exhibit higher trait anxiety ratings. Thirdly, individuals who exercise for recreational purpose showed an association between ratings of compulsive exercise and depression but not with ratings of trait anxiety. Discussion: Individuals who exercise for professional and recreational purpose may use it as a means for alleviating depression and anxiety although this small sample of recreational and professional sportsmen showed clinical levels of anxiety and depression that may require further clinical treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Compulsive exercise is a well-known feature in eating disorders. The Exercise and Eating Disorder (EED) self-report questionnaire was developed to assess aspects of compulsive exercise not adequately captured by existing instruments. This study aimed to test psychometric properties and the factor structure of the EED among women with eating disorders and a control group. Method The study included 449 female participants, including 244 eating disorders patients and 205 healthy controls. The patient group consisted of 32.4% ( n = 79) AN patients, 23.4% ( n = 57) BN, 34.4% ( n = 84) EDNOS and 9.8% ( n = 24) with BED diagnosis. Results The analyses confirmed adequate psychometric properties of the EED, with a four-factor solution: (1) compulsive exercise, (2) positive and healthy exercise, (3) awareness of bodily signals, and (4) weight and shape exercise. The EED discriminated significantly ( p < .001) between patients and controls on the global score, subscales, and individual items. Test-retest reliability was satisfactory ( r = 0.86). Convergent validity was demonstrated by high correlations between the EED and the Eating Disorder Examination Questionnaire (EDE-Q; r = 0.79). Discussion The EED is the first clinically derived, self-report questionnaire to assess compulsive exercise among ED patients. The EED offers assessment that has broader clinical utility than existing instruments because it identifies treatment targets and treatment priorities. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:983-993). [ABSTRACT FROM AUTHOR]

This narrative overview summarises the work on exercise addiction (EA) over the past 12 years and exposes critical conceptual and methodological issues. More than 1000 articles exist on EA, conceptualised as uncontrolled training harming the individual. Still, EA has no clinical diagnosis criteria at this time. Research is increasing continuously, but it is stale in advancing knowledge. Scalar measurement and lack of differentiation between addictive and instrumental exercise could be reasons for insufficient progress. Exercise addiction fits in the framework of behavioural addictions, but excessive exercise patterns also co-occur with other morbidities, including eating or body-image disorders. In these cases, exercise is instrumental; it functions to achieve a non-exercise-related goal. Therefore, it is essential to separate primary from secondary EA. Based on the interactional model, significant stress and capacity-exceeding ambitions fuel primary EA, while chief motives behind secondary EA embed body image dissatisfaction and eating disorders. Few reports exist on EA's brain mechanisms, which could delay its classification as a distinct psychiatric dysfunction. Treatment of EA involves cognitive-behavioural approaches, but we know little about their effectiveness. Conceptually focussed psychophysiological research and in-depth interviews, complementing scalar data, could answer several open questions in this widely studied but relatively stagnant scholastic field., Competing Interests: The authors have no interests or activities that might be seen as influencing the research (e.g., financial interests in a test or procedure, funding by pharmaceutical companies for research)., (© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: Body image dissatisfaction and compulsive exercise behaviors are two main factors in recognizing an eating disorder within active individuals. By examining types of exercise and trends within the general population, it may provide insight into how exercise plays a role in eating disorder symptoms and other mental health concerns., Methods: We employed a cross-sectional study to examine our patient's exercise behaviors, compulsive exercise traits, and body image dissatisfaction. A total of 96 (35 males, 61 females) physically active adults (mmales 26.2±4.47 years, mfemales 25.6±5.13 years) completed a survey that included a modified version of the Body Image Concern subscale of the Body Change Questionnaire (BCQ) and the Obligatory Exercise Questionnaire (OEQ)., Results: The average scores between males and females on the BCQ and OEQ were not statistically different from one another. Strength and aerobic training did not correlate with BCQ scores. There was no correlation between OEQ scores and any of the three exercise methods. A positive correlation existed between OEQ scores and the frequency of workouts per week (r=0.568, P<0.001). Only females demonstrated negative correlations between BCQ scores and mixed-method training (r=-2.54, P=0.049) and between BCQ scores and the frequency of workouts per week (r=-2.57, P=0.046)., Conclusions: Our findings demonstrate the importance of addressing body image dissatisfaction for all populations, regardless of gender. Athletic trainers can utilize mixed-method training to help at-risk individuals train without increasing their body dissatisfaction symptoms.

This is a two-study paper that developed a measure to assess parenting practices related to children's physical activity and explored maternal predictors of such parenting practices. Study 1: A self-report measure of parents' activity-related practices (the Parenting Related to Activity Measure) was developed, and a principal component analysis was carried out using data from 233 mothers of 4.5- to 9-year-old children. The results supported a six-factor model and yielded the following subscales: Responsibility/monitoring; Activity regulation; Control of active behaviours; Overweight concern; Rewarding parenting; and Pressure to exercise. Study 2: Mothers ( N = 170) completed the Parenting Related to Activity Measure, alongside measures of eating psychopathology and compulsive exercise, to identify predictors of activity-related parenting practices. Mothers' eating psychopathology and exercise beliefs predicted activity parenting practices with their sons and daughters, but different predictors were seen for mothers of daughters versus sons. Mothers' eating and exercise attitudes are important predictors of their activity-related parenting practices, particularly with girls. Identifying early interactions around activity/exercise could be important in preventing the development of problematic beliefs about exercise, which are often a key symptom of eating disorders. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Highlights: [•] Obsessive–compulsiveness is a risk factor for compulsive exercise in teen boys. [•] Self-oriented perfectionism is a risk factor for compulsive exercise in teen boys. [•] Levels of compulsive exercise differed between participating schools. [•] Findings can inform compulsive exercise/eating disorders prevention work. [Copyright &y& Elsevier]

Aim There is a critical gap between the literature pertaining to physical activity (PA) in eating disorders and directives regarding the management of PA. There is evidence that managed PA in eating disorders is beneficial, as long as it accounts for compulsive exercise. The goal of this paper is to encourage future research to test the efficacy and safety of the existing protocol, leading to the development of clinical practice guidelines to optimize care. Method A protocol developed for the purpose of individual prescription of PA for adolescents receiving inpatient treatment for AN is described. The protocol uses primary complications related to PA and AN to categorize an adolescents level of PA risk as high, moderate or low. The risk factors assessed include; vital sign instability, percentage of Ideal Body Weight and an evaluation of compulsive exercise. PA recommendations are implemented according to the level of PA risk. Two case studies are presented to illustrate the application of the protocol. Discussion Critical limitations of the research to date regarding managed PA in eating disorders are numerous and a model of compulsive exercise has only recently been proposed, thus restricting the evaluation of existing research. The applicability of the protocol may be limited within Family Based Treatment in outpatient care, where the management of PA is the responsibility of the parents. Conclusion Categorization of PA risk is assessed by the eating disorders team. A physical therapist should be considered for the implementation and management of the proposed PA recommendations according to the level of PA risk. [ABSTRACT FROM AUTHOR]

Background: Anabolic-androgenic steroids (AASs) are abused primarily in the context of intense exercise and for the purposes of increasing muscle mass as opposed to drug-induced euphoria. AASs also modulate the HPA axis and may increase the reinforcing value of exercise through changes to stress hormone and endorphin release. To test this hypothesis, 26 adult males drawn from a larger study on AAS use completed a progressive ratio task designed to examine the reinforcing value of exercise relative to financial reinforcer.Method: Sixteen experienced and current users (8 on-cycle, 8 off-cycle) and 10 controls matched on quantity×frequency of exercise, age, and education abstained from exercise for 24 h prior to testing and provided 24-h cortisol, plasma cortisol, ACTH, β-endorphin samples, and measures of mood, compulsive exercise, and body image.Results: Between group differences indicated that on-cycle AAS users had the highest β-endorphin levels, lowest cortisol levels, higher ACTH levels than controls. Conversely, off-cycle AAS users had the highest cortisol and ACTH levels, but the lowest β-endorphin levels. Exercise value was positively correlated with β-endorphin and symptoms of AAS dependence.Conclusion: The HPA response to AASs may explain why AASs are reinforcing in humans and exercise may play a key role in the development of AAS dependence. [ABSTRACT FROM AUTHOR]

The present study examined the relationships between quantitative and qualitative dimensions of excessive exercise (EE) with the physical self-perception's dimensions and perceptual perspectives of body image (i.e., allocentric/3rd person and egocentric/1st person perspectives). The e LoriCorps Immersive Body Rating Scale 1.1, the very short form version of the Physical Self-Inventory and the Exercise and Eating Disorder test were used. The study includes 36 people with anorexia and/or bulimia seeking an external and specialized transdisciplinary program for eating disorders. Results show a different correlational profile of physical self-perceptions depending on the dimension (qualitative or quantitative) used to define EE. Differences in the perspectives used to assess body dissatisfaction (allocentric or egocentric) were also found. Perceived physical appearance was the key predictor of the qualitative dimension of excessive exercise. Findings suggest that EE in patients with an eating disorder could be explained by the feeling of competence not only related to physical appearance but also to physical abilities., Competing Interests: SB is president of, and own shares in, Clinic and Development In Virtuo, a company that distributes virtual environments, and conflict of interest are managed under UQO’s conflict of interest policy. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ouellet, Monthuy-Blanc, Pauzé, Rousseau and Bouchard.)

Purpose: Mental health problems among university students have been reported to be significantly increasing and suggested to be associated with college drop-out. Body dissatisfaction and compulsive exercise are both constructs relevant for mental health problems in general and eating disorders in particular. This study examined associations between body dissatisfaction, compulsive exercise and self-reported symptoms of depression among Swedish university students., Methods: Participants (n = 4262) are students in an ongoing cohort study, and data from the baseline assessment were used. Four linear regression models were built to explore the associations between body dissatisfaction, compulsive weight control exercise and depressive symptoms., Results: Our findings showed that females reported higher levels of body dissatisfaction than males. Body dissatisfaction and compulsive exercise were associated with self-reported symptoms of depression in this non-clinical population. Results showed that compulsive exercise was negatively associated with reported symptoms of depression, while body dissatisfaction was positively associated with symptoms of depression., Conclusion: In line with previous research, there was a gender difference in body dissatisfaction where females displayed higher levels of dissatisfaction than males.  Body dissatisfaction was  positively associated with reported symptoms of depression, suggesting support of previous research indicating body dissatisfaction to increase mental health problems. Compulsive exercise was negatively associated with symptoms of depression suggesting a behavior negatively reinforced, supporting both constructs to be of interest for reported symptoms of depression in a non-clinical population of Swedish university students., Level of Evidence: III, cohort study., Trial Registration: http://clinicaltrials.gov/ID : NCT04465435., (© 2022. The Author(s).)

Purpose: Evidence suggests that the coronavirus (COVID-19) pandemic has resulted in increased mental health concerns (e.g., anxiety) and there is ample discussion of how the pandemic has resulted in increases in weight control strategies (e.g., maladaptive exercise behaviors). It remains unclear, however, if maladaptive exercise behaviors are on the rise among non-clinical samples. The objective of this study was to examine college students' engagement in exercise behaviors (both adaptive and maladaptive) before and during COVID-19., Method: This study compared reports of compulsive exercise, weight and shape exercise, and positive and healthy exercise in two separate samples recruited from a large southeastern university. Sample 1 was collected pre-COVID-19 (August 2019-February 2020) and Sample 2 was collected during COVID-19 (August 2020-April 2021). Case-control matched samples were generated for this study (N = 144; 52.1% male). Three separate analysis of covariance models tested the differences between (1) adaptive exercise; (2) compulsive exercise; and (3) weight and shape exercise in pre- and during COVID-19 samples, controlling for sex., Results: Individuals in the during COVID-19 sample reported significantly more compulsive exercise (p < .001), weight and shape exercise (p < .001), and adaptive exercise (p < .001) compared to individuals in the pre-COVID-19 sample. Effects were of medium to large sizes., Conclusion: Consistent with reports from the research literature and popular press, the current study observed that both adaptive and maladaptive exercise were higher among college students during COVID-19 compared to pre-COVID-19., Level of Evidence: Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: Motivations underlying exercise may contribute to the extent to which exercise is maladaptive, independent of exercise frequency. Extrinsic and intrinsic exercise motivation may independently moderate associations between exercise frequency and 1) compulsive and 2) healthy exercise. It was expected that among individuals with high extrinsic motivation, greater exercise frequency would be associated with more compulsive exercise, whereas among individuals with high intrinsic motivation, greater exercise frequency would be associated with more healthy exercise., Methods: A total of 446 university students (50.9% female; 67.0% White) completed measures of intrinsic and extrinsic exercise motivations, exercise frequency, compulsive exercise, and healthy exercise. Intrinsic and extrinsic motivations for exercise were entered as simultaneous independent moderators of the associations between exercise frequency and 1) compulsive exercise and 2) healthy exercise in multiple linear regressions., Results: Moderation effects of exercise motivation were not supported for compulsive exercise. Only main effects of frequency (b = 0.04, p < 0.01) and extrinsic motivation (b = 0.27, p < 0.01) were observed. Intrinsic motivation moderated the association between frequency and healthy exercise (b = -0.02, p = 0.03). Among individuals with lower intrinsic motivation, greater frequency was related to more healthy exercise. This association was significantly weaker among individuals with high intrinsic motivation., Conclusion: Consistent with theory and extant work, extrinsic motivation was associated with compulsive exercise, while intrinsic motivation was associated with healthy exercise. Clinically, assessing the extent to which exercise is intrinsically or extrinsically motivated may help identify whether individuals may be more likely to engage in compulsive versus healthy exercise. Results support the importance of exploring the exercise motivations as predictors of compulsive and healthy exercise., Level of Evidence: Level V, Descriptive Cross-Sectional Study., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Fitness instructors, coaches and trainers are often looked up to and seen as role-models within their sporting community. Since problematic exercise is a common symptom of eating disorders, they are also highly likely to meet individuals at risk for developing eating disorders within their profession. Thus, educating coaches about how to promote healthy ideals within their sports/training context and equipping them with knowledge to be able to detect and approach individuals at risk, is of great importance., Method: We studied the pre-to-post effects of the I Care online psychoeducational intervention in 150 coaches, trainers, and fitness instructors. Variables included the Compulsive Exercise Test, as well as knowledge of eating disorders, and confidence and awareness regarding approaching, talking to, and referring individuals whose observed behavior raised concerns., Results: Results showed significant and large improvements in coaches' confidence and knowledge regarding warning signs and how to approach an at-risk person, and a decrease in their perceived ability to recognize eating disorders by sight, e.g., insight about EDs not being recognizable just by looking at a person. Also, significant positive change in attitudes about their own rule-driven exercise behavior and lack of enjoyment of exercise was observed., Conclusions: Although the lack of a control group compels caution, the study suggests that I Care may have positive effects in terms of a "declaration of intent" toward more positive role-modeling and interactions with clients., (© 2022. The Author(s).)

Today, many women are driven to subscribe to a more athletically oriented appearance ideal hallmarked by muscle tone (referred to as athletic- or fit-looking). However, the constellation of unhealthy eating and exercise behaviors that may accompany the pursuit of toned muscularity among women is not yet well characterized. To address this knowledge gap, our study evaluated the associations among the female drive for toned muscularity and both thinness-oriented disordered eating behaviors (e.g., dietary restriction) and muscularity-oriented disordered eating behaviors (e.g., excessive scrutiny of macro-nutrient values of food), as well as dimensions of compulsive exercise. Participants were 388 Australian undergraduate women who completed an online questionnaire including self-report measures of said constructs. Hierarchical regression models were used to determine whether the drive for toned muscularity accounted for unique variance in eating and exercise behaviors after adjusting for theoretically relevant covariates. Results indicated independent relationships between the drive for toned muscularity and several facets of thinness- and muscularity-oriented disordered eating, as well as compulsive exercise (e.g., exercise rigidity). Our findings further contribute to an emerging literature illustrating that women driven to attain a toned appearance may be vulnerable to engaging in a wide range of maladaptive eating and exercise practices., Competing Interests: Conflict of interest statement The authors have no conflicts of interest to declare., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The present study examined the relationship between posting or viewing fitspiration and clean eating imagery in relation to body image, disordered eating, and compulsive exercise among women. Participants (269 women aged 18-30 years) who posted and/or viewed fitspiration, clean eating or travel imagery on Instagram completed an online cross-sectional questionnaire. Results showed engaging with fitspiration and clean eating material (either posting or viewing) was significantly positively associated with increased levels of compulsive exercise and athletic-ideal internalization. However, only viewing (not posting) fitspiration and clean eating content was significantly related to thin-ideal internalization and disordered eating symptomatology. Athletic-ideal internalization mediated the relationships between posting fitspiration/clean eating and disordered eating symptomatology and compulsive exercise. Both thin-ideal internalization and athletic-ideal internalization mediated the relationship between viewing fitspiration/clean eating material and disordered eating and compulsive exercise. Overall, the findings suggest that viewing fitspiration and clean eating content on Instagram is negatively associated with thin-ideal internalization and disordered eating symptomatology, however the same relationships do not exist for people who frequently post these types of material. The mediational pathways provide a nuanced understanding of how engaging with fitspiration and clean eating material on social media influences female users' body image and health behaviour., Competing Interests: Conflict of interest The authors report no conflict of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: Compulsive exercise has been closely linked with eating disorders, and has been widely reported in both clinical and nonclinical settings. It has been shown to have a negative impact on eating disorder treatment and outcome. However, the risk factors for compulsive exercise have not been examined. This study aimed to provide a first step in identifying potential cross-sectional predictors of compulsive exercise. Method: The sample consisted of 1,488 male and female adolescents, aged 12-14 years old, recruited from schools in the United Kingdom. Participants completed measures of compulsive exercise, personality, psychological morbidity, and disordered eating attitudes during a school class period. Results: Multiple stepwise regressions showed that the strongest cross-sectional predictors of compulsive exercise were a drive for thinness, perfectionism, and obsessive-compulsiveness. Discussion: These results are discussed in terms of the role that personal factors may play in the development of compulsive exercise. © 2011 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Abstract: Appearance-and-performance enhancing drug (APED) use is a form of drug use that includes use of a wide range of substances such as anabolic–androgenic steroids (AASs) and associated behaviors including intense exercise and dietary control. To date, there are no reliable or valid measures of the core features of APED use. The present study describes the development and psychometric evaluation of the Appearance and Performance Enhancing Drug Use Schedule (APEDUS) which is a semi-structured interview designed to assess the spectrum of drug use and related features of APED use. Eighty-five current APED using men and women (having used an illicit APED in the past year and planning to use an illicit APED in the future) completed the APEDUS and measures of convergent and divergent validity. Inter-rater agreement, scale reliability, one-week test–retest reliability, convergent and divergent validity, and construct validity were evaluated for each of the APEDUS scales. The APEDUS is a modular interview with 10 sections designed to assess the core drug and non-drug phenomena associated with APED use. All scales and individual items demonstrated high inter-rater agreement and reliability. Individual scales significantly correlated with convergent measures (DSM-IV diagnoses, aggression, impulsivity, eating disorder pathology) and were uncorrelated with a measure of social desirability. APEDUS subscale scores were also accurate measures of AAS dependence. The APEDUS is a reliable and valid measure of APED phenomena and an accurate measure of the core pathology associated with APED use. Issues with assessing APED use are considered and future research is considered. [Copyright &y& Elsevier]

Abstract: Sociocultural factors hypothesised to be influential in eating disorders were assessed for their relationship with compulsive exercise. A sample of 828 adolescent boys and girls completed measures assessing sociocultural messages to change body shape as well as pressure to be thin, and also measures of compulsive exercise and disordered eating. Results showed that the sociocultural influences differed slightly between boys and girls. Hierarchical regressions showed that, after controlling for disordered eating and BMI, messages to become more muscular and media pressure to be thin significantly predicted compulsive exercise in boys, while the same regression in girls reported only media pressure to be thin as a significant predictor of compulsive exercise. These findings demonstrate the influence of the media in boys’ and girls’ compulsive exercising, as well as highlight the influence of body shape messages to become more muscular on boys’ compulsive exercise. [Copyright &y& Elsevier]

Abstract: Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolic-androgenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement; (2) significant body image disturbance; (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed. [Copyright &y& Elsevier]

Abstract: The aim of the present study was to determine the relationship of the high personal standards and self-criticism dimensions of perfectionism with compulsive exercise. Ninety-seven young women who exercise regularly completed measures of perfectionistic high personal standards, self-criticism, and compulsive exercise. Hierarchical multiple regressions analyses indicated that self-criticism substantially accounted for the relationship between high personal standards and compulsive exercise. Compulsive exercisers may require therapeutic interventions that address self-critical tendencies. [Copyright &y& Elsevier]

Abstract: Although internalization of the thin ideal has been extensively researched and is now regarded as a risk factor for eating disturbance, endorsement of the firm, athletic body ideal has received only minimal attention. This short-term longitudinal study explored whether internalization of two aspects of the current cultural ideal (thinness and athleticism) prospectively predicted three potentially deleterious outcomes: body dissatisfaction, dieting, and compulsive exercise. Undergraduate women (N =231) completed self-report measures at the beginning of the academic year and again 7 months later (N =156 at Time 2). Athletic-ideal internalization predicted change in compulsive exercise over the 7-month study period but not body dissatisfaction or dieting; thin-ideal internalization predicted change in all three outcomes. When both internalization measures were tested simultaneously, neither contributed unique variance. Results suggest that athletic-ideal internalization is not as detrimental as thin-ideal internalization. [Copyright &y& Elsevier]

There are similarities in the performance demands of circus and other performance domains such as leanness sports and dance, yet little is known about the mental health of circus artists. We explored self-reported disordered eating and exercise addictions in a sample of 500 circus artists. The sample consisted of aerial acrobats (71%), floor acrobats (13%), object manipulators (9%), and equilibrists (6%) who participate in circus at a range of performance levels (amateur 50%, part/full-time professional 41%, student 6%, retired 3%). Similar to elite athletes in leanness sports, approximately 36% of the circus artists in our sample were classified as 'at risk' of an eating disorder. A binomial logistic regression model suggested that being 'at risk' of an eating disorder was negatively related to participants' age and trait resilience, positively related to exercise addictions, and differences among circus categories were found (i.e., higher among equilibrium and aerial acrobatics). Using a Bayesian estimation procedure, a linear regression model suggested that exercise addiction scores were positively related to participants' weekly training time and being 'at risk' for an eating disorder, negatively associated with their years of experience in circus, and differences between circus categories (high levels in equilibrium) and modality of engagement in circus (higher levels among amateurs) were identified. Consequently, these exploratory study findings indicate that a complex interaction of factors might impact the development of disordered eating and exercise addictions among circus artists. Implications for discipline-specific and experience-specific interventions to address these maladaptive behaviours are discussed. • Disordered eating is as common in circus as in leanness sports. • Exercise addictions are more common among circus artists with disordered eating. • Trait resilience, age, and circus factors predict disordered eating in circus. [ABSTRACT FROM AUTHOR]

Individuals with eating disorders often experience compulsive exercise which, if left untreated, can lead to longer treatment and worsened symptoms. Compulsive exercise must be addressed within eating disorder treatment to help individuals establish a healthy relationship with exercise. However, there are currently no standardized guidelines for treating compulsive exercise or a consensus on which forms of treatment are most effective. Therefore, the purpose of this review was to examine interventions that address compulsive exercise and their impact on treating compulsive exercise among individuals with eating disorders. A systematic review of the literature was conducted. Eleven studies testing treatments for compulsive exercise were included in this review. Participants were diagnosed with anorexia nervosa, bulimia nervosa, or EDNOS, and a small portion had BED. Improvements in compulsive exercise and eating psychopathology were observed across all studies. The interventions focused on exercise psychoeducation and often incorporated exercise sessions. The findings highlight the positive impact of treating compulsive exercise, suggesting it should be a standard component of eating disorder treatment. Future studies should examine differences in treatment approaches and outcomes specific to each eating disorder, and specific to males. More consistency across studies in the conceptualization and measurement of compulsive exercises is also needed.

The COVID-19 pandemic has led to massive changes in almost all aspects of human life, including emotional states such as anxiety and fear, perspectives about healthy lifestyles, and psychological outcomes. This study aimed to disentangle the mechanisms that underlie the relationships of anxiety towards COVID-19 and fear of negative appearance with well-being, we also investigated the effects of cultural variations on levels of anxiety, fear of negative appearance, healthy lifestyles, and well-being. A total of 881 Indonesians ( n = 172) and Poles ( n = 709) participated in this study. Participants completed self-report measures of psychological well-being, anxiety, fear of negative appearance, compulsive exercise, and eating disorders. Multigroup structural equation modelling (SEM) was used. The results showed no statistically meaningful relationship between anxiety towards COVID-19 and well-being. However, it was found that, in the Polish sample, compulsive exercise and eating disorders mediated the relationship between fear of negative appearance and well-being. Cultural differences were also found in the mean scores of all examined constructs, with eating disorders being an exception. Therefore, this study highlights cultural aspects that determine emotional states, healthy lifestyles, and well-being.