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The objective of the study was to examine the prevalence of disordered eating and compulsive exercise in a sample of collegiate athletes; and to investigate the differences in athletes' disordered eating, compulsive exercise, and body image by sex, sport type, and level of athletic participation. One-hundred twenty-eight NCAA Division I varsity and club athletes completed the eating disorders, compulsive exercise, and body image measures. Correlational analyses and t-tests were conducted to establish statistical significance for the relationships of interest. Eleven athletes (8.6%) reported clinical symptoms of disordered eating, while 40 athletes (31.3%) reported subclinical symptoms. Nineteen athletes (14.85%) scored above the clinical cut-off score for compulsive exercise. Female and lean-sport athletes reported greater disordered eating and body image dissatisfaction than male and non-lean sport athletes, respectively. The study findings and implications may aid coaches, athletic administration, and mental health professionals in promptly identifying at-risk athletes and helping them seek professional assistance. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion While Family‐based treatment for anorexia nervosa (FBT‐AN) is effective for weight restoration and improvement in eating‐related cognitions, its effect on exercise attitudes and behaviors is little studied. Compulsive exercise is common in AN and often challenging to change.This secondary analysis examined changes in attitudes toward compulsive exercise (Compulsive Exercise Test‐CET) and behaviors (Eating Disorder Examination‐EDE) using data from a randomized clinical trial testing an adjunctive treatment for adolescents with AN who failed to gain 2.4 kg by Session 4—a predictor of poor outcome. The main hypothesis is that attitudes toward compulsive exercise and decreases in compulsive exercise behavior would improve over the course of treatment.Participants reported decreases in compulsive exercise attitudes by Session 4 and compulsive exercise episodes by end of treatment (EOT). There were no differences between early FBT responders (weight gain of 2.4 kg by session 4) and early non‐responders.These results suggest that FBT facilitates adolescents with AN to change attitudes toward compulsive exercise early in treatment (by Session 4) as well as reduction in compulsive exercise behaviors by EOT. Future studies should assess whether changes in attitudes toward compulsive exercise early in treatment is a mechanism of FBT treatment effect. [ABSTRACT FROM AUTHOR]

Objective: Weight-control compensatory behaviors appear to be a commonly utilized strategy for health management. Individuals engaging in such behaviors believe that the negative consequences from unhealthy behaviors will be neutralized by the positive consequences of healthy behaviors. Existing research has not reached a consensus on whether such behaviors are beneficial to health. This review aims to (1) summarize the patterns of weight-control compensatory health behaviors in different populations, (2) highlight correlates, predictors, and consequences of compensatory health behaviors, and (3) identify gaps for future research. Method: This review identified existing literature using online databases, CINAHL and PubMed. Primary research articles published after 2000 with non-clinical participants of 12 years or older who engaged in compensatory behaviors for weight control purposes were selected. Descriptive statistics were extracted from 35 studies. Results: Different patterns for weight-control compensatory behaviors emerged between the female and male sexes. Meanwhile, no clear association of such behaviors was found across weight status. Studies reviewed also highlighted three main areas of compensatory behaviors for weight management, namely dietary behaviors, physical activity, and alcohol consumption. Weight-control compensatory behaviors had significant negative correlations with mental health indicators, such as psychosocial functioning, emotional differentiation ability, and body esteem. Conclusion: Weight-control compensatory behaviors may be a widely used weight management strategy and can be presented in diverse ways. Although believed to be promoting health, such behaviors appear to be associated with poor psychological well-being. This emerging topic warrants more in-depth investigation to establish the direction of causation. Future research may investigate the relationship between weight-control compensatory behaviors and various aspects of health over longer time periods, examine the engagement of multiple weight-control compensatory behaviors, and focus on high-risk populations. [ABSTRACT FROM AUTHOR]

Background: Compulsive exercise is common in eating disorders (EDs), but a systematic treatment model is lacking. The CompuLsive Exercise Activity TheraPy (LEAP) is a cognitive behavioral therapy treatment for compulsive exercise in EDs, delivered by trained therapists in groups over four consecutive weeks (8 groupsessions and 1 individual session), aiming to promote healthy physical activity. LEAP is currently evaluated in a randomized efficacy trial. In parallel, it is crucial to learn more about how it is perceived by qualitatively investigating participants' subjective experiences. Methods: Nine patients with various EDs participating in the LEAP trial were interviewed about their experiences of taking part in LEAP and about compulsive exercise as an ED symptom using a semi-structured interview guide. The interview transcripts were analyzed according to thematic analysis. Results: The informants expressed that compulsive exercise had not been addressed in their standard ED treatment and that LEAP as such provided an important complement, spurring reflection, awareness, and changed feelings and behaviors in relation to compulsive exercise. Initially, increased PA was triggered for some, but this side effect was transitory. A wish for more treatment time, in terms of longer or additional sessions, was expressed. Conclusions: Overall, LEAP seemed to fill an important treatment need and seemed both acceptable and feasible to patients. However, treatment time and the initial increase in PA may need further investigation and attention in order to optimize this treatment. Trial registration: The trial is registered with the ISRCTN registry (registration date 20200325), trial ID ISRCTN80711391. Plain English summary: Compulsive exercise (CE) is very common in individuals with eating disorders (EDs) often tightly connected with the eating pathology. Even so, most standard treatments do not specifically target CE, leaving patients without strategies to normalize their exercise. The CompuLsive Exercise Activity TheraPy (LEAP) is delivered as an adjunctive treatment to standard ED treatment (targeting CE in patients with EDs. In this study, nine former LEAP patients were interviewed about their experiences of taking part in LEAP and about CE as an ED symptom. The informants were in general satisfied with LEAP and indicated that participation had positive effects on their exercise-related thoughts and attitudes, as well as actual exercise behaviors. They all experienced that CE was not addressed in their standard treatment, although they were motivated to work towards changing it. LEAP was therefore viewed as an important complement. Participating in LEAP initially triggered some informants to exercise more, which fortunately ceased over time and is similar to the temporal negative effect (increased food occupation) often observed initially in cognitive behavioral therapy for eating disorders. The content of LEAP was experienced as valid, informative, and eye-opening, and being able to discuss CE-related topics in a group setting was for many a positive experience. The experiences expressed in this study are very useful for continued development of LEAP. Although preliminary, the results also suggest that LEAP may be a valuable add-on treatment within ED care. [ABSTRACT FROM AUTHOR]

Abstract Background Compulsive exercise is common in eating disorders (EDs), but a systematic treatment model is lacking. The CompuLsive Exercise Activity TheraPy (LEAP) is a cognitive behavioral therapy treatment for compulsive exercise in EDs, delivered by trained therapists in groups over four consecutive weeks (8 groupsessions and 1 individual session), aiming to promote healthy physical activity. LEAP is currently evaluated in a randomized efficacy trial. In parallel, it is crucial to learn more about how it is perceived by qualitatively investigating participants’ subjective experiences. Methods Nine patients with various EDs participating in the LEAP trial were interviewed about their experiences of taking part in LEAP and about compulsive exercise as an ED symptom using a semi-structured interview guide. The interview transcripts were analyzed according to thematic analysis. Results The informants expressed that compulsive exercise had not been addressed in their standard ED treatment and that LEAP as such provided an important complement, spurring reflection, awareness, and changed feelings and behaviors in relation to compulsive exercise. Initially, increased PA was triggered for some, but this side effect was transitory. A wish for more treatment time, in terms of longer or additional sessions, was expressed. Conclusions Overall, LEAP seemed to fill an important treatment need and seemed both acceptable and feasible to patients. However, treatment time and the initial increase in PA may need further investigation and attention in order to optimize this treatment. Trial registration The trial is registered with the ISRCTN registry (registration date 20200325), trial ID ISRCTN80711391.

Objective: Research suggests that both compulsive exercise and eating disordered behaviors increase during college. Despite strong cross‐sectional associations between compulsive exercise and eating disorders, it is unknown if compulsive exercise is a variable risk factor for eating disorders or simply a correlate. It was hypothesized that increases in compulsive exercise would significantly and prospectively predict increases in overall number of eating disorder symptoms over the study period. Method: A total of 265 first year college students who did not meet criteria for a full or subthreshold eating disorder diagnosis at Time 1 (age M = 18.15; SD = 0.42; 122 female [46%] at Time 1) completed reports of compulsive exercise and eating disorder symptoms via online questionnaires at four timepoints over the 9‐month 2021–2022 academic year (76% retention rate). Hypotheses were tested using a bivariate latent change score model. Results: Hypotheses were not supported. Change in compulsive exercise did not predict change in number of eating disorder symptoms. Change in number of eating disorder symptoms also did not predict change in compulsive exercise. Conclusions: Compulsive exercise did not emerge as a variable risk factor for the development of eating disorder symptoms among first year college students. The relationship between these behaviors should be investigated at different developmental timepoints, such as early adolescence, and potential third variables that may explain the observed co‐occurrence should be explored. Public significance: This study investigated whether increases in compulsive exercise predicted increases in number of eating disorder symptoms among first year college students. Compulsive exercise did not significantly predict number of eating disorder symptoms. Additional research is warranted to clarify the relationship between compulsive exercise and eating disorder symptoms. [ABSTRACT FROM AUTHOR]

Compulsive exercise is a common component of eating disorders, characterised by an obsessive need to exercise, often following rigid rules, and using exercise as a maladaptive coping mechanism. However, compulsive exercise is often not well addressed or treated, mainly due to a lack of understanding of how compulsive exercise is developed, experienced, and resolved. Most research, to date, has explored compulsive exercise among individuals with anorexia nervosa and has not considered the social and cultural factors that influence compulsive exercise. Therefore, the purpose of this study was to explore the complex interplay of personal and sociocultural factors that influenced the lived experiences of four individuals with bulimia nervosa and compulsive exercise. A series of four narrative interviews were conducted with each of the participants to allow for an in-depth exploration of lifelong experiences, attitudes, and behaviours around eating, exercise, and the body. The analysis involved two phases: a thematic narrative analysis and creative non-fiction. Two creative non-fiction stories were created that depict the tales of Amber and Carley. Both stories are first-person accounts of their personal experiences developing, living with, and (attempting) recovery from compulsive exercise. Woven through the two stories are the personal, situational, and sociocultural influences that shaped their experiences with exercise, eating, and their body. The two stories recount both different and shared experiences, influences, and trajectories with compulsive exercise and bulimia nervosa, presented through emotional and relatable narratives to appeal to a broad audience of readers. [ABSTRACT FROM AUTHOR]

Objective: The development of novel treatments for anorexia nervosa (AN) requires a detailed understanding of the biological underpinnings of specific, commonly occurring symptoms, including compulsive exercise. There is considerable bio‐behavioral overlap between AN and obsessive‐compulsive disorder (OCD), therefore it is plausible that similar mechanisms underlie compulsive behavior in both populations. While the association between these conditions is widely acknowledged, defining the shared mechanisms for compulsive behavior in AN and OCD requires a novel approach. Methods: We present an argument that a better understanding of the neurobiological mechanisms that underpin compulsive exercise in AN can be achieved in two critical ways. First, by applying a framework of the neuronal control of OCD to exercise behavior in AN, and second, by taking better advantage of the activity‐based anorexia (ABA) rodent model to directly test this framework in the context of feeding pathology. Results: A cross‐disciplinary approach that spans preclinical, neuroimaging, and clinical research as well as compulsive neurocircuitry and behavior can advance our understanding of when, why, and how compulsive exercise develops in the context of AN and provide targets for novel treatment strategies. Discussion: In this article, we (i) link the expression of compulsive behavior in AN and OCD via a transition between goal‐directed and habitual behavior, (ii) present disrupted cortico‐striatal circuitry as a key substrate for the development of compulsive behavior in both conditions, and (iii) highlight the utility of the ABA rodent model to better understand the mechanisms of compulsive behavior relevant to AN. Public Significance: Individuals with AN who exercise compulsively are at risk of worse health outcomes and have poorer responses to standard treatments. However, when, why, and how compulsive exercise develops in AN remains inadequately understood. Identifying whether the neural circuitry underlying compulsive behavior in OCD also controls hyperactivity in the activity‐based anorexia model will aid in the development of novel eating disorder treatment strategies for this high‐risk population. [ABSTRACT FROM AUTHOR]

Exercise tracking technology use is associated with exercise psychopathology in adolescents; however, research is yet to identify components of such technology that can predict maladaptive exercise at this age. This research assessed the relationship between exercise tracking technology use and exercise psychopathology in adolescents. Development of a new measure of exercise tracking behaviours/attitudes was also conducted. Adolescents (N = 327; aged 12–15, mean = 13.64 years (SD = .95); n = 168 girls) participated in this multi-phase study. Following factor analysis to develop and validate the new measure, relationships between exercise tracking behaviours/attitudes and compulsive exercise were explored. Key components of such technology (e.g. pressure to achieve exercise-related goals) were significantly associated with higher compulsive exercise in adolescents. However, using technology to simply monitor their own exercise behaviours was significantly associated with positive exercise and mental wellbeing outcomes. Prospective research should assess how exercise tracking can predict exercise psychopathology changes and mental wellbeing throughout adolescent development.

ObjectiveWeight-control compensatory behaviors appear to be a commonly utilized strategy for health management. Individuals engaging in such behaviors believe that the negative consequences from unhealthy behaviors will be neutralized by the positive consequences of healthy behaviors. Existing research has not reached a consensus on whether such behaviors are beneficial to health. This review aims to (1) summarize the patterns of weight-control compensatory health behaviors in different populations, (2) highlight correlates, predictors, and consequences of compensatory health behaviors, and (3) identify gaps for future research.MethodThis review identified existing literature using online databases, CINAHL and PubMed. Primary research articles published after 2000 with non-clinical participants of 12 years or older who engaged in compensatory behaviors for weight control purposes were selected. Descriptive statistics were extracted from 35 studies.ResultsDifferent patterns for weight-control compensatory behaviors emerged between the female and male sexes. Meanwhile, no clear association of such behaviors was found across weight status. Studies reviewed also highlighted three main areas of compensatory behaviors for weight management, namely dietary behaviors, physical activity, and alcohol consumption. Weight-control compensatory behaviors had significant negative correlations with mental health indicators, such as psychosocial functioning, emotional differentiation ability, and body esteem.ConclusionWeight-control compensatory behaviors may be a widely used weight management strategy and can be presented in diverse ways. Although believed to be promoting health, such behaviors appear to be associated with poor psychological well-being. This emerging topic warrants more in-depth investigation to establish the direction of causation. Future research may investigate the relationship between weight-control compensatory behaviors and various aspects of health over longer time periods, examine the engagement of multiple weight-control compensatory behaviors, and focus on high-risk populations.

AbstractObjectivesMethods and measurementResultsConclusionThis research aimed to construct and psychometrically test a measure of multiple sociocultural dimensions (i.e. family, peers, media) theoretically associated with exercise behaviours/attitudes in adolescents; the Sociocultural Influences on Exercise Behaviours in Adolescents Questionnaire (SIEBAQ).Part 1 of this study focused on measure construction and psychometric testing, involving item generation and exploratory factor analysis (EFA) to refine the item pool, with 905 adolescents (Mage 13.66 years (SD = 0.94); girls = 442). Part 2 sought to explore the convergent validity of the SIEBAQ (n = 846; n = 414 girls).EFA resulted in a 47-item measure with a nine-factor structure (including social media modelling, parent exercise expectations, peer co-participation; α = 0.72-0.92). Correlations revealed weak-moderate significant relationships between the SIEBAQ and related constructs (e.g. compulsive exercise, sociocultural attitudes towards appearance). Regression analyses with the SIEBAQ identified social media modelling of exercise as a significant predictor of compulsive exercise in boys and girls. Proving exercise ability to significant others also significantly predicted compulsive exercise outcomes.This newly developed measure holds promise. Further psychometric testing and validation of the SIEBAQ is the recommended next step to confirm the measure’s nine-factor structure identified through EFA. [ABSTRACT FROM AUTHOR]

Abstract Background There is a strong association between perfectionism and eating disorders. In a cognitive–behavioural model of compulsive exercise it has been suggested there are reciprocal associations between perfectionism, eating disorder pathology, and compulsive exercise. No study has examined if there is an indirect association between perfectionism and compulsive exercise through eating disorder pathology, which would inform a preliminary understanding of the cognitive–behavioural model of compulsive exercise. Methods The sample included 301 adolescent females diagnosed with eating disorders (age M = 14.89, SD = 0.85, range 13–17). We tested models of direct and indirect associations of compulsive exercise in the relationship between perfectionism and eating disorder pathology, and direct and indirect associations of eating disorder pathology in the relationship between compulsive exercise and perfectionism. Results Perfectionism was directly associated with eating disorder pathology and compulsive exercise. Perfectionism was indirectly associated with eating disorder pathology through compulsive exercise. Perfectionism also had an indirect association with compulsive exercise through eating disorder pathology. Discussion The findings suggest it would be useful for future prospective research to examine the cognitive–behavioural model of compulsive exercise in adolescents with eating disorders. Compulsive exercise and perfectionism may be useful targets for future research to improve eating disorder treatment. Level of evidence Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Objective: Although exercise is generally considered healthy, many individuals engage in maladaptive exercise (e.g., compulsive in nature). Several definitions of maladaptive exercise exist, leading to multiple, varied assessment tools; assuming homogeneity across these assessments contributes to low consensus in etiological models. Method: We used a Jaccard Index to quantify content overlap among 15 commonly‐used self‐report instruments measuring maladaptive exercise, with 31 features identified across 224 items. Results: The most common features were exercise to control weight/shape and to avoid negative affect (both included in 9/15 instruments), or compensate for calories consumed (8/15 instruments). Overlap among instruments was low (.206) and no features were common across all instruments. Conclusions: Findings generally support theoretical models of exercise in eating pathology. However, instruments most commonly used to assess maladaptive exercise measure heterogenous content. Careful consideration should be taken when comparing findings derived from differing instruments, when synthesizing literature on maladaptive exercise, and when selecting instruments to measure specific maladaptive exercise features. Public Significance: Many, varied, tools exist for the assessment of maladaptive exercise (e.g., compulsive or compensatory) in the context of eating disorders. Assuming homogeneity across tools contributes to low consensus in the field. We used a Jaccard Index to quantify content overlap among 15 self‐report instruments measuring maladaptive exercise. The most commonly used instruments measure heterogenous content. Careful consideration should be taken when synthesizing literature and selecting instruments to use in research. [ABSTRACT FROM AUTHOR]

Abstract Purpose Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. Methods Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). Results ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p

Purpose: Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. Methods: Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). Results: ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [− 2.24, − 0.34], p = 0.008; r = 0.26, 95% CI [− 2.11, − 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001). Conclusion: Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior. Level of evidence: III: Evidence obtained from cohort studies. [ABSTRACT FROM AUTHOR]

Background: The similarities and differences between orthorexia nervosa symptoms (ONs) and the symptoms and correlates of eating disorders listed in the DSM-5 need to be elucidated. ONs were examined in a volunteer community sample in conjunction with compulsive exercise, disordered eating, as well as emotional and behavioral correlates of eating disorders. Methods: Participants were 561 adult volunteers (93 men, 17.09%) aged 19–72 (M = 32.7 ± 11), recruited via social media networks. Participants self-reported on the following measures online: Düsseldorf Orthorexia Scale, Compulsive Exercise Test, Retrospective Child Feeding Questionnaire, Experiences in Close Relationships, Difficulties in Emotional Regulation Scale, Toronto Alexithymia Scale, and Eating Disorder Examination Questionnaire 13. Data were downloaded and analyzed in SPSS26 and Amos26. Results: A theoretical model of the connections between the study variables was tested via SEM and confirmed. The profiles of participants with high, average and low levels of ONs were compared. Participants with the highest levels also scored highest for compulsive exercise, insecure attachment, alexithymia, emotion regulation difficulties, weight and shape concerns, body dissatisfaction, restriction, bingeing, purging and parental feeding practices of concern about child’s weight and restricting and monitoring the child’s intake of calorie-rich foods. Discussion: High levels of ONs are related to disordered eating attitudes and behaviors, as well as to emotional and behavioral correlates of eating disorders. It is unclear to what extent these ONs are distinguishable from symptoms of other eating disorders listed in the DSM-5. Longitudinal studies may help to elucidate distinct trajectories and risk factors for ON. Level of evidence: Level III, case–control analytic study. [ABSTRACT FROM AUTHOR]

Objective: Few studies have recruited adults with a formal diagnosis of muscle dysmorphia (MD), a psychological illness defined by preoccupation that one lacks muscularity and/or leanness, combined with significant functional impairment. This study presented descriptive statistics for a range of clinically relevant questionnaires in one of the largest samples of adults with confirmed diagnoses of MD. Method: We recruited 29 adults who met diagnostic criteria for MD as determined by semi‐structured diagnostic interviews and administered a battery of questionnaires assessing MD symptomology, compulsive exercise, and disordered eating. Descriptive statistics were calculated for both total and subscale scores for each questionnaire. Raincloud plots are included to show the distribution of total scores. Results: Of the 29 participants, 26 completed all questionnaires. Mean scores were high across all questionnaires and broadly consistent with results in past studies that also recruited a clinical MD sample. Most participants scored above proposed clinical cut‐off scores for questionnaires assessing compulsive exercise and disordered eating. Conclusions: This study adds to the small body of published questionnaire data in clinical MD samples. We stress that questionnaire scores should not be used alone to infer the presence of MD, but could be considered as a useful adjunct to a comprehensive clinical interview. Key Points: We have limited understanding of how people with a formal diagnosis of muscle dysmorphia (MD) present clinically and score on questionnaires assessing core cognitions and behaviours involved in the disorder.People with MD score high on questionnaires assessing MD symptomology, compulsive exercise, and disordered eating.Participant scores exceeded proposed clinical cut‐off scores to a much greater degree on instruments assessing compulsive exercise than disordered eating. [ABSTRACT FROM AUTHOR]

ObjectiveAlthough maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association.MethodWe reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME.ResultsEighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME.DiscussionInconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.

The role of anxiety as a risk factor for compulsive exercise elements among adolescents is unclear. Intolerance of uncertainty (IU), which is a risk feature for anxiety and eating disorders, may be an important, unexplored risk factor for compulsive exercise dimensions. This study aimed to examine the role of IU dimensions and anxiety on compulsive exercise elements. Given previous evidence indicating gender differences in compulsive exercise and IU levels, gender was included as a moderator. A total of 201 adolescent girls and 207 adolescent boys completed the following questionnaires: Eating Disorder Inventory-3, Intolerance of Uncertainty Scale-12 (IUS-12), a brief version of the State-Trait Anxiety Inventory and the Compulsive Exercise Test (CET). The hierarchical regression analyses showed that the interaction between IUS-Prospective and gender emerged as a significant predictor of CET-Avoidance and CET-Weight control exercise beyond symptoms of eating disorders and anxiety. Post hoc analysis revealed that the IUS-Prospective was a significant predictor of CET-Avoidance and CET-Weight Control among boys, but not among girls. These findings suggest that prospective IU may contribute towards obsessive-compulsive attitudes towards exercise among adolescent population, specifically among boys. [ABSTRACT FROM AUTHOR]

Plain English summary Fitness instructors, coaches and trainers are often looked up to within their sporting community. They are also likely to meet individuals at risk for developing eating disorders, since excessive or compulsive exercise is a common symptom of these disorders. Coaches therefore need to know more about how to promote healthy ideals and how to detect and approach individuals at risk of developing an eating disorder. We studied if a brief online education called I Care could improve personal compulsive exercise tendencies, knowledge about eating disorders, and readiness to approach individuals seemingly at risk, in 150 coaches, trainers, and fitness instructors. We found that coaches felt more confident and knowledgeable about warning signs and how to approach a person at risk after completing I Care. They also showed increased insight about EDs not being recognizable just by looking at a person and their attitudes about their own exercise behavior changed in a positive way. Although the lack of a comparison group makes conclusions tentative, I Care may have positive effects in terms of a “declaration of intent” toward more positive role-modeling and interactions with clients.

Abstract. Introduction: There is little consensus on the treatment of unhealthy exercise in eating disorders. Many treatment programmes do not offer any interventions at all. This study explored the attitudes of those with lived experience towards incorporating treatments for unhealthy exercise in eating disorders. Methods: An online survey was created using onlinesurveys.ac.uk and distributed through social media. Analyses included calculation of descriptive statistics and inductive thematic analysis of free text responses. Results: One hundred and forty-six respondents completed the survey, over 50% identified as having lived experience of an eating disorder. Thematic analysis of free text responses from those with lived experience identified themes around the benefits of incorporating exercise into the treatment of eating disorders including the benefits of exercise on mental and physical health and the opportunity to develop a healthier relationship with exercise. The themes around the risks of incorporating exercise included slowing or limiting recovery and physical risks of exercising at low weight. The themes around the risks of not addressing exercise included leaving part of the disorder untreated and how this could affect recovery. Conclusion: Those with lived experience of eating disorders feel unhealthy exercise is an important part of the disorder to treat. There is recognition of the risks of doing so, but also benefits in helping people to learn a new healthy relationship with exercise.

Background: The purpose of the study was to examine the incidence of exercise dependence amongst varsity - level university athletes. Method: Physical activity behavior patterns were measured amongst 62 participants (31 male and 31 female) from a mid - size University in Canada for the purpose of identifying problematic exercise through a questionnaire - based survey utilizing the Exercise Addiction Inventory (EAI). Results: Total scores were tabulated to indicate the number of varsity athletes scoring either "at-risk", "symptomatic" or "asymptomatic" of exercise addiction, and percentages were determined for each of the EAI categories. 72.5% scored "symptomatic" while 19.5% recorded "at - risk" and 8% attained an "asymptomatic" result on the questionnaire. Interestingly, females rated "at - risk" three times higher than males whereas "asymptomatic" scores were four times greater amongst males on the EAI scale. Conclusion: While the EAI can identify individuals at risk from problematic exercise, a limitation is that high scores are not necessarily indicative of exercise addiction due to some people interpreting questions differently than they were intended. In addition, underlying causes such as anxiety, depression, difficulties with relationships or coping with personal hardship can be at the root of exercise addiction. Notwithstanding, individuals who score in the "at - risk" category of the EAI might still best be advised to seek counselling as activity should be pursed so that it enhances one's life through sustainable long - term physical, psychological and social health versus exercising for deriving a sense of physical and psychological fulfillment. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Eating disorders (EDs) are complex, potentially life-threatening mental illnesses associated with low detection in health settings and low treatment rates. Compulsive exercise is a common ED feature, with symptoms likely to manifest in fitness settings. Fitness professionals are ideally placed to identify ED indicators among clients, to encourage help-seeking, and to offer referrals to specialist treatment services. This study aimed to investigate whether existing industry guidelines in Australia (i.e., “Eating Disorders: Recommendations for the Fitness Industry”) help to improve fitness professionals’ awareness and understanding of ED symptoms and appropriate interventions when detected among clients. Design: Cross sectional study; randomised controlled trial Methods: 174 fitness professionals practicing in Australia completed an anonymous online survey. Participants were presented with two vignettes of fictional clients displaying ED indicators and were assessed on their ability to identify ED symptoms and consider appropriate responses. A subgroup of randomised participants was exposed to industry ED recommendations prior to the second vignette, to assess the impact of guideline exposure. Results: Most participants (87.36%) were unaware/unfamiliar with the recommendations at baseline. After exposure to the recommendations, participants in the treatment condition showed small improvements in their ability to identify ED symptoms and their self-reported likelihood of intervening, compared to control participants who were not exposed. Conclusions: More widespread exposure to existing ED recommendations may be a worthwhile step to enhance the awareness and knowledge of fitness professionals interacting with clients with EDs. This study further highlights the need for more in-depth and empirically tested educational resources and programs to optimise early detection and intervention of EDs in fitness settings.

Purpose: The current study evaluated associations between exercise identity (Exercise Identity Scale; EIS), compulsive exercise (Compulsive Exercise Test; CET), and their association with Eating Disorder Examination – Questionnaire (EDE-Q) scores among adult runners registered for mid- and long-distance races (N = 282, 48.2% male). Methods: Runners of half and full marathon races completed the EIS, CET, and EDE-Q. Results: Regression analyses indicated that increased EIS, b = −.21, and CET, b = −3.25, scores contribute to decreased eating pathology amongst half-marathon runners; a significant interaction effect emerged for EIS × CET scores, b =.08, such that relations between EIS and EDEQ scores were significant among runners reporting either lower or higher CET scores. These associations were not demonstrated in marathon runners. Conclusions: Results suggest that it is beneficial to consider running status when addressing the effect that exercise identity and compulsive exercise may have on eating pathology in competitive runners. [ABSTRACT FROM AUTHOR]

Critical comments from parents or coaches about weight or shape have been associated with athletes' body dissatisfaction and disordered eating. However, research is yet to explore how critical comments from an athlete's teammates may impact on eating and exercise psychopathology. This study aimed to (1) explore whether athletes who reported receiving a teammate critical comment have higher eating/exercise psychopathology and poorer psychological wellbeing versus matched athletes who have not, (2) determine whether gender differences exist in the perceived severity of critical comments and (3) evaluate the moderating role of gender when establishing the relative importance of explicit teammate critical comments versus implicit teammate influences (e.g., modelling) on eating/exercise psychopathology. Athletes (N = 646, Mage=23 years, n = 391 female) completed a survey exploring explicit/implicit teammate influences, psychological wellbeing (self-esteem, anxiety, depression) and eating/exercise psychopathology. Athletes receiving a teammate critical comment (n = 323) had significantly higher eating/exercise psychopathology, anxiety, and lower self-esteem compared to those who had not (n = 323). Females (n = 196) perceived the severity of the comment to be significantly worse than males (n = 127). Explicit critical comments had a greater influence on athletes' eating/exercise psychopathology versus implicit teammate influences. Disordered eating/compulsive exercise prevention efforts with athlete populations should highlight the detrimental impact that athletes' comments can have on teammates' wellbeing and body satisfaction. • Athletes reporting a critical comment had poorer body image vs those who did not. • Females perceived severity of teammate comments as significantly worse than males. • Comments had greater impact on athletes' eating and exercise vs implicit influences. • Prevention efforts should highlight the detrimental impact of teammate comments. • Eliminating body-focused commentary may reduce athletes' disordered eating/exercise. [ABSTRACT FROM AUTHOR]

Objective: Weight-control compensatory behaviors appear to be a commonly utilized strategy for health management. Individuals engaging in such behaviors believe that the negative consequences from unhealthy behaviors will be neutralized by the positive consequences of healthy behaviors. Existing research has not reached a consensus on whether such behaviors are beneficial to health. This review aims to (1) summarize the patterns of weight-control compensatory health behaviors in different populations, (2) highlight correlates, predictors, and consequences of compensatory health behaviors, and (3) identify gaps for future research., Method: This review identified existing literature using online databases, CINAHL and PubMed. Primary research articles published after 2000 with non-clinical participants of 12 years or older who engaged in compensatory behaviors for weight control purposes were selected. Descriptive statistics were extracted from 35 studies., Results: Different patterns for weight-control compensatory behaviors emerged between the female and male sexes. Meanwhile, no clear association of such behaviors was found across weight status. Studies reviewed also highlighted three main areas of compensatory behaviors for weight management, namely dietary behaviors, physical activity, and alcohol consumption. Weight-control compensatory behaviors had significant negative correlations with mental health indicators, such as psychosocial functioning, emotional differentiation ability, and body esteem., Conclusion: Weight-control compensatory behaviors may be a widely used weight management strategy and can be presented in diverse ways. Although believed to be promoting health, such behaviors appear to be associated with poor psychological well-being. This emerging topic warrants more in-depth investigation to establish the direction of causation. Future research may investigate the relationship between weight-control compensatory behaviors and various aspects of health over longer time periods, examine the engagement of multiple weight-control compensatory behaviors, and focus on high-risk populations., Competing Interests: The 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 © 2024 Yuan, Bouzari, Bains, Cohen and Kakinami.)

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 eLoriCorps 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.

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. Plain English summary: Fitness instructors, coaches and trainers are often looked up to within their sporting community. They are also likely to meet individuals at risk for developing eating disorders, since excessive or compulsive exercise is a common symptom of these disorders. Coaches therefore need to know more about how to promote healthy ideals and how to detect and approach individuals at risk of developing an eating disorder. We studied if a brief online education called I Care could improve personal compulsive exercise tendencies, knowledge about eating disorders, and readiness to approach individuals seemingly at risk, in 150 coaches, trainers, and fitness instructors. We found that coaches felt more confident and knowledgeable about warning signs and how to approach a person at risk after completing I Care. They also showed increased insight about EDs not being recognizable just by looking at a person and their attitudes about their own exercise behavior changed in a positive way. Although the lack of a comparison group makes conclusions tentative, I Care may have positive effects in terms of a "declaration of intent" toward more positive role-modeling and interactions with clients. [ABSTRACT FROM AUTHOR]

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. • We tested associations of female drive for muscularity with unhealthy eating and exercise. • Female drive for muscularity is linked to several indices of disordered eating. • Female drive for muscularity is linked to several indices of compulsive exercise. • Relationships with compulsive exercise were particularly salient. [ABSTRACT FROM AUTHOR]

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. • Viewing fitness/eating images on Instagram was linked to greater disordered eating. • Posting/viewing fitness/eating content was linked to greater compulsive exercise. • Internalization of appearance ideals mediated these relationships. • Negative relationships were stronger for viewing than posting. [ABSTRACT FROM AUTHOR]

Objectives: Self-compassion, defined as the ability to be accepting and loving towards oneself, has been identified as a potential protective factor against the development of body dissatisfaction and eating disorders (ED). In contrast, compulsive exercise is a core feature in the development and progression of EDs and is often employed as a maladaptive coping strategy for negative emotions and body image concerns. However, the relationships between self-compassion and compulsive exercise attitudes and behaviours are as yet unexplored. Methods: A total of 539 Spanish female university students (Mage = 20.03, SD = 2.22) completed measures of compulsive exercise, frequency of compensatory exercise, self-compassion, eating disorder symptoms, and anxiety and depression. Results: Hierarchical multiple regressions showed that lower levels of self-compassion significantly predicted some compulsive exercise elements (namely, weight control exercise and lack of exercise enjoyment) after controlling for ED symptoms, anxiety, depression and age. However, frequency of compensatory exercise was unrelated to self-compassion elements. Findings from the mediation models suggest an indirect effect of self-compassion on the association between compulsive exercise and ED symptoms. Conclusions: The findings suggest a significant link between low self-compassion and greater harmful exercise attitudes and behaviours towards exercise. Further research is needed to clarify whether self-compassion may be a core feature in the development and maintenance of harmful attitudes and behaviours towards exercise. [ABSTRACT FROM AUTHOR]

Plain English summary For some people, physical activity may be driven by compulsive thoughts, which can be associated with mental health issues and psychosocial impairment. This makes it important to understand the underpinnings to compulsive exercise (CE). Fitness instructors are considered important facilitators for a healthy and physically active lifestyle, but there is little knowledge on the occurrence of CE among these role models. Previous findings report on a significant frequency of symptoms of eating disorders in fitness instructors, and as such it is reasonable to assume that CE is present. By concurrently obtaining information on symptoms of depression, anxiety and eating disorders, this study was able to explore explanations to the variance in occurrence of CE. Our main findings were a moderately elevated frequency of symptoms of depression and anxiety, and that 9% of 270 male and female fitness instructors demonstrated CE behavior. Participants demonstrating CE had higher levels of symptoms of depression, anxiety, and eating disorders compared with those without CE. Nevertheless, only symptoms of eating disorders explained the variation in CE severity. Other than increasing our understanding of CE, the main implication from these findings is a need to increase mental health literacy in fitness instructors.

Abstract Background About half of Swedish eating disorder patients report exercising compulsively and compulsive exercise (CE) is prevalent in all diagnoses and both genders. Yet there are no systematic treatments targeting CE in specialist care. This study aims to evaluate the effects of The CompuLsive Exercise Activity TheraPy (LEAP) - a promising group treatment targeting compulsive exercise, in Swedish eating disorder patients. Method One hundred twenty-eight adult females and males suffering from anorexia nervosa, bulimia nervosa or other specified feeding and eating disorders (type 1, 2, or 4) with CE will be recruited via four specialist eating disorder treatment units. Participants will be randomized to receive treatment as usual (control group) or treatment as usual plus LEAP (intervention group). The groups will be assessed on key variables (e.g., BMI, eating disorder symptoms, exercise cognitions and behaviors) at three occasions: initially, after 3 months and after 6 months. Discussion The project takes place in a clinical setting, including both male and female patients with different eating disorder diagnoses with CE, enabling a good indication of the efficacy of LEAP. If our results are positive, LEAP has the potential of benefiting about half of the eating disorder population, with remission and recovery hopefully improving as a result. Trial registration The trial is registered with the ISRCTN registry (registration date 2020-03-25), trial ID: ISRCTN80711391 .

Background: This preregistered (https://osf.io/g9ajb) analysis sought to integrate the current literature on trait compulsivity into maintenance models of driven exercise in anorexia nervosa (AN). We tested whether compulsivity increases the likelihood of driven exercise via interpersonal and affect-regulatory pathways.Methods: We used multilevel structural equation modeling to test the hypothesis that trait compulsivity predicts a stronger within-person link between affect-regulatory difficulties or interpersonal sensitivity and driven exercise in female adolescents and adults with AN. We used data from five assessments across inpatient treatment and 6-months follow-up of 207 adult and adolescent patients with AN (1035 datapoints).Results: In line with our hypotheses, patients who generally experienced more affect-regulatory difficulties or stronger interpersonal sensitivity tended to engage in driven exercise more strongly. Moreover, high levels of trait compulsivity amplified the effect of interpersonal sensitivity on driven exercise across time. Contrary to our hypotheses, the link between affect regulation and driven exercise was not moderated by compulsivity. Similar effects on general eating disorder psychopathology were found, but no cross-level moderation effect of compulsivity.Limitations: Due to sample size, potential AN subtype-dependent effects were not analyzed.Conclusion: Our results suggest that driven exercise coincides with self-reported experiences of interpersonal sensitivity and that this link varies as a function of compulsivity such that the within-person coupling is stronger among those scoring high on compulsivity. To derive clinically useful functional models of driven exercise, future studies might use intensive longitudinal data to investigate its momentary associations with affect and interpersonal sensitivity in the context of compulsive traits. [ABSTRACT FROM AUTHOR]

With the global COVID-19 pandemic, governments from many countries in the world implemented various restrictions to prevent the SARS-Cov-2 virus's spread, including social distancing measures, quarantine, in-home lockdown, and the closure of services and public spaces. This led to an in-creased use of social media platforms to make people feel more connected, but also to maintain physical activity while self-isolating. Concerns about physical appearance and the desire to keep or reach a muscular and toned ideal body, might have further reinforced the engagement in fitness-related social media activities, like sharing progresses in training achievements or following more fitness contents on popular profiles. To better understand the underlying relation among these factors, the present study investigates 729 responses to the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), the Self-Compassion Scale (SCS) and their association to social media usage and compares the results cross-culturally in five countries (Spain, Lithuania, United Kingdom, Japan, and Hungary). Findings highlight significant differences between males and females, espe-cially in regard to the time spent online (U = 477.5, p = 0.036). Greater levels of appearance anxiety were associated with the exposure to fitness-related contents on social media. These results strongly confirm the previously highlighted association between fitspiration media and body image anxiety predominantly in females. Clinical implications and future considerations in terms of prevention and treatment in a situation of global emergency are also discussed. [ABSTRACT FROM AUTHOR]