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J Eat Disord. 2018 Feb 5;6:2. doi: 10.1186/s40337-018-0188-0. eCollection 2018.

Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa.

Author information

1Griffith Taylor Building, School of Psychology, University of Sydney, Sydney, Australia.
2School of Psychology, University of Sydney, Sydney, Australia.
3WMG, University of Warwick, United Kingdom & University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
4Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK.
5Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK.
6School of Medicine, University of Sydney, Sydney, Australia.
Eating Disorders Service at the Sydney Children's Hospitals Network, Westmead, Australia.
8Division of Behavioral Health Services and Policy Research, Columbia University, New York, USA.
9Department of Psychiatry, College of Physicians and Surgeons of Columbia University, Weill Cornell Medical College, New York, USA.
10Neuropsychiatric Research Institute, Fargo, North Dakota USA.
11University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota USA.
12Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia.



For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN.


A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change.


Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL.


These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients' engagement in treatment.

Trial registration:

ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.


Anorexia nervosa; Anxiety; Compulsive exercise; Depression; Motivation to change; Obsessive-compulsive; Quality of life

Conflict of interest statement

Ethics approval was granted by the Western Sydney University Human Research Ethics Committee; the National Health Service Research Ethics Committee in the UK, as part of the Health Research Authority; and the Institutional Review Board at Columbia University in New York, USA.Not applicable as the project did not report individual data.ST and PH receive royalties from Routledge, Hogrefe, and Huber and McGraw-Hill publishers for printed contributions on eating disorders. SM and ST receive honoraria from Shire Pharmaceuticals. PH received royalties from Oxford University Press and receives sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry. RDC is a statistical consultant to Health Outcome Solutions, in Winter Park, Florida. PH and ST are Editors-in-Chief of this journal, and CM, JA, SM, KP, JA, RDC and SY are on the editorial board. All authors have other published papers cited in this manuscript. SY submitted an alternate version of this manuscript as a part of her PhD thesis.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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