Exercise as it relates to Disease/Excessive exercise and anorexia nervosa

Anorexia Nervosa (AN) is an eating disorder that is characterised by the refusal to maintain a healthy weight. It is a very severe and often chronic mental health illness that can lead to health complications such as malnutrition and emaciation, and can impact heavily upon the physical, emotional, social and educational development of patients. Sufferers often experience fear, anxiety and an overriding obsession with becoming ‘fat’ and use excessive exercise (hyperactivity) and restricted caloric intake to irrationally help satisfy unrealistic expectations of body image.

Prevalence and Mortality
•	In Western societies approximately 0.3%-0.5%  of the population have Anorexia

•	The average age of onset of the disorder is 14–19 years

•	95% of sufferers are females

•	The chance of recovery in the first 10 years is less than 50%

•	Mortality occurs in approximately 5-20% of patients

== Diagnosis of Patients ==

•	Low body weight when compared to normative figures of weight for their particular age and height

•	Have an intense fear of weight gain, although already underweight

•	Distortion in perception of body image

•	Denial of the severity of their low body weight

•	In females - amenorrhea for at least three consecutive menstrual cycles

•	In males – reduction in testosterone levels and sperm count

Possible Causes
The cause for weight loss in these patients is simply because energy expenditure is greater than energy intake. However the risk-factors that lead to this condition include:

•	Low-self esteem

•	Family issues

•	Sociocultural and media pressures

•	Improvement in athletic performance because of reduction in body fat e.g. runners

•	Heredity

•	Want for better appearance

Excessive Exercise and Anorexia
It has long been known that an inverse relationship between activity and energy intake exists in those suffering from Anorexia. This is due partly to the excessive levels of exercise that anorexic patients partake in leads to a reduced caloric intake by means of its’ appetite-suppressing effects (malnutrition). Conversely, low energy intake can also increase the drive to exercise (hyperactivity). Further compounding this issue, vigorous exercise and food restriction may result in continuation of this irrational behaviour, because it becomes somewhat of an addiction for the individual, of which is suggested to be closely linked with other mental health conditions such as Obsessive Compulsive Disorder.

Not only does excessive exercise affect the physical attributes of anorexia patients-such as peripheral edema, osteopenia and hypotension, but it is also important to note the psychological and social effects of being excessively active. Because of the perceived image of providing ‘fitness’, increased exercise levels may lead to false credibility being given to drastic weight-loss behaviour. As the individuals' condition worsens, their strenuous exercise routines become less pleasurable, yet further severe. Recreational and extra-curricular activities in the sufferer’s life are often sacrificed to maintain the hectic exercise regime, which may lead to relationship breakdowns with family and friends and academic/work performance declines because such excessive amounts of time are being spent exercising.

Recommendations
Exercise as Medicine:

Those who suffer from this disorder often engage in excessive physical activity to increase weight loss. With this in mind, when treating someone with this condition, permission to exercise constitutes a powerful reward for compliance and potentially weight gain. In combination with counselling and a total therapy program with inclusion of diet restoration, this can greatly improve the chance for treatment to be effective. Anaerobic activities in particular are ideal as they generally require less energy to perform. Patients also need to be informed on the amount of exercise deemed to be healthy, as well as becoming aware of kinaesthetic sensation allowing them to understand their body and no longer ignore pain and fatigue as previously done. The duration, intensity and type of exercise to be prescribed as treatment is subject dependent and includes:

•	Stretching/Flexibility training

•	Resistance training

•	Low weight bearing aerobic activity

•	Postural improvement classes

•	Social sport

Other treatment options:

•	Family Therapy – Helping other family members to better understand the eating disorder affecting someone in the household by educating them on promoting healthier eating and exercise habits, as well as ensuring a constant, positive and supportive relationship with the individual affected

•	Psychotherapy

Further Reading / Information Sources
Australian Government Anorexia Nervosa Resource

Anorexia Nervosa Exercise Prescription Guidelines