International recommendations agree on the importance of regular physical activity to maintain good health: about 30 minutes of brisk walking each day, according to specialists (WHO).
It is recognized that moderate and regular physical activity provides physiological, psychological and social benefits. However, when physical practice is excessive, it can be harmful to physical health (trauma, injuries) and mental health (obsessive behavior, feelings of ignored fatigue, sports activity at the expense of social life). In some cases, this excessive practice may be linked to other disorders, such as eating disorders or dysmorphic disorders.
There is therefore an ambiguous relationship between physical activity and eating disorders.
But is physical activity an aggravating factor in eating disorders or is it a way to regulate it?
Physical hyperactivity is defined as an excessive, repetitive and unpleasant physical activity, i.e., motivated by a desire to burn calories and achieve a sense of self-satisfaction rather than a desire for well-being (Source: Beumont, 1994).
The prevalence of physical hyperactivity in anorexic patients varies from one study to another, with figures ranging from 40 to 80% of patients.
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For anorexics diagnosed with hyperactivity, physical practice is described as a solitary routine, which they must perform every day, in the same way and at the same time.
They are not carried out in a search for pleasure, but out of a sense of obligation, or even addiction to physical activity for the purpose of weight loss. Physical activity is therefore practiced as an obsessive behavior, with the risk of increasing injuries due to the poor physical condition of sick people (Source: Varray, 1988).
Indeed, it has been shown that hyperactive anorexic patients often suffer from osteoporosis, stress fractures and joint damage (Source: Creen & Melchior, 2007). In addition, excessive physical activity increases the risk of cardiovascular complications (Source: Tolomio, 2007).
According to some scientists, hyperactivity can be a risk factor for anorexia nervosa. Indeed, according to the explanatory behavioral model of Epling and Pierce (1988), regular physical practice causes a decrease in appetite, which in turn reduces the value placed on food, leading to dietary restriction and weight loss.
A recurring question is what causes this hyperactive behavior in the most vulnerable people. According to the literature, the risk factors most likely to promote and maintain physical hyperactivity are mainly socio-cultural (social comparison of the appearance and quantity of sport practiced by peers, internalization of the ideal of thinness, etc.). However, additional motivations may explain the development of physical hyperactivity. This is the case in particular in the field of sport, or in response to a desire for performance, some individuals may increase their participation in sport and modify their eating behavior accordingly. This is called athletic anorexia, which is defined as “an eating disorder secondary to excessive sports activity” (Source: Powers, Schoken, Boyd, 1998).
It therefore appears that physical activity, depending on how it is carried out and the goals that motivate it, will not have the same impact on health. When properly practiced, physical activity can have multiple beneficial effects.
However, when it is practiced in excess, it can be harmful. Given the limited scientific research conducted in this field, it is still difficult to identify the exact nature of the link between physical activity and anorexia nervosa.
Indeed, this link differs according to the predispositions of each person, the specificity of the discipline, the pressures experienced, but also the behavior and intentions of the practitioner.
Thus, the same physical practice can be, depending on the situations and individuals, a risk factor or a therapeutic means in ED (Source: Moscone, Leconte and Le Scanff, 2014).
Indeed, some researchers recommend sports as a complementary care to the management of anorexia nervosa.
Beumont (1994) states in particular that the practice of yoga, Tai-chi or dance movement are the most appropriate physical activities for the problems of anorexic patients.
Many physicians specializing in the treatment of Eating Disorders recommend low to moderate intensity physical activity (two to three one-hour sessions per week for a minimum of three to six months, conducted by an adapted physical activity specialist).
Indeed, such an activity could be a complement to therapeutic care for anorexia nervosa.
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