Compulsive exercise in higher levels of eating disorder care: Trajectory of change over time among adolescents with anorexia nervosa

Compulsive exercise is commonly observed in adolescent anorexia nervosa (AN) and relates to more severe eating disorder pathology and worse outcomes. Within higher levels of care (HLOC) for eating disorders, physical activity is often restricted in an attempt to reduce compulsive exercise; yet, the effectiveness of these restrictions across levels of care remains understudied. The current study examined how compulsive exercise presents and changes within HLOC as individuals with AN transition from settings with greater supervision to those with more autonomy over movement. Given the central role of weight restoration in HLOC, the association between change in percent of expected body weight (%EBW) and compulsive exercise frequency at discharge was also explored. Participants were 443 adolescents with AN admitted to inpatient or residential treatment and stepped down to partial hospitalization or intensive outpatient programs. At admission, stepdown, and discharge, participants reported compulsive exercise frequency using the Eating Disorder Examination-Questionnaire. Among participants who endorsed compulsive exercise at admission (58.0%, n = 257), piecewise growth curve analyses found a significant decrease in compulsive exercise frequency from admission to stepdown (β = -0.21, p < .001) and no significant change from stepdown to discharge (β = -0.02, p = .080). Change in %EBW was not associated with compulsive exercise frequency at discharge (β = 0.17, p = .941, IRR = 1.19). Eating disorder recovery in the context of HLOC settings that initially restrict access to exercise is associated with reported decreases in compulsive exercise for many adolescents with AN, irrespective of weight stabilization. Research involving measures of exercise motivation, controlled designs, and follow-up data is needed to inform the development of personalized compulsive exercise interventions.