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Latest Clinical Research Published by ACSM

Jaworski, Carrie A. MD, FACSM, FAAFP

doi: 10.1249/JSR.0b013e3182a62af7
Scanning Sports Medicine

Division of Sports Medicine, Department of Family Medicine, University of Chicago/NorthShore University Health System, Glenview, IL

Address for correspondence: Carrie A. Jaworski, MD, FACSM, FAAFP, Division of Sports Medicine, Department of Family Medicine, University of Chicago/NorthShore University Health System, Glenview, IL 60026; E-mail:

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Assessment of Physical Activity in Anorexia Nervosa and Treatment Outcome

In the September 2013 issue of Medicine & Science in Sports & Exercise ®, authors compare objective and subjective assessments of physical activity (PA) in patients with anorexia nervosa and its effect on treatment outcome (1). It is well established that excessive PA is a commonly seen behavior in patients with anorexia nervosa. This is particularly true in the inpatient setting where patients typically gain more weight than in the outpatient setting. Excessive PA may take different forms in the anorexic patient. It may be incorporated into routine daily activities, structured sports activities, or abnormal exercising. This heterogeneity makes assessment of excessive PA a difficult task. Many previous studies have relied on direct interview or self-reported questionnaires to assess the role of excessive PA in treatment outcome. However, as denial is a common feature in anorexia nervosa, the authors hypothesized that some patients underestimate the amount of their PA, which can lead to significant bias and inaccuracy of the data regarding both its extent and its role in treatment outcomes.

In order to address this concern, the authors of this study used both an objective measure, the Actiheart (AH), and a subjective measure, the International Physical Activity Questionnaire (IPAQ), to assess PA in a selected group of patients with anorexia nervosa during the first week of inpatient treatment.

The sample consisted of 52 female patients consecutively admitted to the eating disorder unit of an inpatient facility in northern Italy between January 2010 and April 2012. All patients were subjected to both objective and subjective assessment of their PA. Objective PA assessment was carried out using AH, which combines a heart rate monitor with a piezoelectric accelerometer. AH also is able to assess activity energy expenditure, duration, and intensity of PA. An AH was placed on the second day of hospitalization and was kept in place for three consecutive days. The IPAQ short, last 7-day, self-administered format was used for subjective PA assessment. The IPAQ was administered to all patients on the eighth day of hospitalization.

The main findings of the study were as follows: 1) The levels of PA assessed by the subjective IPAQ were significantly below those objectively measured using AH. 2) Patients with anorexia nervosa spent significantly longer periods in activity classified as sedentary and light, as compared to activities classified as moderate or vigorous. 3) Higher light PA (LPA) in the first days of inpatient treatment seems to be associated with less improvement in eating disorder psychopathology at the end of the program.

Bottom Line: PA in patients with anorexia nervosa is underestimated by subjective assessment when compared with objective measurement. Objective measures of LPA showed a negative association with improvement in eating disorder psychopathology and indicated the need for better PA assessment and monitoring in the care of anorexic patients.

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How Young Is Too Young to Start Training?

Current trends indicate growing numbers of participation in organized youth sports at younger ages. With that comes the question from parents, coaches, and clinicians about the appropriate age to begin specialized physical training, especially strength training and conditioning programs, in an attempt to improve performance, enhance motor skill development, and prevent injury. Authors in the September/October 2013 issue of ACSM’s Health & Fitness Journal ® address the topic of when and how to integrate safely more specialized physical training into the lives of youth athletes through a review of the available literature on the design and implementation of integrative neuromuscular training (INT) programs in school-age children (2). INT is a conceptual training model that the authors define as a training program that incorporates general (e.g., fundamental movements) and specific (e.g., exercises prescribed to target motor control deficits) strength and conditioning activities including resistance training, dynamic stability exercises, core-focused training, plyometric drills, and agility training that specifically are designed to enhance health and skill-related components of physical fitness.

The cornerstone of INT is age-appropriate education and instruction by qualified professionals who understand the fundamental principles of pediatric exercise science and genuinely appreciate the physical and psychosocial uniqueness of children and adolescents. The authors explain that INT is designed to help youth master fundamental motor skills, improve movement mechanics, and gain confidence in their physical abilities while participating in a program that includes variety, progression, and proper recovery intervals based on their training age.

Training age is defined as the amount of time accumulated from both periodic and longitudinal participation in training programs and sport-related activities that foster the development of musculoskeletal health, basic movement patterns, and overall physical fitness. One’s training age does not always equal one’s chronological or biologic age.

Within this review, the authors also discuss the different approaches to starting, and maintaining, INT training based on the athlete’s training age as well as their stage within pubertal development. They discuss that the initiation of INT early in youth can help increase training age, which is vital for children and adolescents whose motor capabilities are highly “plastic” and responsive to training. The article goes on to review the effects of ongoing INT training throughout the stages of puberty and postpubertal development as an effective tool to prevent injury and improve athletic performance. Research demonstrates that significant, amenable benefits can be gained from such training age appropriate interventions.

Bottom Line: Safe, age-appropriate guidelines exist for integrating training activities in the lives of young athletes that will enhance neuromuscular function, increase muscular strength, and improve a child’s ability to participate more safely in sports and recreational activities.

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1. Alberti M, Galvani C, El Ghoch M, et al. Assessment of physical activity in anorexia nervosa and treatment outcome. Med. Sci. Sports Exerc. 2013; 45: 1643–8.
2. Myer GD, Lloyd RS, Brent JL, Faigenbaum AD. How young is “too young” to start training? ACSM’s Health & Fitness Journal 2013; 17: 14–23.
Copyright © 2013 by the American College of Sports Medicine.