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Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines


Medicine & Science in Sports & Exercise: July 2016 - Volume 48 - Issue 7 - p 1408–1414
doi: 10.1249/MSS.0000000000000912
Applied Sciences

Introduction Although exercise is an effective intervention for many psychological health issues, it has often been overlooked as a potential adjunct to eating disorder (ED) treatment. Thus, our objective was to summarize the literature by synthesizing themes identified in clinical studies and explicit guidelines or recommendations for the use or management of exercise in ED interventions into a proposed set of guidelines for the use of exercise in ED treatment.

Methods A literature search in exercise science, health psychology, and the ED literature was conducted. The focus was to obtain articles that reported on therapeutic effects and/or guidelines for the therapeutic use of exercise in individuals with ED.

Results Our review identified 11 core themes describing techniques that have been successful in using exercise therapeutically in ED treatment. These 11 guidelines are as follows: employ a team of relevant experts, monitor medical status, screen for exercise-related psychopathology, create a written contract of how therapeutic exercise will be used, include a psychoeducational component, focus on positive reinforcement, create a graded exercise program, begin with mild-intensity exercise, tailor the mode of exercise to the needs of the individual, include a nutritional component, and debrief after exercise sessions.

Conclusion Our review identifies specific guidelines that may enhance ED treatment outcomes. It is the first to summarize divergent literature and synthesizes previous successes that may guide the use of therapeutic exercise in some, but not all ED patients. This review provides a practical set of guidelines for the clinical management and therapeutic use of exercise in ED treatment by focusing on empowering individuals with exercise as a tool for healthy living.

1California State University Monterey Bay, Seaside, CA; 2Neuropsychiatric Research Institute, Fargo, ND; 3University of North Dakota School of Medicine and Health Sciences, Fargo, ND; 4Indiana University, Bloomington, IN; 5Bloomington, IN; and 6The Victory Program at McCallum Place, St. Louis, MO

Address for correspondence: Brian Cook, Ph.D., Kinesiology Department, California State University Monterey Bay, 100 Campus Center Drive, Valley Hall/82D-101, Seaside, CA 93955; E-mail:

Submitted for publication November 2015.

Accepted for publication February 2016.

© 2016 American College of Sports Medicine