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Understanding Excessive Exercise as part of an Eating Disorder

23. Resources

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Glossary

TermDefinition
RLO

Reusable Learning Object

Resources

ED Charities and Services

There are a number of ED charity websites that will help locate nearby services:

Organisation/TitleLink
Hub of Hopehttps://hubofhope.co.uk/ [Accessed: 25-03-24].
Beat Eating Disorders - Helpfinderhttps://helpfinder.beateatingdisorders.org.uk/ [Accessed: 25-03-24].
Beat Eating Disorders - Help Linehttps://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/i-need-support-now/helplines/ [Accessed: 25-03-24].

Steroid Misuse

OrganisationLink
CAMH - Steroidshttps://www.camh.ca/en/health-info/mental-illness-and-addiction-index/steroids [Accessed: 25-03-24].
National Health Service (NHS) - Anabolic Steroid Misusehttps://www.nhs.uk/conditions/anabolic-steroid-misuse/ [Accessed: 25-03-24].
National Institute on Drug Abuse (NIH) - Anabolic Steroids and Other Appearance and Performance Enhancing Drugs (APEDs)https://www.nhs.uk/conditions/anabolic-steroid-misuse/ [Accessed: 25-03-24].

Journals/Books

Title/Description
Bates, G., Tod, D., Leavey, C., & McVeigh, J. (2018). ‘An evidence-based socioecological framework to understand men’s use of anabolic androgenic steroids and inform interventions in this area’. Drugs: Education, Prevention and Policy, 26:6, 484-492, DOI: 10.1080/09687637.2018.1488947
Cook, B., Wonderlich, S.A., Mitchell, J., Thompson, R., Sherman, R., McCallum, K. (2016). ‘Exercise in eating disorders treatment: Systematic review and proposal of guidelines’. Medicine & Science in Sports & Exercise 48(7), 1408-1414. DOI: 10.1249/MSS.0000000000000912
Danielsen, M., Rø, Ø., Bjørnely, S. (2018). ‘How to integrate physical activity and exercise approaches into inpatient treatment for eating disorders: fifteen years of clinical experience and research’. Journal of Eating Disorders 6(34). DOI: 10.1186/s40337-018-0203-5
Dittmer, N., Jacobi, C., Voderholzer, U. (2018) ‘Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment’. Journal of Eating Disorders  6(42). DOI: 10.1186/s40337-018-0219-x
Ganson, K., Cunningham, M., Murray, S., Nagata, J., (2022a). ‘Use of appearance- and performance-enhancing drugs and substances is associated with eating disorder symptomatology among U.S. college students’. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 6(26). DOI: 10.1007/s40519-022-01364-z
Ganson, K., Murray, S., Mitchison, D., Hawkins, M., Layman, H., Tabler, J., Nagata, J. (2021). ‘Associations between Adverse Childhood Experiences and Performance-Enhancing Substance Use among Young Adults’. Substance Use & Misuse, 56(6), 854-860. DOI: 10.1080/10826084.2021.1899230
Haas, V., Kent, D., Kohn, M.R., Sloane, M., Clarke, S., Briody, J., Fischer, F., Müller, M. Gaskin, K. (2018) ‘Incomplete total body protein recovery in adolescent patients with anorexia Nervosa’. American Journal of Clinical Nutrition (3), 303-312. DOI: 10.1093/ajcn/nqx061
Kuhn, C. (2002). ‘Anabolic steroids’. Nordisk Medicin, 68, 1593–1597. DOI: 10.1210/rp.57.1.411
Meyer, C., Taranis, L., Goodwin, H., Haycraft, E. (2011). ‘Compulsive exercise and eating disorders’. European Eating Disorder Review 19(3), 174-189. DOI: 10.1002/erv.1122
Nagata, J. M., Ganson, K. T., Gorrell, S., Mitchison, D., Murray, S. B. (2020). ‘Association Between Legal Performance-Enhancing Substances and Use of Anabolic-Androgenic Steroids in Young Adults’. JAMA Pediatrics, 174(10), 992–993.DOI: 10.1210/er.2013-1058
Noetel, M., Dawson, L. (2017). ‘The assessment and treatment of unhealthy exercise in adolescents with anorexia Nervosa: A delphi study to synthesize clinical knowledge’. International Journal of Eating Disorders 50, 378-388.
Schalla, M.A., Stengel, A. (2019). ‘Activity based anorexia – a systematic review’. Frontiers in Nutrition(6). 1-25.
Sundgot-Borgen, J., Meyer, N.L., Lohman, T.G., Ackland, T.R., Maughan, R.J., Stewart, A.D., Müller, W. (2013). ‘How to minimise the health risks to athletes who compete in weight-sensitive sports review and position statement on behalf of the Ad Hoc Research Working Group on Body Composition. Health and Performance, under the auspices of the IOC Medical Commission’. British Journal of Sports Medicine, 47(16), pp.1012-1022.
Trott, M., Jackson, S. E., Firth, J., Jacob, L., Grabovac, I., Mistry, A., Stubbs, B., & Smith, L. (2020). ‘A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders’. Eating and Weight Disorders 26(1), 37-46. DOI:  10.1007/s40519-019-00842-1
Watson, H.J., et al. (2019) ‘Genome wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa’. Nature Genetics 51(8), 1207-1214. DOI: 10.1038/s41588-019-0439-2
Young, S., Rhodes, P., Touyz, S., Hay, P. (2013). ‘The role of exercise in the treatment and recovery process of anorexia nervosa’. Journal of Eating Disorders 08.
Zunker, C. (2011). ‘Exercise Interventions for Women with Anorexia Nervosa: A review of the literature’. Journal of Eating Disorders 44, 579-584.

Learning outcomes

This training has been developed with sports and healthcare professionals, as well as people who have experience of excessive exercise as part of an eating disorder.

It aims to help you in your professional practice in the following areas:

  • to understand the role exercise plays in the life of an individual with an eating disorder - regardless of their gender, age and body size & type;
  • to start a conversation with them about excessive exercise;
  • to help them change their relationship with exercise.

Understanding Excessive Exercise as part of an Eating Disorder: was developed by:

Content Authors: Heike Bartel (University of Nottingham), George Mycock (University of Worcester) & Una Foye (King’s College London).

Narrator: George Mycock.

Project mentor: Richard Windle.

Development This learning resource was developed using the ASPIRE methodology; Aims, Storyboarding, Population, Implementation, Review, Evaluation. Content was developed in consultation with, and peer reviewed by, experts in diverse areas of health and care.

Many people helped us in developing this tool. Our special thanks go to:

Dr. Caz Nahman, Dr. Amit Mistry, Dr. Dom Thompson, Stacy Bias (animation), Jack Benfield (soundscape for animation), The team ‘Sport at the University of Nottingham’, First Steps Eating Disorders Charity, The EDIFY team and the people with lived experience who helped design this tool.

Implementation: Michael Taylor and Lydia Jones.

Funding: The project was funded with help from Wellcome and the University of Nottingham.

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