Brian Cook

Objective assessment of changes in physical activity and sedentary behavior: Pre- through 3 years post-bariatric surgery

To evaluate change in sedentary behavior (SB) and physical activity (PA) over 3 years following bariatric surgery.

Pathological motivations for exercise and eating disorder specific health‐related quality of life

OBJECTIVE To examine associations among pathological motivations for exercise with eating disorder (ED) specific health-related quality of life (HRQOL). METHOD Survey data assessing ED severity (i.e., Eating Disorder Diagnostic Survey), ED specific HRQOL (i.e., Eating Disorders Quality of Life Instrument), and pathological motivations for exercise (i.e., Exercise Dependence Scale) were collected from female students (N = 387) at seven universities throughout the United States. Regression analyses were conducted to examine the associations among exercise dependence, ED-specific HRQOL and ED severity, and the interaction of exercise dependence and ED severity on HRQOL scores. RESULTS The overall model examining the impact of ED severity and exercise dependence (independent variables) on HRQOL (dependent variable) was significant and explained 16.1% of the variance in HRQOL scores. Additionally, the main effects for ED severity and exercise dependence and the interaction among ED severity and exercise dependence were significant, suggesting that the combined effects of ED severity and exercise dependence significantly impacts HRQOL. DISCUSSION Our results suggest that pathological motivations for exercise may exacerbate EDs detrimental impact on HRQOL. Our results offer one possible insight into why exercise may be associated with deleterious effects on ED HRQOL. Future research is needed to elucidate the relationship among psychological aspects of exercise, ED, and HRQOL.

Exercise in eating disorders treatment: Systematic review and proposal of guidelines

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.

Exercise dependence as a mediator of the exercise and eating disorders relationship: A pilot study

OBJECTIVE Excessive exercise is a common feature of eating disorders (ED) and is associated with earlier ED onset, more ED symptoms, and higher persistence of ED behavior. Research indicates that exercise amount alone is not associated with ED. The purpose of this study was to investigate pathological attitudes and behaviors related to exercise (e.g., exercise dependence) as a mediator of the exercise and ED relationship. METHOD Participants were 43 women with an ED who completed measures of ED symptoms, exercise behavior, and exercise dependence. Analyses were conducted using the indirect bootstrapping method for examining mediation. RESULTS Exercise dependence mediated the relationship between exercise and ED. This mediation model accounted for 14.34% of the variance in the relationship. DISCUSSION Our results extend the literature by offering preliminary evidence of a psychological variable that may be a candidate for future interventions on the exercise and ED relationship. Implications and suggestions for future research are discussed.

Exercise Addiction and Compulsive Exercising: Relationship to Eating Disorders, Substance Use Disorders, and Addictive Disorders

The recent addition of a behavioral addictions category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has provided a framework to examine when behaviors progress from normal to pathologically excessive. Several behaviors that are either typically harmless (e.g., gambling, shopping) or even healthy (e.g., alcohol consumption, sex) when performed in moderation have been identified as having addictive potential. Exercise is one such behavior that may be viewed as an addiction. However, the literature is confused by several terms such as compulsion, addiction, and dependence that all may refer to similar, if not the same, pathological patterns of problematic exercise. This chapter will first review the various terms that are widely used and provide a clear distinction among exercise addiction, dependence, and compulsion. Next, we will review assessment measures that are commonly used in research and in clinical practice to screen for problematic exercise patterns. Finally, we will discuss the emerging literature that examines the co-occurrence of problematic exercise and eating pathology, substance use disorders, and other behavioral addictions.

Objectively-measured sedentary time and cardiometabolic health in adults with severe obesity

It is unknown whether sedentary behavior is independently associated with the cardiometabolic health of adults with severe obesity. Additionally, there is debate regarding how best to derive meaningful indices of sedentary time (ST) from activity monitor data. A convenience sample of adults with severe obesity (N=927; 79% female, median age 45y, median body mass index (BMI) 46kg/m(2)) completed a research assessment at one of ten US hospitals in 2006-2009 prior to bariatric surgery. Cardiometabolic health was assessed via physical measures, fasting blood samples and medication use. Indices of ST were derived from StepWatch™ activity monitor data with minimum bout durations of 1min, 10min and 30min. Cross-sectional associations were examined. Median (25th, 75th percentile) ST was 9.3h/d (8.1, 10.5) in ≥1min bouts, 6.5h/d (5.2, 8.0) in ≥10min bouts, or 3.2h/d (2.1, 4.5) in ≥30min bouts. Associations with ST were generally strongest with the ≥10min bout duration. Independent of moderate-to-vigorous intensity physical activity, BMI and other potential confounders, 1h/day ST in ≥10min bouts was associated with higher odds of diabetes by 15% (95%CI: 1.05-1.26), metabolic syndrome by 12% (95%CI: 1.01-1.24) and elevated blood pressure by 14% (95%CI: 1.02-1.26), and was associated with 1.4cm (95%CI: 0.9-1.9) larger waist circumference. Findings indicate the importance of considering ST as a distinct health risk among adults with severe obesity, and suggest a 10min minimum duration may be preferable to 1min or 30min for establishing ST from activity monitor data.

The influence of exercise identity and social physique anxiety on exercise dependence

Background Previous research has identified exercise identity and social physique anxiety as two independent factors that are associated with exercise dependence. Aims The purpose of our study was to investigate the unique and interactive effect of these two known correlates of exercise dependence in a sample of 1,766 female runners. Methods Regression analyses tested the main effects of exercise identity and social physique anxiety on exercise dependence. An interaction term was calculated to examine the potential moderating effect of social physique anxiety on the exercise identity and exercise dependence relationship. Results Results indicate a main effect for exercise identity and social physique anxiety on exercise dependence; and the interaction of these factors explained exercise dependence scores beyond the independent effects. Thus, social physique anxiety acted as a moderator in the exercise identity and exercise dependence relationship. Discussion Our results indicate that individuals who strongly identify themselves as an exerciser and also endorse a high degree of social physique anxiety may be at risk for developing exercise dependence. Conclusions Our study supports previous research which has examined factors that may contribute to the development of exercise dependence and also suggests a previously unknown moderating relationship for social physique anxiety on exercise dependence.

A pilot study examining diagnostic differences among exercise and weight suppression in bulimia nervosa and binge eating disorder

OBJECTIVE The objective of this study was to investigate diagnostic differences in weight suppression (e.g., the difference between ones current body weight and highest non-pregnancy adult body weight) and exercise among Bulimia Nervosa (BN) and Binge Eating Disorder (BED). Because exercise may be a key contributor to weight suppression in BN, we were interested in examining the potential moderating effect of exercise on weight suppression in BN or BED. METHOD Participants with BN (n = 774) and BED (n = 285) completed self-report surveys of weight history, exercise and eating disorder symptoms. Generalised linear model analyses were used to examine the associations among diagnosis, exercise frequency and their interaction on weight suppression. RESULTS Exercise frequency and BN/BED diagnosis were both associated with weight suppression. Additionally, exercise frequency moderated the relationship between diagnosis and weight suppression. Specifically, weight suppression was higher in BN than in BED among those with low exercise frequency but comparable in BN and BED among those with high exercise frequency. DISCUSSION Our results suggest that exercise frequency may contribute to different weight suppression outcomes among BN and BED. This may inform clinical implications of exercise in these disorders. Specifically, much understanding of the differences among exercise frequency and the compensatory use of exercise in BN and BED is needed.

The Role of Negative Affect in Eating Disorders and Substance Use Disorders

Affect regulation is one mechanism that has been implicated in the development and maintenance of both eating disorders and substance use disorders. Specifically, the affective processing model of negative reinforcement posits that negative affect, as a symptom of withdrawal, is the main impetus in substance use disorder development and maintenance. Similarly, a recent transactional model of emotion dysregulation posits that individuals with eating disorders display heightened emotional sensitivity and reactivity, which in turn predisposes these individuals to eating disorder behaviors (e.g., binge eating, purging, etc.) as a means of attempting to modulate heightened negative affect. While affect regulation is similar in eating disorders and substance use disorders, differences in precursors of negative affect, cognitions, and withdrawal symptoms are present in these two forms of psychopathology. Despite these differences, affect regulation models in both eating and substance use disorders have begun to influence treatment. Thus, understanding the role of negative affect may be a key component of treating substance use disorders and eating disorders independently, as well as the co-occurrence of these disorders.

Physical Activity and Sociodemographic Correlates of Adolescent Exergamers

PURPOSE Exergame use (or active video games that promote physical activity [PA]) has the potential to increase PA in youth, but there is a scarcity of information about PA of youth who are current exergamers. The current study examined PA behaviors in exergamers versus nonexergamers. METHODS Adolescents (N = 2,793; mean age = 14.4 ± 2.0 years) participating in EAT 2010 (Eating and Activity in Teens) self-reported sociodemographic characteristics and exergaming and PA behavior. Height and weight were measured. RESULTS Both male and female exergamers tended to be younger and black compared with nonexergamers (p < .001). Generally, exergamers did not report significantly more PA than nonexergamers, except for female exergamers who engaged in more vigorous PA than female nonexergamers (p < .01; 1.3 ± .05 h/wk vs. 1.6 ± .06 h/wk, respectively). CONCLUSIONS PA behavior in exergamers is similar to PA behavior in nonexergamers. However, when targeting vigorous PA, exergaming may be an innovative and appealing intervention strategy for adolescent girls.