Treatment Considerations for Compulsive Exercise in High-Performance Athletes with an Eating Disorder

Area of Science:

• Sports Medicine
• Psychiatry
• Eating Disorders

Background:

• Compulsive exercise negatively impacts eating disorder (ED) treatment outcomes.
• High-performance athletes with EDs present unique challenges, requiring specialized conceptualizations of compulsive exercise.
• Existing ED treatments show limited efficacy for compulsive exercise, with athletes underrepresented in trials.

Purpose of the Study:

• To explore the effectiveness of current ED treatments for compulsive exercise in high-performance athletes.
• To discuss alternative and adjunct treatment strategies for compulsive exercise in this population.
• To provide practical guidance for clinicians treating athletes with EDs and compulsive exercise.

Main Methods:

• Opinion paper drawing on expertise from sports leadership, lived experience, and ED clinicians.
• Discussion of exercise abstinence, mindfulness-based interventions, wearable technology, and exercise variation.
• Consideration of cognitive-behavioural interventions (CBI) adapted for athletes.

Main Results:

• Current ED treatments may not be sufficient for compulsive exercise in athletes.
• Exercise abstinence may not be suitable for all athletes with EDs.
• Mindfulness, technology, exercise variation, and adapted CBIs show potential.

Conclusions:

• Tailored treatment approaches are crucial for compulsive exercise in athletes with EDs.
• Further research is needed to understand pathological compulsive exercise in athletes and validate treatment efficacy.
• Integrating foundational CBI elements into athlete ED treatment plans is recommended.