Short summary

In-patients with severe anorexia nervosa (AN) often drop out of treatment, because of ambivalence towards treatment and anxiety for weight gain. However, physical therapy has shown some positive effects on symptoms of AN. This study aims to investigate the feasibility of an RCT-study of a standardized physiotherapeutic program for patients with severe AN with compliance to nutritional therapy as the primary outcome measure.

Rationale

Anorexia nervosa (AN) is a serious and complex disease with unknown etiology. It is characterised by disturbed body image and extreme and devastating fear of gaining weight. The illness leads to a considerable and sometimes dangerous weight loss because of the limited food intake and often an exaggerated exercise behavior. AN can affect people of all ages and of both sexes, but girls or young women are more at risk.  The prevalence among young women in Denmark is estimated to be between 0.4% and 1%. AN is associated with a high rate of comorbidity and mortality.

The treatment of AN consist of re-feeding and psychotherapy. Different therapeutic methods and theories have been applied, but none have shown to be superior. The patient alliance and motivation for treatment seem to be essential for a successful treatment. Drop-out is a common challenge. Hence, attention must be directed to how the therapeutic alliance and the patient's motivation can be optimized in order to secure a better treatment effect.

Studies have shown that physical therapy, including supervised exercise and bodily focused interventions, may have a positive effect on symptoms of AN. It may reduce the distorted body image and anxiety. However, it is unknown whether physical therapy can affect compliance and drop out rate to the nutrition therapy. The objective of this study is to investigate the feasibility of a RCT design in this group of patients with severe AN at a specialized unit. The intervention is supervised, standardized physical therapeutic exercises mainly consisting of light strength training.  The development of the intervention is based partly on the literature, and partly on interviews and observations with two patients with severe AN. 

Description of the cohort

The patients are recruited from the Nutrition Unit, Center for Eating Disorders at Odense University Hospital. The inclusions criteria are in-patients who meet the DSM-5 criteria for AN and are respiratory and circulatory stabile. Patients must be 18 years of age or above. Patients must be included in the study within the first two weeks of hospitalization.

There are no healthy control groups included.

Data and biological material

The final endpoint is the degree of completion of a definite treatment plan, but also several secondary measures as grip strength, functional movement, quality of life, body image score and BMI are collected and analyzed. The data will be collected from the patient's record, short surveys and clinical examinations.

Collaborating researchers and departments

Department of:  Nutrition Clinic, Center for Eating Disorders, Odense University Hospital. Psychiatric Services in the Region of Southern Denmark

• Professor and Consultant René Klinkby Støving, MD, PhD

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Associate Professor Carsten Bogh Juhl, MPH, PhD

Department of Rehabilitation, Odense University Hospital

• Physical Therapist Karen Hede Poulsen