Anorexia nervosa, sometimes called anorexia by the general public, is an eating disorder that appears most often during adolescence, with a prevalence of 1 to 4% in women and 0.3% in men. The main symptoms are strict and voluntary food deprivation over a long period of time, leading to extreme and potentially health-threatening weight loss, as well as a distorted perception of one’s body, often leading those affected to see themselves as overweight.
A risk of complications and suicides
Anorexia nervosa is considered a particularly fatal psychiatric illness. According to sources, 5 to 9% of sick people die, mainly due to somatic complications or following suicide.
Indeed, in addition to its main symptoms, a series of psychological disorders worsen the clinical picture. Firstly, there is depression, which leads to the emergence of negative thoughts, social withdrawal and loss of interest in activities once enjoyed.
Additionally, anxiety disorders may develop, leading to excessive worries about food, weight, and body image. Mood disorders and emotional fluctuations are also common, and can further impair social interactions and self-perception. Finally, sleep problems are often present, and manifest mainly through restless nights or insomnia.
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Anorexia nervosa also has significant physical and physiological consequences. These are very often linked to weight loss and malnutrition, and can be characterized by a reduction in muscle mass and capacity, weakening of bones, heart problems, multiple deficiencies, hair loss. , kidney and intestinal problems, etc.
When they become chronic, all these disorders lead to an impoverishment of relational and emotional life, with an impact on school or professional life. Increasingly considered as a serious pathology of adolescence, anorexia nervosa constitutes a major public health issue in France, which requires new, more effective therapeutic strategies.
Physical activity adapted to help heal
Thus, in order to treat the main symptoms of the disease and to prevent or reduce as best as possible the various associated disorders, it is necessary to offer early and multidisciplinary care. If the practice of physical activity has long been prohibited, particularly in cases of advanced malnutrition or in patients with physical hyperactivity or even a dependence on physical activity, it can also contribute to the cure of anorexia, to from the moment it is adapted to the characteristics of the patients.
We then speak of adapted physical activity (APA), which can be defined as a means allowing the movement of people who, due to their physical, mental or social state, cannot practice physical activity under usual conditions. Practicing suitable physical activity requires first consulting a doctor.
Read more: Adapted physical activity to stay in good health for a long time
In the case of anorexia nervosa, APA can be a response tailored to the specific needs of patients, both physical and emotional, and play a crucial role in the healing process. This non-drug therapy must take place in a secure setting, and be supervised by a professional trained in APA. This avoids the pitfalls of overtraining while targeting therapeutic objectives.
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Studies show a reduction in symptoms
Various clinical research studies have demonstrated the major role of adapted physical activity in the treatment of anorexia. In particular, it has been shown that regular APA practice over a period of 8 to 16 weeks could induce a reduction in the main symptoms of anorexia, as well as an improvement in physical and mental health. In addition, the results made it possible to observe that depending on the nature of the physical activities practiced, improvements are observed more particularly in the dimensions targeted by the exercises carried out.-
Thus, programs integrating exclusively endurance exercises mainly improve the cardiorespiratory capacity of patients, even if they are likely to lead to dependence on physical activity. Programs focused on muscle strengthening contribute more to improving strength and muscle mass.
Wellness practices such as yoga, tai chi or Pilates have a greater impact on reducing symptoms of illness, body concerns and anxiety-depressive disorders, and help restore a healthier relationship to physical activity (i.e. a reduction in dependence on physical exercise). Finally, it has been shown that APA programs combining mixed exercises seem to be the most favorable for weight regain.
Read more: Why are humans so vulnerable to the risk of depression?
No official recommendation
Despite all these benefits in the treatment of anorexia nervosa, in clinical field practices, adapted physical activity is not prescribed systematically, and no national or international recommendations exist to date. Nevertheless, APA is becoming increasingly recognized and practiced in healthcare centers. Despite its delay compared to other countries such as the United States, Canada or Australia, France today has a few hospital centers which integrate APA into their routine care protocol, such as the CHU Paul- Brousse in Villejuif, the Nantes University Hospital and the Saint Vincent de Paul hospital in Lille.
This lack of recommendation and integration of APA into the patient’s therapeutic plan is mainly linked to the innovative nature of research in this area. Indeed, even if a few studies were published in the early 2000s, it is only in the last 15 years that experimental protocols have been carried out more frequently.
An innovative protocol launched at Caen University Hospital
Thus, today, we are beginning to consider the real potential of adapted physical activity in the treatment of anorexia nervosa. Recently, innovative protocols have shown promising results. This is particularly the case of the “APAREXIM’Pilot” study carried out with young patients suffering from anorexia nervosa, followed in the child and adolescent psychiatry department of the Caen University Hospital in Normandy, which we are conducting as teacher-researchers at the COMETE laboratory (UMR-S 1075 Inserm/UNICAEN – Mobilities: Aging, Pathologies, Health) at the University of Caen Normandy. This pilot study, entitled “APAREXIM’Pilot”, is supported by Professor Fabian Guénolé, head of this service as well as Drs Delphine Nimal and Marine Hamon-Marie, working within this service.
This close collaboration between researchers and clinicians allowed the implementation of this innovative protocol with 30 minor patients, aimed at evaluating the short and medium term effects of an APA program supervised by videoconference on the main symptoms of anorexia nervosa, as well as on mental health, physical health and sleep.
A program supervised by videoconference
The benefit of videoconferencing is to promote better accessibility to care and more effective therapeutic continuity for the greatest number of patients, regardless of their geographic location and socio-economic conditions, and thus reduce social inequalities in health. The program is delivered over a period of 8 weeks, with 2 weekly one-hour sessions, consisting of muscle strengthening exercises and yoga, of light to moderate intensity.
The preliminary results concerning the first 15 participants of this study are positive. The main benefits obtained by patients at the end of the APA program are an improvement in muscular strength and endurance as well as an improvement in sleep efficiency, which results in more stable sleep, more restorative and less fragmented by nighttime awakenings.
These preliminary results will soon be presented at national and international conferences and will be the subject of scientific publications, in order to highlight the feasibility and effectiveness of a remote APA program in the treatment of anorexia nervosa. In addition, this pilot study should make it possible to establish recommendations for good practices to innovate and diversify the care offering dedicated to anorexia nervosa.
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