1. Anorexia KELLY HENSON EXS 486 WEST CHESTER UNIVERSITY OF PENNSYLVANIA

2. Eating Disorders  An eating disorder is characterized by having an unhealthy relationship with food  Affects part of normal daily living  Types of eating disorders:  Anorexia Nervosa  Bulimia  Binge Eating Disorder  OSFED (other specified feeding or eating disorder) (National Institute of Mental Health (n.d.))

3. Anorexia Nervosa  Unhealthy relationship with food  Abnormally low body weight  Extreme dieting  Extreme exercising  Obsession with weight and fear of gaining weight  Distorted image of body weight (National Institute of Mental Health (n.d.))

4. Statistics  90%-95% of Anorexia sufferers are female  The third most common chronic illness among adolescents  Only 1 in 10 people with eating disorders will receive treatment  Between 5%-20% of Anorexia sufferers will die  Has the highest death rates of any mental illness (National Association of Anorexia Nervosa and Associated Disorders, 2015).

5. Statistics

6. Factors  Genetics  Psychological Factors  Cultural Influence  Emotional Stress or Trauma (Sharan, P., & Sundar, A. S., 2015).

7. Co-existing Mental Illnesses  Depression  Bipolar Disorder  Substance Abuse  Obsessive Compulsive Disorder (National Association of Anorexia Nervosa and Associated Disorders, 2015).

8. Physiological Effects  Decrease in Blood Pressure  Increase in Cholesterol  Osteopenia  Electrolyte Disturbance  Amenorrhea  Bradycardia  Dehydration  Muscle loss  Fatigue  Hair Loss (Sidiropoulos, M., 2007).

9. Treatment and Management of Anorexia Nervosa  Psychotherapy  In-Patient  Out-Patient  Nutritional Counseling (Sharan, P., & Sundar, A. S., 2015).  Medication for management of co-existing psychological conditions  Depression – Antidepressants  Bupropion  Citalopram  Duloxetine  Etc. (Ehrman, et. al., 2013)  Medication for management of co-existing physiological conditions  Osteopenia – Medicines that reduce osteoclast activity  Hormone Replacement  Raloxifene  Alendronate  Zoledronic Acid  Etc. (Ehrman, et. al., 2013)

10. Case Study (during active state of disease)  22 year old, woman  5’5” (1.65 m), 80 lbs. (36.4 kg)  Non-Smoker  Depression  Extensive Exerciser (7 days a week, 3 hours a day)  BP - 90/60 mmHg, HR – 45 BPM  Hypokalemia  Osteopenia  No family history of heart disease  Hypercholesterolemia  TC – 300 mg/dL  HDL – 70 mg/dL  LDL – 225 mg/dL  Triglycerides – 175 mg/dL

11. Precautions of exercise prescription  Exercise should NOT begin until the client has met a “recovered” state  Should be closely monitored  Reintroduced in steps (Grave, 2009).

12. Case Study (recovering stage of disease)  22 year old, woman  5’5” (1.65 m), 105 lbs. (47.7 kg)  Non-Smoker  Depression  Sedentary for past three months  BP - 110/70 mmHg, HR – 60 BPM  Osteopenia  No family history of heart disease  Hypercholesterolemia  TC – 220 mg/dL  HDL – 38 mg/dL  LDL – 160 mg/dL  Triglycerides – 150 mg/dL

13. Risk Stratification  Positive Risk Factors  Hypercholesterolemia  Client is at Low Risk

14. Exercise Testing  For strength testing, 10 RM test would be most appropriate to find current level  No test for flexibility  If desired, a standard YMCA bike test can be used to test aerobic capacity (Ehrman, et. al., 2013)

15. Exercise Prescription (aerobic)  Frequency – 4 days a week  Intensity – Moderate Intensity (40 – 60% of HRR)  Time – 30 minutes a day  Type – Biking, Walking or Swimming (No Jogging) Must be low impact (Ehrman, et al., 2013) (Hechler, T., et al., 2008).

16. Exercise Prescription (resistance)  Frequency – 2 days a week  Intensity –1 or 2 sets of 15 reps of 5-8 exercises  Time – 15 – 20 minutes  Type - Using body weight, elastic bands or weight machines (Ehrman, et al., 2013) (Hechler, T., et al., 2008).

17. Exercise Prescription (flexibility)  Frequency – 5 – 7 days a week  Intensity – To max range of motion with no pain  Time – 15 – 20 minutes  Type – Stretching (Ehrman, et al., 2013) (Hechler, T., et al., 2008).

18. Conclusion  Anorexia is a complex disease that has both psychological and physiological effects  It’s important to consider both when creating an exercise prescription for the client  Remember to monitor their exercise habits at all times for signs of relapse

19. References  Ehrman, J., Gordon, P., Visich, P., Keteyian, S. (2013). Clinical exercise physiology. Champaign, IL: Human Kinetics, Inc.  Grave, R.D. (2009). Features and management of compulsive exercising in eating disorders. The Physician and Sports medicine, 37(3).Retrieved from http://www. physsportsmed.com/index.php?free=psm_10_2009?article=1725&ex=1725  Hechler, T., Rieger, E., Touyz, S., Beumont, P., Plasqui, G., & Westerterp, K. (2008). Physical activity and body composition in outpatients recovering from anorexia nervosa and healthy controls. Adapted Physical Activity Quarterly, 25(2), 159-173.  National Association of Anorexia Nervosa and Associated Disorders (2015). Eating Disorder Statistics. Retrieved from http://www.anad.org/get-information/about-eating-disorders/eating- disorders-statistics/  National Institute of Mental Health (n.d.). What are eating disorders?. Retrieved from http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml  Sharan, P., & Sundar, A. S. (2015). Eating disorders in women. Indian Journal Of Psychiatry, 57S286- S295. doi:10.4103/0019-5545.161493  Sidiropoulos, M. (2007). Anorexia Nervosa: The physiological consequences of starvation and the need for primary prevention efforts. McGill Journal of Medicine: MJM, 10(1), 20–25. Sharan, P., & Sundar, A. S. (2015). Eating disorders in women. Indian Journal Of Psychiatry, 57S286-S295. doi:10.4103/0019-5545.161493