Table 3 Outcome measures and results of included studies
Authors (Year) (Country) | Outcomes | Quality index assessment | Results relating to OCD | Results relating to OCPD | Limitations |
|---|---|---|---|---|---|
Anderluh et al. (2009) (Slovenia/UK)[35] | EATATE1 to assess diagnosis, screen for lifetime obsessive compulsive disorder and eating disorder diagnosis using ICD-10 criteria; as well as obsessive compulsive traits in childhood. | 9 | Groups did not differ in lifetime duration of excessive exercising. No differences between groups in frequency of current or lifetime OCD. | No differences between groups in frequency of current OCPD. Children who were rule bound/cautious exercised excessively later in life (p < .005, p < . 02). | Retrospective assessment subject to memory biases, although anchor points were used. Data from informants could have assisted with this. Participants recruited from secondary and tertiary treatment centre. |
Bewell-Weiss & Carter (2010) (Canada)[36] | EDE2; EDE-Q; BSI for anxiety; BDI-II for depression; RSES for self-esteem; Padua Inventory for obsessive compulsive symptoms; EDI for eating disorder attitudes and behaviours. | 11 | Overall model significant (p < .05) explained 31% of variance in exercise status. Restraint, self esteem and depression positively associated with exercise (p < .05), OC symptomatology negatively associated with exercise status (p = . 038). | NA | Need to replicate findings with other measures. Study of factors associated with specific definition of exercise. Cross-sectional nature could not demonstrate direction of associations. No measure of OCPD. |
Davis & Claridge (1998) (Canada/UK)[37] | EPQR3 for addictiveness; obsessive-compulsive personality subscales; Drive for thinness for weight preoccupation; Interview to determine lifetime and current exercise status- classified as excessive or non-excessive exercisers. | 11 | NA | Both addictiveness and obsessive-compulsiveness were positively associated with over-exercising (both currently and historically, p < .05 and p < .01 respectively). | Patients were specifically chosen to represent the two diagnoses, although commonly both AN and BN features co-occur in clinical syndromes and in personality structure of patients. |
Davis & Kaptein (2006) (Canada)[38] | Interview to determine lifetime and current exercise status (excessive or non-excessive); MOCI4 to assess for OCD symptomatology; obsessive-compulsive personality subscales; BMI. | 11 | Excessive exercisers showed higher intensity/number of OCD symptoms than non-excessive patients (p = .007). There was a decline in symptom severity between admission and discharge (p < . 001). | Excessive exercisers demonstrated greater OC personality traits than non-excessive patients (p = . 03). There was no significant decline in OC personality traits between admission and discharge. | Self-report recall data was used in this study. Indirect historical data is necessary, on account of low prevalence of AN-R. Difficulties with prospective designs. |
Davis et al. (1998) (Canada)[2] | MOCI5 -symptoms of OCD; Obsessive Compulsive Personality subscales; MPS for perfectionism; CES for commitment to exercise; EDI: weight preoccupation; BES for body image; JFFIS for self-esteem; BMI. | 11 | Exercisers scored significantly higher than non-exercisers on OC symptomatology, (p = .02). Exercisers also reported more obligatory and pathological attitudes to exercise (p < 0.01). | Exercisers scored significantly higher than non-exercisers on OC personality characteristics (p < . 05), and self-oriented perfectionism (p < . 05). | No information as to whether exercise and obsessionality influence prognosis. Obsessionality data obtained solely from self-report data, not structured diagnostic interview. |
Davis et al. (1995) (Canada)[39] | SCL-906 to measure obsessive-compulsiveness; Drive for thinness to measure weight preoccupation; CES to measure commitment to exercise; interview to assess for physical activity. | 12 | Obsessive-compulsiveness significantly positively related to level of activity among AN patients (p < .01), and obligatory and pathological aspects of exercise were related to weight preoccupation (p < .01). | NA | Proposed activity-based anorexia model explains AN development only for some individuals. Does not take into account motivational factors, differences in selecting forms of exercise and reasons for exercising. No OCPD measure. |
Holtkamp et al. (2004) (Germany)[40] | SIAB7 to assess AN subtype; SCL-90-R to assess for anxiety, depression and obsessive-compulsiveness. | 11 | Obsessive-compulsiveness was not associated with physical activity levels (r = -.072, p = .705). Regression model based on BMI, food restriction, subtype, anxiety, depression and obsessive-compulsiveness (OC) explained 64% of variance in model, OC was not a significant contributor. | NA | Small sample size; data on food restriction were answered retrospectively; need more detailed measure of OCD symptoms; need to examine OCPD symptoms; SCL-90-R only validated for people 14 years and older. |
Naylor et al. (2011) (UK)[41] | Exercise Frequency; CET8 to measure beliefs about exercise; OBQ-44 to assess OCD constructs; OCI-R to assess distress associated with OCD symptoms; EDE-Q. | 12 | Clinical: women with higher exercise beliefs had higher levels of obsessive beliefs and obsessive compulsive behaviours (p < 0.01). OBQ and OCI-R accounted for significant increase in variance of weight control exercise explained. | NA | Cross-sectional design of study does not show direction of variables; rather just associations. Use of Self-report measures risks of socially desirable responses. Student samples are arguably unrepresentative of general population, could use other control groups. |
Penas-Lledo et al. (2002) (Spain)[31] | EAT-409: overall level of eating pathology. BITE: bulimic attitudes and behaviours. SCL-90-R: current psychological symptoms BMI. | 11 | AN patients who exercised had higher levels of eating pathology (EAT; p < .01) Exercisers had higher levels of anxiety and depression on SCL-90-R (p < .01), but not OCD symptoms (p > .05). | NA | Problems in definition of excessive exercise used to classify groups; require different measures to examine OCD symptoms in more detail; no measurement of OCPD symptoms |
Shroff et al. (2006) (USA)[42] | Clinical variables: ED duration, current/minimum/maximum BMI obtained; SIAB; SCID for diagnosis; TCI for temperament; MPS for perfectionism; STAI for anxiety; Y-BOCS for OC symptoms; YBC-EDS; excessive exercise classification from SIAB. | 13 | Excessive exercise was associated with greater severity of ED symptoms, worst ritual, preoccupation and worst motivation to change in YBC-EDS. Also associated with higher obsessions and compulsions (YBOCS) (p < . 001) | Excessive exercise was associated with all perfectionist traits (p < .001), as measured by MPS. | Exercise group determined by retrospective reports of exercise behaviour. Exercise assessment not comprehensive. Unable to determine association between duration of excessive exercise and other ED behaviours. |