Resistance training enhances muscular performance in patients with anorexia nervosa: a randomized controlled trial. Fernandez-del-Valle M, Larumbe-Zabala E, Villaseñor-Montarroso A, Cardona Gonzalez C, Diez-Vega I, Lopez Mojares LM, Perez Ruiz M. International Journal of Eating Disorders 2014 Sep;47(6):601-9.
From the Abstract
From a total of 36 female patients with AN-R, one group (intervention, n = 18) underwent a supervised high-intensity resistance training program lasting 8 weeks, and the other group with no exercise (control, n = 18). Body weight, body mass index, whole-body muscular strength, and agility were assessed before, after, and 4 weeks after training (detraining).
Leg-press, bench-press, and lateral row tests improved significantly (p < 0.001) after 8 weeks of training compared with controls. Improvements were maintained after the detraining period. The training program also showed beneficial effects on agility.
A high-intensity resistance training program adapted to the recommendations for adolescents in AN-R patients was effective and safe, improving muscular strength in the whole body and the ability to perform daily tasks. However, long-term maintenance of gains seems to be linked to the continuance of training or the use of a maintenance program.
This was a good study to see done as prior recommendations for patients with anorexia have been quite lame, either due to low intensities or there just being no exercise done, at all, with the general fear being that patients with anorexia nervosa will become obsessive with the exercise and that’s a risk factor for relapses of symptoms. The caution seems perhaps somewhat misplaced here as the exercise that contributes to the runner’s high like addiction anorexic’s get and subsequent weight loss is aerobic exercise. I expect (at least early on in this population) aerobic exercise might be a bad idea. Aside from psychological effects I would expect yoga and the like to be largely neutral, and as this study shows, weight lifting, or resistance exercise led to considerable improvements in strength levels, with girls in the weight training group increasing leg press strength 52%, bench press strength 41%, and row strength 37% after 8 weeks of training 3 times per week. The training program consisted of bench press, leg press, rows, leg extensions, lat pulldowns for 3 sets of 8-10 reps, starting at 70% of their 6 RM. Abdominal crunches, back extension and push-ups were also done working up to as much as 30 reps.
I would have liked to have seen them use some squats, and deadlifts, but overall the program looked pretty good and is a lot better than other paper I have read for the rehabilitation of anorexia. Which oft consisted of a bunch of low intensity physical therapy exercises which are all but worthless, like the ever popular (among physical therapist that don’t know how to workout) bridges, pelvic tilts, and rhythmic stabilization. One of the big fears with anorexia also seems to be fracture risk per the lessened bone mineral density, but since squat exercises seem exceeding beneficial for the treatment of osteoporosis, I would expect squats to work very well for the functional recovery with anorexia as well.
After 4 weeks of detraining, some strength was lost (~15%) emphasizing the importance of continuing the weight training indefinitely, which is the same as I would say for anyone, but it has especial importance in those with anorexia given the considerable deficits in strength, muscle mass, and bone mineral density they are starting off with. Long term I would love to see them transition into a CrossFit type exercise program as I would think the aggressive weight bearing type exercise would be near optimal for ultimate gains in strength, muscle, and bone mass. I would however urge caution and perhaps a transitional period consisting general weight training (much like this program) first as it is unknown if the explosive nature of Crossfit training would lead to increased risk of injuries early on. I’m not too concerned with the olympic lifts because they can always be done lighter, but I would be more concerned about plyometrics, which I don’t think are particularly good exercises anyway. That said, I think the group exercise environment of CrossFit would be psychologically ideal as well, since in CrossFit people (A LOT of whom are women) come to value strength, performance, and muscle as ideal as opposed to mere thinness.
I know some people think that yoga, Pilates, theraband or faddish boot camps will make them are just as strong, but generally that’s because those folks, instructors included, don’t know what strong is. Not to mention, if I had weakened bones, the last thing I would want to do is yoga. So if one want’s the best of both mind and body, I’d suggest skipping the hour long yoga class, and instead doing 50 minutes of lifting weights, followed by 10 minutes of meditation. And it’s not like general exercise, to include weight training doesn’t have positive mental effects by itself.
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Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed Yoga Teacher Training at Sampoorna Yoga in Goa, India.