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Fitness Wearables and Exercise Dependence in College Women: Considerations for University Health Education Specialists
Abstract
Background
Research has elucidated some harmful aspects of fitness wearable devices including their role in exacerbating disordered eating and exercise behaviors in young adults. Purpose: The purpose of this study was to examine 1) if use of wearables was associated with exercise dependence and 2) prevalence of compensatory behaviors (CB) in response to not meeting goals set within the wearable. Methods: University students completed an anonymous online survey with the Exercise Dependence Scale-21. Participants also provided information about wearable use and CB (e.g. restricting food) in response to not meeting fitness goals. Multiple linear regression assessed the association between wearable use, CB, and exercise dependence. Results: Majority of participants using wearables reported CB if they did not meet goals set by wearables. Using wearables and engagement in CB were associated with higher exercise dependence scores. Discussion: This study suggests that wearables may exacerbate harmful compulsions, like exercise dependence, and should be recommended with caution by health education specialists. Translation to Health Education Practice: Consequences of wearable use are important to consider in the development of health education materials and interventions promoting wearable use. Certified Health Education Specialists should consider how to address negative aspects of fitness technology in physical activity promotion.
... Technology-savvy college students seem to have access to wearable technologies more than ever before [29,30]. A few studies have investigated the use of health and fitness apps among college students in the United States [31][32][33][34][35], finding overall support for their use, even if a randomized trial has shown null effects to encourage physical activity [35]. A systematic review shoed that wearable devices appeared to appeal to college students aged between 18 and 29 years old [36]. ...
... Our findings show that about a third of our sample (53/200, 27%), representing about 41% of the entire population of AUB student-athletes, had owned a wearable device. Our figures align with the proportion of participants who declared using wearable devices in similar cross-sectional studies, which targeted college students in the United States [31][32][33][34][35]. Notably, this segment of the population represents the 'innovators' or 'early adopters' of technology in the niche market of wearable devices. ...
... Our analyses showed a significant association between age and the use of mobile apps. We did not find significant associations between wearable use and other sociodemographic factors, or health profile, including BMI, consistent with findings from previous studies focusing on wearable use among college students [31,33,34]. In our study, younger students who used a health and fitness app were significantly less likely to own a wearable device compared to their older counterparts, who had not used an app. ...
The markets of commercial wearables and health and fitness apps are constantly growing globally, especially among young adults and athletes, to track physical activity, energy expenditure and health. Despite their wide availability, evidence on use comes predominantly from the United States or Global North, with none targeting college student-athletes in low- and middle-income countries. This study was aimed to explore the use of these technologies among student-athletes at the American University of Beirut (AUB). We conducted a cross-sectional survey of 482 participants (average age 20 years) enrolled in 24 teams during Fall 2018; 230 students successfully completed the web-based survey, and 200 provided valid data. Fifty-three (26.5%) have owned a fitness tracker, mostly for self-monitoring. The most popular were Fitbit, Apple Watch, and Garmin. Similarly, 82 students (40%) used apps, primarily MyFitnessPal, Apple Health, and Samsung Health. Nevertheless, many participants discontinued use due to loss of interest or technical issues (breaking, usability, obsolescence, or lack of engagement). Wearable devices were considered superior to mobile phones alone as physical activity monitors. However, forming regular habits made self-monitoring via technology irrelevant. Further research is needed to better understand what motivates continuous use among student-athletes, who could use trackers to improve athletic performance and overall health.
... It is, therefore, worth considering that wearables, especially those connected to social media, may negatively impact people's mental health and feelings of isolation [22]. Moreover, continuous feedback and alerts about one's physiological state may put some individuals at risk for pathologic self-monitoring [23][24][25] or compensatory behaviors [26]. Are wearables therefore part of the "anxiety problem" and is it appropriate to use them to help? ...
As wearable devices, which allow individuals to track and self-manage their health, become more ubiquitous, the opportunities are growing for researchers to use these sensors within interventions and for data collection. They offer access to data that are captured continuously, passively, and pragmatically with minimal user burden, providing huge advantages for health research. However, the growth in their use must be coupled with consideration of their potential limitations, in particular, digital inclusion, data availability, privacy, ethics of third-party involvement, data quality, and potential for adverse consequences. In this paper, we discuss these issues and strategies used to prevent or mitigate them and recommendations for researchers using wearables as part of interventions or for data collection.
... There is evidence that especially in certain groups, societal pressure to optimise may lead to negative effects. e.g., exercise dependency is exacerbated by CHT use in female users, 68 who are supposed to be influenced by specifically gendered expectations (weight loss and self-discipline for the purposes of beauty). 69 Without sufficient guidance in economized health care systems, especially on the quality criteria of non-certified apps, 15 there is a risk that false diagnoses may result in fear, 70,71 though we found no empirical studies that report on this issue. ...
Objective
The term consumer health technologies we use in this paper refers to fitness and health apps, wearables and other self-tracking devices that collect health-related data. Our paper aims to bridge the gap between the growing literature base of sociological research and ethical reflection on the (non-intended) effects of consumer health technology use on the psycho-social level, such as stress, responsibilization or a loss of intuitive sense for signs of health or illness. Special consideration should be given to vulnerable individuals, as the positive and negative effects of consumer health technology use may be unequally distributed. This perspective may help to guide policymaking and the responsible development of consumer health technologies.
Methods
Using a narrative review approach, we refer to empirical and theoretical studies dealing with user types and effects related to the use of consumer health technologies. We provide an overview of consumer health technology user typologies and evidence of the unintended psycho-social effects of consumer health technology use. On this basis, we propose a user typology that may serve as a future tool for ethical reflection on negative side effects.
Results
Evidence of the potential negative side effects of consumer health technology use, as presented in the literature, is inconclusive due to the high diversity of consumer health technology users and the way they use consumer health technologies. Our proposed user typology aims to more comprehensively document the diversity of users by incorporating the way in which users identify with and use their self-tracked data, attitudes towards the new technology and social interactions via consumer health technologies, and the purpose and self-determinedness of consumer health technology use.
Conclusions
More systematic and quantitative empirical research on the effects of consumer health technology use in diverse settings and with diverse user types is necessary to inform public health policy. In addition to evidence-based certification of medical consumer health technologies, more practical and flexible ways to protect users from side effects may have to be developed and adopted, especially regarding the increasing number of non-medical consumer health technologies.
... Compulsive exercise is typically an unhealthy behavior, commonly seen alongside disordered eating behaviors in adolescents 25,53 and, as such, it is important to understand drivers of such unhealthy exercise given that adolescence is the peak time for eating disorder onset. 54 Quantitative research with young adults has found a positive relationship between perceived pressure to achieve fitness tracking device goals, increased frequency of device use and increased compulsive exercise, 55 and so it is crucial for future research to identify whether this relationship is also evident in adolescent populations. As adolescents in this study reported pressure from parents and peers to achieve exercise-related goals, such as increasing competence and controlling weight, future research should explore whether parent and peer use of fitness tracking technology can impact adolescent fitness tracking technology use through modeling and conformity to achieve shared exercise-related goals. ...
Background:
Research to date has identified a relationship between exercise in adolescence and 4 sociocultural influences: peers, family, media, and technology. Less is known, however, about the role that these sociocultural influences play in driving adolescents' exercise behaviors and attitudes, particularly social media and fitness tracking technology use. This study aimed to investigate how and why sociocultural factors are linked to exercise behaviors and attitudes in adolescent boys and girls.
Methods:
Eight focus groups were conducted in UK secondary schools with fifty-five 12- to 16-year-old adolescents (M = 14.11; SD = 1.49; n = 27 females). Following transcription and thematic analysis, 2 key themes were identified: (1) exercise pressures and (2) modeling exercise behaviors and attitudes.
Results:
Exercise pressures were reported to stem from parental and peer expectations around exercise, and from feeling pressure to meet externally prescribed fitness tracking technology goals. Adolescents also reported modeling the exercise behaviors of their parents or peers for social affiliation and as a means to achieve socially endorsed "ideal" body types.
Conclusions:
These findings highlight the need for exercise interventions to consider the importance of exercise-related messages from others and tendencies toward conformity as a result of sociocultural expectations around exercise in adolescents.
... It is noteworthy that the results from these 19 excluded studies reported similar mechanisms in the relationship between sociocultural influences on compulsive exercise, such as unfavorable comparisons with, and pressure to conform to, body ideals. Some excluded studies, however, highlighted the importance of goal setting on fitness tracking technology and internalization of body related content on social media (i.e., fitspiration) as being associated with increased compulsive exercise (Blackstone & Herrmann, 2020;Raggatt et al., 2018). It is therefore crucial that future research remains up to date with changing technological influences on compulsive exercise behaviors and attitudes in young people and explores the potential impact of fitness devices and social media on exercise behaviors specifically in adolescents. ...
Compulsive exercise commonly coexists with eating psychopathology. While the impact of sociocultural influences on disordered eating has been identified in young people, sociocultural influences on compulsive exercise are yet to be systematically synthesized. This systematic review therefore aimed to synthesize literature examining sociocultural influences from peers, family and media on compulsive exercise, to explore the potential importance of such influences on the development and maintenance of compulsive exercise in young people. A systematic literature search was conducted following PRISMA guidelines in PsycINFO, PsycARTICLES, MEDLINE, SPORTDiscus and Web of Science databases up to November 2021. Seven quantitative studies were included (five cross-sectional, two prospective). The review highlighted three key factors underpinning the relationship between sociocultural influences and compulsive exercise in young people: body-related messages from significant others, and unfavorable comparisons with, and pressure to conform to, body image ideals. The findings support the notion that compulsive exercise behaviors and attitudes can be socially determined. However, the limited research with young people necessitates further exploration of sociocultural influences on the development and onset of compulsive exercise in adolescence/young adulthood to develop robust conclusions. It is also crucial that research remains up to date with changing technological influences on exercise behaviors.
... Results emphasised that positive feedback from participants was high, demonstrating the feasibility and acceptability of using accelerometers with university students. In spite of the advantages of using wearable devices, there are issues around the negative motivational consequences [42], demonstrating peer pressure [43], and the affordance of the device [44]. Therefore, future coursebased interventions should consider using activity trackers combined with other technologies, such as websites or mobile apps. ...
Physical activity levels tend to decrease as adolescents' transition to adulthood. University course-based interventions utilising technology are a promising idea to combat this decrease. This review aims to systematically identify, critically appraise, and summarise the best available evidence regarding technology-supported university courses that aim to increase student's physical activity levels. The second aim is to create initial design principles that will inform future practice in the area.
Data sources:
CINAHL, ERIC, MEDLINE, ProQuest, PsycINFO, Scopus, SPORTDiscus, Web of Science. Search dates from January 2010 to December 2020. Study Inclusion: RCT or non-RCT or quasi-experimental studies describing university course-based interventions using technology that aim to increase the physical activity levels of university students.
Data extraction:
Source (country), methods, participants, interventions, theoretical frameworks and type of technologies, outcome and measurement instrument, and results.
Data synthesis:
Systematic review.
Result:
A total of 1939 articles were identified through databases. Six studies met the inclusion criteria.
Conclusion:
Four of the six included studies reported significant increases in university students' physical activity levels. An analysis of the six included studies identified four design principles that future course designers could utilise as they develop technology-supported university courses that aim to increase the physical activity levels of university students. Further work is required to test the effectiveness of these four design principles.
... There is a need to reframe the problem and exploring it while moving away from pre-existing assumptions that lead to unsuitably specified problems and unfeasible answers [65]. The example of wearable technology as means to support increased physical activity patterns is an assumption made and failing to incorporate more active lifestyles [66]. Contrary, the idea of Augmented Reality to support PA literacy/education and more active lifestyles remains viable and untested to a large extend [67]. ...
Various theoretical models of Health Literacy (HL) discuss its importance for behaviour change, supporting long-term health and disease prevention. During the 21st century Physical Activity (PA), Exercise and Sedentariness (SD) have received an increased priority over other health indices for quality of life purposes due to their central importance over metabolic conditions and their comorbidities. This review aims to conceptualise the main issues and challenges of Physical Inactivity (PI) and SD through the new proposals of Design Thinking (DT) which is considered one of the most promising pathways in health promotion. DT is prioritising empathy for service users, brings together collaborative multidisciplinary teams and provides the opportunity to assess various solutions via iterative practices. This chapter: A. provides a review over the efficacy of health promotion strategies during the current era and the urgency of behaviour change in PA and SD for various population segments. B. Explains how HL links self-care practices to PA and SD habits. And C. Presents DT as a new layout for supporting the exploration and feasibility of more active lifestyles for overall health and quality of life.
... Exercise dependence is a stereotyped unhealthy behavior pattern, usually manifested as an individual exercising excessively under an impulse that cannot be controlled (Li and Ma, 2011;Antunes et al., 2016). It is characterized by an inability to tolerate behavior interruption and withdrawal symptoms such as fatigue, irritability, insomnia, or loss of passion (Christopher et al., 2016;Blackstone and Herrmann, 2020). Reche-Garcia et al. (2018) pointed out that college students with obesity over-emphasized weight control or insist on exercising after injury, and the tolerance will be improved by means of compulsive thoughts; the tolerance will make adolescents with exercise dependence repeat a single form of exercise, and it is easy to lose control causing anxiety (Hamer and Karageorghis, 2007). ...
Objectives
The objectives of the study were to explore the effect of self-presentation and psychological needs on exercise dependence and to provide an essential reference for preventing and inhibiting the production of exercise dependence in overweight college students.
Methods
The freshmen in two comprehensive universities accepted physical fitness tests, filled out the scales of self-presentation, psychological needs, and exercise dependence after obtaining their consent. A sample of 747 overweight college students who have regular exercise was screened using the formula of Fox sports participation and the standard of overweight for Chinese adults. Multiple regression, exploratory factor, and confirmatory factor analyses were used to analyze the related data.
Results
(1) In overweight college students, compared with the lower peers, those with higher physical attractiveness were more likely to suffer from detoxification of emotion, physiology, and vitality, and compared with the lower peers, those with higher self-presentation were more likely to appear in physiological abstinence. (2) The self-presentation of overweight male and female students has a significant positive influence on psychological needs (beta = 0.31, p < 0.01, and 0.37, p < 0.01, respectively, for males and females) and exercise dependence (beta = −0.21, p < 0.01, and 0.26, p < 0.01, respectively, for males and females). In contrast, psychological needs have a significant negative influence on exercise dependence (beta = −0.21, p < 0.01, and −0.26, p < 0.01, respectively, for males and females). (3) The psychological needs of overweight male and female college students were established as the mediating effect of self-presentation and exercise dependence. The mediating effect of psychological needs of females was higher than that of males (18.5 vs. 15.5%). The “ability display” of male and female students can affect “emotional distress” by “autonomy” and “competence.” The sense of relationship partially mediated the “attractiveness” of male and female students. Also, females on the one hand, rely on “weight control” by “competence” to produce some mediating effects on “physiological distress.” At the same time, the “ability display” by “competence” has a full mediating effect on “physiological distress.”
Conclusion
In the self-presentation of the overweight college students, the higher scores in “attractiveness,” “weight control,” and “ability display,” the higher the psychological needs and exercise dependence; the higher the autonomy, competence, and relationship, the less the emotional, physiological, and dynamic distress.
Approximately 24% of U.S. adolescents attempted to lose weight during 2009-2010, and studies show that girls are more likely than boys to attempt weight loss (1,2). Adolescents are known to use multiple weight loss and weight control practices (3). This report describes the percentage of U.S. adolescents who tried to lose weight in the past year from 2013 through 2016 by sex, race and Hispanic origin, and weight status. Methods of intentional weight loss are also reported.
Background: The study was focused on identifying the relationship between the incidence of exercise dependence attitudes, the level of body perception, and preferences for use of fitness technology monitoring. Methods: We investigated 241 students from physical education and sports specializations. We used a questionnaire structured in 5 parts: personal information (age, gender, weight, height, and institutional membership), Exercise Dependence Scale-R (EDS-21), the Compulsive Exercise Test (CET), Body perception questionnaire, and Fitness Monitoring Technology. Results: Application of EDS-21 revealed 8.3% with dependence and CET with 13.4%. Body mass index (BMI) in combination with self-image body: 18 (7.4%) of subjects over-estimated themselves, 18 (7.4%) of subjects underestimated themselves, 38.6% of the subjects were satisfied with their appearance, 17% were very satisfied and none were dissatisfied. A total of 36.1% thought they had the correct weight and 8.7% thought of losing weight. The most preferred monitoring technologies were the treadmill and the smartphone’s fitness applications. A total of 11.6% of the subjects always used technologies, and 17% of subjects never did so. Conclusions: In order to identify the level of incidence of exercise dependence, body perception, and preference and frequency of use of monitoring technology, it is necessary to expand the level of knowledge about health and physical activities. The approach would diminish medical incidences of addiction, improve proactive behaviors, and correct prohealth.
Understanding the relationship between college students' physical activity (PA) self-monitoring and PA levels has the potential to inform initiatives to promote PA. This study's purpose was to examine the prevalence of technology-based self-monitoring among college students the potential relationship between device usage, goal setting behaviors, PA enjoyment, and PA levels. An online survey assessed students' demographics, current PA level, technology-based PA self-monitoring, and psychosocial outcomes. Independent t-tests examined differences in PA level and psychosocial outcomes by device use. 55.5% of the final sample (N=1,154) reported technology-based self-monitoring. Mobile phone app-based PA tracking was the most commonly reported (29.9%), followed by heart rate monitors (23.1%). Device use was significantly related to vigorous PA and psychosocial outcomes. Findings have the potential to inform development of technology-based interventions that promote student PA.
This study examined the effects of utilizing a wearable activity tracker in a credit-based physical activity instructional program (PAIP) for promoting physical activity (PA) in college students. Fourteen PAIP courses in a large public university were randomly assigned into intervention (k = 7; n = 101) and control (k = 7; n = 86) groups. All courses focused on a core curriculum that covers basic exercise and behavioral science contents through lectures and activity sessions. A Misfit Flash activity tracker was provided to students in the intervention group. Objective PA assessments occurred at baseline, mid-, and end-of-semester during a 15-week academic semester. The control group showed a significant reduction in moderate- and vigorous-intensity PA (MVPA) minutes from baseline to the end-of-semester (P <.05), whereas the intervention group showed no changes in MVPA minutes over time. However, the intervention group also showed increased sedentary time and decreased time spent in light-intensity PA during the intervention period. Taken together, the present study found null effects of utilizing the wearable activity tracker in promoting PA in college students suggesting that intervention of primary using the wearable activity tracker as a behavior change strategy may not be effective to increase in PA in this setting.
Background: Considerable numbers of young people are not meeting physical activity guidelines. Wearable fitness devices can provide opportunities for physical activity promotion. Purpose: The aim of the study was to explore whether wearable healthy lifestyle technologies impacted on adolescents’ (13- to 14-year-olds) motivation for physical activity. Methods: The study was a mixed method sequential design. Participants were 84 adolescents (44 girls, 40 boys) from 6 physical education classes. Pupils were issued with a Fitbit to wear for 8 weeks and completed pre-/posttest questionnaires that assessed motivational regulation and psychological need satisfaction. Adolescents also engaged in focus group interviews after wearing the Fitbit for 8 weeks. Quantitative data were analyzed using a repeated measures multivariate analysis of variance (MANOVA) to explore differences between gender and time. Qualitative data analysis was conducted deductively using self-determination theory. Results: The quantitative findings identified significant reductions in need satisfaction and autonomous motivation and significant increases in amotivation after 8 weeks. Qualitative evidence suggested short-term increases in motivation through feelings of competition, guilt, and internal pressure. Discussion: Findings suggest that healthy lifestyle technology may have negative motivational consequences. Translation to Health Education Practice: Certified Health Education Specialists should support young people to personalize health targets in order to critically engage with normalized health targets.
It is well known that regular physical activity helps improve overall health and fitness and reduces the risk of many chronic diseases. However, excessive exercise might be harmful. Exercise addiction (EA) is a pattern of uncontrolled exercise that involves a craving for overwhelming exercise with addictive attributes. So far, little is known about this unique behavioral addiction. The aim of the current study is to introduce the diagnosis and assessment of EA, and to summarize several developing theoretical models. Eating disorders, body image disorder, low self-esteem, and high narcissism are related to high risk of EA. The paper also discusses the distinction between EA and highly involved physical activity.
Background
The proliferation and popularity of wearable activity trackers (eg, Fitbit, Jawbone, Misfit) may present an opportunity to integrate such technology into physical activity interventions. While several systematic reviews have reported intervention effects of using wearable activity trackers on adults’ physical activity levels, none to date have focused specifically on children and adolescents.
Objective
The aim of this review was to examine the effectiveness of wearable activity trackers as a tool for increasing children’s and adolescents’ physical activity levels. We also examined the feasibility of using such technology in younger populations (age range 5-19 years).
Methods
We conducted a systematic search of 5 electronic databases, reference lists, and personal archives to identify articles published up until August 2016 that met the inclusion criteria. Articles were included if they (1) specifically examined the use of a wearable device within an intervention or a feasibility study; (2) included participants aged 5-19 years old; (3) had a measure of physical activity as an outcome variable for intervention studies; (4) reported process data concerning the feasibility of the device in feasibility studies; and (5) were published in English. Data were analyzed in August 2016.
Results
In total, we identified and analyzed 5 studies (3 intervention, 2 feasibility). Intervention delivery ranged from 19 days to 3 months, with only 1 study using a randomized controlled trial design. Wearable activity trackers were typically combined with other intervention approaches such as goal setting and researcher feedback. While intervention effects were generally positive, the reported differences were largely nonsignificant. The feasibility studies indicated that monitor comfort and design and feedback features were important factors to children and adolescents.
Conclusions
There is a paucity of research concerning the effectiveness and feasibility of wearable activity trackers as a tool for increasing children’s and adolescents’ physical activity levels. While there are some preliminary data to suggest these devices may have the potential to increase activity levels through self-monitoring and goal setting in the short term, more research is needed to establish longer-term effects on behavior.
Importance:
Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these are effective at improving weight loss.
Objective:
To test the hypothesis that, compared with a standard behavioral weight loss intervention (standard intervention), a technology-enhanced weight loss intervention (enhanced intervention) would result in greater weight loss.
Design, setting, participants:
Randomized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012, with data collection completed by December 2014.
Interventions:
Participants were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. At 6 months, participants randomized to the standard intervention group initiated self-monitoring of diet and physical activity using a website, and those randomized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity.
Main outcomes and measures:
The primary outcome of weight was measured over 24 months at 6-month intervals, and the primary hypothesis tested the change in weight between 2 groups at 24 months. Secondary outcomes included body composition, fitness, physical activity, and dietary intake.
Results:
Among the 471 participants randomized (body mass index [BMI], 25 to <40; age range, 18-35 years; 28.9% nonwhite, 77.2% women), 470 (233 in the standard intervention group, 237 in the enhanced intervention group) initiated the interventions as randomized, and 74.5% completed the study. For the enhanced intervention group, mean baseline weight was 96.3 kg (95% CI, 94.2-98.5) and 24-month weight 89.3 kg (95% CI, 87.1-91.5). For the standard intervention group, mean baseline weight was 95.2 kg (95% CI, 93.0-97.3) and 24-month weight was 92.8 kg (95% CI, 90.6-95.0). Weight change at 24 months differed significantly by intervention group (estimated mean weight loss, 3.5 kg [95% CI, 2.6-4.5} in the enhanced intervention group and 5.9 kg [95% CI, 5.0-6.8] in the standard intervention group; difference, 2.4 kg [95% CI, 1.0-3.7]; P?=?.002). Both groups had significant improvements in body composition, fitness, physical activity, and diet, with no significant difference between groups.
Conclusions and relevance:
Among young adults with a BMI between 25 and less than 40, the addition of a wearable technology device to a standard behavioral intervention resulted in less weight loss over 24 months. Devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioral weight loss approaches.
Trial registration:
clinicaltrials.gov Identifier: NCT01131871.
Method:
We conducted a systematic review of the relationship between problematic use
with psychopathology. Using scholarly bibliographic databases, we screened 117
total citations, resulting in 23 peer-reviewer papers examining statistical relations
between standardized measures of problematic smartphone use/use severity
and the severity of psychopathology.
Results:
Most papers examined problematic use in relation to depression, anxiety, chronic
stress and/or low self-esteem. Across this literature, without statistically adjusting
for other relevant variables, depression severity was consistently related to
problematic smartphone use, demonstrating at least medium effect sizes. Anxiety
was also consistently related to problem use, but with small effect sizes. Stress
was somewhat consistently related, with small to medium effects. Self-esteem
was inconsistently related, with small to medium effects when found. Statistically
adjusting for other relevant variables yielded similar but somewhat smaller
effects.
Limitations:
We only included correlational studies in our systematic review, but address the
few relevant experimental studies also.
Conclusions:
We discuss causal explanations for relationships between problem smartphone
use and psychopathology.
Background:
Both men and women are vulnerable to weight gain during the college years, and this phenomenon is linked to an increased risk of several chronic diseases and mortality. Technology represents an attractive medium for the delivery of weight control interventions focused on college students, given its reach and appeal among this population. However, few technology-mediated weight gain prevention interventions have been evaluated for college students.
Objective:
This study examined a new technology-based, social media-facilitated weight gain prevention intervention for college students.
Methods:
Undergraduates (n =58) in two sections of a public university course were allocated to either a behavioral weight gain prevention intervention (Healthy Weight, HW; N=29) or a human papillomavirus (HPV) vaccination awareness intervention (control; N=29). All students were enrolled, regardless of initial body weight or expressed interest in weight management. The interventions delivered 8 lessons via electronic newsletters and Facebook postings over 9 weeks, which were designed to foster social support and introduce relevant educational content. The HW intervention targeted behavioral strategies to prevent weight gain and provided participants with a Wi-Fi-enabled scale and an electronic physical activity tracker to facilitate weight regulation. A repeated-measures analysis of variance was conducted to examine within- and between-group differences in measures of self-reported weight control practices and objectively measured weight. Use of each intervention medium and device was objectively tracked, and intervention satisfaction measures were obtained.
Results:
Students remained weight stable (HW: -0.48+1.9 kg; control: -0.45+1.4 kg), with no significant difference between groups over 9 weeks (P =.94). However, HW students reported a significantly greater increase in the number of appropriate weight control strategies than did controls (2.1+4.5 vs -1.1+3.4, respectively; P =.003) and there was no increase in inappropriate weight control behaviors (P =.11). More than 90% of students in the HW arm opened the electronic newsletters each week, and the average number of Facebook interactions (comments and likes) per student each week was 3.3+1.4. Each self-monitoring device was initialized by 90% of HW students. On average, they used their physical activity tracker for 23.7+15.2 days and their Wi-Fi scale for 14.1+13.1 days over the 9 weeks. HW students rated the intervention favorably.
Conclusions:
The short-term effect of this technology-based weight gain prevention intervention for college students is promising and merits evaluation over a longer duration to determine whether engagement and behavioral improvements positively affect weight outcomes and can be maintained.
We study the association between weight fluctuation and activity tracking in an on-line population of thousands of individuals using digital health trackers (1,749 ≤ N ≤ 14,411, depending on the activity tracker considered) with millions of recorded activities (119,292 ≤ N ≤ 2,221,382) over the years 2013-2015. In a first between-subject analysis, we found a positive association between activity tracking frequency and weight loss. Users who log food with moderate frequency lost an additional 0.63% (CI [0.55, 0.72]; p < .001) of their body weight per month relative to low frequency loggers. Frequent workout loggers lost an additional 0.38% (CI [0.20, 0.56]; p < .001) and frequent weight loggers lost an additional 0.40% (CI [0.33, 0.47]; p < .001) as compared to infrequent loggers. In a subsequent within-subject analysis on a subset of the population (799 ≤ N ≤ 6,052) with sufficient longitudinal data, we used fixed effect models to explore the temporal relationship between a change in tracking adherence and weight change. We found that for the same individual, weight loss is significantly higher during periods of high adherence to tracking vs. periods of low adherence: +2.74% of body weight lost per month (CI [2.68, 2.81]; p < .001) during adherent weight tracking, +1.35% per month (CI [1.26, 1.43]; p < .001) during adherent food tracking, and +0.60% per month (CI [0.44, 0.76]; p < .001) during adherent workout tracking. The findings suggest that adherence to activity tracking can be utilized as a convenient real-time predictor of weight fluctuations, enabling large-scale, personalized intervention strategies.
Obesity is a growing global health concern that may lead to cardiovascular disease, type II diabetes, and cancer. Several systematic reviews have shown that technology is successful in combating obesity through increased physical activity, but there is no known review on interventions that use an electronic activity monitor system (EAMS). EAMSs are defined as a wearable device that objectively measures lifestyle physical activity and can provide feedback, beyond the display of basic activity count information, via the monitor display or through a partnering application to elicit continual self-monitoring of activity behavior. These devices improve upon standard pedometers because they have the ability to provide visual feedback on activity progression, verbal encouragement, and social comparison. This systematic review aimed to synthesize the efficacy and feasibility results of EAMSs within published physical activity interventions.
Electronic databases and journal references were searched for relevant articles. Data sources included CINAHL, Cochrane CENTRAL, Medline Ovid, PsycINFO, and clinicaltrials.gov. Out of the 1,574 retrieved, 11 articles met the inclusion criteria. These articles were reviewed for quality and content based on a risk of bias tool and intervention components.
Most articles were determined to be of medium quality while two were of low quality, and one of high quality. Significant pre-post improvements in the EAMS group were found in five of nine studies for physical activity and in four of five studies for weight. One found a significant increase in physical activity and two studies found significant weight loss in the intervention group compared with the comparator group. The EAMS interventions appear to be feasible with most studies reporting continual wear of the device during waking hours and a higher retention rate of participants in the EAMS groups.
These studies provide preliminary evidence suggesting that EAMS can increase physical activity and decrease weight significantly, but their efficacy compared to other interventions has not yet been demonstrated. More high-quality randomized controlled trials are needed to evaluate the overall effect of EAMS, examine which EAMS features are most effective, and determine which populations are most receptive to an EAMS.
Many current measures of eating disorder (ED) symptoms have 1 or more serious limitations, such as inconsistent factor structures or poor discriminant validity. The goal of this study was to overcome these limitations through the development of a comprehensive multidimensional measure of eating pathology. An initial pool of 160 items was developed to assess 20 dimensions of eating pathology. The initial item pool was administered to a student sample (N = 433) and community sample (N = 407) to determine the preliminary structure of the measure using exploratory and confirmatory factor analyses. The revised measure was administered to independent samples of patients recruited from specialty ED treatment centers (N = 158), outpatient psychiatric clinics (N = 303), and students (N = 227). Analyses revealed an 8-factor structure characterized by Body Dissatisfaction, Binge Eating, Cognitive Restraint, Excessive Exercise, Restricting, Purging, Muscle Building, and Negative Attitudes Toward Obesity. Scale scores showed excellent convergent and discriminant validity; other analyses demonstrated that the majority of scales were invariant across sex and weight categories. Eating Pathology Symptoms Inventory scale scores had excellent internal consistency (median coefficient alphas ranged from .84-.89) and reliability over a 2- to 4-week period (mean retest r = .73). The current study represents one of the most comprehensive scale development projects ever conducted in the field of EDs and will enhance future basic and treatment research focused on EDs. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Dieting is a common practice among young women, irrespective of age, race, ethnicity, and weight. We aimed to determine the prevalence of dieting and its relationship with eating behavior, body weight, and body mass index (BMI) in college women.
This was a cross-sectional survey of female students aged 18-35 years (n = 308). Measures included BMI, restraint, disinhibition, hunger, dieting, weight loss, and perceived weight.
A high percentage of college females consider themselves overweight or obese, despite having a BMI in the normal range. Dieting was practised by 43%, and 32% were avoiding weight gain, despite 78% having a healthy BMI. Women classified themselves as overweight or obese (27%), while only 11% were actually in these categories. Exercise was a common method of weight loss and positive associations were observed between dieting and BMI. Assessment of eating behavior showed that 27% were classified as high-restraint. Restraint and disinhibition were positively correlated with BMI.
Despite the widespread availability of nutrition information, there is incongruity in measured and perceived BMI in young educated women. Dieting practices and BMI are associated with restraint and disinhibition. Nutrition professionals should consider educating college women about healthy body weight regardless of their clients' BMI.
Regular physical activity plays a crucial role in health maintenance and disease prevention. However, excessive exercise has the potential to have adverse effects on both physical and mental health. The scholastic and empirical discussion of excessive physical activity focuses on obsessive and compulsive exercising, and uses several labels. However, in this review, we argue that the most appropriate term for this phenomenon is exercise addiction, emphasizing that excessive physical exercise fits the typical and most common characteristics of behavioral addictions. The aim of this review is to synthesize the current knowledge on symptomology, diagnosis, epidemiology, and etiology of exercise addiction.
In order to elucidate the nature of excessive exercise among individuals with eating disorders, exercise behaviours were compared between eating disorder patients receiving specialist treatment and healthy women, and between subgroups of patients.
Self-report measures of obligatory exercise, motivation for exercise and frequency of hard exercise for weight or shape reasons were completed by eating disorder patients (n=102) and healthy women (n=184).
The experience of intense guilt when exercise is missed and exercising solely or primarily for reasons of weight, shape or physical attractiveness, were the exercise behaviours that most clearly differentiated between women with eating disorders and healthy women. Patients with the purging form of anorexia nervosa (n=13) and those with bulimia nervosa (n=41) tended to have higher scores on measures of these behaviours than those with the restricting form of anorexia nervosa (n=15).
Research addressing the prevalence and correlates of excessive exercise in eating disorder patients would benefit from a broader assessment of exercise behaviour than has typically been used in previous studies. In addition, the findings may indicate specific targets for the clinical management of excessive exercise as well as for community-based health promotion initiatives.
The present study examined the risk of disordered eating and its relation to attempts to lose weight by surveying a Maritime Canadian sample of 247 girls and boys in grades 6, 7 and 8. Current attempts to lose weight were highest in grade 8 girls (41% of girls and 9% of boys) compared with grade 6 (14% of girls and 24% of boys) and grade 7 (21% of girls and 13% of boys) children. Of those trying to lose weight, 71.4% were in the average range for weight and height, 12.2% were overweight and 16.3% were obese. The Children's version of the Eating Attitudes Test (ChEAT) was used to assess eating attitudes and behaviours, and the Rosenberg Self-Esteem Scale was used as a measure of self-esteem. The results showed that 8.5% of the children fell in the high-risk group for disordered eating (ChEAT score 20 or higher). Those in the high-risk group were significantly more likely to fear being overweight (90%), to have tried to lose weight in the past (81%), to be currently trying to lose weight (76%), and to have engaged in binge eating (38%) and self-induced vomiting (24%). The best predictor of membership in the high-risk group for girls was current attempts at weight loss and having lower self-esteem. Only two boys fell in the high-risk group. Body mass index and current weight category (underweight, average, overweight and obese) could not explain the differences between the low- and high-risk groups. Knowing that a child is trying to lose weight can aid in identifying youth at risk for disordered eating, and can provide an opportunity for preventive education.
Unlabelled:
Clinical, epidemiological and basic research evidence clearly supports the inclusion of regular physical activity as a tool for the prevention of chronic disease and the enhancement of overall health. In children, activities of a moderate intensity may enhance overall health, and assist in preventing chronic disease in at-risk youth. The numerous health benefits of regular exercise are dependent on the type, intensity and volume of activity pursued by the individual. These benefits include reduction of low density lipoproteins while increasing high density lipoprotein; improvement of glucose metabolism in patients with type II diabetes; improved strength, self esteem and body image; and reduction in the occurrence of back injuries. In addition, a progressive, moderate-intensity exercise program will not adversely effect the immune system and may have a beneficial effect on the interleukin-2/natural killer cell system. Furthermore, by decreasing sedentary behaviors and, thus, increasing daily physical activity, individuals may experience many stress-reducing benefits, which may enhance the immune system.
Conclusion:
Moderate intensity exercise of a non-structured nature seems to facilitate most of the disease prevention goals and health promoting benefits. With new guidelines promoting a less intense and more time-efficient approach to regular physical activity, it is hoped that an upward trend in the physical activity patterns, and specifically children at risk for chronic disease, will develop in the near future.
This study was concerned with the concept of exercise dependence. Levels of psychological morbidity, personality profiles, and exercise beliefs were compared among subjects screened for exercise dependence and eating disorders.
Adult female exercisers were allocated on the basis of questionnaire screening to one of the following groups: primary exercise dependence (n = 43); secondary exercise dependence, where there was the coincidence of exercise dependence and an eating disorder (n = 27); eating disorder (n =14); control, where there was no evidence of either exercise dependence or eating disorder (n = 110). Questionnaire assessment was undertaken of psychological morbidity, self esteem, weight and body shape dissatisfaction, personality, and exercise beliefs.
Aside from a higher incidence of reported menstrual abnormalities, the primary exercise dependence group was largely indistinguishable from the controls. In stark contrast, the secondary exercise dependence group reported higher levels of psychological morbidity, neuroticism, dispositional addictiveness, and impulsiveness, lower self esteem, greater concern with body shape and weight, as well as with the social, psychological, and aesthetic costs of not exercising than the controls, but differed little from the eating disorder group.
In the absence of an eating disorder, women identified as being exercise dependent do not exhibit the sorts of personality characteristics and levels of psychological distress that warrant the construction of primary exercise dependence as a widespread pathology.
This study examined associations among excessive exercise, eating disorders, and selected psychological characteristics in college women (N = 586). Participants were recruited from university classes and administered the Obligatory Exercise Questionnaire, Eating Disorders Inventory-2, Bulimia Test-Revised, and other psychosocial measures. Results indicated that obligatory exercise is best viewed as multidimensional. These dimensions were used, through cluster analysis, to generate a typology of exercisers. One identified group clearly manifested eating disorder traits and behaviors, as well as signs of psychological disturbance. Another group who exercised with equal intensity but less emotional fixation showed the fewest signs of eating disorders and psychological distress.
Although disordered eating behaviors and obligatory exercise are relatively common among undergraduate females, many questions about their etiology remain unanswered. In the current study, structural equation modeling was used to investigate whether a model of personality, exercise attitudes, and exercise behavior that was previously developed with a clinical sample [Davis, C., Katzman, D.K., & Kirsh, C. (1999). Compulsive physical activity in adolescents with anorexia nervosa: A psychobehavioral spiral of pathology. The Journal of Nervous and Mental Disease, 187, 336-342.] would also fit for a sample of non-clinical college females (n=599). Further, a second model extended the first model to predict exercise behavior and eating/weight restriction. Results indicated that the original structural model fit the non-clinical sample extremely well. Specifically, addictiveness and obsessive-compulsiveness were associated with obligatory attitudes toward exercise, which was then associated with exercise behavior. In the second model, obligatory attitudes toward exercise were equally associated with eating/weight restriction as it was with exercise behavior. In a third model, bootstrapping analyses demonstrated that while obligatory exercise was directly associated with eating and weight restriction, this association was partially mediated by weight-related reasons for exercise. These data suggest that the aforementioned variables are predictive of obligatory exercise and eating pathology in non-clinical samples, and that reasons for exercise is important in understanding the complex relations among disordered eating and exercise attitudes and behaviors.
Our study examined the potential mediating or moderating effect of exercise dependence on the exercise-eating pathology relationship. Female university students (N = 330) completed Internet-based self-report measures of exercise behavior, exercise dependence, and eating pathology. Exercise dependence served as a mediator for the relationship between exercise and eating pathology. This unidirectional causal model suggests that an individual's pathological motivation or compulsion to exercise is the critical mediating component in the exercise-eating pathology relationship. The best target for removing the link between exercise behavior and eating pathology may be reformulating exercise dependence symptoms.
Purpose of review:
The present review aimed to explore the range and characteristics of interventions that utilize WAM and descriptively summarize the efficacy of these interventions.
Recent findings:
A total of 65 articles (61 studies) were included in this review. Most of the WAM-based interventions (n=58) were designed to improve physical activity (PA). Interventions targeting sedentary behavior (SB) were much less common (n=12), and even less frequent were WAM-based sleep interventions (n=3). Most studies tested the feasibility of WAM-based interventions; hence, efficacy of these interventions in improving PA, SB, and/or sleep could not be conclusively determined. Nonetheless, WAM-based interventions showed considerable potential in increasing PA and decreasing SB.
Summary:
WAM-based PA interventions exhibited preliminary efficacy in increasing PA. Although not as many interventions were focused on SB, current interventions also showed potential in decreasing sedentary time. Meanwhile, more evidence is needed to determine the utility of WAM in improving sleep. Major challenges with including WAM as part of interventions are reduced engagement in using the devices over time and the rapid changes in technology resulting in devices becoming obsolete soon after completion of an efficacy trial.
Background: Nearly half of all college students do not engage in the recommended amount of physical activity which may contribute to chronic diseases such as obesity. Purpose: To investigate college students’ use and perceptions of wearable fitness trackers (WFTs) and the impact on confidence and motivation for increasing physical activity. Reasons for non-use were also explored. Methods: 356 College students completed a 25 -item paper survey. Results: 22.5% reported using a WFT. Most wore their WFT either “every day without fail” or “most days” and half wore their WFT “all day and while sleeping”. Analyses were significant for those reporting a high increase in physical activity and or a high increase in number of steps as being more likely to report a high motivation for physical activity. Discussion: Two reasons for use of WFT were weight loss and to track sleep. A common reason for non-use of WFT was cost. WFTs may help to increase motivation to engage in physical activity. Translation to Health Education Practice: When considering the use of WFTs, Health Educators would do well to identify affordable WFTs for use in interventions and be mindful of the barriers related to discontinuation of use.
Background: Research indicates that increased exercise behaviors collectively called FIT (frequency, intensity, and time) values, equate with positive health outcomes. Young college adults often gain weight due to decreased exercise. Purpose: This study seeks to understand whether wearable exercise technology is associated with increased exercise among university students. Methods: A questionnaire identified motivational stages for exercise and wearable use. Results: Of the 115 students meeting all three FIT recommendations, 70 regularly exercised within the last 6 months. Of these, nearly half (n = 31) also regularly wore a wearable technology. Overall, 90 students were identified as regularly using wearable technology, 31 met all three FIT recommendations, and 53 met two FIT recommendations (frequency and time). Of total regular exercisers meeting two of three recommendations (n = 112), nearly half (n = 53) were wearable technology users. Discussion: Findings suggest that wearables may be associated with increased exercise and FIT values among university students. Translation to Health Education Practice: Wearable exercise technology has potential to enhance theory-based physical activity promotion to help students increase exercise and decrease risks of obesity and chronic disease. Future studies could examine how active student exercisers and active users of wearable technology use that technology to motivate them to exercise more.
A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars
Background:
Extreme fitness and nutrition programs, that are said to "jump start" a healthy lifestyle, are becoming more pervasive. While some research has explored the harmful impact of fitspiration, thinspiration, and pro-anorexia/bulimia websites, no studies have examined the content associated with these extreme programs that advertised as promoting a healthy lifestyle. The objective of this study was to analyze posts found on extreme fitness and nutrition program support pages on Facebook. As these programs have become more popular, along with Facebook platforms for their participants, examining online user-generated posts related to these programs can provide information about the types of messages being promoted, and whether these can contribute to disordered eating and other harmful health behaviors.
Methods:
User data were selected from one month from public posts on two popular Facebook fitness groups. Both groups were short-term programs that set extreme guidelines for fitness and nutrition. Researchers examined the data for harmful health messages using an individual coding strategy with inter-rater reliability (Kappa =0.92).
Results:
Majority (88.6%) of messages analyzed promoted harmful health messages. Common categories of messages included losing weight/fat, promoting dieting/restraint, and harmful body messages, which promoted unsafe ways to attain certain body types.
Conclusions:
The data analyzed in this study represent overwhelmingly negative commentary relating to harmful health and body messages. Messages in this study normalized dysfunctional behaviors and promoted fixating on certain body parts and objectifying bodies. These Facebook groups, though intended to be a sort of online support forum, provide an open space for body negativity and promotion of extreme behaviors for the sake of thinness. Most concerning, participants of these programs, which are advertised as promoting health, are expressing unhealthy thoughts and behaviors surrounding food, exercise, and body image. Given the ease of accessibility to this content using online platforms, these harmful messages can reach large groups of people and continue adding to a culture that values physical appearance to the detriment of health.
Mobile phone and tablet usage has become a part of modern life. Mobile applications that count calories, such as My Fitness Pal, are frequently employed on a daily basis. Recent research has shown that in undergraduates, calorie tracking is associated with eating disorder pathology. In the current study (N=105 individuals diagnosed with an eating disorder), we assessed usage of My Fitness Pal to track calories. We also assessed perceptions that My Fitness Pal contributed to eating disorder symptoms and if these perceptions were associated with eating disorder symptoms. We found that a substantial percentage (~75%) of participants used My Fitness Pal and that 73% of these users perceived the app as contributing to their eating disorder. Furthermore, we found that these perceptions were correlated with eating disorder symptoms. This research suggests that My Fitness Pal is widely used in an eating disorder population and is perceived as contributing to eating disorder symptoms. Further research is needed to clarify the role calorie tracking applications play within a sample of individuals with eating disorders.
College students are an important priority population, and higher education is an opportune setting for chronic disease prevention and health promotion. Yet many people do not understand why enhancing the well-being of college students is of value. In this commentary, we address 3 common misperceptions about college health promotion: (1) College students are privileged and do not reflect most of the United States population; (2) college students are generally healthy; and (3) it is not the university’s responsibility to focus on students’ health. We contend that in actuality, college students increasingly represent the US population; that college students struggle with numerous health concerns and are in fact unhealthier than many other subpopulations; and that institutions of higher education are a unique setting that can not only improve the health of a large segment of the US population but that doing so is actually integral to the mission of higher education. Topics that merit additional research are discussed in an effort to further enhance college health promotion practice.
The use of online calorie tracking applications and activity monitors is increasing exponentially. Anecdotal reports document the potential for these trackers to trigger, maintain, or exacerbate eating disorder symptomatology. Yet, research has not examined the relation between use of these devices and eating disorder-related attitudes and behaviors. This study explored associations between the use of calorie counting and fitness tracking devices and eating disorder symptomatology. Participants (N=493) were college students who reported their use of tracking technology and completed measures of eating disorder symptomatology. Individuals who reported using calorie trackers manifested higher levels of eating concern and dietary restraint, controlling for BMI. Additionally, fitness tracking was uniquely associated with ED symptomatology after adjusting for gender and bingeing and purging behavior within the past month. Findings highlight associations between use of calorie and fitness trackers and eating disorder symptomatology. Although preliminary, overall results suggest that for some individuals, these devices might do more harm than good.
Objective
This study took the form of an intervention examining change in physical activity and quality of experience among students in an introductory health course who were asked to wear a Fitbit activity monitor throughout the semester.
Method
College students ( N = 56) took part in this controlled trial. Students enrolled in an introductory health course (Education + Fitbit; n = 24) were asked to purchase a Fitbit and wear it throughout the semester. This activity monitor purchase replaced the textbook requirement to reduce the financial burden for students. Change in objectively measured physical activity within this group was compared to students enrolled in a traditional introductory health course (Education Only; n = 14) and students enrolled in an introductory humanities course (Control; n = 18). To assess objectively measured physical activity, all participants wore a sealed pedometer for one week at the beginning and end of the semester. Students in the Education + Fitbit group also provided written feedback on their experience with the Fitbit.
Results
A 2 × 3 repeated-measures analysis of variance (ANOVA) revealed a significant interaction between time and group, F(2, 53) = 3.957, p = .025. Post hoc analysis of this interaction indicated that students in the Education + Fitbit group significantly increased ( p = .014) objectively measured physical activity by 1,078 steps/day, whereas physical activity in Education Only and Control groups did not significantly change. Qualitative data demonstrated that student experiences with the Fitbit were resoundingly positive.
Conclusion
Replacing a textbook requirement with requiring a commercially available activity monitor in an introductory health course may be an effective and enjoyable strategy to increase physical activity among US college students.
Background: College students experience weight gain that can contribute to serious health issues. Health education efforts with college students are increasingly utilizing new technologies. Smartphone applications (apps) in particular are growing in popularity and use in all young adults. Purpose: Formative research was conducted to describe how college students in the southwestern United States use health/fitness apps to change behavior. Method: College students (n = 27) ages 18-30 reporting use of health/fitness apps were recruited on a large public university campus and participated in interviews about app choice, behavioral goals, features, and reasons for continued use. Interviews were recorded, transcribed, and analyzed for themes using a 4-person coding team and the qualitative research software NVivo. Results: Most participants downloaded an app to meet a goal and felt that the app helped them meet it. Two distinct groups emerged, those who used apps to support an established behavior and those who used them to adopt a new behavior. The majority of participants reported that acceptable apps were free, easy to use, provided visual/auditory cues, and had game-like rewards. Most participants strongly opposed linking their social media with apps and did not use those features. Discussion: College students use apps to meet different goals such as developing an exercise routine or improving eating habits. Examining what influences health/fitness app choices among college students may provide important insights for future interventions developed to promote app use over long periods of time. Translation to Health Education Practice: Health education programming may benefit from the use of apps, because college students are already adopting these technologies. Features that are important such as ease of use and game-like rewards can help health educators choose appropriate apps for college student programs.
This paper presents five studies with 2,420 total participants on the development and validation of the Exercise Dependence Scale (EDS), which is conceptualized based on the Diagnostic and Statistical Manual-IV (APA, 1994) criteria for substance dependence, and differentiates among at-risk, nondependent-symptomatic, and nondependent-asymptomatic exercisers. Results of the studies revealed evidence for the a priori hypothesized components, acceptable test-retest and internal consistency reliability, and content and concurrent validity of the EDS. Individuals at-risk for exercise dependence reported more strenuous exercise, perfectionism, and self-efficacy compared to the nondependent groups. The findings provide initial support for the EDS and indicate the need for a multifaceted approach to its conceptualization and measurement.
Objective. This study investigated the relationship between exercise and eating disorder features in a community sample of adult women with and without eating disorder psychopathology. The research focus was on the cognitions of exercisers who scored high and low on eating disorder symptoms. It was hypothesized that women with eating disorder symptoms would have more negative thoughts and beliefs about eating and body appearance but would not differ in cognitions relating to exercise.Design. A cross-sectional comparative study.Method. A community sample of 260 female sports center users completed a measure of eating disorder psychopathology (EDE-Q), the sentence completion test for eating and exercise (SCEE), assessments of depression, exercise commitment and an exercise diary.Results. In the whole sample, EDE-Q global score was positively correlated with commitment to exercise but unrelated to frequency or duration. High EDE-Q scoring women (n=30) had more dysfunctional beliefs and negative thoughts than medium or low scoring comparison groups, particularly concerning body appearance. They exercised with the same frequency as comparison women and were equally positive about exercise, in spite of being more negative about their appearance.Conclusion. The association between commitment to exercise and eating disorder psychopathology is consistent with previous research. The positive cognitions regarding exercise, concurrent with negative thoughts and dysfunctional beliefs about eating and body appearance, suggest a functional value for exercise in eating disorder symptomatic women.
The problem of defining appropriate levels of exercise and the need to differentiate excessive exercise from healthy levels lead us to investigate the rate of obsessive-compulsive symptomatology and eating disordered behaviour in excessive exercisers. We hypothesized that excessive exercisers will score significantly higher on measures of obsessive-compulsiveness than non-excessive exercisers. Also, excessive exercisers will score significantly higher on measures of body dissatisfaction, drive for thinness, and perfectionism than non-excessive exercisers. Participants consisted of 172 male and female volunteers who exercise at a local fitness club. Instruments included the Demographic/Background Questionnaire, Obligatory Exercise Questionnaire (OEQ; Pasman & Thompson, 1988), Obsessive-Compulsive Scale (OCS; Gibb et al. , 1983) and three sub-scales of the Eating Disorder Inventory-2 (EDI-2; Drive for Thinness, Body Dissatisfaction and Perfectionism; Garner, 1991). A simple regression was run between scores on the obsessive-compulsive scale and obligatory exerciser questionnaire. Findings were significant ( p < 0.001) level and support the hypothesis that excessive exercisers do rate higher on obsessive-compulsive symptomatology than non-excessive exercisers. Findings also support our hypothesis that excessive exercisers do rate higher on measures of drive for thinness, body dissatisfaction and perfectionism. Implications of the study help clarify the characteristics of excessive exercisers and further the understanding of the relationship between obsessive compulsiveness, eating disordered behaviour and excessive exercisers.
This study investigated the use and frequency of multiple methods of compensatory behaviors and how they relate to eating-related and general psychopathology for youth with eating disorders (ED).
Participants were 398 referrals to a pediatric ED treatment program (91.2% female; M age = 14.9 ± 2.2). ANOVA and chi-square tests compared participants reporting multiple methods of compensatory behaviors, single method of compensatory behaviors, and no compensatory behaviors on measures of ED and general psychopathology. Partial correlations examined associations between compensatory behavior, frequency and severity of ED and general psychopathology.
Participants reporting multiple methods of compensatory behaviors had significantly greater ED and general psychopathology than the other groups (ps < .001). Frequency of compensatory behaviors was associated with ED psychopathology (partial r = .14; p = .007) but not with general psychopathology.
Engaging in multiple methods of compensatory behaviors is related to greater ED and general psychopathology, whereas frequency is only related to greater ED symptom severity.
Mickey, R. M. (Dept of Mathematics and Statistics, U. of Vermont, Burlington, VT 05405) and S. Greenland. The impact of confounder selection criteria on effect estimation. Am J Epidemiol 1989;129:125–37.
Much controversy exists regarding proper methods for the selection of variables in confounder control. Many authors condemn any use of significance testing, some encourage such testing, and others propose a mixed approach. This paper presents the results of a Monte Carlo simulation of several confounder selection criteria, including change-in-estimate and collapsibility test criteria. The methods are compared with respect to their Impact on Inferences regarding the study factor's effect, as measured by test size and power, bias, mean-squared error, and confidence Interval coverage rates. In situations in which the best decision (of whether or not to adjust) is not always obvious, the change-in-estimate criterion tends to be superior, though significance testing methods can perform acceptably If their significance levels are set much higher than conventional levels (to values of 0.20 or more).
Excessive exercise is present in 40%-80% of anorexia nervosa (AN) patients. Hyperactivity often plays a role in developing and maintaining AN and represents an obstacle to weight gain in refeeding. Interconnections among caloric restriction, psychopathology, and physical activity in humans with AN are poorly investigated.
Physical activity and food restriction during the last 3 months and status of body image/slimness ideal were assessed by the Structured Interview of Anorexia and Bulimia Nervosa (SIAB) in 30 adolescent patients with acute AN at admission to inpatient treatment. Anxiety, depression, and obsessive-compulsiveness were assessed with the Symptom Check-List-90-Revised (SCL-90-R). A regression model based on the independent variables body mass index, food reduction, body image/slimness ideal, anxiety, depression, and obsessive-compulsiveness was calculated to determine the relevant prediction variables of physical activity.
The regression model explained 64% (R(2) = .64, p = .000) of the variance of physical activity. Only food restriction (p = .006) and anxiety (p = .004) contributed significantly to the variance.
Our results indicate that anxiety symptoms and food restriction synergistically contribute to increased levels of physical activity in the acute phase of AN.
The criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; Washington, DC: American Psychiatric Association) for bulimia nervosa include "excessive exercise" as an inappropriate compensatory behavior, suggesting that it is the quantity of the physical activity that is symptomatic, rather than its quality. The current study evaluated the hypothesis that psychological commitment to exercise (compulsive quality) will be more predictive of disordered eating attitudes and behaviors than the amount of time devoted to exercise (excessive quantity).
Female (n = 162) and male (n = 103) undergraduates completed the Eating Disorder Inventory (EDI) subscales, the Obligatory Exercise Questionnaire (OEQ), and questions to assess the duration and frequency of exercise.
Using multivariate analysis, the OEQ score was a positive predictor of disordered eating attitudes and behaviors, and exercise time was a negative predictor.
"Compulsive" may be a better description than "excessive" in characterizing exercise as a symptom of bulimia nervosa.
Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders.
Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N=1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB).
Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence.
Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders.
The aim of this study was to carry out a preliminary study of the proposed Continuum Model of Obligatory Exercise, which states that obligatory exercise lies on a continuum--a continuum that is characterized not only by differences in severity, but by qualitative differences in the way the syndrome manifests, as the behaviour changes from mildly obsessive attitudes to exercise, to extremely disordered attitudes to exercise, which are accompanied by an eating disorder.
Structural equation modelling (SEM) was used to investigate the Continuum Model of Obligatory Exercise utilizing data from a longitudinal study of female triathletes.
The structural model specifying the hypothesized causal pathways confirmed many of the postulates of the Continuum Model of Obligatory Exercise, including the role of weight and shape preoccupation in predicting food restriction, eating disorder behaviour, and increased obligatory exercise behaviour, as well as the role of obsessive-compulsiveness and increased physical activity in predicting eating disorder behaviour in exercisers.
The structural model investigated is reasonable and can serve as a starting point for a theory-based empirical exploration of the notion that obligatory exercise behaviour lies on a continuum.
The study was aimed at assessing the prevalence of compulsive exercising to control shape and weight in eating disorders (EDs) and its relationship with treatment outcome.
Compulsive exercising to control shape and weight, defined according to a modified version of the Intense Exercising to Control Shape or Weight section of the Eating Disorder Examination (EDE), was assessed in 165 consecutive ED inpatients entering a protocol based on the transdiagnostic cognitive behavior theory and treatment of EDs. Baseline assessment also included anthropometry, the global EDE interview, the Beck Depression Inventory, the State-Trait Anxiety Inventory (STAI), the Eating Disorders Inventory-Perfectionism Scale, and the Temperament and Character Inventory.
Of the patients, 45.5% were classified as compulsive exercisers, the prevalence being highest (80%) in restricting-type anorexia nervosa (AN), lowest in EDs not otherwise specified (31.9%), and intermediate in binge/purging AN (43.3%) and in purging-type bulimia nervosa (39.3%). Compulsive exercising to control shape and weight was independently predicted by the EDE restraint score (odds ratio, 1.32; 95% confidence interval, 1.06-1.64; P = .014) after adjustment for ED; the total amount of exercise was associated with EDE restraint, as well as with the Temperament and Character Inventory reward dependence. At follow-up, an improved EDE global score was predicted by lower baseline values, higher baseline STAI and STAI improvement, and lower amount of exercise in the last 4 weeks. Voluntary treatment discontinuation was not predicted by baseline exercise.
Compulsive exercising to control shape and weight is a behavioral feature of restricting-type AN, associated with restraint and temperament dimensions, with influence on treatment outcome.
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