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PURPOSE: The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. METHOD: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. RESULTS: Eight randomised controlled trials involving 213 patients (age range: 16-36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score>/=3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. CONCLUSIONS: The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating disorder.
PURPOSE: Since a distorted body experience and a sedentary lifestyle are central in the course of binge eating disorder (BED), physical therapy might be an interesting add-on treatment. The aim of this study was to systematically review randomised controlled trials (RCTs) evaluating physical therapy on binge eating and physical and mental health in BED patients. METHOD: EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and Cochrane Library were searched from their inception until 15 August 2012 for relevant RCTs comparing physical therapy with a placebo condition, control intervention or standard care. RESULTS: Three RCTs involving 211 female community patients (age range: 25-63 years) met all selection criteria. Review data demonstrate that aerobic and yoga exercises reduce the number of binges and the body mass index (BMI) of BED patients. Aerobic exercise also reduces depressive symptoms. Only combining cognitive behavioural therapy (CBT) with aerobic exercise and not CBT alone reduces BMI. Combining aerobic exercise with CBT is more effective in reducing depressive symptoms than CBT alone. CONCLUSIONS: The limited number of available studies and the heterogeneity of the interventions limit overall conclusions and highlight the need for further research. IMPLICATIONS FOR REHABILITATION: Because of severe co-morbid psychiatric and physical conditions, binge eating disorder is one of the most difficult psychiatric conditions to treat. Both yoga and aerobic exercise have shown promise in reducing binge eating pathology and weight. Combining aerobic exercise with cognitive behavioural therapy seems more effective in reducing depressive symptoms than cognitive behavioural therapy alone.