Physical Activity in Anorexia Nervosa

描述（申请人提供）：神经性厌食症（AN）是一种严重的精神疾病，其预后因素尚不清楚，尚未建立有效的药物治疗方法，并且复发率很高。长期以来，AN 患者的体力活动 (PA) 水平升高就已被注意到，并被一些人认为是“该疾病的基本特征”。众所周知，体力活动在其他体重调节障碍中发挥着关键作用，有证据表明，高水平的 PA 是某些 AN 患者复发的危险因素。然而，令人惊讶的是，PA 在 AN 研究中经常被忽视，可能是因为它很难测量。目前还没有系统地尝试描述 AN 中 PA 的行为和动机表现，也没有对 PA 对临床结果的影响进行明确的评估。对于疾病来说，这些都是关键问题，阐明表型、病理生理学和预后因素可能对推进治疗至关重要。该 R01 拨款提案的总体目标是描述 PA 的特征及其在 AN 患者预后中的作用。为此，我们提出了一项全面的、多维的评估，采用从两个相关研究领域转化而来的尖端方法。具体目标是 (1) 应用代谢研究中使用的新型设备 IDEEA 与加速度测量相结合，定性和定量地表征 AN 中的 PA； (2) 应用广泛用于行为经济学和成瘾研究的渐进比率 (PR) 任务来量化运动对 AN 患者的强化作用，以及 (3) 确定根据目标 1 和 2 获得的测量方法预测 AN 住院治疗体重恢复后一年结果的能力。合作者将包括新陈代谢、行为经济学和成瘾研究方面的专家。这项工作的预期收益包括识别具有不同治疗需求的 AN 行为表型，以及此类治疗的生理和行为目标。公共卫生相关性：神经性厌食症是一种严重的自我饥饿精神疾病，其中体力活动水平有时会极度升高。该项目将应用新颖的平移测量来确定体力活动的性质及其在神经性厌食症结果中的作用。结果可能会提高我们预测神经性厌食症预后的能力，并可能导致开发出针对这种疾病的更有效的治疗方法。

DESCRIPTION (provided by applicant): Anorexia Nervosa (AN) is a serious psychiatric illness for which prognostic factors remain unclear, no effective pharmacotherapy is established, and rates of relapse are high. Elevated levels of physical activity (PA) have long been noted in patients with AN and are considered by some a "fundamental feature of the disorder." Physical activity is known to play a critical role in other disorders of weight regulation and evidence suggests that high-level PA is a risk factor for relapse in some patients with AN. However, PA is often surprisingly overlooked in research on AN, possibly because it has been difficult to measure. There has been no systematic attempt to characterize the behavioral and motivational manifestations of PA in AN, and there has been no definitive assessment of the effect of PA on clinical outcome. These are critical questions for a disorder in which clarification of the phenotype(s), pathophysiology, and prognostic factors may prove essential to advancing its treatment. The overarching goals of this R01 grant proposal are to characterize PA and its role in the outcome of patients with AN. To do so we propose a comprehensive, multidimensional assessment employing cutting-edge approaches translated from two related fields of research. Specific Aims are to (1) Apply a novel device employed in metabolism research, the IDEEA, in conjunction with accelerometry, to characterize PA in AN qualitatively and quantitatively; and (2) Apply the Progressive Ratio (PR) task, used extensively in behavioral economics and addictions research, to quantify the reinforcing effect of exercise in patients with AN, and (3) Determine the ability of measures obtained under Aims 1 and 2 to predict one-year outcome following inpatient treatment with weight restoration for AN. Collaborators will include experts in research on metabolism and behavioral economics and addictions. Anticipated dividends of this work include identification of behavioral phenotype(s) of AN with distinct treatment needs, and of physiological and behavioral targets for such treatment. PUBLIC HEALTH RELEVANCE: Anorexia Nervosa is a serious psychiatric disorder of self-starvation, in which physical activity levels are sometimes extremely elevated. This proposed project will apply novel translational measurements to determine the nature of physical activity and its role in the outcome of Anorexia Nervosa. Results may improve our ability to predict prognosis in Anorexia Nervosa and may lead to development of more effective treatments for this disorder.