Physical Activity in Anorexia Nervosa

描述（由申请人提供）：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，没有有效的药物治疗，复发率高。长期以来，AN患者的身体活动（PA）水平升高一直被注意到，并被一些人认为是“这种疾病的基本特征”。众所周知，体育活动在其他体重调节障碍中起着关键作用，有证据表明，高水平的PA是一些AN患者复发的危险因素。然而，令人惊讶的是，在对AN的研究中，PA经常被忽视，可能是因为它难以测量。目前还没有系统的尝试来描述AN中PA的行为和动机表现，也没有明确的评估PA对临床结果的影响。这些都是疾病的关键问题，其中澄清表型，病理生理学和预后因素可能对推进其治疗至关重要。本R01拨款提案的总体目标是表征PA及其在AN患者预后中的作用。为此，我们提出了一个全面的、多维的评估，采用了从两个相关研究领域翻译过来的尖端方法。具体目标是：(1)应用代谢研究中使用的新设备idea，结合加速度计，定性和定量地表征AN中的PA；(2)应用在行为经济学和成瘾研究中广泛使用的递进比率（Progressive Ratio， PR）任务来量化运动对AN患者的强化作用；(3)确定目标1和目标2中获得的测量方法预测AN患者住院后体重恢复治疗一年预后的能力。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。这项工作的预期红利包括识别具有不同治疗需求的AN的行为表型，以及这种治疗的生理和行为靶点。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障碍，患者的身体活动水平有时非常高。这个拟议的项目将应用新的平移测量来确定身体活动的性质及其在神经性厌食症结果中的作用。结果可能提高我们预测神经性厌食症预后的能力，并可能导致开发更有效的治疗这种疾病的方法。

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.