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，没有建立有效的药物治疗，复发率很高。长期以来，AN患者的体力活动(PA)水平升高一直被注意到，一些人认为这是“这种疾病的基本特征”。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，在AN的研究中，PA经常令人惊讶地被忽视，可能是因为它一直很难测量。目前还没有系统的尝试来描述PA在AN中的行为和动机表现，也没有关于PA对临床结果的影响的明确评估。对于这种疾病来说，这些都是关键问题，在这种疾病中，表型(S)、病理生理学和预后因素的澄清可能被证明是推进其治疗的关键。这份R01拨款提案的首要目标是描述PA及其在AN患者预后中的作用。为此，我们建议采用从两个相关研究领域翻译的尖端方法进行全面的、多维度的评估。具体目标是(1)应用新陈代谢研究中使用的新设备，IDEEA，结合加速度计，定性和定量地表征PA；以及(2)应用在行为经济学和成瘾研究中广泛使用的累进比率(PR)任务，以量化运动对AN患者的增强效果，以及(3)确定根据AIMS 1和2获得的测量方法预测AN住院治疗和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。这项工作的预期成果包括确定具有不同治疗需求的AN的行为表型(S)，以及此类治疗的生理和行为靶点。

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.