Journal Article Review Ahead of print
PubMed: 42314357 DOI: 10.1016/j.jpsychires.2026.06.022
The state urge to be physically active in anorexia nervosa: a systematic review of mechanisms and clinical implications.
J Psychiatr Res 201:149-162
Authors: Margherita Boltri, Carolina Gabutti, Lara Pignattai, Federico Brusa, Emanuela Apicella, Gianluca Castelnuovo, Walter Sapuppo, Leonardo Mendolicchio, Mouna Hanachi, Johannes Hebebrand, Georgios Paslakis
Affiliations
- I.R.C.C.S. Istituto Auxologico Italiano, Experimental Laboratory for Metabolic Neurosciences Research, Piancavallo, VCO, 28824, Italy; Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy; Doctoral School n° 569 ITFA - Innovation thérapeutique: du fondamental à l'appliqué, Université Paris-Saclay, France.
- I.R.C.C.S. Istituto Auxologico Italiano, Experimental Laboratory for Metabolic Neurosciences Research, Piancavallo, VCO, 28824, Italy.
- I.R.C.C.S. Istituto Auxologico Italiano, Experimental Laboratory for Metabolic Neurosciences Research, Piancavallo, VCO, 28824, Italy; Department of Psychology, Sigmund Freud University, Milan, Italy.
- I.R.C.C.S. Istituto Auxologico Italiano, Experimental Laboratory for Metabolic Neurosciences Research, Piancavallo, VCO, 28824, Italy; I.R.C.C.S. Istituto Auxologico Italiano, U.O.C. dei Disturbi dell'Alimentazione e della Nutrizione, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
- Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy; I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
- Department of Psychology, Sigmund Freud University, Milan, Italy.
- Clinical Nutrition Department, AP-HP Hôpital Paul-Brousse, University of Paris-Saclay, Villejuif, France; INRAE, AgroParisTech, MICALIS Institute, Université Paris-Saclay, Jouy-en-Josas, France.
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany; Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany.
Abstract
OBJECTIVE
Anorexia nervosa (AN) is a severe eating disorder, leading to life-threatening complications and psychosocial impairment. Among its complex clinical features, a prominent but poorly understood feature is the intense State Urge to be Physically Active (SUPA), which may not always manifest as observable physical activity. This systematic review followed PRISMA guidelines to synthesize current empirical evidence regarding the characteristics, biological underpinnings, assessment methods and clinical implications of SUPA in AN across varying illness severity levels.
METHODS
A systematic search of PubMed, Scopus, and EBSCOhost databases identified 1165 records, of which 17 studies met the inclusion criteria and were included in the final review. These studies employed both objective and subjective assessments of the SUPA.
RESULTS
Findings suggest that the SUPA may persist regardless of BMI changes, including during recovery, and may function as a maladaptive emotion regulation strategy, rather than reflect a dispositional feature. Higher SUPA levels during weight restoration seem to predict poorer post treatment weight maintenance.
DISCUSSION
In clinical settings, SUPA may signal illness severity and resistance to weight restoration, warranting its proactive inclusion in diagnostic and treatment frameworks. To advance understanding and management of SUPA in AN, future research should address confounding factors such as illness duration, validate standardised assessment tools and procedures, and explore targeted interventions to improve outcomes in AN.
MeSH
Anorexia, Therapeutics, Anorexia Nervosa, Psychiatry