TABlE 1.
Study characteristics, key findings, and quality scores
| Study | ED group(s) and sample size(s) |
Mean age (years) | Mean BMI (kg/m2) | Gender (% female) |
Ethnicity | Ambulatory assessment/ intervention |
Key findings | Total quality score |
|---|---|---|---|---|---|---|---|---|
| Bomba et al.(2014) | 21 adolescents with AN; 21 adolescents with FHA (10 Hy-FYA; 11 N-FHA); 21 controls | AN: 15.9 (SD = 1.1); Hy-FHA: 16.5 (SD = 0.8); N-FHA: 15.9 (SD = 0.9); control: 16.2 (SD = 1.0) | AN: 15.1 (SD = 2.6); Hy-FHA: 18.1 (SD = 1.1); N-FHA: 18.7 (SD = 1.1); control: 19.7 (SD = 1.8) | 100 | N.S. | HRV was measured by a 24-hour ECG recording using the Accuplus 363 holter (DelMarAvionics, Irvine, CA). | The AN group evidenced dysregulation in HRV parameters (i.e., higher SDNN and rMSSD) compared to control and N-HFA groups. | 7 |
| Bouten and Westerterp (1996) | 11 women with AN; 13 NW women | AN: Range = 21–48; NW control: Range = 20–35 | AN: Range = 12.5–18.3; NW control: Range = 19.2–26.7 | 100 | N.S. | Physical activity over 7 days was determined using output from a portable motion sensor (Tracmor accelerometer). Physical activity was measured by average daily activity in terms of energy expenditure (PAL). | AN and NW groups did not differ in physical activity levels; in AN only, BMI was positively correlated with physical activity levels. | 7 |
| Dellava, Hamer, Kanodia, Rodríguez, and Bulik (2011) | 15 participants with AN-rec; 22 controls | AN-rec: 32.5 (SD = 14.3); control: 28.9 (SD = 10.7) | AN-rec: 21.4 (SD = 2.0); control: 23.6 (SD = 4.4) | 100 | N.S. | Physical activity was assessed for 3 weekdays and 1 weekend day by an Actigraph monitor. | Total daily activity (mean counts) did not differ between groups. | 7 |
| Galetta et al. (2003) | 25 participants with AN; 25 age-matched thin controls; 25 age matched NW controls | AN: 17.5 (SD = 4.2); thin controls: 17.7 (SD = 3.9); NW controls: 18.1 (SD = 4.5) | AN: 15.3 (SD = 1.4); thin controls: 18.7 (SD = 1.7); NW controls: 21.9 (SD = 2.8) | 100 | N.S. | HRV was measured via 24-hour ECG monitoring using a 2-channel amplitude modulated tape recorder (Diagnostic Monitoring System, Santa Ana, CA). | The AN group was higher on all HRV parameters compared to thin and NW controls, reflecting increased vagal tone. | 4 |
| Gianini et al. (2016) | 61 participants with AN; 24 age-matched NW controls | AN: 24.4 (SD = 6.5); control: 26.0 (SD = 3.9) | AN low weight: 16.1 (SD = 1.0); AN weight restored: 20.2 (SD = 0.7); AN follow-up: 19.5 (SD = 2.0) | 100 | N.S. | Physical activity was assessed for 3 days at 3 time points (during inpatient at a low weight, during inpatient when weight-restored, and outpatient follow-up 4–6 weeks after discharge); controls were assessed at 1 time. Physical activity was assessed by the intelligent device for energy expenditure and activity accelerometer (IDEEA; MiniSun, Fresno, CA). | Post-treatment AN patients were more physically active than controls during the day but less active at night. Fidgeting did not differ between post-treatment AN and control groups. Total activity count at follow-up did not predict BMI change in the year following inpatient discharge. | 8 |
| Keyes et al. (2015) | 37 outpatients with AN; 18 inpatients with AN; 24 participants with moderate anxiety (GAD-7 score ≥ 10); 30 controls | AN groups: 29 (range: 18–67); anxiety group: 27 (range: 18–54); control: 29 (range: 20–52) | AN outpatient: 16.04 (SD = 1.44); AN inpatient: 14.1 (SD = 2.11); anxiety group: 22.24 (SD = 3.88); control:21.2 (SD = 1.53) | 100 | N.S. | Physical activity over 1 week was assessed by actigraphy using the Actiwatch AW4 (Cambridge Neurotechnology, Cambridge, UK); objective activity was measured as average and peak actimetry data (counts per minute). | No group differences were found in objective measures of physical activity. | 6 |
| Karr et al. (2017) | 9 participants with AN | 26.38 (SD = 4.81) | 17.46 (SD = .88) | 100 | N.S. | Physical activity was measured for 7 days using Actigraph GT3X; objective activity was measured as total minutes of light and moderate-vigorous activity. EMA simultaneously measured positive and negative affect. | Within the same day, greater physical activity time was related to less instability in positive affect and stress but not negative affect. Higher physical activity predicted greater positive affect within the same hour and at the next hour, and vice versa. | 8 |
| Kostrzewa et al. (2013) | 37 adolescents with AN | 15.15 (SD = 1.21) | 15.66 (SD = 1.38) | 100 | N.S. | Physical activity was measured for 3 days by Actiwatch AW4 (Cambridge Neurotechnology, Cambridge, UK) at admission, end of treatment (12 months), and 1-year follow-up. Participants were divided into low and high physical activity groups based on moderate or vigorous physical activity measured by the Actiwatch | The high activity group had longer illness duration. Physical activity stabilized and was maintained at follow-up, in that patients initially high in activity decreased in activity, whereas patients low in activity increased activity. Patients who recovered who had higher initial activity had higher fat mass at the follow-up assessment. | 7 |
| Latzer, Tzischinsky, Epstein, Klein, and Peretz (1999) | 25 participants with BN; 21 controls | BN: 22.3 (SD = 8.3); control: 24.0 (SD = 8.11) | BN: 21.7 (SD = 2.9); control: 20.3 SD = 1.4) | 100 | N.S. | Sleep-wake patterns were assessed using mini Actigraphs (Min-Act; AMA-32, AMI, Ardsley, NY) for 1 week. | The BN group evidenced sleep onset and offset 1 hr later than controls. | 5 |
| Latzer, Tzischinsky, and Epstein (2001) | 21 participants with AN; 16 controls | AN: 18.7 (SD = 3.5); control: 19.4 (SD = 3.9) | AN: 16.8 (SD = 1.3); control: 20.0 (SD = 1.3) | 100 | N.S. | Sleep-wake patterns were assessed using mini Actigraphs (Min-Act; AMA-32, AMI, Ardsley, NY) for 1 week. | AN and control groups did not differ on any actigraph sleep parameters | 5 |
| Melanson, Donahoo, Krantz, Poirier, and Mehler (2004) | 6 participants with AN; 10 controls | AN: 29 (SD = 3); control: 24 (SD = 3) | N.S. | 100 | N.S. | HRV was assessed using a holter monitor for 2 days. | AN group evidenced reduced ambulatory HRV (rMSSD, pNN50, SDNN, and SDANN parameters) compared to controls | 4 |
| Mont et al. (2003) | 31 adolescents with AN | 16.3 (SD = 1.4) [second exam] | 19.2 (SD = 1.0) [second exam] | 80.6 | N.S. | HRV was measured by 24-hour holter monitoring (Marquette 8500 ambulatory tape recorder) at admission and 3- to 18-months later (after weight stabilization). | HRV normalized after weight restoration. | 7 |
| Myers, Ridolfi, and Crowther (2015) | 30 undergraduates who met criteria for EDs based on the EDDS (17 BN, 3, BED, 5 sub-threshold AN, 5 sub-threshold BN); 63 undergraduate controls | 19.53 (SD = 3.37) | 24.15 (SD = 5.41) | 100 | 78.5% Caucasian | RTs to a modified word-stem task were used an implicit measure of appearance schema activation. Participants completed a 5-day EMA protocol using palm handheld personal data assistant (PDA) model Z22. RTs (ms) for selection of appearance and nonappearance related words were assessed at EMA recordings. | Women with ED psychopathology evidenced longer RTs when selecting appearance-related words on the word-stem task compared to women without ED psychopathology. | 7 |
| Petretta et al. (1997) | 13 participants with AN; 13 thin controls; 10 NW controls | AN: 20.0 (SD = 2.0); thin control: 22.0 SD = 3.0); NW control: 21.0 (SD = 3.0) | AN: <19; thin control: <20; NW control: 20–27 | 100 | 100 | HRV was measured by 24-hour holter monitoring. | The AN group evidenced higher HRV (i.e., high-frequency power and all time domain measures) compared to control groups. | 6 |
| Ranzenhofer et al. (2016) | 17 adolescents with LOC eating | 14.77 (SD = 1.55) | 2.17 (SD = .48) [BMI-Z] | 100 | N.S | HR and HRV were measured for 2 days using a Mortara H12 holter monitor; EMA was conducted for 2 weeks that assessed momentary LOC eating. | Higher HR and lower HRV (i.e., rMSSD) prior to eating predicted higher LOC eating ratings at the within-subjects level | 6 |
| Tzischinsky and Latzer (2004) | 22 participants with nocturnal binge eating (10 BN, 12 BED) | 38.1 (SD = 12.3) | 30.1 (SD = 10.0) | 100 | N.S. | Sleep–wake patterns were monitored using Actigraph (Mini-Act, Ardsley, NY) for 1 week. | Objective sleep parameters did not differ between BN and BED groups. Compared to previously published data on non-NES BN and BED groups, the BN + NES but not BED +NES group evidenced lower sleep efficiency. | 6 |
| Tzischinsky and Latzer (2006) | 44 adolescents (15 OB + BE, 17 OB-BE, 12 NW controls) | OB groups: 15.0 (SD = 1.7); NW control: 15.6 (SD = 1.4) | OB + BED: 36.5 (SD = 6.0); OB-BED: 32.1 (SD = 3.1); NW control: 15.6 (SD = 1.4) | OB groups: 53.1 | N.S. | Sleep–wake patterns were monitored using Actigraph (Mini-Act, Ardsley, NY) for 1 week. | Objective sleep parameters did not differ between the 3 groups. | 5 |
Abbreviations: AN, anorexia nervosa; AN-BP, AN binge/purge type; AN-R, An restricting type; AN-rec, recovered from AN; BE, binge eating; BMI, body mass index; BN, bulimia nervosa; BP, blood pressure; ED, eating disorder; EDDS, Eating Disorder Diagnostic Scale; EDE-Q, Eating Disorder Examination Questionnaire; EDNOS, eating disorder not otherwise specified; EMA, ecological momentary assessment; FHA, functional hypothalamic amenorrhea; GAD-7, General Anxiety Disorder-7 questionnaire; HF, high frequency; HR, heart rate; HRV, heart rate variability; HyFHA, hypogonadotropic FHA; LF, low frequency; LOC, loss of control; MESOR, Midline Estimating Statistic of Rhythm; ms, millisecond; N.S., not specified; NES, nocturnal eating syndrome; N-FHA, normogonadotropic FHA; NW, normal weight; OB + BED, obesity with binge eating disorder; OB-BED, obesity without binge eating disorder; pNN50, percentage of intervals that differ by >50 ms; RAR, rest-activity circadian rhythm; rMSSD, square root of mean successive difference of successive NN intervals; RT, reaction time; SDANN, standard deviation of average NN intervals over 5-minute periods; SDNN, standard deviation of normal beat (NN) intervals.