Swedish Clinicians' Knowledge, Practices, and Access to Structured Guidance Regarding Maladaptive Exercise in Eating Disorders

Maladaptive exercise is a common and serious symptom in eating disorders (EDs), yet often poorly addressed in treatment. This study examined clinicians' knowledge, practices, and access to structured guidance such as clinic-level practices/informal protocols related to maladaptive exercise, and whether these varied by profession, experience, or personal exercise habits. A cross-sectional survey was completed by 102 clinicians working in Swedish ED care. The survey assessed self-reported knowledge, clinical practices, and access to clinic-level practices/informal protocols. Differences by profession, years of ED work experience, and personal physical activity were analyzed using Fisher's exact test and Spearman correlations. Most clinicians viewed maladaptive exercise as an aggravating symptom but reported limited formal training and moderate confidence in managing it. Assessment was common, but structured interventions were rare and opinions about them varied by profession. Only 42% reported access to clinic-level practices/informal protocols, while 84% expressed a need for national guidance. Despite recognizing maladaptive exercise as clinically significant, ED clinicians report limited training and inconsistent guidance. Profession-specific differences and the strong demand for national guidelines underscore the need for structured, evidence-based approaches to both the assessment and treatment of maladaptive exercise, as well as adequate training for clinicians in their application.