A home-based video-supervised adapted physical activity program in adult women with anorexia nervosa: a pilot study

Anorexia nervosa is a severe mental disorder associated with high mortality and reduced quality of life. Adapted physical activity programs have shown promising results but have been developed primarily in inpatient settings. This pilot study aimed to assess the safety and satisfaction of a home-based adapted physical activity program delivered via videoconference in outpatient adult women with anorexia nervosa, and to generate preliminary data including initial uptake, session completion, and retention to inform a future randomized controlled trial. APAMAdom is a prospective, single-arm, non-randomized multicenter pilot study conducted in two specialized eating disorder centers within two French university hospitals (ClinicalTrials.gov: NCT05803707). Adult women aged 18 to 60 years with anorexia nervosa and a body mass index below 18.5 kg/m² were eligible. The program consisted of 10 sessions including 8 weekly 45-minute adapted physical activity sessions delivered by qualified instructors via videoconference. Potential pre-to-post program changes in body weight, body composition, physical activity levels, exercise dependence, quality of life, and self-esteem were assessed. Results are reported descriptively, with pre-to-post program comparisons performed using a paired Wilcoxon signed-rank test. A total of 36 women were included (median age 33 [26–47] years, median body mass index 15.6 [14.7–16.8] kg/m², median disease duration 10 [1–17] years). The retention rate for the completion of the end-of-program visit was 63.9%. The initial uptake rate defined as the proportion of eligible participants (n = 66) who completed the first session, was 36.4%. Among enrolled participants, 13.9% (n = 5) completed all 10 sessions. One participant was withdrawn due to weight loss exceeding 5% of baseline body weight. Satisfaction was high, with 77.3% of the 22 respondents wishing to continue the program. Body weight, body composition, physical activity levels, and exercise dependence remained stable throughout the program, whereas medium effect sizes suggesting improvement in quality of life and self-esteem were observed (r = 0.40 and r = 0.36 respectively). This pilot study provides real-world data for a home-based adapted physical activity program delivered by videoconference in adult women with anorexia nervosa, including estimates of initial uptake, session completion, and retention, together with a reassuring safety profile. The data generated also provide the foundation for the design of a future randomized controlled trial, for which quality of life is proposed as the primary outcome. Anorexia nervosa is a serious eating disorder with severe consequences on health and quality of life. In some patients, it is associated with excessive exercise. Adapted physical activity programs, led by qualified instructors, have been shown to help patients manage their relationship with exercise in a healthier way, but have mostly been offered in hospital settings, leaving many people without access to this care. In this study, we tested whether it was possible to offer such a program at home, via videoconference, once a week for eight weeks, to adult women with anorexia nervosa. The program was safe, with only one participant stopping due to weight loss. Most participants were satisfied and would like to continue. Some participants also reported improvements in quality of life, though the difference was too small to draw firm conclusions given the limited number of participants. These results provide useful information on participation in this type of remote program and will help design a larger study in the future.