Associations between exercise, bone mineral density, and body composition in adolescents with anorexia nervosa

  • Jason M. NagataEmail author
  • Jennifer L. Carlson
  • Neville H. Golden
  • Stuart B. Murray
  • Jin Long
  • Mary B. Leonard
  • Rebecka Peebles
Brief Report



To identify the effect of duration of weight-bearing exercise and team sports participation on bone mineral density (BMD) and body composition among adolescents with anorexia nervosa (AN).


We retrospectively reviewed electronic medical records of all patients 9–20 years old with a DSM-5 diagnosis of AN evaluated by the Stanford Eating Disorders Program (1997–2011) who underwent dual-energy X-ray absorptiometry.


A total of 188 adolescents with AN were included (178 females and 10 males). Using multivariate linear regression, duration of weight-bearing exercise (B = 0.15, p = 0.005) and participation in team sports (B = 0.53, p = 0.001) were associated with higher BMD at the hip and team sports (B = 0.39, p = 0.006) were associated with higher whole body BMC, controlling for covariates. Participation in team sports (B = − 1.06, p = 0.007) was associated with greater deficits in FMI Z-score. LBMI Z-score was positively associated with duration of weight-bearing exercise (B = 0.10, p = 0.018) and may explain the relationship between exercise and bone outcomes.


Duration of weight-bearing exercise and team sports participation may be protective of BMD at the hip and whole body BMC, while participation in team sports was associated with greater FMI deficits among adolescents with AN.

Level of evidence

Level V, descriptive retrospective study.


Eating disorders Dual-energy X-ray absorptiometry DXA Bone density Bone health Body composition Exercise Sports 



The authors thank Laura Bachrach for advice in study design; Audrey Chang, Alaina Critchlow, and Jessica Kao for help with data collection; and Nicole Capdarest-Arest for help with the literature searches.


Supported by the National Institutes of Health (K23DK100558 to RP, K23 MH115184 to SM, and 5R01HD08216602 to NG); the Pediatric Scientist Development Program (K12 HD000850) supported by the American Academy of Pediatrics and American Pediatric Society to JN; and the Hilda and Preston Davis Foundation to RP.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the university’s Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Because data were retrospectively collected and anonymized, a waiver of informed consent was approved by the Stanford University Committee on Human Research (IRB).

Supplementary material

40519_2018_521_MOESM1_ESM.tif (32 kb)
Flow diagram of included study participants (TIF 31 KB)
40519_2018_521_MOESM2_ESM.docx (16 kb)
Supplementary material 2 (DOCX 16 KB)
40519_2018_521_MOESM3_ESM.docx (15 kb)
Supplementary material 3 (DOCX 15 KB)
40519_2018_521_MOESM4_ESM.docx (15 kb)
Supplementary material 4 (DOCX 14 KB)
40519_2018_521_MOESM5_ESM.xlsx (42 kb)
Supplementary material 5 (XLSX 41 KB)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PediatricsStanford University School of MedicinePalo AltoUSA
  2. 2.Department of PediatricsUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of PsychiatryUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Department of PediatricsChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

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