Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Master of Science




Calogero, Rachel M.


Engaging in dysfunctional exercise (DEX) is detrimental to eating disorders (EDs) prognosis, although common amongst clients. Though nutritionally supported exercise can improve ED treatment outcomes, without negatively impacting weight restoration, clinicians remain hesitant to address DEX, perhaps due to a lack of information and training. The current study examined the effects of a Safe Exercise at Every Stage (SEES) training on clinician knowledge and self-efficacy in managing DEX in ED treatment. Eating disorders clinicians completed measures before (n = 96) and after (n = 44) SEES training to assess their knowledge and self-efficacy around treating DEX, with a subsample completing both time points (n = 40). Paired sample t-tests revealed a significant increase in both overall self-efficacy and knowledge after the SEES training. Semi-structured interviews exploring clinicians' thoughts on managing DEX were conducted. Three themes were revealed: “The SEES Training Impact,” “Bridging the Gap Through Staff and Community Support,” and “On the Horizon”. Results highlight the benefits of clinician training round exercise I the context of ED treatment and the need for continued training and providing accessible guidelines to ED clinicians for the management of DEX.

Summary for Lay Audience

Eating disorders (ED) have a lifetime prevalence of 9% in the general population. One symptom present in nearly 80% of all cases is dysfunctional exercise (DEX), which is associated with an elevated risk of relapse, longer illness chronicity and length of hospital stay, and worse overall pathology. Recent meta-analyses have noted that nutritionally supported exercise interventions can improve ED symptomatology, vital signs, and musculoskeletal health, without negatively impacting weight gain in EDs. However, clinicians lack resources, guidelines, and training to help them manage and safely integrate exercise into ED treatment. The Safe Exercise at Every Stage (SEES) guideline is a clinical tool developed to support safe exercise engagement in ED populations. The proposed study tested the effect of a 2-day interactive SEES training on eating disorders clinicians’ knowledge and self-efficacy around managing DEX. Clinicians completed a survey before and after the training, and a subsample of clinicians participated in semi-structured interviews to discuss the perceived benefits, costs, and barriers to managing DEX in ED settings. We found that the SEES training had a positive impact on the clinicians’ knowledge and self-efficacy. Clinicians also reported being highly satisfied with the training. The semi-structured interviews highlighted the importance of staff and community support for understanding and addressing DEX during ED treatment, and how the ED field could better support addressing DEX in this special population. Overall, the SEES training may be a valuable tool in helping ED clinicians gain confidence in this area of ED treatment and thereby help to close the gap between knowledge and practise currently plaguing the ED field.