Female sex: beyond risk prediction in mental health.

Maladaptive exercise, defined as exercise that is excessive in nature, has a driven or compelled quality, and/or is intended to compensate for binge eating behaviors, is common among individuals with transdiagnostic eating disorders (EDs). Maladaptive exercise is associated with adverse consequences (e.g., elevated risk for suicide, lower quality of life) and contributes to the maintenance of eating pathology over time, likely explaining why individuals with maladaptive exercise have poorer treatment responses than those without maladaptive exercise. Accordingly, the recent increase in attention to understand and effectively targeting maladaptive exercise in ED treatment is warranted. To date, the vast majority of research on maladaptive exercise in EDs has relied upon self-report assessment methods. These measures are inherently subjective and limited by participant insight, recall, and burden. Recent technological advances contributing to the ubiquity of accelerometers and other sensors in smartphones and wearables (e.g., smartwatches) provide the opportunity to use sensor-based measurement to further understand the role of exercise in EDs. Sensors allow for objective, continuous assessment of physical activity without significant user burden. These tools have been widely applied to behavioral health research, especially in the domains of weight loss and physical activity promotion. Perhaps because of their efficacy for producing modest increases in physical activity among non-clinical populations, many clinicians and researchers within the field of EDs express concerns about sensor-based measurement of physical activity; especially consumer-grade wearable sensors designed for weight loss and physical activity promotion. Specifically, clinicians and researchers report concerns that wearables may produce an iatrogenic increase in maladaptive exercise (i.e., ‘reactivity’) among individuals with EDs. A very small body of preliminary research has found significant, positive associations between use of commercial wearable fitness trackers and global eating pathology and compulsive exercise behaviors specifically.