神経性食思不振症のリハ栄養のエビデンス

神経性食思不振症のリハ栄養のエビデンスがどの程度あるのか、文献検索してみましたが、結論からいうときちんとしたエビデンスはほとんどありませんでした。3つの論文を簡単に紹介します。運動療法の効果のエビデンスを作るのは、神経性食思不振症では難しいのかもしれません。

大きな流れとしては、体重減少の時期、体重増加が期待できない時期は維持的リハ、体重増加の時期、今後も体重増加を期待できる時期は積極的リハ（軽度のレジスタンストレーニング、体力増強訓練含め）となると思います。ただ、体重増加への恐怖から過活動になりやすいことに十分留意が必要です。

一度治療が奏功しても再発しやすいこと、体重が増加しても適切な栄養改善ではなく、単に摂食障害が拒食モードから過食モードに移行しただけで疾患の解決にはなっていない場合があること、にも留意が必要です。体重が増えればよいというほど単純ではありません。

①Villaseñor A, et al: Does resistance training improve the functional capacity and well being of very young anorexic patients? A randomized controlled trial. J Adolesc Health. 2010 Apr;46(4):352-8.

軽中度の筋トレは有害ではないが、明らかな効果も認めない。ただ、サンプルサイズが1群11人と少ないので、より多くの人数で行えば何らかの効果があるという結果が出るかもしれない。

Abstract
PURPOSE: We determined the effects of a 3-month low-moderate-intensity strength training program (2 sessions/week) on functional capacity, muscular strength, body composition, and quality of life (QOL) in 22 young (12-16 yrs) anorexic outpatients. METHODS: Patients were randomly assigned to a training or control group (n=11 [10 females] each). Training sessions were of low intensity (loads for large muscle groups ranging between 20%-30% and 50%-60% of six repetitions maximum [6RM] at the end of the program). We measured functional capacity by the time up and go and the timed up and down stairs tests. Muscular strength was assessed by 6RM measures for seated bench and leg presses. We estimated percent body fat and muscle mass. We assessed patients' QOL with the Short Form-36 items. RESULTS: The intervention was well tolerated and did not have any deleterious effect on patients' health, and did not induce significant losses in their body mass. The only studied variable for which a significant interaction (group x time) effect was found (p=.009) was the 6RM seated lateral row test. CONCLUSIONS: Low-moderate-intensity strength training does not seem to add major benefits to conventional psychotherapy and refeeding treatments in young anorexic patients.

②Chantler I, et al: Muscular strength changes in hospitalized anorexic patients after an eight week resistance training program. Int J Sports Med. 2006 Aug;27(8):660-5.

筋トレ群で筋力が増強したという論文。ただし、3群間での比較ではなく、筋トレ群の前後比較で筋力が増えただけであり、他の2群との統計学的有意差の記述はないので、いわゆる比較研究ではなく、単なる前後研究レベルのエビデンスと解釈すべき。

Abstract
We investigated whether an eight week, light resistance program could increase the muscular strength of the knee and elbow extensors and flexors in a group of hospitalized anorexic patients compared to anorexic controls (AC) who did not participate in the training program, but received the same caloric intake, and non-anorexic exercisers (NAE) who undertook the resistance training program. After the resistance training program, the seven anorexic exercisers (AE) significantly increased the peak torque (PT) of their knee extensors (p < 0.001), flexors (p < 0.0001) and elbow flexors (p < 0.01). In comparison, the seven anorexic non-exercisers (anorexic controls, AC) and seven non-anorexic exercisers (NAE), who performed the same program, showed no significant increase in peak torque after the program (p > 0.05). The study has demonstrated that an eight week, light resistance program increases the knee and elbow strength of the hospitalized anorexic patients.

③Thien V, et al: Pilot study of a graded exercise program for the treatment of anorexia nervosa. Int J Eat Disord. 2000 Jul;28(1):101-6.

身体機能に合わせて強度を漸増する運動プログラムは、短期的（3カ月）には明らかな効果を認めない。この研究もサンプルサイズが1群8人と少ないので、より多くの人数で行えば何らかの効果があるという結果が出るかもしれない。

Abstract
OBJECTIVE: To determine whether a graded exercise program used in the treatment of anorexia nervosa improves quality of life and does not decrease the rate of gain of body fat. METHODS: A randomized controlled trial with outcome measures: change in percent body fat, body mass index (BMI), and Medical Outcomes Survey Short Form 36-item Quality of Life questionnaire. RESULTS: Fifteen females and one male meeting the DSM-IV criteria for the diagnosis of anorexia nervosa were randomized. There was no difference in change in BMI or percent body fat at 3 months. Quality of life outcomes improved from baseline in the experimental group compared with the control group. However, this difference was not statistically significant. DISCUSSION: Incorporation of a graded exercise program may increase compliance with treatment, but it did not reduce the short-term rate of gain of body fa or BMI. Longer studies with more subjects are necessary to determine the usefulness of a graded exercise program in anorexia nervosa.