Skip to main content

SYSTEMATIC REVIEW article

Front. Psychiatry, 19 March 2020
Sec. Psychological Therapy and Psychosomatics
This article is part of the Research Topic Body Image Across Health and Disease - A Bio-Psych-Social Perspective View all 11 articles

Influence of Physical Activity Interventions on Body Representation: A Systematic Review

Duangkamol Srismith,,*Duangkamol Srismith1,2,3*Leona-Magdelena WiderLeona-Magdelena Wider1Hong Yu Wong,Hong Yu Wong4,5Stephan ZipfelStephan Zipfel1Ansgar ThielAnsgar Thiel6Katrin Elisabeth GielKatrin Elisabeth Giel1Simone Claire Behrens,Simone Claire Behrens1,2
  • 1Medical University Hospital Tübingen, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
  • 2Max Planck Institute for Intelligent Systems, Department of Perceiving Systems, Tübingen, Germany
  • 3Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tübingen, Tübingen, Germany
  • 4Werner Reichardt Centre for Integrative Neurosciences, University of Tübingen, Tübingen, Germany
  • 5Department of Philosophy, University of Tübingen, Tübingen, Germany
  • 6Institute of Sports Science, Faculty of Economic and Social Sciences, University of Tübingen, Tübingen, Germany

Distorted representation of one's own body is a diagnostic criterion and corepsychopathology of disorders such as anorexia nervosa and body dysmorphic disorder. Previousliterature has raised the possibility of utilising physical activity intervention (PI) as atreatment option for individuals suffering from poor body satisfaction, which is traditionallyregarded as a systematic distortion in “body image.” In this systematic review,conducted according to the PRISMA statement, the evidence on effectiveness of PI on body representation outcomes is synthesised. We provide an update of 34 longitudinal studies evaluating the effectiveness of different types of PIs on body representation. No systematic risk of bias within or across studies were identified. The reviewed studies show that the implementation of structured PIs may be efficacious in increasing individuals’ satisfaction of their own body, and thus improving their subjective body image related assessments. However, there is no clear evidence regarding an additional or interactive effect of PI when implemented in conjunction with established treatments for clinical populations. We argue for theoretically sound, mechanism-oriented, multimethod approaches to future investigations on body image disturbance. Specifically, we highlight the need to consider expanding the theoretical framework for the investigation of body representation disturbances to include further body representations besides body image.

Introduction

Disturbances in body representation have been identified as the crux of many debilitating psychiatric disorders, such as body dysmorphic disorder (1), body integrity identity disorder (2), somatoparaphrenia (3), and asomatognosia (4). It has also been proposed as a core psychopathology of eating disorders [e.g., (49)]—especially in anorexia and bulimia nervosa. Heightened body dissatisfaction has been interpreted as a predisposition indicator in subclinical populations. Individuals with body image concerns are reportedly more vulnerable to developing eating and dieting pathologies (1013). As yet, however, mechanisms of change in body representation are still poorly understood, limiting mechanism-oriented interventions for prevention and treatment of disturbed body representation.

Previous literature has suggested that regular physical activity has beneficial effects on thephysical health of the body, as well as a significant impact on the level of satisfaction with whichthe body is perceived [e.g., (1416)]. This is surprising, insofar as cross-sectional studies in individuals withhigh levels of physical activity suggest decreased rather than increased body satisfaction (17). However, it is important to note that there has been little critical appraisal of the existing studies. Previous systematic reviews and meta-analyses on the topic of physical activity and its potential interactions with body satisfaction have been conducted from an outcome-centric perspective [e.g., (14, 15, 1820)]—focusing on evaluating the effectiveness of physical activity as an intervention for the improvement of individuals’ body satisfaction—with an emphasis on the affective and cognitive aspects (i.e., body image). Nevertheless, the question of which potential mechanisms might be responsible for the apparent shift in body image after the introduction of physical activity has not been inadequately addressed.

Despite the lack of a unified consensus on its exact nature, the term body image has been widelyused in research across psychology, neuroscience, and psychiatry. Body image can roughly becharacterised as the conscious, predominantly visual, mental representation of one’s own body,which in turn provides a basis upon which perceptual, cognitive, and affective attitudes toward thebody are assigned (21, 22). However, it is important to note that the current literature largely concurson the use of the term body image as a measure of body satisfaction—in that body image as anoutcome measure is interpreted as the degree with which individuals are satisfied with various aspects of themselves that is influenced by the visual aspect of their body (e.g., appraisal of body shape information). In this review, we therefore adopt the term body representation when referring to the broad range of mental representations of one’s own body, whereas body image only refers to cognitive-affective appraisal of the body. The fact that body image investigations in health research has so far been conducted from an almost exclusively perceptual-affective perspective is worth discussing.

Longo (23) argued that higher level representations of thebody are unlikely to emerge from abstract cognition alone. Rather, they are constructed through theinterplay of multiple distinct body representations. Not only do individuals have immediateknowledge of their body from within (i.e., bodily awareness through interoception), they are alsoable to objectively reflect on their own body from an external perspective, in the same way thatexternal objects are cognitively assessed (with regards to their shape, size, location, aesthetics, et cetera). Relying on neuroscientific evidence, Longo’s framework of body perception consists of multiple distinct body representations that are informed by different sensory modalities and can be arranged along two orthogonal axes: explicit vs. implicit & perceptual vs. conceptual. However, most empirical data concerning body image has been based on self-report or visual body size judgments, which effectively leads to the underrepresentation of other somatically driven/sensory inputs when considering the potential mechanism underlying the concept of body image (24). Although these subcomponents of body representation have been demonstrated to have distinct underpinning neural networks [see (25) for review], the mechanisms responsible for the development and regulation of these subcomponents are still very much unexplored (e.g., the idea that body satisfaction, or the lack thereof, could be socially and/or somatically driven—or the product of their interactions). As such, it is not at all clear why the body image should remain the sole focal point when investigating how individuals mentally represent their own body, and the potential distortions therein.

In this systematic review, we aim to synthesise existing literature investigating longitudinal interaction between physical activity and body image. Our purpose is to synthesise the empirical evidence from previous studies with a focus on effects, broader potential, and eventual impact mechanisms of PI on body representation. Specifically, our research questions were:

i. Are there systematic effects of PI on body representation?

ii. Are previous studies informative with regard to prevention or treatment of sub-clinical or clinically relevant body image disturbance?

iii. Are there specific mechanisms of how long-term engagement in structured PI that influence thedynamics of individuals’ body representations?

Method

The systematic review process was conducted according to the PRISMA statement (26). Methods of analysis and inclusion criteria were specified in advance and documented in a protocol.

Literature Search

Studies were identified via searching the following electronic databases: PubMed, Web of Science and SPORTDiscus. The search was weekly updated until January 2020.

The specific search terms are as follows: (“body image” OR “body representation” OR “body dissatisfaction” OR “body satisfaction” OR “body image disturbance”) AND (“physical activity” OR “physical exercise” OR “exercise intervention” OR “endurance training” OR “exercise training” OR “exercise intervention” OR “aerobic exercise” OR “aerobic training” OR “anaerobic exercise” OR “anaerobic training” OR “motor activity” OR “resistance training” OR “resistance exercise” OR “strength training” OR “weight training” OR “weightlifting” OR “cardio training” OR “cardio” OR “athletic sports” OR “exercise program” OR “fitness training” OR “cardiovascular training” OR “interval training” OR “intermittent training” OR “interval exercise” OR “intermittent exercise” OR “sprint training” OR “sprint exercise” OR “high intensity interval training” OR “high intensity interval exercise” OR “moderate intensity training” OR “moderate intensity exercise” OR “exercise/psychology” OR “exercise therapy/methods” OR “resistance training/methods”).

Additionally, reference lists of included articles were hand searched.

Eligibility Criteria and Study Selection

Each step of the eligibility assessment was performed independently by two reviewers according to the PICOS criteria (27). Only articles in English were considered.

Studies had to fulfil the following criteria:

Population: a sample of adult participants,

Intervention: include a longitudinal physical activity intervention (PI; no lifestyle counselling; specific targeting of body image/body representation not compulsory),

Comparison/Control: include a validated measure of body image/body representation, a control group was not required,

Outcome: at least one pre & post measurement of a validated self-report or experimental body image/body representation measure, and

Study Type: published as a peer-reviewed original article.

Exclusion criteria were as follows:

i. samples younger than 18 years old, and

ii. no inference statistics performed.

The first author (DS) applied the search terms to three databases, extracted the search results and removed duplicates. DS and LW screened titles to identify relevant records. Abstracts and full texts of the identified records were subsequently screened by DS and SB. All studies included in the qualitative synthesis were rated according to the eligibility criteria by DS and SB. Interrater reliability between DS and LW for title screening was good (κ = 0.61; 94.2% agreement). Articles were included in the full-text screening if one reviewer rated it as a potential match. Interrater reliability between DS and SB for the subsequent steps was very good (κ = 1.0 for abstract screening; κ = 0.94 for full-text screening). Disagreements between the reviewers were solved by discussion and, when in doubt, articles were included. DS extracted relevant data from the included studies (i.e., sample characteristics, PI types and dosage, measure of fitness level, measures of body composition, measures of body image/body representation, and results).

Risk of Bias in Individual Studies

To assess the risk of bias in individual studies, DS and SB conducted a quality rating. The Qualitative Assessment Tool for Quantitative Studies by the Effective Public Health Practice Project (28, 29) is recommended by the Cochrane Handbook for Systematic Reviews of Interventions to be used for assessing any quantitative study design (30) and was judged a suitable tool for systematic reviews of effectiveness (31). The tool consists of component ratings for the following categories: selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts. Components were rated according to the accompanying dictionary. Studies received ratings of either “strong”, “moderate”, or “weak” for each category. A global rating was assigned at the end of the process via the summarisation of the number of categories rated as “weak”. Disagreements between the reviewers were solved by discussion.

Results

Study Selection

The searches yielded a total of 3,318 results. Duplicates were discarded (n = 602), leaving 2,716 records for title and abstract screening. During this process, 2,659 studies were discarded, and the remaining 57 studies were identified for full-text analysis. Subsequently, 34 studies were included in the systematic review. For the PRISMA flow chart, see Figure 1.

FIGURE 1
www.frontiersin.org

Figure 1 PRISMA flowchart for study selection.

Study Quality

The overall study quality within the current review showed a slight majority for “weak” (55.88%; n = 19), followed by “moderate” (41.17%; n = 14). Only 1 study (2.94%) included in the review qualified for the global “strong” rating. The detailed components ratings are included in Table 1.

TABLE 1
www.frontiersin.org

Table 1 Overview on main characteristics and findings of included studies.

Notably, included studies only received weak (n = 26) and moderate (n = 8) ratings for the selection bias category. The main reason for depreciation was the recruitment in sports classes or from community samples; thus producing a selection bias favouring highly motivated, sports-oriented participants. In the same vein, most studies qualified for moderate rating in the study design category (n = 27). This is due to the lack of randomisation in the selection as well as group allocation process, as participants often conducted the PI of their choice. This limits explanatory power regarding general recommendations of effective types of training. To summarise, there is a possibility for risk of bias in the studies included in the current review.

Study Characteristics

The study characteristics of included studies are detailed in Table 1. All studies employed a longitudinal design, as defined by the inclusion criteria. Of the total 34, 6 studies were described as quasi-experimental. Twenty-three studies included control groups in their experimental design, while the remaining 11 did not. Within the 23 controlled studies, 18 studies included “no intervention” comparison groups, while the remaining 5 studies included participants who performed low to moderate exercise as controls. Eight studies included clinical and/or sub-clinical groups. The remaining 26 studies had healthy samples. Eleven studies aimed to compare different types of PIs and their impact on body image/body representation of participants. Most studies (n = 27) did not have a randomised participant selection and/or group allocation process.

Physical Activity Interventions

The most commonly investigated types of PI were weight/strength training (n = 14), as well as aerobics/cardiovascular training (n = 13). Three studies implemented the combination of both types as a singular intervention. Dancing (n = 3) was also investigated. Other PIs included walking, running, swimming, cycling, pilates, hydrogymnastics, yoga, fascial fitness, and functional training. The mean length of time for the implementation of the PI was 13.29 (SD = 8.45) weeks, with the maximum of 52 weeks (1 year) and the minimum of 2 weeks. The median for PI duration was 12 weeks.

VO2max was used as a measure of fitness in 9 studies. Eleven studies conducted strength tests as a marker of fitness level (i.e., variations of maximum repetition test). Heartrate was also measured as a marker of fitness level (n = 4). Twelve studies did not report any measure of physical fitness.

Outcome Measures

Studies were homogeneous in terms of the operationalisation of body image/body representation measures. Almost all studies exclusively implemented validated questionnaires assessing body image. Only 3 studies additionally implemented more visual-oriented measures (i.e., Stunkard Scale of Silhouette, Figure Rating Scale)—though nevertheless still affective/subjective in nature. No study used experimental assessments of body representation (e.g., depictive/metric body size and visual estimation tasks). As such, the domains of visual, tactile and affordance perception of body representation were not at all investigated.

The most commonly employed scales were MBSRQ (Multidimensional Body Self-Relations Questionnaire; (66) and PSPP (Physical Self-Perception Profile; (67) at 23.53% (n = 8) each. The Body Cathexis Scale was also frequently implemented in earlier studies (n = 7; 20.59%; (68).

Systematic Effects of PI on Body Representation

PI was considered effective if significant improvement in body representation measures was reported at post-test among the intervention group, relative to the control group. The overall results are as follows: 5 studies (14.71%) observed no significant improvement in both control and PI groups across all body image measures; 3 studies (8.82%) observed significant improvement in both control and PI groups across all body image measures; 10 studies (29.41%) reported significant improvement in PI group across all body image measures; 16 studies (47.06%) reported partial significance effect in PI groups (i.e., not all improvement in scores measured in the subscales of the implemented questionnaires reached significance).

However, due to the low number of clinical and sub-clinical studies (n = 8) included in this systematic review, we cannot reliably synthesise significant evidence with regard to utilising long-term PI (structured or otherwise) as a treatment measure for clinically relevant groups.

Mechanisms Underpinning the Interplay Between PI and Body Representation

All studies included neither explicitly addressed/proposed a form of a mechanistic interplay between PI and body representation, nor provided evidence to support one. As such, the question of which potential mechanisms might be responsible for the apparent shift in body representation after the introduction of physical activity remain inadequately addressed.

Discussion

In this systematic review, we synthesised the empirical findings from longitudinal intervention studies on effects of structured PI on body representation. Overall, the studies suggest that the implementation of structured PI is associated with improved body image. Effects on other body representations were not investigated. To our knowledge, this review is the first to demonstrate such an effect in longitudinal settings. The effectiveness of these interventions seems promising for future research and possible development of prevention interventions. However, we argue that due to the quality of existing studies, further research is highly necessary to investigate whether the positive effects of PI can be generalised across healthy (active or sedentary), sub-clinical as well as clinical populations, and to capture a more complete sense of body representations that allows for exploring potential mechanisms of change.

Based on the evidence available, PI can be cautiously regarded as a potentially effective option regarding body image related outcomes. Notably, the studies included in the review examined predominantly volunteer groups (i.e., people who were generally open to the idea of engaging in physical activity), even if they were previously sedentary. It remains unclear whether positive effects of PI would also generalise to the voluntarily sedentary population who are physical-activity-reluctant. From a clinical perspective, these groups would be very relevant, since they are at higher risk for cardiovascular diseases and obesity. Thus, from the current studies, it remains unclear whether PI can be recommended as a general treatment to people suffering from poor body image.

Based on our systematic review, it would not be responsible to simply conclude that PI might be a promising treatment option for sub-clinical and/or clinical populations whose core psychopathology is centred around body dissatisfaction and distorted representation of one's own body. Despite the fact that a general improvement in measures of body representations can be observed, the percentage of clinical and sub-clinical studies included within the systematic review is too low to draw such a conclusion (23.53%). Additionally, there is no clear evidence regarding an additional or interactive effect of PI when implemented in conjunction with established treatments for clinical populations. More importantly, a previous meta-analytic review of stand-alone interventions to improve body image by Alleva and colleague (18) has provided evidence which cautioned against discussing physical activity with patients, as it was significantly associated with poorer body image outcomes. The meta-analysis proposed that by discussing physical activity as an intervention, patients may inadvertently have their attention drawn to their own weight and appearance, as well as the associated societal standards for physical fitness and physical attractiveness. Further, it was also not reported to be significantly associated with larger intervention effects on body image. Until the literature on the underlying mechanism between physical activity and body representation is further investigated, physical activity-related interventions targeting body image/representation should therefore be exclusively kept to psychologically healthy populations or be closely embedded in an overall treatment concept.

Notably, objective improvements in bodily composition and physical fitness brought about by PI are inconsistently related to changes in body image. This is surprising, insofar as people typically assume that their body image is based on an objective evaluation and comparison of their body. Instead, it appears that complex appraisal processes, eventually involving perceived improvements in physical capacities or more intense somatosensation experiences during PI may play a more important role. PI interventions could serve to improve body image/body representation by allowing individuals to redirect their attention more toward the functionality of their body and less on their appearance, or by increasing their sense of physical efficacy (69, 70). In this sense, the previous literature supports the need for a comprehensive, multisensory assessment of body representation as suggested by the Longo framework.

Strengths and Methodological Considerations

To our knowledge, this review is the first to provide a comprehensive systematic review on the topic of the longitudinal interactions between PI and body representation—the definition of which we have updated and adapted to fit the more complex theories and discussions which have arisen over the years.

Methodological limitations of this review arise from our study selection process as well as fromthe included studies. As we only searched for published results, a publication bias towardsignificant effects cannot be excluded. Further, as terminology in the field is very heterogeneous,it is possible that despite our broad search strategy, a few relevant articles may have been missed.Notably, some of the included studies had small sample sizes and may have been underpowered. Thecurrent systematic review is also potentially limited by biases within studies. Although nosystematic risk of bias across or within studies were identified, 97% of the included studies wereconsidered at risk with regards to selection bias and study design. More importantly, all studiesare lacking in the variety of validated outcome measures. Only self-report questionnaires wereimplemented, and the main component of body image addressed here was body satisfaction or the lackthereof. Additional visual scales implemented were used to measure the disparity between participants’ subjective ideal versus actual body shapes, which, once again, only measured participants’ attitudinal/conceptual issues of their own body image. Moreover, the two studies whose results also reported long-term effects of PI on body image were shown to be in direct contradiction (40, 50). One possible explanation for the contrasting results might be the difference in the type and dosage of the PIs implemented. As such, it remains unclear whether PI-induced body image improvement is indeed sustainable.

Perspectives and Future Directions

Our systematic review revealed that evidence on PI as a means to change body representation is still limited. A major challenge for future research is not only to reduce selection bias in the investigated samples, but also to explore potential mechanisms of body image improvement via PI through adopting a broader perspective on body representation. Based on our review, we argue for a more comprehensive view that takes various sources of information about the body into account (71, 72). In pursuit of a mechanism-oriented intervention, it is imperative to have a solid grasp on the understanding of how body image/body representation are constructed and which aspects drive changes in how individuals mentally represent their body.

The assessment of multisensory body representation is challenging. However, an increasing number of experimental paradigms have been developed in recent years to assess such concepts as: interoception [e.g., (7375)], implicit knowledge of body dimensions (7678) and multisensory integration (24). Despite reports of potentially disturbed multisensory integration and interoception in eating disorders (24, 79, 80), these measures have so far been largely neglected in clinical research. We expect that a broader use and further development of these methods in body representation assessment could give rise to a more informed understanding of the mechanisms of disturbed body representation and its malleability.

To this end, it is important to undertake future research on (i) identifying valid tasks to investigate different body representations (e.g., through combining actual body measures with tasks assessing body size estimation, interoceptive abilities or affordance estimates with questionnaires assessing cognitive-affective appraisal of the body), and (ii) investigate the malleability and interactions between different body representations.

Author Contributions

DS, KG, SB, SZ, and AT conceptualized the project. DS, SB, and L-MW performed the literature review. DS wrote the first draft of the manuscript. SB, KG, HW, and AT critically reviewed the manuscript with respect to their areas of expertise: body image and eating disorders (KG, SB, SZ); philosophy and cognitive science of body perception (HW); and sports science (AT).

Funding

This review was supported by a grant from the intramural graduate school “iReAct” of the University and the University Hospital Tübingen. We acknowledge support by Open Access Publishing Fund of the University Tübingen.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

1. Phillips KA, Didie ER, Feusner J, Wilhelm S. Body dysmorphic disorder: treating an underrecognized disorder. Am J Psychiatry (2008) 165:1111–8. doi: 10.1176/appi.ajp.2008.08040500

PubMed Abstract | CrossRef Full Text | Google Scholar

2. First MB.Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder. Psychol Med (2005) 35:919–28. doi: 10.1017/S0033291704003320

PubMed Abstract | CrossRef Full Text | Google Scholar

3. Vallar G, Ronchi R. Somatoparaphrenia: a body delusion. A review of the neuropsychological literature. Exp Brain Res (2009) 192:533–51. doi: 10.1007/s00221-008-1562-y

PubMed Abstract | CrossRef Full Text | Google Scholar

4. Critchley M. The parietal lobes. London, UK: Edward Arnold & Co (1953).

Google Scholar

5. Cash TF, Deagle EA .3rd. The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta-analysis. Int J Eating Disord (1997) 22:107–25. doi: 10.1002/(SICI)1098-108X(199709)22:2<107::AID-EAT1>3.0.CO;2-J

CrossRef Full Text | Google Scholar

6. Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther (2003) 41(5):509–28. doi: 10.1016/s0005-7967(02)00088-8

PubMed Abstract | CrossRef Full Text | Google Scholar

7. Fairburn CG, Harrison PJ. Eating disorders. Lancet (2003) 361(9355):407–16. doi: 10.1016/S0140-6736(03)12378-1

PubMed Abstract | CrossRef Full Text | Google Scholar

8. Pennesi JL, Wade TD. A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions? Clin Psychol Rev (2016) 43:175–92. doi: 10.1016/j.cpr.2015.12.004

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Treasure J, Caludino AM, Zucker N. Eating disorders. Lancet (2010) 375:583–93. doi: 10.1016/S0140-6736(09)61748-7

PubMed Abstract | CrossRef Full Text | Google Scholar

10. Attie I, Brooks-Gunn J. Development of eating problems in adolescent girls: a longitudinal study. Dev Psychol (1989) 25(1):70–9. doi: 10.1037/0012-1649.25.1.70

CrossRef Full Text | Google Scholar

11. Heatherton TF, Mahamedi F, Striepe M, Field AE, Keel P. A 10-year longitudinal study of body weight, dieting, and eating disorder symptoms. J Abnormal Psychol (1997) 106(1):117–25. doi: 10.1037//0021-843x.106.1.117

CrossRef Full Text | Google Scholar

12. Killen JD, Taylor CB, Hayward C, Haydel KF, Wilson DM, Hammer L, et al. Weight concerns influence the development of eating disorders: a 4-year prospective study. J Consult Clin Psychol (1996) 64(5):936. doi: 10.1037/0022-006X.64.5.936

PubMed Abstract | CrossRef Full Text | Google Scholar

13. Stice E, Agras WS. Predicting onset and cessation bulimic behaviors during adolescence: a longitudinal grouping analysis. Behav Ther (1998) 29(2):257–76. doi: 10.1016/S0005-7894(98)80006-3

CrossRef Full Text | Google Scholar

14. Campbell A, Hausenblas HA. Effects of exercise interventions on body image: a meta-analysis. J Health Psychol (2009) 14(6):780–93. doi: 10.1177/1359105309338977

PubMed Abstract | CrossRef Full Text | Google Scholar

15. Hausenblas HA, Fallon EA. Exercise and body image: a meta-analysis. Psychol Health (2006) 21(1):33–47. doi: 10.1080/14768320500105270

CrossRef Full Text | Google Scholar

16. Reel JJ, Greenleaf C, Baker WK, Aragon S, Bishop D, Cachaper C, et al.Relations of body concerns and exercise behavior: a meta-analysis. Psychol Rep (2007) 101(3):927–42. doi: 10.2466/pr0.101.3.927-942

PubMed Abstract | CrossRef Full Text | Google Scholar

17. Giel KE, Hermann-Werner A, Mayer J, Diehl K, Schneider S, Thiel A, et al. Eating disorder pathology in elite adolescent athletes. Int J Eating Disord (2016) 49(6):553–62. doi: 10.1002/eat.22511

CrossRef Full Text | Google Scholar

18. Alleva JM, Sheeran P, Webb TL, Martijn C, Miles E. A meta-analytic review of stand–alone interventions to improve body image. PLoS One (2015) 10(9):1–32. doi: 10.1371/journal.pone. 0139177.

CrossRef Full Text | Google Scholar

19. Bassett-Gunter R, Mcewan D, Kamarhie A. Physical activity and body image among men and boys: a meta-analysis. Body Image (2017) 22:114–28. doi: 10.1016/j.bodyim.2017.06.007

PubMed Abstract | CrossRef Full Text | Google Scholar

20. Lewis-Smith H, Diedrichs PC, Rumsey N, Harcourt D. A systematic review of interventions on body image and disordered eating outcomes among women in midlife. Int J Eating Disord (2015) 49(1):5–18. doi: 10.1002/eat.22480

CrossRef Full Text | Google Scholar

21. Gallagher S. Philosophical conceptions of the self: implications for cognitive science. Trends Cogn Sci (2000) 4(1):14–21. doi: 10.1016/s1364-6613(99)01417-5

PubMed Abstract | CrossRef Full Text | Google Scholar

22. Longo MR, Haggard P. An implicit body representation underlying human position sense. Proc Natl Acad Sci U S A (2010). 107(26):11727–32. doi: 10.1073/pnas.1003483107

PubMed Abstract | CrossRef Full Text | Google Scholar

23. Longo MR. Implicit and explicit body representations. Eur Psychol (2015) 20(1):6–15. doi: 10.1027/1016-9040/a000198

CrossRef Full Text | Google Scholar

24. Gaudio S, Brooks SJ, Riva G. Nonvisual multisensory impairment of body perception in anorexia nervosa: a systematic review of neuropsychological studies. PLoS One (2014) 9(10):e110087. doi: 10.1371/journal.pone.0110087

PubMed Abstract | CrossRef Full Text | Google Scholar

25. Gaudio S, Wiemerslage L, Brooks SJ, Schiöth HB. A systematic review of resting-state functional-MRI studies in anorexia nervosa: evidence for functional connectivity impairment in cognitive control and visuospatial and body-signal integration. Neurosci Biobehav Rev (2016) 71:578–89. doi: 10.1016/j.neubiorev.2016.09.032

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Internal Med (2009) 151(4):264–9. doi: 10.7326/0003-4819-151-4-200908180-00135

CrossRef Full Text | Google Scholar

27. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Internal Med (2009) 151(4):W-65–94. doi: 10.7326/0003-4819-151-4-200908180-00136

CrossRef Full Text | Google Scholar

28. Thomas BH, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing. (2004) 1(3):176–84. doi: 10.1111/j.1524-475X.2004.04006.x

PubMed Abstract | CrossRef Full Text | Google Scholar

29. Thomas BH, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evidence-Based Nurs (2004) 1(3):176–84. doi: 10.1111/j.1524-475X.2004.04006.x

CrossRef Full Text | Google Scholar

30. Armstrong R, Waters E, Doyle J. Reviews in public health and health promotion. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. (2008) Chichester, UK: Wiley-Blackwell. p. 593–606.

Google Scholar

31. Deeks JJ, Dinnes J, D'Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess (2003) 7(27):1–173. doi: 10.3310/hta7270

CrossRef Full Text | Google Scholar

32. Folkins CH. Effects of physical training on mood. J Clin Psychol (1976) 32(2):385–8. doi: 10.1002/1097-4679(197604)32:2<385::aid-jclp2270320237>3.0.co;2-7

PubMed Abstract | CrossRef Full Text | Google Scholar

33. Tucker LA. Effect of a weight-training program on the self-concepts of college males. Perceptual Motor Skills (1982) 54(3_suppl):1055–61. doi: 10.2466/pms.1982.54.3c.1055

CrossRef Full Text | Google Scholar

34. Tucker LA. Weight training: a tool for the improvement of self and body concepts of males. J Hum Mov Stud (1983) 9:31–7.

Google Scholar

35. Tucker LA. Effect of weight training on body attitudes: who benefits most? J Sports Med Phys Fitness (1987) 27:70–8.

PubMed Abstract | Google Scholar

36. Caruso CM, Gill DL. Strengthening physical self-perceptions through exercise. J Sports Med Phys Fitness (1992) 32(4):416–27.

PubMed Abstract | Google Scholar

37. Tucker LA, Maxwell KA. Effects of weight training on the emotional well-being and body image of females: predictors of greatest benefit. Am J Health Promotion (1992) 6(5):338–71. doi: 10.4278/0890-1171-6.5.338

CrossRef Full Text | Google Scholar

38. Tucker LA, Mortell RA. Comparison of the effects of walking and weight training programs on body image in middle-aged women: an experimental study. Am J Health Promotion (1993) 8(1):34–42. doi: 10.4278/0890-1171-8.1.34

CrossRef Full Text | Google Scholar

39. McAuley E, Mihalko SL, Bane SM. Exercise and self-esteem in middle-aged adults: multidimensional relationships and physical fitness and self-efficacy influences. J Behav Med (1997) 20(1):67–83.

PubMed Abstract | Google Scholar

40. McAuley E, Blissmer B, Katula J, Duncan TE, Mihalko SL. Physical activity, self-esteem, and self-efficacy relationships in older adults: a randomized controlled trial. Ann Behav Med (2000) 22(2):131–9. doi: 10.1007/bf02895777

PubMed Abstract | CrossRef Full Text | Google Scholar

41. Williams PA, Cash TF. Effects of a circuit weight training program on the body images of college students. Int J Eating Disord (2001) 30(1):75–82. doi: 10.1002/eat.1056

CrossRef Full Text | Google Scholar

42. Aşçı F. The effects of step dance on physical self-perception of female and male university students. Int J Sport Psychol (2002) 33(4):431–42.

Google Scholar

43. Aşçı F. The effects of physical fitness training on trait anxiety and physical self-concept of female university students. Psychol Sport Exercise (2003) 4(3):255–64. doi: 10.1016/s1469-0292(02)00009-2

CrossRef Full Text | Google Scholar

44. Depcik E, Williams L. Weight training and body satisfaction of body-image-disturbed college women. J Appl Sport Psychol (2004) 16(3):287–99. doi: 10.1080/10413200490498375

CrossRef Full Text | Google Scholar

45. Annesi JJ. Relations of body esteem factors with exercise session attendance in women initiating a physical activity program. Perceptual Motor Skills (2005) 100(4):995. doi: 10.2466/pms.100.4.995–1003

PubMed Abstract | CrossRef Full Text | Google Scholar

46. Annesi JJ, Westcott WL. Age as a moderator of relations of physical self-concept and mood changes associated with 10 weeks of programmed exercise in women. Perceptual Motor Skills (2005) 101(3):840–4. doi: 10.2466/pms.101.3.840–844

PubMed Abstract | CrossRef Full Text | Google Scholar

47. Ginis KAM, Eng JJ, Arbour KP, Hartman JW, Phillips SM. Mind over muscle? Sex differences in the relationship between body image change and subjective and objective physical changes following a 12-week strength-training program. Body Image (2005) 2(4):363–72. doi: 10.1016/j.bodyim.2005.08.003

PubMed Abstract | CrossRef Full Text | Google Scholar

48. Hős ÁT. The effects of guided systematic aerobic dance programme on the self-esteem of adults. Kinesiology (2005) 37(2):141–50.

Google Scholar

49. Henry RN, Anshel MH, Michael T. Effects of aerobic and circuit training on fitness and body image among women. J Sport Behav (2006) 29(4):281–303.

Google Scholar

50. Opdenacker J, Delecluse C, Boen F. The longitudinal effects of a lifestyle physical activity intervention and a structured exercise intervention on physical self-perceptions and self-esteem in older adults. J Sport Exercise Psychol (2009) 31(6):743–60. doi: 10.1123/jsep.31.6.743

CrossRef Full Text | Google Scholar

51. Özdemir RA, Çelik Ö, Aşçı FH. Exercise interventions and their effects on physical self-perceptions of male university students. Int J Psychol (2010) 45(3):174–81. doi: 10.1080/00207590903473750

PubMed Abstract | CrossRef Full Text | Google Scholar

52. Cruz-Ferreira A, Fernandes J, Gomes D, Bernardo LM, Kirkcaldy BD, Barbosa TM, et al. Effects of pilates-based exercise on life satisfaction, physical self-concept and health status in adult women. Women Health (2011) 51(3):240–55. doi: 10.1080/03630242.2011.563417

PubMed Abstract | CrossRef Full Text | Google Scholar

53. Moore JB, Mitchell NG, Bibeau WS, Bartholomew JB. Effects of a 12-week resistance exercise program on physical self-perceptions in college students. Res Q Exercise Sport (2011) 82(2):291–301. doi: 10.1080/02701367.2011.10599757

CrossRef Full Text | Google Scholar

54. Van Puymbroeck M, Schmid A, Shinew KJ, Hsieh PC. Influence of Hatha yoga on physical activity constraints, physical fitness, and body image of breast cancer survivors: a pilot study. Int J Yoga Ther (2011) 21:49–60.

Google Scholar

55. Appleton KM. 6 x 40 mins exercise improves body image, even though body weight and shape do not change. J Health Psychol (2012) 18(1):110–20. doi: 10.1177/1359105311434756

PubMed Abstract | CrossRef Full Text | Google Scholar

56. Hatipoglu E, Topsakal N, Atilgan OE, Alcalar N, Camliguney AF, Niyazoglu M, et al. Impact of exercise on quality of life and body-self perception of patients with acromegaly. Pituitary (2013) 17(1):38–43. doi: 10.1007/s11102-013-0463-7

CrossRef Full Text | Google Scholar

57. Pearson ES, Hall CR. Examining body image and its relationship to exercise motivation: an 18-week cardiovascular program for female initiates with overweight and obesity. Baltic J Health Phys Act (2013) 5(2):121–31. doi: 10.2478/bjha-2013-0012

CrossRef Full Text | Google Scholar

58. Seguin RA, Eldridge GC, Lynch W, Paul L. Strength training improves body image and physical activity behaviors among midlife and older rural women. J Extension (2013) 51(4):4FEA2.

Google Scholar

59. Zarshenas S, Houshvar P, Tahmasebi A. The effect of short-term aerobic exercise on depression and body image in Iranian women. Depression Res Treat (2013), 2013:132684. doi: 10.1155/2013/132684

CrossRef Full Text | Google Scholar

60. Ginis KAM, Strong HA, Arent SM, Bray SR, Bassett-Gunter RL. The effects of aerobic- versus strength-training on body image among young women with pre-existing body image concerns. Body Image (2014) 11(3):219–27. doi: 10.1016/j.bodyim.2014.02.004

PubMed Abstract | CrossRef Full Text | Google Scholar

61. Mendonça RSC, Araujo ASC, De Sousa MSC, Fernandes HSC. The psychological health of women after 16 weeks of practicing different exercise programs. J Exercise Physiol Online (2015) 18(2):32–44.

Google Scholar

62. Vurgun N. Effects of regular aerobic exercise on physical characteristics, body image satisfaction and self-efficacy of middle-aged women. South Afr J Res In Sport Phys Educ Recreation (2015) 37:151–63.

Google Scholar

63. Baur H, Gatterer H, Hotter B, Kopp M. Influence of structural integration and fascial fitness on body image and the perception of back pain. J Phys Ther Sci (2017) 29(6):1010–3. doi: 10.1589/jpts.29.1010

PubMed Abstract | CrossRef Full Text | Google Scholar

64. Megakli T, Vlachopoulos SP, Thøgersen-Ntoumani C, Theodorakis Y. Impact of aerobic and resistance exercise combination on physical self-perceptions and self-esteem in women with obesity with one-year follow-up. Int J Sport Exercise Psychol (2017) 15(3):236–57. doi: 10.1080/1612197x.2015.1094115

CrossRef Full Text | Google Scholar

65. Aukštuolytė E, Mauricienė V, Daunoravičienė A, Knispelytė G, Berškienė K. Dynamics of body composition and body image of sedentary working women who attend zumba or functional training programs: pilot study. Baltic J Sport Health Sci (2018) 2(109):2–8. doi: 10.33607/bjshs.v2i109.190

CrossRef Full Text | Google Scholar

66. Cash TF. MBSRQusers" manual. 3rd ed. Norfolk, VA: Old Dominion University Press (2000).

Google Scholar

67. Fox K, Corbin C. The Physical self-perception profile: development and preliminary validation. J Sport Exercise Psychol (1989) 11:408–30. doi: 10.1123/jsep.11.4.408

CrossRef Full Text | Google Scholar

68. Secord PF, Jourard SM. The appraisal of body-cathexis: body-cathexis and the self. J Consult Psychol (1953) 17(5):343–7. doi: 10.1037/h0060689

PubMed Abstract | CrossRef Full Text | Google Scholar

69. Ginis KAM, Bassett RL. Exercise and changes in body image. In: Cash TF, Smolak L, editors. Body image: A handbook of science, practice and prevention. New York: Guilford Press. (2011) p. 378–86.

Google Scholar

70. Martin KA, Lichtenberger CM. Fitness enhancement and changes in body image. In: Cash TF, Pruzinsky T, editors. Body image: A handbook of theory, research, and clinical practice. New York: Guilford Press. (2002) p. 414–21.

Google Scholar

71. Karnath HO, Mölbert SC, Klaner AK, Tesch J, Giel KE, Wong HY, et al.Visual perception of one’s own body under vestibular stimulation using biometric self-avatars in virtual reality. PLoS One (2019) 14(3):e0213944. doi: 10.1371/journal.pone.0213944

PubMed Abstract | CrossRef Full Text | Google Scholar

72. Longo MR, Azañón E, Haggard P. More than skin deep: body representation beyond primary somatosensory cortex. Neuropsychologia (2010) 48(3):655–68. doi: 10.1016/j.neuropsychologia.2009.08.022

PubMed Abstract | CrossRef Full Text | Google Scholar

73. Boeckxstaens GE, Hirsch DP, Van den Elzen BDJ, Heisterkamp SH, Tytgat GNJ. Impaired drinking capacity in patients with functional dyspepsia: relationship with proximal stomach function. Gastroenterology (2001) 121:1054–63. doi: 10.1053/gast.2001.28656

PubMed Abstract | CrossRef Full Text | Google Scholar

74. Katkin ES, Reed SD, Deroo C. A methodological analysis of 3 techniques for the assessment of individual-differences in heartbeat detection. Psychophysiology (1983) 20(4):452–2.

Google Scholar

75. Schandry R. Heart beat perception and emotional experience. Psychophysiology (1981) 18(4):483–8. doi: 10.1111/j.1469-8986.1981.tb02486.x

PubMed Abstract | CrossRef Full Text | Google Scholar

76. Engel MM, Keizer A. Body representation disturbances in visual perception and affordance perception persist in eating disorder patients after completing treatment. Sci Rep (2017) 7(1):16184. doi: 10.1038/s41598-017-16362-w

PubMed Abstract | CrossRef Full Text | Google Scholar

77. Mergen J, Keizer A, Koelkebeck K, Heuvel MRVD, Wagner H. Women with Anorexia Nervosa do not show altered tactile localization compared to healthy controls. Psychiatry Res (2018) 267:446–54. doi: 10.1016/j.psychres.2018.06.007

PubMed Abstract | CrossRef Full Text | Google Scholar

78. Longo MR, Mattioni S, Ganea N. Perceptual and conceptual distortions of implicit hand maps. Front Hum Neurosci (2015) 9:656. doi: 10.3389/fnhum.2015.00656

PubMed Abstract | CrossRef Full Text | Google Scholar

79. Eshkevari E, Rieger E, Musiat P, Treasure J. An investigation of interoceptive sensitivity in eating disorders using a heartbeat detection task and a self-report measure. Eur Eating Disord Rev (2014a) 22(5):383–8. doi: 10.1002/erv.2305

CrossRef Full Text | Google Scholar

80. Eshkevari E, Rieger E, Longo MR, Haggard P, Treasure J. Persistent body image disturbance following recovery from eating disorders. Int J Eating Disord (2014b) 47(4):400–9. doi: 10.1002/eat.22219

CrossRef Full Text | Google Scholar

Keywords: body image, body representation, physical activity, eating disorders, body dysmorphic disorders

Citation: Srismith D, Wider L-M, Wong HY, Zipfel S, Thiel A, Giel KE and Behrens SC (2020) Influence of Physical Activity Interventions on Body Representation: A Systematic Review. Front. Psychiatry 11:99. doi: 10.3389/fpsyt.2020.00099

Received: 30 August 2019; Accepted: 06 February 2020;
Published: 19 March 2020.

Edited by:

Josef Jenewein, Psychiatric Clinic Zugersee, Switzerland

Reviewed by:

Marwan El Ghoch, Beirut Arab University, Lebanon
Enrica Marzola, University of Turin, Italy

Copyright © 2020 Srismith, Wider, Wong, Zipfel, Thiel, Giel and Behrens. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Duangkamol Srismith, duangkamol.srismith@med.uni-tuebingen.de

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.