*4.4. Problematic Use of Physical Activity and ED Symptomatology*

Keyes et al. [75] found that ED pathology was one of the most important predictors of the variance of PPA in Group 2 in AN outpatients, but when compared to healthy controls, PPA in AN patients were significantly and positively associated with drive for thinness. It seems that AN patients are likely to increase their levels of PPA (quantitatively and qualitatively) when preoccupied about their weight and motivated by their drive for thinness. Vansteelandt el al. [37] explained high levels of physical activity in ED throughout psychological mechanisms and emphasized the fact that AN and BN patients have place too much value in their body shape and weight. Thus, physical activity is a result of a conscious attempt to work-off calories and obtain their desired thinness ideal, making the drive for thinness an important motive to engage in PPA. This is also the case in the general population, where weight and shape control reasons for exercise participation are very common [97].
