The state urge to be physically active in anorexia nervosa: a systematic review of mechanisms and clinical implications

OBJECTIVE: Anorexia nervosa (AN) is a severe eating disorder, leading to life-threatening complications and psychosocial impairment. Among its complex clinical features, a prominent but poorly understood feature is the intense State Urge to be Physically Active (SUPA), which may not always manifest as observable physical activity. This systematic review followed PRISMA guidelines to synthesize current empirical evidence regarding the characteristics, biological underpinnings, assessment methods and clinical implications of SUPA in AN across varying illness severity levels. METHODS: A systematic search of PubMed, Scopus, and EBSCOhost databases identified 1165 records, of which 17 studies met the inclusion criteria and were included in the final review. These studies employed both objective and subjective assessments of the SUPA. RESULTS: Findings suggest that the SUPA may persist regardless of BMI changes, including during recovery, and may function as a maladaptive emotion regulation strategy, rather than reflect a dispositional feature. Higher SUPA levels during weight restoration seem to predict poorer post treatment weight maintenance. DISCUSSION: In clinical settings, SUPA may signal illness severity and resistance to weight restoration, warranting its proactive inclusion in diagnostic and treatment frameworks. To advance understanding and management of SUPA in AN, future research should address confounding factors such as illness duration, validate standardised assessment tools and procedures, and explore targeted interventions to improve outcomes in AN.