Journals / KTO Karatay Üniversitesi Sağlık Bilimleri Dergisi / 2026 / Cilt: 7 Sayı: 1

Associations of Physical Activity Intensity and Cognitive Flexibility with Orthorexia Nervosa Tendencies Among Health Sciences Students

Sağlık Bilimleri Öğrencilerinde Fiziksel Aktivite Şiddeti ve Bilişsel Esnekliğin Ortoreksiya Nervoza Eğilimleri ile İlişkisi

Pages
—
Publication Date
2026-10-19
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Keywords: orthorexia nervosa, physical activity, cognitive flexibility, health sciences students, physiotherapy

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objective: Orthorexia nervosa tendencies may reflect rigid health-oriented eating behaviors.
📊
Key Findings & Data:Materials and Methods: This cross-sectional study included 492 health sciences students from a public university in Türkiye.
💡
Conclusion & Impact:Keywords: orthorexia nervosa, physical activity, cognitive flexibility, health sciences students, physiotherapy
🔬Design:Modeling & Simulation
📍Scope:Comprehensive Sample
⚙️Variables:ortoreksiya nervoza · fiziksel aktivite · bilişsel esneklik

Abstract

Objective: Orthorexia nervosa tendencies may reflect rigid health-oriented eating behaviors. Physical activity is central to health promotion and physiotherapy, but its association with orthorexic tendencies may vary by activity intensity and cognitive flexibility. This study examined these associations among health sciences students. Materials and Methods: This cross-sectional study included 492 health sciences students from a public university in Türkiye. Orthorexia nervosa tendencies, physical activity, and cognitive flexibility were assessed using the Turkish Düsseldorf Orthorexia Scale, Physical Activity Scale-2, and Cognitive Flexibility Inventory, respectively. Spearman correlation and multivariable linear regression with robust standard errors were used. Models were adjusted for age, sex, body mass index, and class year. Results: The mean orthorexic tendency score was 22.80±5.76. Orthorexic tendency score correlated positively with the Physical Activity Scale-2 total score and light-, moderate-, and vigorous-intensity physical activity, and negatively with cognitive flexibility scores. In the adjusted model, the Physical Activity Scale-2 total score was positively associated with orthorexic tendency score (B=0.609 per 100 MET-min/day, 95% CI: 0.489–0.730), whereas cognitive flexibility total score was negatively associated (B=-0.459 per 10 points, 95% CI: -0.844 to -0.074). The control dimension, but not the alternatives dimension, was associated with lower orthorexic tendency. The moderate-intensity association did not remain significant after false discovery rate correction. Conclusion: Higher physical activity scores were associated with greater orthorexia nervosa tendencies, whereas higher cognitive flexibility, particularly perceived control, was associated with lower tendencies. Physical activity should be promoted with flexible messages. Keywords: orthorexia nervosa, physical activity, cognitive flexibility, health sciences students, physiotherapy

Özet

Amaç: Ortoreksiya nervoza eğilimleri, sağlıklı beslenmeye yönelik katı sağlık odaklı yeme davranışlarını yansıtabilir. Fiziksel aktivite, sağlığın geliştirilmesi ve fizyoterapi açısından temel bir bileşendir; ancak ortorektik eğilimlerle ilişkisi fiziksel aktivite şiddetine ve bilişsel esnekliğe göre değişebilir. Bu çalışma, sağlık bilimleri öğrencilerinde bu ilişkileri incelemeyi amaçladı. Gereç ve Yöntem: Bu kesitsel çalışmaya Türkiye’deki bir devlet üniversitesinde öğrenim gören 492 sağlık bilimleri öğrencisi dahil edildi. Ortoreksiya nervoza eğilimleri Düsseldorf Ortoreksiya Ölçeği Türkçe formu, fiziksel aktivite Fiziksel Aktivite Ölçeği-2 ve bilişsel esneklik Bilişsel Esneklik Envanteri ile değerlendirildi. Spearman korelasyon analizi ve HC3 sağlam standart hatalı çok değişkenli doğrusal regresyon kullanıldı. Modeller yaş, cinsiyet, beden kütle indeksi ve sınıf yılına göre düzeltildi. Bulgular: Ortorektik eğilim puanı ortalaması 22,80±5,76 idi. Ortorektik eğilim puanı, Fiziksel Aktivite Ölçeği-2 toplam puanı ve hafif, orta ve yüksek şiddetli fiziksel aktivite ile pozitif; bilişsel esneklik puanları ile negatif yönde ilişkiliydi. Düzeltilmiş modelde Fiziksel Aktivite Ölçeği-2 toplam puanı ortorektik eğilim puanı ile pozitif yönde ilişkiliyken (B=0,609/100 MET-dk/gün, %95 GA: 0,489–0,730), bilişsel esneklik toplam puanı negatif yönde ilişkiliydi (B=-0,459/10 puan, %95 GA: -0,844 ile -0,074). Kontrol boyutu, alternatifler boyutundan farklı olarak, ortorektik eğilim puanının daha düşük olmasıyla ilişkiliydi. Orta şiddetli fiziksel aktivite ile gözlenen ilişki, yanlış keşif oranı düzeltmesinden sonra anlamlılığını korumadı. Sonuç: Daha yüksek fiziksel aktivite puanları daha yüksek ortoreksiya nervoza eğilimiyle ilişkiliyken, daha yüksek bilişsel esneklik, özellikle algılanan kontrol, daha düşük ortoreksiya nervoza eğilimiyle ilişkiliydi. Fiziksel aktivite, esnek ve dengeli sağlık davranışı mesajlarıyla birlikte desteklenmelidir.

🔖

Cite This Article

Güler, M. A., Güler, M. B. (2026). Associations of Physical Activity Intensity and Cognitive Flexibility with Orthorexia Nervosa Tendencies Among Health Sciences Students. KTO Karatay Üniversitesi Sağlık Bilimleri Dergisi, Cilt: 7 Sayı: 1. https://doi.org/10.59244/ktokusbd.1971645

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (35)

  1. Anderson, E., & Durstine, J. L. (2019). Physical activity, exercise, and chronic diseases: A brief review. Sports Medicine and Health Science, 1(1), 3–10. https://doi.org/10.1016/j.smhs.2019.08.006
  2. Barthels, F., Barrada, J. R., & Roncero, M. (2019). Orthorexia nervosa and healthy orthorexia as new eating styles. PLOS ONE, 14(7), e0219609. https://doi.org/10.1371/journal.pone.0219609
  3. Barthels, F., Meyer, F., & Pietrowsky, R. (2015). Die Düsseldorfer Orthorexie Skala – Konstruktion und Evaluation eines Fragebogens zur Erfassung orthorektischen Ernährungsverhaltens. Zeitschrift für Klinische Psychologie und Psychotherapie, 44(2), 97–105. https://doi.org/10.1026/1616-3443/a000310
  4. Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J. P., Chastin, S., Chou, R., Dempsey, P. C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., Lambert, E., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. https://doi.org/10.1136/bjsports-2020-102955
  5. Caferoglu, Z., & Toklu, H. (2022). Orthorexia Nervosa in Turkish dietitians and dietetic students. L’Encéphale, 48(1), 13–19. https://doi.org/10.1016/j.encep.2020.12.006
  6. Champely, S. (2020). pwr: Basic functions for power analysis (Version 1.3-0) [Computer software]. https://CRAN.R-project.org/package=pwr
  7. Dennis, J. P., & Vander Wal, J. S. (2010). The Cognitive Flexibility Inventory: Instrument development and estimates of reliability and validity. Cognitive Therapy and Research, 34, 241–253. https://doi.org/10.1007/s10608-009-9276-4
  8. Donini, L. M., Barrada, J. R., Barthels, F., Dunn, T. M., Babeau, C., Brytek-Matera, A., Cena, H., Cerolini, S., Cho, H. H., Coimbra, M., Cuzzolaro, M., Ferreira, C., Galfano, V., Grammatikopoulou, M. G., Hallit, S., Håman, L., Hay, P., Jimbo, M., Lasson, C., Lindgren, E. C., … Lombardo, C. (2022). A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eating and Weight Disorders: EWD, 27(8), 3695–3711. https://doi.org/10.1007/s40519-022-01512-5
  9. Ephrem, C., Rizk, R., Saadeh, D., Hallit, S., Obeid, S., & Martijn, C. (2025). Orthorexia nervosa in dietitians and dietetics students-prevalence, risk factors, and interventions: a scoping review using a systematic approach. Nutrition Reviews, 83(2), 382–396. https://doi.org/10.1093/nutrit/nuae009
  10. Geidl, W., Deprins, J., Cassar, S., Streber, R., Portenlänger, F., Sudeck, G., & Pfeifer, K. (2020). Exercise therapy and physical activity promotion: do exercise therapists assess or receive information on clients’ relevant personal factors? A national survey from Germany. European Journal of Physiotherapy, 22(5), 290–298. https://doi.org/10.1080/21679169.2019.1617776
  11. Genç, H. İ., Hepsert, S., Öktem, T., Kiratli, T., Yildirim, Y., & İlgin, Ö. (2025). Orthorexia nervosa: an investigation in the context of personality, body image, and physical activity. Frontiers in Psychology, 16, 1672773. https://doi.org/10.3389/fpsyg.2025.1672773
  12. Guglielmetti, M., Ferraro, O. E., Gorrasi, I. S. R., Carraro, E., Bo, S., Abbate-Daga, G., Tagliabue, A., & Ferraris, C. (2022). Lifestyle-Related Risk Factors of Orthorexia Can Differ among the Students of Distinct University Courses. Nutrients, 14(5), 1111. https://doi.org/10.3390/nu14051111
  13. Gür, F. (2021). Fiziksel Aktivite Ölçeği-2’nin Türkçe geçerlilik ve güvenilirlik çalışması. Spor ve Performans Araştırmaları Dergisi, 12(3), 252–263. https://doi.org/10.17155/omuspd.891196
  14. Hanras, E., Boujut, E., Barrada, J. R., & Dorard, G. (2024). Differentiating healthy orthorexia from orthorexia nervosa: sociodemographic, psychological and dietary characteristics in a French sample. Public Health Nutrition, 27, e255. https://doi.org/10.1017/S1368980024002374
  15. Hohl, K., & Dolcos, S. (2024). Measuring cognitive flexibility: A brief review of neuropsychological, self-report, and neuroscientific approaches. Frontiers in Human Neuroscience, 18, 1331960. https://doi.org/10.3389/fnhum.2024.1331960
  16. Howlett, C. A., Miles, S., Berryman, C., Phillipou, A., & Moseley, G. L. (2023). Conflation between self-report and neurocognitive assessments of cognitive flexibility: a critical review of the Jingle Fallacy. Australian Journal of Psychology, 75(1), 2174684. https://doi.org/10.1080/00049530.2023.2174684
  17. Kavsara, H. K., Gül Koyuncu, A., Dere Yelken, H., Barthels, F., & Stroebele-Benschop, N. (2025). Validity and reliability of the Turkish version of the Düsseldorf orthorexia scale (TR-DOS) and the prevalence of orthorexia nervosa among Turkish university students. Psychology, Health & Medicine, 30(4), 782–797. https://doi.org/10.1080/13548506.2024.2439133
  18. Matting, L., Pfeifer, K., Sudeck, G., Jung, A., Langhirt, F., & Geidl, W. (2025). Physical activity promotion in physical therapy, exercise therapy and other movement-based therapies: a scoping review and content analysis of intervention studies and theoretical works. International Journal of Behavioral Nutrition and Physical Activity, 22(1), 72. https://doi.org/10.1186/s12966-025-01772-1
  19. Mitrofanova, E., Pummell, E. K. L., Mulrooney, H. M., & Petróczi, A. (2021). Using Behavioural Reasoning Theory to Explore Reasons for Dietary Restriction: A Qualitative Study of Orthorexic Behavioural Tendencies in the UK. Frontiers in Psychology, 12, 685545. https://doi.org/10.3389/fpsyg.2021.685545
  20. Moccia, L., Anesini, M. B., Callovini, T., Janiri, D., Policola, C., Cintoni, M., Focà, F., Kotzalidis, G. D., Conti, F., Bandettini Di Poggio, A., Camardese, G., & Sani, G. (2025). Understanding Orthorexia Nervosa: A Systematic Review of Meta-analytical Findings. Current Nutrition Reports, 14(1), 126. https://doi.org/10.1007/s13668-025-00714-4
  21. Ng, Q. X., Lee, D. Y. X., Yau, C. E., Han, M. X., Liew, J. J. L., Teoh, S. E., Ong, C., Yaow, C. Y. L., & Chee, K. T. (2024). On Orthorexia Nervosa: A Systematic Review of Reviews. Psychopathology, 57(4), 1–14. Advance online publication. https://doi.org/10.1159/000536379
  22. Opitz, M. C., Newman, E., Alvarado Vázquez Mellado, A. S., Robertson, M. D. A., & Sharpe, H. (2020). The psychometric properties of Orthorexia Nervosa assessment scales: A systematic review and reliability generalization. Appetite, 155, 104797. https://doi.org/10.1016/j.appet.2020.104797
  23. Plichta, M., & Jezewska-Zychowicz, M. (2023). Nutrition knowledge, diet quality and orthorexic behaviors in Polish students-a pre-post repeated cross-sectional study. PLOS ONE, 18(6), e0287165. https://doi.org/10.1371/journal.pone.0287165
  24. Portoghese, I., Lasio, M., Conti, R., Mascia, M. L., Hitchcott, P., Agus, M., Gemignani, A., & Penna, M. P. (2020). Cognitive Flexibility Inventory: Factor structure, invariance, reliability, convergent, and discriminant validity among Italian university students. PsyCh Journal, 9(6), 934–941. https://doi.org/10.1002/pchj.401
  25. Rozmiarek, M., Grajek, M., Krupa-Kotara, K., & Malchrowicz-Mośko, E. (2024). Orthorectic behavior among students and motivation for physical activity, dietary habits, and restrictive eating. Frontiers in Nutrition, 11, 1367767. https://doi.org/10.3389/fnut.2024.1367767
  26. Sapmaz, F., & Doğan, T. (2013). Assessment of cognitive flexibility: Reliability and validity studies of Turkish version of the Cognitive Flexibility Inventory. Ankara University Journal of Faculty of Educational Sciences, 46(1), 143–162. https://doi.org/10.1501/Egifak_0000001278
  27. Sousa, J. R., Afreixo, V., Carvalho, J., & Silva, P. (2024). Nutrition and Physical Activity Education in Medical School: A Narrative Review. Nutrients, 16(16), 2809. https://doi.org/10.3390/nu16162809
  28. Strahler, J., Wachten, H., & Mueller-Alcazar, A. (2021). Obsessive healthy eating and orthorexic eating tendencies in sport and exercise contexts: A systematic review and meta-analysis. Journal of Behavioral Addictions, 10(3), 456–470. https://doi.org/10.1556/2006.2021.00004
  29. Van Horn, L., Lenders, C. M., Pratt, C. A., Beech, B., Carney, P. A., Dietz, W., DiMaria-Ghalili, R., Harlan, T., Hash, R., Kohlmeier, M., Kolasa, K., Krebs, N. F., Kushner, R. F., Lieh-Lai, M., Lindsley, J., Meacham, S., Nicastro, H., Nowson, C., Palmer, C., Paniagua, M., … Lynch, C. (2019). Advancing Nutrition Education, Training, and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building Competencies and Interdisciplinary Coordination. Advances in Nutrition (Bethesda, Md.), 10(6), 1181–1200. https://doi.org/10.1093/advances/nmz083
  30. Wachten, H., Wurst, R., Paganini, S., & Strahler, J. (2024). Excessive health behaviors in sports: links of orthorexia nervosa and exercise addiction with well-being, exercise activity in sports categories, and gender effects. Frontiers in Nutrition, 11, 1494958. https://doi.org/10.3389/fnut.2024.1494958
  31. Yilmaz, F. C. (2023). Orthorexia and eating attitudes in health sciences students. Nigerian Journal of Clinical Practice, 26(4), 502–507. https://doi.org/10.4103/njcp.njcp_507_20
  32. Zagaria, A., D’Amico, M., Cerolini, S., Mocini, E., & Lombardo, C. (2024). A psychometric examination of the Cognitive Flexibility Scale and its association with orthorexia nervosa. BMC Psychology, 12(1), 724. https://doi.org/10.1186/s40359-024-02179-6
  33. Zickgraf, H. F., & Barrada, J. R. (2022). Orthorexia nervosa vs. healthy orthorexia: relationships with disordered eating, eating behavior, and healthy lifestyle choices. Eating and Weight Disorders: EWD, 27(4), 1313–1325. https://doi.org/10.1007/s40519-021-01263-9
  34. Donini, L. M., Barrada, J. R., Barthels, F., Dunn, T. M., Babeau, C., Brytek-Matera, A., Cena, H., Cerolini, S., Cho, H. H., Coimbra, M., Cuzzolaro, M., Ferreira, C., Galfano, V., Grammatikopoulou, M. G., Hallit, S., Håman, L., Hay, P., Jimbo, M., Lasson, C., Lindgren, E. C., … Lombardo, C. (2022). A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eating and Weight Disorders: EWD, 27(8), 3695–3711. https://doi.org/10.1007/s40519-022-01512-5
  35. Zickgraf, H. F., & Barrada, J. R. (2022). Orthorexia nervosa vs. healthy orthorexia: relationships with disordered eating, eating behavior, and healthy lifestyle choices. Eating and Weight Disorders: EWD, 27(4), 1313–1325. https://doi.org/10.1007/s40519-021-01263-9