Regarding physical activity, select one of the following:
___ I should do more
___ I do an appropriate amount
___ I should do less
___ I should do less and cannot stop
Exercise is uncommonly perceived as a potential eating disorder behavior, but that is not always the case. Depending on frequency, type and nutrition, it can either help or hinder one’s recovery process. If those three components are not properly balanced, physical activity has the potential to evolve from a healthy habit to a harmful one.
How can exercise be harmful? Isn’t it beneficial for immune health and blood pressure maintenance? Well, yes, but there is a threshold that can be crossed and at that point, exercise is no longer healthy, but instead, quite damaging. This occurs when someone is not eating enough for their body to afford any extra energy expenditure or when exercise turns into a compulsion. Once this line is crossed, the body cannot benefit from exercise. In fact, exercising out of moderation can result in a lowered metabolism, decreased immune strength, worsened vitals, injuries, mood instability, and slowed body systems. In contrast, it is only when one’s body is fully nourished that exercising moderately can enhance moods and improve body systems overall.
It is important to understand what exercising moderately means because it looks different for everyone. Moderate physical activity for one person might mean practicing and training on most days per week, whereas for another it might mean chasing the kids around all day or walking the dog. Whichever level of activity that aligns with one’s life goals, values, and encourages longevity and emotional balance is the healthiest option for them.
Appropriate exercise highly corresponds to one’s nutritional status. For example, if an athlete is well-nourished and can maintain his or her activity level and still maintain life balance, then that is moderation for them. Their body will be able to afford the energy expended and their mindset will remain open to fluctuations in schedule and amount of activity. But say that person begins to compulsively exercise (obsessing over the routine, or adding more activity but not eating more), then the moderation and balance is lost. This will likely disrupt physical and/or emotional health, because, remember, only when a person is fully nourished are they able to get the positive benefits of exercise.
You may now be wondering how to know what moderate exercise looks like for you and if your current food intake is appropriate. Some examples of exercising outside of moderation include not eating adequate energy for the body to rebuild tissue post-exercise, not stopping an activity when feeling lightheaded or fatigued, ignoring the advice of a physician regarding physical activity, continuing to exercise despite injury, avoiding social situations to go to the gym, basing calories or grams of food choices only based on how many calories you burned running, or exercising in private. Another example is how much someone thinks about exercise, and what kind of thoughts they are having about it. If thoughts about exercise involve secrecy and wanting to make up for what was eaten, then one might lose touch with their body and what it needs. The percentage of time spent thinking about exercise should also be minimal; it should be just one part of life and not something that is a constant worry or thought. When we listen to our bodies and follow what they tell us regarding physical activity, we can prevent exercising out of moderation.
For those who are struggling with an eating disorder, there are special considerations, which are assessed by the patient’s treatment team. Often times, an individual with an eating disorder cannot afford even moderate physical activity and resting and nutrition rehabilitation may be the best thing for their body at that time.
During this assessment, together, the patient’s treatment team, will follow guidelines such as the following to help incorporate physical activity into their eating disorder treatment:
- Screen for medical concerns and any contraindications.
- Assess any attitudes and behaviors towards exercise.
- This will help determine if any exercise will exacerbate ED pathology. At this point, the team will determine if the patient will be restricted from exercise during treatment.
- Create a contract outlining the timeline for when the physician might clear the patient from his or her exercise restriction.
- Utilize education as a part of CBT and other therapies to help the patient understand their current relationship with exercise and to develop a new, appropriate one, when they are ready to do so. Through this process, the patient and their treatment team will work on:
- Learning the appropriate use of exercise for health benefits
- Recognizing when exercise is becoming problematic
- Developing healthy attitudes towards exercise
- Finding body awareness
- Learning enjoyment of physical activity, rather than as a functional role in maintaining ED
- Identifying factors related to overtraining, misuse, or burnout
- Reintroduce activities that can be added back in increments, allowing the patient to participate in the approved activities via trial and error and process the experience with the team.
- Monitor nutrition and body systems function throughout the treatment process and be the main determinant of activity allowance.
As with any part of treatment, the patient’s safety is the main concern when applying these guidelines and determining how to positively incorporate exercise into it. During this time, it is very important that patients understand they will be guided to relearn a positive relationship with exercise in whichever way that is best for them, and their team is there to encourage safety on the patient’s way to finding a fulfilling recovery.
Herrin, M., & Larkin, M. (2003). Treatment. In Nutritional Counseling in the Treatment of Eating Disorders (pp. 266-267).
Cook, B. J., Wonderlich, S. A., Mitchell, J. E., Thompson, R., Sherman, R., & Mccallum, K. (2016). Exercise in Eating Disorders Treatment. Medicine & Science in Sports & Exercise, 48(7), 1408-1414. doi:10.1249/mss.0000000000000912