October 9, 2023
Exercise has many well-documented health benefits – mentally, physically, and socially. Physical activity can improve your muscular, cardiovascular, and bone health. It can also improve your mood, body image, self-esteem and helps to lower your stress levels [1].
And,
for many, physical activity can become a harmful component of the eating disorder and be detrimental to health.
In this blog post, we aim to explore the connection between eating disorders and physical activity, and review the role of activity in the treatment care plan for those in the recovery of their eating disorder.
NOTE: This blog post is for information and education purposes only. Please connect with your care team to talk about your specific needs when it comes to activity.If you’re looking to reintroduce exercise into your recovery process, book a connection call with the team at The Balanced Practice today!
Listen to podcast #156 with Marie-Pier to learn more about the intersection of fitness and eating disorder recovery. Listen here.
We often see abnormally high levels of physical activity in people with eating disorders, especially in people with Anorexia Nervosa [2]. Research estimates that 31% to 80% of people with Anorexia Nervosa have documented levels of abnormal exercise [2].
That being said, excessive exercise is common in almost all eating disorders – including Binge Eating Disorder and Bulimia Nervosa. In the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders), excessive exercise is also listed as a purging behaviour for Bulimia Nervosa [3].
Physical activity and exercise are included in eating disorder diagnostic criteria because many people with eating disorders use exercise as a harmful strategy to try to control their weight, appearance, or to ahve a sense of control [8].
Traits like anxiety, depression, obsession, and perfectionism that we commonly see in people with eating disorders (especially anorexia nervosa), are also closely linked with dysfunctional or excessive exercising [4]. It is therefore not surprising that we see excessive amounts of exercise or dysfunctional relationships with exercise more commonly in people with eating disorders.
“Dysfunctional exercise” (AKA exercise addiction, exercise dependence, or compulsive exercise) can involve things like rigid exercise routines, exercising in spite of injuries, feeling anxious if unable to exercise, prioritising exercise over other important activities, or using exercise as punishment for eating (i.e. as a form of purging) [3].
Professionals on an eating disorder treatment team may explore your thoughts and feelings about movement and your body, in addition to exploring patterns of how often and what types of exercise you do. Together, you may explore how your motivations for exercise may be related to your emotions, body image, compulsive thoughts, or even self-harm behaviours.
Some key questions to ask yourself if you think that you may have a dysfunctional relationship with exercise are:
The team here at The Balanced Practice can help you explore these questions in more detail and determine what your relationship with exercise is truly like. In addition to this, the team can help to support you in redefining your relationship with movement and making sure it is supportive for you.
If you have an eating disorder, you may have been asked by your treatment team to limit or refrain from exercise for a period of time. So how do you know when it’s safe to add exercise back in? Will it hinder your recovery progress? How much and what types of exercises should you start with?
It’s important to know that including exercise in your recovery journey can be both beneficial and potentially triggering. Being honest with your team throughout your journey about your thoughts and feelings towards exercise is a key factor in healing your relationship with movement and your body!
Including physical activity in eating disorder treatment is dependent upon a variety of physical, behavioural, and psychological factors. Decisions regarding exercise will likely take into consideration factors including, but not limited to [6]:
As you can see, incorporating exercise into your eating disorder recovery journey is not a one-size-fits-all approach. It requires thoughtful consideration and professional guidance to help foster a more positive relationship with movement and your body.
The idea that exercise hinders recovery is a common belief in the field of eating disorders. And it makes sense. If your body needs energy but your activity routine is competing for that same energy, it is extremely difficult for the body to properly heal.
This being said, incorporating movement earlier in recovery (when medically safe) can have a lot of benefits[4]. A dietitian can help support the incorporation of physical activity by making sure that the body has adequate fuel for movement in recovery. To learn more about how a dietitian can support you in your eating disorder recovery, check out our blog post on the topic here!
A 2018 study found that in women undergoing treatment for bulimia nervosa or binge eating disorder, combining physical activity and nutrition therapy was as effective as cognitive behavioural therapy (CBT) for reducing compulsive exercise behaviours [7].
Physical activity can play an important role in eating disorder recovery. Engaging in activity that is appropriate for where you’re at in your recovery journey can actually help to improve motivation for recovery! Beyond that, some of the benefits of physical activity in recovery include [6]:
All this to say, when done under the supervision of a care team, exercise CAN be a safe and beneficial part of your recovery process in terms of your physical, mental, and emotional health.
Many treatment programs follow a model of starting with no intentional exercise in the initial stage of recovery. Then, the next step is slowly introducing some yoga, and then potentially transitioning to a walking group [4]. However, as we mentioned previously, the incorporation of exercise is not a one-size-fits-all approach and will depend on your treatment plan.
Together with your treatment team, you can explore the physical activity that you included in your life previously and what purpose it served. You may delve into questions like:
Debriefing with your treatment team is also an effective tool to help you as you heal your relationship with exercise. Having honest conversations about exercise-related thoughts, triggers, and challenges helps to ensure that the role of exercise in your treatment journey remains beneficial and not dysfunctional.
Your care team may bring up the idea of mindful movement with you. You have probably heard of mindful eating, but what exactly is mindful movement?
Mindful movement involves engaging in physical activities that you enjoy, while being present and aware of how your body feels, all without judgement.
Mindful movement promotes overall well-being rather than focusing on bdy changes [1]. This may include things like yoga, stretching, walking in nature, dance or other forms of expression, social activities like team games and sports, etc. A good rule of thumb is trying to reconnect with the idea and feeling of “play” that you had as a child. Children don’t play tag for physical fitness, they do it because they enjoy the movement and spending time with their friends.
To learn more about mindful movement, check out our blog post on the topic here!
It is possible to heal your relationship with exercise during your recovery journey and get back to enjoying movement and letting yourself “play”. Use the link here to book a session with a dietitian on The Balanced Practice team!
Athletes who are recovering from an eating disorder require a unique approach to including exercise in their treatment plan. For many athletes, exercise is more than just part of training for their sport. For many, exercise and their sport is a significant part of their lives in terms of their identity, community, and daily routine.
The central role that exercise plays in the life of athletes can sometimes put them at increased risk of developing a dysfunctional relationship with exercise, food, and their body. Athletes often are very driven by success and can face external expectations relating to their body, weight categorization, and athletic performance [1].
For athletes, incorporating exercise into the recovery journey requires a thoughtful and multi-disciplinary approach. Together with the treatment team, it’s important to have discussions regarding the role that sport and exercise plays in the person’s life – mentally, physically, and socially.
Athletes and the treatment team should set clear expectations about the demands of sport, the proper nourishment needed to fully engage in said demands, checking in with body cues, and the mental health impacts of their sport. This helps to ensure that exercise once again becomes something that enhances the life of the athlete, rather than becoming dangerous.
Eating disorders are complex illnesses that impact all aspects of our health – mental, emotional, social, and physical. While including exercise in recovery can be a nuanced topic, the most current evidence shows that exercise can have mental, physical and social benefits for people in recovery (specifically when incorporated in collaboration with a treatment team!).
Here at The Balanced Practice, our dietitians and therapists take an anti-diet, weight-inclusive, and trauma-informed approach to eating disorder recovery. If you are looking to heal your relationship with food, movement, and your body, click here to book a connection call!
Written By: Olivia Kuhlmann, RD, MPH, CDE
Reviewed By: Marie-Pier Pitre D’Iorio, RD, B.Sc. Psychology
If you are looking for more support from our team - We are happy to help
Every month, The Balanced Practice offers a low-cost workshop on topics related to eating disorders/disordered eating. Check out the next one coming up!
We offer different services in order to meet you exactly where you are at and provide you with the most appropriate level of support to reach your goals (no one-size-fits-all here). Our team works closely together and with other healthcare professionals to make sure we can provide you with the very best care.
Here at The Balanced Practice, we get it. We believe that you deserve more joy, more connection, and more fulfillment. After all, life is meant to be experienced fully (and not spent feeling stuck in our own heads). And we want to help, our team is available during the day and into the evening!
