August 25, 2016

How to Overcome Excessive Exercise in Eating Disorder Treatment — Beth Riley

excessive exercise In our culture, exercise is viewed as a positive behavior. In fact, daily exercise is promoted as part of a healthy lifestyle and the “more is better” attitude seems to have become the norm.

For many people with eating disorders, however, the concept of daily exercise is taken to the extreme.

Individuals might begin an exercise routine with good intentions but it can quickly spin out of control.

As an example, a high-achieving, competitive individual advised by a coach or doctor to exercise an hour a day will likely feel compelled to do more.

Technology, in the form of fitness apps or wearable devices, can drive individuals to relentlessly compete with themselves and others. Compulsive or excessive exercise may take place for multiple hours each day, often in spite of injuries or illness, and even if it means neglecting friends, family members and other daily activities.

Can you exercise too much?

Excessive or compulsive exercise is frequently a symptom of an eating disorder and can even promote the development of the illness. Physical activity, in this sense, can become too much of a good thing.

For individuals who are restricting their food intake (a potential warning sign of anorexia) — too much exercise could lead to serious medical complications or even death.

Electrolyte imbalances can occur even if the individual is drinking a lot of water since food is necessary for hydration.

In addition, many individuals seeking treatment for anorexia also have anxiety, depression or obsessive compulsive disorder. Studies have shown that the combination of food restriction and excessive exercise temporarily reduces these symptoms. It can become a form of self-medication and a pattern that some liken to an addiction.

To determine if you or a loved one has a problem with excessive or compulsive exercise, there are many screenings available online. ERC’s Jenni Schaefer has a compulsive exercise test on her website at jennischaefer.com.

Managing exercise in eating disorder treatment

When an individual begins treatment at Eating Recovery Center, we do a thorough assessment of their relationship with exercise to determine whether or not it is a symptom of the eating disorder. The assessment includes the following:
  • History of individual exercise activities
  • When physical activity became out of control and possible reasons why
  • Record of athletics, including types of sports and for how long
  • Family history of excessive/compulsive exercise, eating disorders or related symptoms
  • Personal history of stress, trauma or anxiety
  • Feelings of shame or guilt when not exercising
  • Using exercise as a form of self-punishment
Statements such as “I am going to get fat if I don’t exercise today,” “I’m worthless if I don’t run ten miles” or “my girlfriend won’t think I’m attractive if I don’t work out three hours a day” indicate an unhealthy relationship with exercise. These components are important to address and will be jointly considered in treatment, along with any other mental health and physical symptoms.

A treatment plan for excessive exercise

If it is determined that the individual’s relationship with exercise is disordered they could be asked to temporarily refrain from all forms of physical activity other than gentle yoga or movement therapy. This can be extremely challenging for the individual who has become physiologically and psychologically dependent on exercise.

In the early stages of treatment at our eating disorder clinic, an individual may struggle with decreasing their exercise. The combination of eating more and exercising less can increase anxiety, trigger phobias about weight gain and increase negative body image. The individual may experience increased depression or anxiety, irritability, and even a sense of a loss of identity.

The importance of being treated by a multi-disciplinary team of experts cannot be overemphasized. At ERC, the treatment team consists of a physician, psychiatrist, registered dietitian, therapist, psychiatrist, certified eating disorder specialists and movement therapists working together to support each patient’s individual needs during this very difficult phase of treatment.

Here’s what an individualized treatment plan at our eating disorder treatment center typically looks like:
  • A thorough psychiatric assessment to determine if medicine may be necessary to treat anxiety or depression
  • Therapy using ACT (Acceptance and Commitment Therapy), DBT (Dialectical Behavior Therapy) and CBT (Cognitive Behavioral Therapy) to increase awareness of the underlying causes of the behaviors and to introduce coping tools and strategies for managing symptoms such as guilt, shame, or intrusive thoughts about body image or weight
  • Customized meal plans to help restore nutritional balance
  • Yoga/movement therapy for relaxation and improving body image
  • Recreational activities including gardening, crafts, music to help develop coping tools and alternatives to exercise
The good news is that individuals who follow the recommendations of the treatment team and stay the course can develop a healthier relationship with exercise. They learn to listen to their bodies while providing the fuel that they need to be active. They discover ways to incorporate exercise into their lives while maintaining relationships with friends and family. They often find that by putting excessive/compulsive exercise behind them, they find more enjoyment in physical activity and feel more connected with what they truly value in life.

In a future blog post, I will discuss the timing and process of re-integrating physical activity into daily life.

Beth Riley, MSW, LISW-CP, CEDS is Executive Director of Eating Recovery Center, the Carolinas in Greenville, SC.
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