Is it Safe to Exercise? Eating Disorder Recovery Tips
If you are in recovery for an eating disorder, we encourage you to speak with your treatment team before starting an exercise practice. If it seems appropriate to reintegrate physical activity back into your daily routine, a mindful and gradual approach is recommended. Some recommendations for exercise may look something like this:
Tip 1: Start with gentle movement
Consider starting the movement program in a social setting; a social or group setting can be very therapeutic, particularly if you have exercised in isolation in the past. Also, a group or social setting actively encourages you to branch out beyond your usual routine, creating a new mindset on movement.
The type of movement will also be important. Consider exploring one of the following types of movements first:
- Gentle yoga in a group setting
- Tai Chi
- Mindful nature walks in a group setting
- Short family walks around the neighborhood
Additionally, use mindfulness as you move: focusing on your breath and being present in the moment. These skills work to replace what you may have been focusing on in the past: the length of time you are exercising, the intensity of the exercise, the number of calories burned or even negative self-talk. An example of a mindful walk might include noticing your surroundings (birds, trees, clouds in the sky).
Tip 2: What to avoid
While mindful group movement works for some of our patients in recovery, there are some types of movement and triggering situations that we caution our patients and families against. I list some of these examples below:
While yoga can foster mindfulness and emotional healing, we find certain yoga classes (power yoga, hot yoga and other types of yoga that require great physical exertion) to be very triggering to patients. Instead, we encourage patients to start yoga in a non-competitive environment that is not focused on strength-building, calorie-burning or weight loss.
Instead of fast-paced power walking or jogging, we encourage patients to try gentle walking with family and friends.
Focusing on numbers
We try not to use numbers as we talk about re-introducing exercise back into a patient’s routine. These numbers can be triggering. Instead of focusing on the numbers, we encourage our patients to begin by walking “at a gentle, slow pace” for “a short amount of time.”
Using technology to track exercise
We also educate our patients about the concerns of using technology regarding physical activity. Technical gadgets that count and keep track of exercise have become a significant factor for those who exercise excessively. This is especially true for perfectionists and over-achievers. We recommend that patients avoid Fitbits and turn off any health tracking settings on their iPhones or watches. Family members should also avoid using these devices and watch what they say around the patient.
When can you exercise after eating disorder treatment?
Physical movement shouldn’t make you feel worn out and depleted; instead, it can be fun and enjoyable and make you feel good. Instead of living a life that is structured around exercise, balance and moderation will be key. In treatment, we ask our patients to look at movement as something that is to be enjoyed. We ask them several questions to help them through this process.
- What movement did you enjoy as a child?
- Did you enjoy being out in nature or in classes with others?
- Did you enjoy biking in the neighborhood with friends?
- Do you find pleasure in exercise?
- Can you make it a social event?
In the long term, through specialized treatment, patience and a gradual progression back, you may be able to resume regular activity and may even be able to compete in sports or visit a gym again. I estimate that it takes one to seven years in recovery to get to this place, and it really depends on the individual.
For athletes in eating disorder recovery
When it comes to resuming athletic or competitive activities, timing is important. There must be a thoughtful and structured plan created by the eating disorder treatment plan in conjunction with the athlete's sports medicine and sports performance staff. In some cases, it is best that the patient first return as a team manager or as a non-active participant. Also, it is important that coaches, athletic trainers, and team doctors have been educated about the patient’s history of excessive exercise, eating disorders and warning signs of relapse. Monitoring of the patient will be critical.
If you are a caregiver
Family members and loved ones play a critical role in eating disorder recovery and can help by monitoring the patient at home. Some patients will hide their exercise behaviors at home: waking up early to run or exercising in their bedroom or bathroom. If you are a caregiver, here are some ways to support your loved one in recovery.
Do not talk about exercise
Do not invite your loved one to go to the gym, take part in a 5K or attend an exercise class other than gentle yoga. Put in-house exercise machines out of sight. Families that focus on physical activity often, such as those that run marathons or play soccer together, can try other activities to connect, such as festivals, dining out, plays and movies.
Avoid discussing nutrition, supplements, foods and weight
We recommend that patients avoid certain places and situations that can be triggering. For example, patients can avoid attending classes in locations that promote weight loss, nutrition/supplements or places that have scales easily accessible. Be careful about attending health classes or gym classes in schools or universities that promote calorie counting, weighing and exercise tracking.
Watch out for social media
Unfollow exercise- and weight-focused accounts. Remove or unfollow friends or accounts that could trigger eating disorder thoughts and behaviors. Adjust social media settings so that these types of posts aren’t being suggested.
It’s important that the outpatient team (alumni support, dietitian, therapist and MD) work together to keep each patient’s best needs in mind. As movement is added back in, patients should be encouraged to stay in outpatient therapy.
How ERC helps those with eating disorders integrate movement back into their lives
In treatment, patients are allowed a controlled amount of moderate activity during the day — if they do not have a history of excessive exercise and have been cleared by the treatment team. We monitor these individuals closely during and after treatment for any significant changes in their attitude or behaviors related to exercise (i.e., exercising to compensate for increased food intake or exercising to cope with anxiety about changes in their body).
We give patients with a history of excessive exercise a detailed exercise plan during treatment. For these patients, the exercise reintroduction process is highly individualized and depends on several factors, including:
- Progress in recovery
- Medical status
- Exercise history
- Attitudes, thoughts and feelings about exercise
- Rationale behind decision to return to exercise
During this process, the treatment team works closely with the patient, caregivers and outpatient providers to develop a reasonable plan that can be maintained after treatment ends. Patients can and should be involved in this decision-making process. Exercise physiologists and recreation therapists can also be helpful in developing this plan.
Clinically reviewed by Amy Gooding, PsyD, a clinical psychologist offering specialized treatment for athletes and individuals with eating disorders, on June 2, 2023.
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