Returning to Exercise After Eating Disorder Treatment
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Exercising in recovery
As someone recovers from an eating disorder (ED) like anorexia, or compulsive exercise, it's common to wonder how and when to safely resume exercise.
We spoke with Adee Levinstein, MS, RD, LD, CEDS-C (she/her/hers), clinical dietitian training specialist at Eating Recovery Center (ERC) to see how the eating disorder clinicians at ERC encourage movement both within our treatment centers and after discharge.
“Many individuals can safely implement exercise—if done intentionally, with multidisciplinary support, and taking the various complex factors of eating disorder recovery into consideration."
If you are recovering from an eating disorder or excessive exercise, we encourage you to speak with your treatment team before you start an exercise routine.
While the type and frequency of exercise will vary based on your unique circumstances, a mindful and gradual approach is sometimes recommended.
Tip 1: Make a plan
The first step to starting exercise in eating disorder recovery is to make a clear plan. Set clear parameters for exercise along with your treatment team and loved ones. It’s important to be intentional and communicate with your support system about challenges, progress and goals each step of the way.
Tip 2: Look for social support
Individuals in recovery can look for opportunities to exercise in a social or group setting, especially if you’ve exercised alone in the past. Joining others in exercise can build connection and encourage branching out from your usual routine and create a new mindset around exercise.
Tip 3: Let mindfulness guide your movement
When you first begin to exercise, focus on gentle movements. These may include:
- Gentle yoga in a group setting
- Tai chi
- Mindful nature walks in a group setting
- Short family walks around the neighborhood
- Unstructured activities like gardening and playing with pets
Use mindfulness as you move, focus on your breath, and be present in the moment. You might, for example, take time to notice your surroundings (birds, trees, clouds) while on a nature walk. These skills work to replace what you might 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. That type of focus on fat-or calorie-burning or weight loss can be triggering.
Mindful movement can also support our mental health in other ways: being present in the moment and giving us space to decide what to do with our feelings or thoughts. Family members can also be mindful of what they say and do around their loved one in recovery.
Tip 4: Shift the mindset around exercise
Those in recovery may want to put down any fitness trackers or technology tools that are so common these day. Use of these devices can potentially trigger excessive exercise patterns, especially for someone who has a perfectionistic or overachieving personality. Fitbits and health tracking settings on mobile phones and watches can all be a slippery slope leading to ED thoughts and behaviors.
Another way to shift the mindset is to find non-competitive environments to move within. Gentle walks with family and friends are a great way to enjoy movement.
Supportive movement is key
Physical movement is meant to be enjoyable and energizing. If movement makes you feel worn out or depleted, you may want to reach out to your treatment team (e.g., therapist, dietitian).
At ERC, our providers ask patients to look at movement from a variety of angles, asking several questions to help them through this process. Try it now. Ask yourself:
- What type of movement did I enjoy as a child?
- Did I enjoy being out in nature or in classes with others?
- Did I enjoy biking in the neighborhood with friends?
- Do I find pleasure in exercise?
- How can I make exercise a social event?
Exercise can have powerful effects on both your physical and emotional well-being, boosting mood, improving self-image and self-esteem, and reducing stress. This is why it is so important to create a positive relationship with movement, to reap the benefits while reducing chances for harm. Focus on self-compassion and self-care rather than achievement or perfectionism.
FAQs: Exercising in recovery
Here, we answer some commonly asked questions to help you identify ways to integrate movement back into your life in recovery.
When can I exercise in recovery?
In the early stages of recovery, we may recommend that you take a break from exercise for a while, to allow your body to heal. If your treatment team does make this recommendation, consider spending this time establishing a more mindful, stable relationship with food and prioritizing nutrition. As you progress in recovery, develop positive coping strategies and improve your relationship with food and your body, your treatment team may recommend reintroducing exercise.
What goals should I set for exercise in recovery?
At ERC, our experts recommend that you establish exercise goals with feedback from your treatment team. Your goals for movement will be unique to you, based on multiple factors and treatment progress.
Overall, individuals recovering from eating disorders can create a more positive mindset toward exercise by focusing on self-compassion and self-care rather than achievement. What might that look like? Practicing mindfulness, focusing on the breath, enjoying the present moment -- rather than creating rigid exercise schedules, calorie tracking or negative self-talk over missed workouts.
How long will it take before I resume regular activity?
In the long term, with specialized treatment, patience and a gradual progression back, you may be able to resume regular activity. You may even be able to compete in sports or visit a gym again. It may take time to get to this place, and it really depends on the individual. With support from friends, family members and your treatment team, many things are possible.
Special consideration for athletes with eating disorders
For athletes, exercise isn’t just a part of their sport. It’s also a significant part of their identity and daily routine. That’s why athletes resuming exercise in eating disorder recovery face unique challenges.
“Often, athletes have a strong connection to their team, and their identity as an athlete is an important part of their own self-worth,” Levinstein says. “Additionally, college and professional athletes may rush returning to athletic pursuits due to considerations related to scholarships or salaries.”
When resuming competitive activities, athletes in eating disorder recovery can follow a structured plan created with their eating disorder treatment team, sports medicine and sports performance staff. In some cases, we recommend athletes first return to their sport as a team manager or non-physically active participant.
Also, we recommend that coaches, athletic trainers and team doctors educate themselves on the harm of dysfunctional exercise and eating disorders. Those close to the athlete should know how to identify the warning signs of eating disorder relapse.
Learn more about eating disorders in athletes here.
How to help a loved one in recovery
Family members and loved ones play a critical role in eating disorder recovery and can help by supporting the individual at home. Sometimes monitoring is needed (e.g., some people will hide their exercise behaviors by waking up early to run or secretly exercising in their bedroom or bathroom).
The following five tips from the experts at ERC can help you support your loved one as they resume activity.
1. Focus on a variety of activities
You may have enjoyed going with your loved one to go to the gym, taking part in 5Ks together or attending group fitness classes. Families that focus on physical activity often -- such as those that run marathons or play soccer together -- can try to connect through other activities, such as attending a festival together, dining out, or watching movies. If you have in-house exercise gear or machines, you may want to store them out of sight.
2. Watch for discussions about nutrition, supplements, food or weight
We recommend people in recovery seek out supportive situations to avoid possible triggers. Loved ones can play a major role in this; helping the person in recovery identify what this means to them. Joining exercise classes in locations that discuss or promote weight loss or the use of nutritional supplements may present significant challenges for individuals. Be mindful when attending health or gym classes in schools or universities because they might promote calorie counting, weighing and exercise tracking.
3. Be careful on social media
Those in ED recovery may benefit from unfollowing exercise- and weight-focused accounts and removing/unfollowing friends that could trigger eating disorder thoughts and behaviors. Help your loved one adjust their social media settings so these types of posts aren’t being suggested.
4. Stay in touch with the treatment team
As movement is added back in, loved ones can encourage patients to remain in outpatient therapy. “Family members can help make sure the prescribed exercise plan is being followed,” Levinstein says. “They can also help communicate a patient’s challenges, progress and goals to everyone on the team—primary care doctor, dietitian and therapist—as long as they have the consent to do so.”
When to stop exercise in ED recovery
People with eating disorders and related mental health struggles sometimes struggle with black-and-white thinking that leads to extreme or all-or-nothing behavior. This type of thinking can make it difficult for them to achieve a balanced relationship with exercise. Family members can help make exercise helpful and reduce the chance of harm by watching for signs of relapse.
“Just like everything else in life, there is beauty in the grey space,” Levinstein says. “Different types of movement can serve different functions. But if disordered thoughts and urges are motivating the exercise behavior, activity that would often be considered ‘good’ can quickly turn into ‘bad’ or unsupportive behavior."
If exercise starts to feel overwhelming or triggering for your loved one, encourage them to talk with their treatment team and adjust their exercise plan accordingly.
Exercise during eating disorder treatment
During treatment at ERC, individuals may receive a structured amount of moderate activity during the day if they have been cleared by their treatment team. We closely monitor any significant changes in someone's exercise-related attitudes and behaviors, such as exercising to compensate for food intake or exercising to cope with anxiety about changes in their body.
Excessive/compulsive exercise recovery
Those with a history of excessive or compulsive exercise can work with their treatment team to create a detailed exercise plan that can help to reduce the risk of harm. For these individuals, the return to exercise will be unique and depends on several factors, including:
- Progress in recovery
- Medical status
- Exercise history
- Attitudes, thoughts and feelings about exercise
- Rationale behind the decision to return to exercise
During this process, the treatment team works closely with the individual in recovery, their loved ones, and their outpatient providers to develop a reasonable, sustainable plan that can be maintained after treatment ends. The individual can and should be involved in this decision making process. Exercise physiologists and recreation therapists can also be helpful in developing this plan.
Find help today
If you or your loved one has a complicated relationship with exercise, you can connect with one of our mental health professionals today or call us at (866) 622-5914 to get matched with the exact support you need.
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Written by
Written by
Written by
Adee Levinstein, MS, RD, LD, CEDS-C
