Eating Disorders and Exercise - Eating Disorders Victoria
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Eating disorders and exercise

Home ~ Eating disorders A-Z ~ Eating disorders and exercise

This page outlines how exercise intersects with eating disorders. It includes the signs of excessive exercise, how exercise is managed during recovery, and what to consider when returning to exercise.

When does exercise go too far?

Engaging in enjoyable movement is an important part of maintaining overall wellbeing. However, sometimes engaging in too much exercise can be a sign of more complex issues.

Exercise can be considered excessive when someone shows signs of any of the following.

  • Prioritising exercise over other important life activities, like work, school, social outings and sleep
  • Frequently engaging in exercise at times that may not be considered appropriate and feeling unable to stop
  • Engaging in a high volume of exercise daily (from 3+ hours)
  • Exercising despite experiencing sickness or injury, and without medical clearance
  • Distress if unable to exercise

Some symptoms of over exercise can be:

  • Overuse injuries
  • Tiredness
  • Dehydration
  • Withdrawal symptoms if unable to exercise, such as moodiness, irritability, anxiety and depression
  • Weight loss

When someone engages in excessive exercise they may be considered to be experiencing an exercise addiction or exercise dependence. Many argue this should be classified as a standalone disorder, however the term is not currently recognised in the in the DSM-5 as a behavioural addiction. Rather, the terms ‘primary’ and ‘secondary’ exercise dependence are used to help describe this behavior. When someone is experiencing excessive exercise as a symptom of an eating disorder, it is known as secondary exercise dependence.

Excessive exercise and eating disorders

Excessive exercise is a common symptom across a range of eating disorders.

Excessive exercise is often seen in those with:

Excessive exercise is also seen in those with Muscle dysmorphia. While Muscle dysmorphia falls under the category of anxiety disorders, it can exist alongside eating disorders.

For those who experience excessive exercise as a symptom of their eating disorder, dependence on this behaviour can be very difficult to stop. Many describe their need to exercise or move their body as a compulsion, similar to OCD behaviours.

It can feel very scary to have to stop exercising as part of eating disorder recovery, especially when the exercise or movement is compulsive and involuntary.

Did you know?

Those who experience exercise dependence are four times more likely to also experience an eating disorder compared to the general population (Trott et al, 2020).

Exercise in recovery

Decisions around exercise during recovery should always be made in consultation with medical professionals. However, as a general rule, most people will be required to stop exercising until full weight restoration has occurred at a minimum.

Needing to stop exercise can be a significant barrier for people in recovery. For those who experience exercise dependence, taking away exercise may seem like an impossible request. However, in the context of eating disorder recovery, it’s important to remember why this is so important.

Exercising in recovery can undermine your progress in recovery both physically and emotionally.

  • Physically, because increased energy expenditure through exercise means increased nutritional needs which can already be challenging to meet in recovery. Additional stress on the body can impact hormonal regulation, which can cause significant physical issues, such as weakened bones and higher blood glucose and cholesterol levels.
  • Emotionally, despite how minor the exercising may feel, your eating disorder may still feel it is a way of compensating for eating, and in doing so, means that the eating disorder is still having control.
Incidental exercise

With traditional exercise out of the question in recovery, incidental exercise can sometimes take over as a way to engage in movement. Incidental exercise may include things like walking to the shops instead of driving, or cleaning the house vigorously. It’s important to reduce incidental exercise just as you would traditional exercise, as this can be just as detrimental to recovery.

While stopping exercise during recovery is important, it doesn’t mean you will need to stop exercising forever. Below we have detailed what to think about when considering returning to safe movement.

Important!

Full weight restoration is not only crucial for those considered underweight. Weight restoration is required for the improvement of psychological and physical symptoms for people with restrictive eating disorders in all body shapes and sizes. Weight restoration, no matter the starting point, is the single biggest predictor of long term recovery.

Returning to exercise safely

Knowing when, how or even if you should return to movement and physical activity can be a very complex question. At EDV, we know the worries that you have, along with the worries of carers and health professionals.  

Are you ready physically?

This of course is a question best answered by your treatment team. It is essential that before you consider returning to movement, you have the “go ahead” from your treatment team that your body is able to engage in movement safely. Returning to movement shouldn’t be a rapid change, but a gentle process that works for your own unique body and its capabilities. If you get given permission to engage in movement, make sure you understand from your team what type of movement they mean. Are they talking about a stroll around the block? Or something with more intensity?  

Are you ready emotionally?

It can be helpful to think about what a return to movement looks like and feels like for you. Are you expecting to immediately return to high intensity workouts? Is there a part of you that only values movement that is high intensity? What does a good relationship with exercise look like?

Exercise is a celebration of what your body can do, it can help you feel energised and connected with your body. Something to ask yourself might be why do I want to exercise? Is it to feel the things listed above? If your response is more towards wanting to  change your body, to compensate for what you have eaten, or if you feel that you HAVE to exercise (i.e. it causes anxiety or stress if you don’t engage in movement), maybe exercise isn’t the best idea for you just yet.

It is essential that you feel emotionally prepared for a return to movement and it can be helpful to discuss this with your treatment team and other supports. Often we look back on what our movement regime was like when unwell or prior to being unwell and want to return to that, but often this regime is fueled by weight stigma and diet culture, whether you realized it or not! This is certainly not the case for everyone, but it can be helpful to spend time mapping out what your experience of movement has been, and make sure to share your answers with your supports:  

What movement or activities have been fueled by the ED or unhelpful thinking patterns? 

  • How has this type of movement made you feel emotionally & psychologically? 
  • How has it made you feel physically? 
  • What thoughts might you have when engaging in this type of movement?
  • How would you feel (physically & emotionally) after the movement? 

What movement or activities have you previously enjoyed or do you currently enjoy? 

  • How has this type of movement made you feel emotionally & psychologically? 
  • How has it made you feel physically? 
  • What thoughts might you have when engaging in this type of movement?
  • How would you feel (physically & emotionally) after the movement? 
How will you keep an eye on your safety?

Returning to movement can be exciting and scary. We may start out feeling recovery focused and positive, but it is possible to experience a return of unhelpful thoughts around movement. So, what can you do to help stay safe when returning to movement?

Perhaps you want to keep regular appointments with your treatment teams, keep a log of how the movement makes you feel, or only engage in movement with a friend or family member. It is important that you keep safety as a key aspect of your plan to return to movement. Be aware of the physical experiences of movement and any sensation or bodily experience that is worrying or strange should be followed up by a health care professional. Similarly, if you feel a return of unhelpful thoughts. It doesn’t mean that you can’t return to movement, or that you will never feel safe engaging in movement, it is just a sign that perhaps your plan needs to be tweaked to adjust to where you are in your journey at the moment. 

Where do you begin?

This might be the most overwhelming question of them all! In a world full of diet culture, before and after pictures and a gym on every corner advertising its latest challenge, it can be an absolute mine field trying to figure out how to start safely!  

Engage a professional

It can be helpful to link in with someone who specializes in the body and how it moves to help guide you through these initial stages. Did you know our EDV database keeps a list of physiotherapists and exercise physiologists that are able to safely support eating disorder clients? 

  • Physiotherapist: A health professional who specializes in promotion of health through supporting movement and functionality of bones, muscles, cardiovascular system, nerves and other parts and systems of the body. Visit Physiotherapy – Allied Health Professions Australia (ahpa.com.au)
  • Exercise Physiologist: A health professional who specializes in using exercise and movement to support and rehabilitate the body, optimizing health and quality of life. Visit Exercise Physiology – Allied Health Professions Australia (ahpa.com.au)
  • Yoga: Though it is not widely known, a few yoga classes are popping up around Victoria that are suitable for people who are recovering from an eating disorder. The classes focus on connection to the body and rebuilding that relationship, rather than flexibility, strength and endurance. If you aren’t able to find an ED friendly yoga class, you might like to explore a yoga class for trauma. The general underpinnings of yoga for trauma and yoga for ED recovery have a strong cross over and aim to provide a space to safely explore the internal experience through movement. If this type of yoga isn’t available to you, a good place to start is by attending Yin Yoga or Restorative Yoga classes at your local studio or online. Make sure you declare you are in recovery on your health waiver, so that the teachers can support you appropriately. 
  • Personal training: Personal training can be a nice way to get 1:1 support on returning to movement and activity. It is essential, however, that you find a trainer who is informed about eating disorders and trauma, as well as understand the following:Health At Every Size: HAES Australia Inc – Home
    Safe Exercise at Every Stage Guidelines: SEES (safeexerciseateverystage.com)
    Relative Energy Deficiency in Sport: Relative Energy Deficiency in Sport (RED-S) | Clearinghouse for Sport
  • Plan your own: For some this might be a bit daunting. Start small and slow and make a plan before you begin. It can be helpful to start in an environment that is comfortable for you first, rather than heading off to your local gym. Get someone you trust to review your plan and help monitor that you aren’t overdoing it. Consider what your priorities are in your return to movement and ensure that they align with your healthy/recovering self, rather than your ED self. It doesn’t have to be a complex plan and might start with walking around the block once or twice a week.Go slow, listen to your body and support yourself as best you can. 

Need help?

Eating Disorders Victoria has put together a step-by-step guide take if you are concerned that you may be experiencing an eating disorder. It also covers how to talk to family or friends about what you’re going through. Remember that you have the best chance of success if you include people you trust on your journey.

Visit My Recovery Journey

References

Mike Trott, Sarah E. Jackson, Joseph Firth, Louis Jacob, Igor Grabovac, Amit Mistry, Brendon Stubbs, Lee Smith. A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 2020

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