Background: Physical activity/exercise is often extolled for its physical and psychological health benefits. Nevertheless, unhealthy physical activity is common among eating disorder patients. If patients have inappropriate/unhealthy exercise as their symptom complex, should it be treated? Contrary to "conventional wisdom", literature on exercise suggests physical activity is safe and beneficial.
Physical Activity: Should it be Exorcised or Exercised in Eating Disorder Treatment?
I. Introduction
A. Some eating disorder treatment programs do not allow physical activity by patients
during treatment or after discharge
B. Rationales/Reasons for prohibiting physical activity include:
1. It is medically unsafe
2. It will impede weight gain in patients needing weight restoration
3. It is an addiction and must be avoided.
II. Practical Considerations
A. Exercise is recommended as a part of a healthy lifestyle.
B. It can be a healthy way to discharge troubling emotions such as stress.
C. It is difficult to control in intensive treatment.
D. Intensive treatment is an ideal time to treat symptomatic exercise.
III. Excessive, Unhealthy/Unbalanced
A. Normal, healthy exercise
B. Excessive or unhealthy/unbalanced?
IV. Evidence for including exercise in treatment
A. Evidence suggests exercise is safe during treatment.
B. Evidence suggests that exercise can facilitate treatment.
V. Implementation of adding exercise to treatment
A. Exercise is considered when treatment staff feels it would not increase risk
B. Exercise specialist consults with patient and therapist regarding recommendations
C. Dietitian recommends caloric increase to account for exercise/pt agrees
D. Exercise may be monitored
E. Patient completes an exercise debriefing
F. Exercise decisions are tentative and related to treatment progress
VI. Treatment of unbalanced/unhealthy exercise
A. Change the patient’s attitudes and beliefs about exercise.
B. Change the relationship between eating and exercise.
C. Increase body awareness while decreasing body obsessiveness.
D. Assist patients in meeting needs previously met by, or associated with,
unhealthy exercise.
E. Guidelines/Recommendations
VII. Questions/Discussion
Physical activity or exercise is often extolled for its physical and psychological health benefits. Nevertheless, unhealthy physical activity is a common symptom among many eating disorder patients. If patients have inappropriate/unhealthy exercise as part of their symptom complex, should it be treated? Conventional wisdom suggests that physical activity should not be a part of eating disorder treatment because it would be medically risky and would impede weight restoration in patients who need to gain weight. Additionally, some healthcare professionals believe that some of these patients have an “exercise addiction;” that is, the activity is thought to be out of the patient’s control, and thus should be avoided. As a consequence, should eating disorder patients be forbidden from exercising not only while in treatment but also after treatment for a specified period of time or even for a lifetime despite the apparent health benefits of regular healthy exercise? Contrary to “conventional wisdom,” the literature on exercise in eating disorder treatment suggests that not only is physical activity safe for eating disorder patients, it is also beneficial. This workshop will discuss when and how symptomatic exercise might best be treated. It will also describe how the idea was presented to the treatment staff at an eating disorder treatment facility, and how it is currently being implemented. Additionally, presenters will discuss why intensive treatment, especially at the inpatient or residential level of care, would be the ideal time to re-educate the eating disorder patient regarding cognitions and attitudes related to healthy exercise and to retrain patients regarding how to make exercise fun and social rather than compulsive, as well as how to appropriately use exercise for emotional regulation.
Kimberli McCallum, MD, CEDS, FAPA, is board-certified in child, adolescent, and adult psychiatry. Kim is a fellow of the APA and Associate Professor of Clinical Psychiatry at Washington University. She is a psychotherapist with a range of skills, including DBT, CBT, FBT, ACT, and psychoanalysis. She received her medical degree from Yale, completed training at UCLA Neuropsychiatric Institute, and completed her Child/Adolescent Psychiatry Fellowship at Washington University. She serves on the board of directors of NEDA and IAEDP. She has developed several eating disorder treatment programs including McCallum Place, The Victory Program, and Cedar Springs Austin.
Ron Thompson is Co-Director of the Victory Program at McCallum Place. He has been a consultant on eating disorders to the NCAA, where he coauthored the "NCAA Coaches Handbook: Managing the Female Athlete Triad." He also coauthored the Disordered Eating section of the IOC Medical Commission’s Position Stand on the Female Athlete Triad. His publications include "Bulimia: A Guide for Family and Friends," "Helping Athletes with Eating Disorders," "The Exercise Balance," and "Eating Disorders in Sport." He is a Fellow in the Academy for Eating Disorders (AED). Dr. Thompson and Dr. Roberta Sherman jointly received the AED’s 2008 Leadership Award.
