I’ve been getting a lot of questions lately from clients about how to change their relationship with exercise, and what exercise looks like as part of the recovery process. It’s a sticky topic, for sure, and I’ve decided to tackle it here today. Or to at least start the conversation.
There’s a lot we don’t know
One of the things that is very clear is that exercise is an often neglected component of treatment, partially because well-tested research-based protocols don’t really exist, especially for the outpatient setting, which is where most people will spend the bulk of their time in the recovery process.
As clinicians, we are trained to use “evidence-based practice” – which is hard to do when solid evidence doesn’t yet exist. So we do the best we can, using the evidence that is out there, along with our own clinical wisdom and intuition, and we team together with the client to find what works for them. Not a perfect science to say the least – but none of the eating disorder treatment process is.
What we DO know
Numerous studies have shown that “dysfunctional” exercise behaviors often start before the eating disorder and are one of the last symptoms to resolve, probably in part because we aren’t very effectively addressing it in the treatment process or fully understanding the functions it is serving our clients.
Another important statistic that we look at as clinicians is the fact that returning to exercise within the first 3 months of discharge from a hospitalization is a predictor of relapse (Carter et al, 2004). Thus, we are cautious when incorporating exercise.
To use an analogy I recently heard (I can’t remember where or I’d cite the source!) – we can list the health of benefits of drinking red wine. However, for an alcoholic, the risks by far outweigh the potential benefits, and we wouldn’t recommend they start consuming it. We look at exercise the same way – if it is too risky for a person, we may not recommend it, or we may recommend holding off for now until they are more stable in their recovery.
“In sum, evidence clearly indicates that DEX [disordered exercise] is related to ED pathogenesis, can disrupt treatment, can bring about relapse, and occurs across the spectrum of ED diagnoses.” — Rachel M. Calogero and Kelly N. Pedrotty-Stump in Treatment of Eating Disorders: Bridging the Research-Practice Gap, 2010.
And back to what we don’t know
The research that does exist is almost solely focused on young females with anorexia who have been hospitalized in inpatient or residential treatment programs where it is easier to carry out the research protocols and gather data.
This doesn’t tell us much about men, older adults, or folks with other diagnoses, particularly those with binge eating disorder – which is actually the most common eating disorder diagnosis now that it’s actually been added to the diagnostic manual.
Anecdotally, what we tend to see in those with binge eating disorder is that their relationship with exercise has been very off and on, and it tends to coincide with times that they are dieting or trying to be “good” or “healthy” with their eating. And when they fall “off the wagon” with food, the exercise tends to go away with it.
For people in larger bodies, they are constantly being told they “should” exercise and that it would make them healthier and would help them lose weight. They often go on to develop what has been coined “exercise resistance syndrome” which is essentially a mental and emotional block against being able to exercise in an enjoyable sustainable way.
How do we help these individuals find peace with exercise? Nobody really knows yet. So we as clinicians fumble through and do the best we can.
There is hope
I say all of this, not to be a pessimist, but to paint a realistic picture for you of where the science is in our field surrounding this topic. I want you who are working on this issue for yourself to know that you have not failed in any way. There are just a lot of unknowns, and there’s no “right way” to go about it in your recovery process.
And just because the research is lagging behind doesn’t mean it isn’t something that your treatment team can help you with. Your doctor can tell you if you are medically stable enough to be cleared for exercise. Your therapist can explore your thoughts and feelings surrounding it, and your dietitian can help you nourish your body for movement. All 3 of these pieces are important.
Getting started – reflection questions:
–Step back and take a break from exercising or telling yourself you “should” be exercising: Sit with the discomfort of not doing what society tells us we must to do be “healthy.” Show yourself that you CAN tolerate this discomfort. The eating disorder may throw a tantrum and try to shame you for it. Weather the storm.
–Consider this: If exercise didn’t burn calories, what would you want to do? By removing calories and weight from the equation, it frees you up to mentally explore what might actually feel good or be enjoyable.
–Reframe exercise as “movement”: We’ve been given so many cultural messages about exercise should’s and shouldn’t’s and the idea of “no pain, no gain” and that “more is better.” These messages aren’t going to help you recovery. By reframing it as “movement,” you allow your brain create new associations with the word.
–Cultivate mindfulness: Be aware of the thoughts, beliefs and fears you have related to exercising or not exercising. Notice these thoughts without judgment, just awareness. When you do movement, stay fully present in your body, connected with the sensations and the way it makes you feel. Try taking a 5 minute mindfulness walk to play around with this and then journal about the experience.
My hope is that you’ll take away from this some insight into the complexity of this topic, and the huge hurdles we have to overcome with the cultural messages we are bombarded with in this area.
Each person’s relationship with exercise is different, so their recovery process surrounding it is also going to be unique to them.
What have been your challenges with exercise? Email me your thoughts here. I read every response.