Navigating Exercise in Eating Disorder Treatment: Balancing the Benefits and Triggers

While an effective treatment plan for eating disorders typically involves a combination of therapeutic modalities, nutritional support and medical management, the role of exercise can be highly complex and multifaceted. Incorporating exercise into an eating disorder treatment plan requires careful consideration, as it can be both beneficial and potentially triggering. Yet there are ways to include exercise during and after treatment while mitigating triggers and prioritizing overall, long-term recovery.

A clinical literature review of exercise and eating disorder treatment found core themes that can support the therapeutic use of exercise in treatment, including working with relevant experts, beginning with mild-intensity exercise, focusing on positive reinforcement and debriefing after exercise sessions. Moreover, similar to other facets of eating disorders, studies point to the critical importance of a collaborative approach among both clinicians and other supportive networks such as peers, athletic staff, educators and more.

Understanding the role of exercise in eating disorder treatment

It is well documented that exercise can have positive effects on both physical and mental well-being. Regular physical activity improves mood, enhances body image, increases self-esteem and supports stress reduction. Yet individuals with eating disorders can have a distorted relationship with exercise, often using it as an eating disorder behavior.

Studies have found that patients with eating disorders can experience intense guilt when missing exercise and/or exercise solely for reasons related to weight and body shape. This dynamic must be addressed during eating disorder treatment in order to develop a healthier, well-balanced mindset around exercise and any kind of physical activity.

And while the suggestion of including exercise in eating disorder treatment was previously viewed as controversial, a growing body of evidence suggests that closely monitored, nutritionally supported exercise is safe and may produce multiple benefits.

Is exercise appropriate?

The incorporation of exercise into an eating disorder treatment plan should be done in collaboration with a multidisciplinary team including therapists, dietitians and medical professionals who are well versed in treating eating disorders. Their expertise and guidance can help determine if and when exercise is appropriate, based on the individual's physical and mental health. The incorporation of exercise into eating disorder treatment is not a one-size-fits-all approach; rather, it requires a team of experts to help determine if and when it is appropriate. All support systems should be aligned regarding treatment plan recommendations in order to reduce the chance of splitting, and work together in a collaborative way to facilitate long-term change.

Read: When Is It OK to Exercise After Eating Disorder Treatment?

Introducing exercise

The introduction of exercise should be approached with considerable caution, and one should consider the stage of treatment and the individual's readiness. In the early stages of recovery, it is often recommended to abstain from exercise entirely to allow the body to heal – and focus on establishing a more mindful, stable relationship with food while prioritizing nutrition. Exercise may gradually be reintroduced during later stages when the individual has developed healthier coping mechanisms and strategies, in addition to a more balanced relationship with both body and food.

Mindful movement

Mindful movement involves engaging in physical activities that prioritize enjoyment, bodily awareness and overall well-being rather than solely focusing on calories or body shape. Activities such as yoga, stretching, walking in nature or dance can be incorporated into the treatment plan.

Even unstructured activities like gardening and playing with pets can be considered mindful movement. The emphasis should be on connecting with the body's sensations, fostering self-compassion and appreciating the joy of movement rather than pushing for physical intensity or weight loss.

For any mental health condition, mindful movement can also involve the process of slowing down: being present in the moment and allowing that pause to help us decide what to do with our feelings or thoughts.

Setting goals for exercise

During eating disorder treatment and recovery, it is essential to establish exercise goals that align with the individual's physical capabilities, emotional state and treatment progress.

Encouraging self-compassion and self-care – rather than achievement or perfection – can help create a more positive exercise mindset. It is crucial to avoid rigid exercise schedules, tracking calories or punitive self-talk associated with missed workouts.

Monitoring exercise-related thoughts

Regular communication between the individual, treatment team and overall support system is vital to monitor the impact of exercise on recovery. Honest discussions about exercise-related thoughts, triggers and challenges help ensure that exercise remains a supportive aspect of treatment as opposed to a dysfunctional coping mechanism. If exercise begins to feel or manifest as overwhelming or triggering, adjustments can be made to the treatment plan accordingly.

Athletes and eating disorders

Athletes face unique challenges when it comes to exercise in eating disorder recovery, as exercise is not only a component of their sport but also a significant part of their identity and daily routine. Incorporating exercise into an eating disorder recovery plan for athletes requires careful consideration, understanding the impact on physical and mental health and finding a balance between healing and maintaining athletic performance. The drive for success can potentially lead to an increased risk of developing an eating disorder due to external pressures related to body image, weight categorization or performance expectations.

Treatment plans for athletes should also incorporate gradual reintroduction of exercise, monitoring and accountability, a supportive exercise environment and an individualized approach.

Overall, incorporating exercise into an eating disorder treatment plan requires thoughtful consideration, professional guidance and a focus on fostering a more positive relationship with movement. By taking a phased approach, prioritizing mindful movement, setting realistic goals and maintaining open and honest communication with the treatment team, exercise can become a positive and supportive component of the recovery journey.

For athletes, a multidisciplinary approach can – and should – involve a comprehensive understanding of the individual’s physical and mental health, performance goals and sport-specific demands. Recovery is about well-being in all aspects of life, and exercise should enhance, not hinder, the healing process. Practical guidelines for the clinical management and therapeutic use of exercise in eating disorder treatment must focus on empowering individuals with exercise as a tool for living a full life in recovery.

Read These Next:

• Compulsive Exercise and Eating Disorders in Athletes: A Comprehensive Guide
• Can I Exercise After Eating Disorder Treatment?
• Student Athlete Mental Health: Behind the Applause

Taking place at the 15th Annual Eating Recovery Conference on Eating Disorders, the on-demand session “Integrating Exercise Into Eating Disorder Treatment” will address the transition from medical clearance to the commencement of progressive activity in the early stages of eating disorder recovery. Presenters will focus on the benefits of activity and how to differentiate between movement, physical activity, exercise, fitness, anorexia athletica, compulsive exercise and addiction. The session will additionally clarify the necessary medical and therapeutic clearance at the initiation of programming and best practices for follow-up medical guidelines throughout participation. The discussion will conclude with an outline of supervised guidelines that not only incorporate reeducation regarding healthy and restrained activity, but also provide an in-depth description of how a variety of movement interventions such as walking, yoga and tai chi can enhance the recovery process.

Sneak Peek of the Session

Speakers:

• Adee Levinstein, MS, RD, LD, CEDS-S (she/her), nutrition manager
• Kelsey Horton, PA-C, RD (she/her), psychiatric physician assistant