Well ain’t that a controversial topic for discussion….
In the spirit of this week being #Eating DisorderAwarenessWeek, I thought I would bring that into our lil regular Friday Fitness chat.
I knew it would be a big deal. I know that many will not agree with my words, but hear me out, have you ever thought that treatment and exercise could co-exist when looking at eating disorders?
I know what you’re all thinking.
Exercise is a method to fuel eating disorders
Exercise is a means of dropping weight and burning too many calories
How the hell is exercise going to help put weight on when clearly it just increases their energy requirements?
This is why this topic is a great one to discuss.
The points above are completely valid. In fact, those are the beliefs that many professionals give
or yell if the thought of exercise is brought up.
Take me for example, during my short time at the Oakville outpatient program for family therapy, it happened to slip out that I was going to be starting to slowly get into training (this was a few months post-inpatient) and my therapist freaked the eff out. Like I’m not kidding, she actually called my house and my parent’s cells and left frantic messages saying “Chelsea is not to workout!!!!”
Not that her words stopped it from happening, and honestly, we left that place faster than we came in (not because of that incident, but a bunch of other things..), but I’m just trying to give you an idea of how most clinicians feel about this topic
I.e. They are mostly against the thought of exercising.
Like I said, these arguments are all valid concerns and I see where they are coming from…
~I was a compulsive exerciser
~Most use it as a way to burn more calories and loose weight
~Most don’t know limits or when to stop
~Many can let it consume them and take over their lives
So I will say again, I understand their fears, but look at it from another perspective. When you just say NO and/or NEVER AGAIN, where does that get you? It teaches the individual nothing about control or other benefits aside from the superficial ones. It tells them that they have lost a free right to do something many people do. It places restrictions on them, which can lead to them deciding to go and do it anyways. Lastly, it prevents them gaining some of the many benefits you get from exercise that can be critical to the health of a person struggling with an eating disorder (*provided they are stable enough to perform exercises) such as bone and cardiorespiratory strength, helping with psychological disturbances, distraction from nagging negative and obsessive thoughts and potential social opportunities.
There are many people I have seen who have gone from treatment to the gym and are strong, independent people who are in control and did not slip back into old habits. They successfully took their health into their hands and chose to use exercise as a way to ‘come back’ and heal. A way to gain strength when their body was so weak before. A way to build confidence in themselves and eventually find that the gym is more than a place to burn calories. It’s gives them a place to deal with their emotions and re-build themselves physically and psychologically.
So with all of that being said, I wanted to present you with some research on the topic and how these types of interventions have faired in the treatment of eating disorders. I mean, you have heard my story and I could give you anecdotal evidence of the possible benefits for some, but does it actually show more pros than cons in treatment settings?
Lets find out.
To be honest, I was shocked at the number of articles I actually found. I still believe most are completely dead set on NO EXERCISE but there was a surprising number of studies and pilot programs in treatment facilities exploring the use of exercise as intervention.
I will stick to the main findings of each study and link each so that you can read more if you desire. I am also going to label them in order of earliest to latest. Lastly, I could have found more, but for the sake of your attention span, I left it to these interesting ones.
Thein et al (1999) –> “Pilot Study of a Graded Exercise Program for the Treatment of Anorexia Nervosa”
Main Findings: With the addition of exercise (amount based on % of ideal body weight IBW), the experimental group (diagnosed with AN) showed no difference in change in BMI or body fat, suggesting that the exercise did not inhibit the primary goal of weight gain. The EXPT group also saw a general increase in quality of life measures while the control saw a trend downward from their initial testing.
Szabo and Green (2002) –> Hospitalized anorexics and resistance training: Impact on body composition and psychological well-being. A preliminary study
Main Findings: Study included a non-AN group (exercise group and non-exercise group) with a group of girls currently in an inpatient facility for AN (exercise and non exercise groups). They were both on an 8-week training program of resistance-based exercises. There were trends found for the psychological variables, however it was speculated that perhaps 8 weeks was not enough. Interestingly enough, there was no decrease in weight of the ED-exercise group but a significant drop in those not in the exercise group.
Lutter and Smith-Osborne (2011) –>Exercise in the Treatment of Eating Disorders: An Alternative View
Main Findings: Exercise was significantly associated with greater improvements in eating disorder and depressive symptoms where the number of METS was associated positively with improvements in the measures of depression (BDI) and eating disorder behaviours (EDI). This study was interesting because the exercise was equine based.
Hall et al (2016) –> Use of yoga in outpatient eating disorder treatment: a pilot study
Main Findings: Adolescent girls (all met the requirements for AN/BN/EDNOS but were clinically stable) in an outpatient eating disorder treatment facility attended 12 yoga classes at one class per week. After the intervention, there was no decrease in BMI and significant improvements in anxiety, depression and body image disturbance scores.
I did a yoga class or two when I was an inpatient at Sick Kids. This was for the advanced stages only but was a nice change of pace. Definitely saw first hand the mood enhancing features.
This article by Hausenblas et al (2008) also provides a good overview of 6 further studies showing the benefits of exercise based interventions in eating disorder populations on social, psychological and biological factors if you’re interested in even more reading 😉
Finally, here is an article, Bratland et al (2009), that discusses how exercise based programs are managed in treatment facilities and how many places actually have them! It was limited to a few countries in Europe, but can provide some insight for how they could be implemented and managed here.
To conclude, many articles find that there are benefits to exercise in both outpatient and inpatient treatments for eating disorders. Also, rarely did any study (I didn’t find any) report negatives (such as weight loss or stalling the weight gain process) of incorporating exercise into the programs.
I want to say that, yes I know it may take more work and there will have to be strict guidelines in place, like ensuring they are stable enough to participate, etc, but from what I see from research and from my own experience I definitely think that it would be something to really look into further and do more pilot studies on.
Weight gain is already hard enough, try to make it easier on us all. Plus, by being exposed to it in a controlled setting it can also help to make the transition back to ‘reality’ potentially more smooth.
Something I would like to know is if incorporation of exercise during treatment can lower the risk of over exercising or going back to negative exercise habits when they are discharged.
What are you thoughts?