The Cessation of Exercise:
I was never specifically told by my recovery team to stop exercising, but there was an unspoken understanding between my treatment team and I that the amount of exercise I was doing and the amount of food I was eating wasn’t going to get me anywhere in recovery. If anything, it was going to send me straight to intensive outpatient or residential treatment. On top of that, it was kind of hard for me to exercise when I felt like I was going to pass out after walking half a mile at the park with my mom.
I knew what to do and I wanted to get better, so I stopped….kind of.
It took a while, but I eventually cut out all cardio for a few months in hopes that I would be able to recover faster. I lifted weights some, but most of the time I left the gym hungry and frustrated. In the beginning of recovery, exercise wasn’t appropriate for me, but that didn’t mean that cutting it out was easy. I became extremely irritable, moody, and frustrated when I wasn’t able to use exercise as a coping mechanism to my anxiety and depression.
When I gave up exercise, I was giving up apart of my identity. I was known for my discipline and dedication to my workout regimens. I was often complimented on my body by others, many of them wanting to know what “my secret” was. If they only knew that the secret to my success was self-starvation and a debilitating dependency on exercise, I don’t think they would have been so eager to jump on my bandwagon.
The thought of exercise cessation, even for a brief period of time, terrified me. All I could think about was my body and the weight that I would gain. I followed friends on Instagram that were constantly posting pictures or videos of themselves working out. It seemed so unfair to me that they could workout and I couldn’t.
I had to be honest with myself and remind myself that I wasn’t eating enough to perform the type of exercise that I was used to. I had to stop comparing myself and my journey to other people’s. It was difficult, but I knew it was what my body needed. I needed to restore weight to get better. Weight restoration was the key to all of the medical complications that I was experiencing due to chronic food restriction and excessive activity. My heart rate would only normalize with consistent refeeding. My period would only come back if I stopped exercising so much. My sleeping patterns would only normalize if I stopped going to bed hungry. My body and soul would only recover if I learned to survive without turning to maladaptive coping mechanisms.
It was only when my body and mind were healthy enough to reintroduce exercise that I began to do so. Some people who go through recovery will never be able to go back to the same form of exercise they depended on during their eating disorder. It’s too triggering and provokes too many unhealthy thoughts. Others are able to go back to exercise that they once did truly love before ED took over. There is no right or wrong, just whatever is right for your situation during whatever season of recovery you are in.
The following guidelines are adapted from Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines and Can I Exercise Now? Exercise During the Recovery Journey.
When is it OK to exercise?
- Medically appropriate: Safety is the primary concern when reintroducing exercise in eating disorder recovery. All precautions must be taken to prevent harm. If you fail to maintain an adequate body weight, (as determined by MD), exhibit heart beat irregularities/abnormalities, and/or exhibit signs of osteopenia, you should not exercise. You should also stop exercising if you experience a shortness of breath, dizziness, chest pain, nausea, vomiting, cramping, or arrhythmia.
- Adequate nutrition: Exercise is only appropriate if nutritional needs are consistently met, and exercise is consistent with recovery goals established by your treatment team. If you are fully weight restored, calories in must equal calories out. If you are not fully weight restored, calories in should be greater than calories out.
- Weight restoration: Exercise should not be recommended if you are not either consistently gaining weight towards your weight restoration goal, or you are completely weight restored.
- Demonstrated the ability to refrain from eating disorder behavior: You should exhibit a capacity to refrain from eating disorder behaviors (restriction, compensatory measures), before you are allowed to reintroduce exercise.
- Introduction to exercise: Your treatment team should work collaboratively to develop an individualized exercise program. If you have not been cleared to exercise, you should voice that concern to your treatment team. They will be able to re-evaluate and determine if exercise is appropriate at this time.
*A written contact that details program rules, goals, outcomes, expectations, and contingencies for the progression and regression of physical activity should be agreed upon by all members of the treatment team and yourself. The contract should discuss who you will exercise with, what you will be doing, when you will be doing it, and why you want to do that activity for exercise. The exercise plan should start with mild intensity and slowly build to moderate intensity.
- Value based experience: The exercise should line up with the your true values, rather than your eating disorder’s.
- Explore the experience and the outcomes: Afterward, you should “debrief” thoughts, sensations, emotions, and feelings evoked by exercise with your treatment team to determine its level of appropriateness related to the individual’s recovery.
- Describe your current relationship with exercise.
- Are you currently allowed to engage in physical activity? Why or why not?
- What are some things that inhibit you from engaging in physical activity?
- Is your current relationship with exercise one that is beneficial or detrimental to your recovery? Explain.
- Cook BJ, Wonderlich SA, Mitchell JE, et al. Exercise in Eating Disorders Treatment: Systematic Review and Proposal of Guidelines. Medicine & Science in Sports & Exercise. 2016;48(7):1408-1414. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938770/
- Jeffrey S. Can I Exercise Now? Exercise During the Recovery Journey. 2017 EDRDpro Symposium.