Should Eating Disorder Treatment Include Exercise?

Despite the fact that exercise may improve a range of biopsychosocial outcomes in patients with eating disorders (ED), exercise does not figure prominently, if at all, as a currently established adjunct within ED treatment. Many researchers focus on the deleterious effects of compulsive exercise behaviors as a means of maintaining ED, as opposed to regarding its potential as a treatment tool. In this article, we delve into exercise as an eating disorder treatment can be helpful, especially with the emotional aspects.

Statistics Support Exercise as an Eating Disorder Treatment

Eating disorders affect nearly 2.4% of the female population, and remain the leading cause of death among all psychiatric disorders. This frightening statistic, coupled with the estimated 39% comorbidity rate of excessive exercise tendencies, points to a need for prudent and cost-effective treatment programs. Exercise in a controlled environment might represent an innovative and practical approach for those dealing with ED, provided they have received medical approval to participate.

Benefits of Safe Movement

Regular exercise aligns with improvements in several physiological, psychological, and social benefits, even for the most acute ED patients. Statistics reveal how a regular exercise program can reduce substance abuse (that often accompanies some eating disorders), while simultaneously facilitating improvements in ED symptoms/warning signs such as self-esteem, anxiety, depression, negative mood, and body image.

While a majority of recreational gym-goers cite “seeking a more positive frame of mind” as a primary reason for exercise, individuals suffering from disordered eating of any kind often become overexercisers, but for the same reason. Because patients with ED may resort to isolated eating practices and reduced social contact, exercise may aid in fostering interactive relationships. From a physical/physiological aspect, exercise as a can aid in diminishing the uncomfortable sensations of bloating and distention typically observed during the re-feeding process.

Data on experiments that examine excessive exercise and its concomitant pathology reveals that a direct relationship between exercise behavior and ED symptoms may in fact not exist. Scientists Cook and Hausenblas determined that one’s pathological motivation to exercise, and not the exercise behavior per se, forms a critical component in eating disorders. Professionals who deal exclusively with ED clientele have historically felt that caloric requirements for weight gain must increase for existing anorexia nervosa patients, even without added exercise. However, current studies indicate that even when including a moderate amount of exercise, satisfactory levels of weight gain do seem achievable for severely underweight patients.

The Brain Effects of Exercise on Eating Disorders

Moving from a strictly medical/physiological model to a psychological one, exercise as part of treatment seems to render patients more willing to look at the underlying reasons for their eating disorder. Individuals suffering from anorexia nervosa and bulimia often display stunted or disturbed family/peer relations, such as purposeful isolated eating and extreme social avoidance. Exercise, particularly in a group dynamic, may aid in improving these behaviors. For active bulimics, structured exercise offers the potential for stress release/management, as daily stress seems to trigger bingeing/purging. Professional therapists and sports psychologists can tailor one’s exercise dynamics to maximize overall effectiveness and long-term adherence, while fostering a safe social environment.

Researchers in the field looked at six physical activity interventions with volunteers suffering from varying types of eating disorders, to assess the effectiveness of exercise as an eating disorder treatment. Patients engaged in either aerobics classes, resistance training, both, or no exercise at all as a control group. The former medical dogma (underweight women should refrain from engaging in additional physical activity during treatment), guided by the maligned belief that they use exercise solely to lose weight, clashed with the emerging preliminary data. As in so many other studies of this nature, the psychological benefits of exercise included fostering body satisfaction, a positive state of mind, and improved quality of life.

Some professionals dare to espouse that exercise in and of itself causes eating disorders. The findings of these six studies indicate quite the opposite, suggesting that such beliefs clearly overlooked the potential usefulness of healthy exercise as an eating disorder treatment tool, seeing how exercise can help to control the pathological motivation driving excessive exercise behavior. Those in the exercise groups demonstrated a reduction in their former attitudes toward exercise as an obligatory punishment for their bodies. If all of these positive outcomes coexist with a consistent health-restoring weight gain, treatment centers might consider revamping their recovery processes to include some form of monitored physical activity.

The Feldenkrais Method^® and ED Treatment

The Feldenkrais Method^® operates under the theory that focused, gentle movement can promote willingness to choose different paths toward self-improvement. Professionals in this field teach that physical movement reflects the manner in which one moves through life. As such, the Feldenkrais methodology seeks to harness/empower emotional regulation and problem-solving capabilities.

Moshe Feldenkrais, the founder of this movement, said, “We move according to our perceived self-image.” By raising self-esteem through movement/kinesthetic awareness, patients often uncover their subconsciously-driven habits and tensions, ultimately cultivating new ways of moving through each day.

Those suffering from eating disorders typically lack the resources required to face the overwhelming challenges associated with healing. Through the Feldenkrais process, ED patients “learn how to learn,” observing patterns in their daily movements/life choices, facilitating self-discovery, and learning new and healthier self-regulation mechanisms.

Feldenkrais encourages “emotional flexibility/integration” qualities that thwart the existence of an eating disorder and promote recovery. Experts note a reciprocal relationship between improved well-being/body image and a decrease in ED risk factors/prevalence/maintenance.

Somatic Understanding Leads to Psychological Change

Such somatic education treatment offers patients tools for learning “from the inside out,” commonly known as neurological change, by challenging the patient to think about the following:

• How did it feel to explore the inside of your body/mind?
• How might you describe the sensation of transitioning into the unknown?
• What emotions accompanied holding onto those feelings?
• Could you locate a “safe place” within your body where you can sit with these emotions?
• When and where might you have experienced similar emotions/thought processes?
• Can you see yourself moving forward with these new options for initiating change?

Eating disordered patients who participated in adjunct somatic treatment report a new-found sense of self-awareness, self-control, self-determination, and self-regulation. Some report feeling “more comfortable in their own skin” and more connected, no longer viewing themselves simply as a collection of damaged/shameful body parts. One recovering bulimic/drug addict who existed as a slave to her compulsions observed, “If I can create changes in mood and body sensations so readily through this work, there is no reason to believe I can’t make changes in other areas of my life as well.”

More research into this field will hopefully cast an even brighter light on recovery options for individuals living with emotionally debilitating eating disorders. (This author writes from a personal history with anorexia nervosa for most of her life, and truly believes she can continue to safely incorporate exercise as a therapeutic training tool rather than a brutal punishment to her body for a damaged psyche. Following years of intensive treatment, her strength now lies within each muscle fiber!)

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References:

1. https://pubmed.ncbi.nlm.nih.gov/16864521/
2. https://www.feldenkraisguild.com/article_content.asp?edition=1&section=23&article=143
3. https://digitalcommons.usf.edu/cgi/viewcontent.cgi?article=3375&context=psy_facpub
4. https://feldenkrais.com/about-the-feldenkrais-method/
5. https://journals.lww.com/acsm-essr/Fulltext/2008/01000/Can_Exercise_Treat_Eating_Disorders_.9.aspx?WT.mc_id=HPxADx20100319xMP
6. Hausenblas, Heather A.; Cook, Brian J.; Chittester, Nickles I. Exercise and Sport Sciences Reviews:January 2008 – Volume 36 – Issue 1 – p 43-47