Exercise in Eating Disorder Recovery
Understanding the Risks and When to Reintroduce Movement
For many individuals in recovery from an eating disorder (ED), exercise can be a complex and nuanced topic. While exercise is commonly thought of as a healthy behavior, it can have serious physical and psychological risks for individuals with EDs. The reintroduction of exercise in recovery requires careful, structured planning, emphasizing a focus on both physical safety and mental well-being. The Safe Exercise at Every Stage (SEES) guidelines, developed by a panel of ED experts, offer a framework for determining when and how to gradually reintroduce exercise safely. In this post, we’ll discuss the risks associated with exercise during recovery, when it’s appropriate to begin reintroducing movement, and how a step-by-step process can best support sustainable recovery.
Risk Factors of Exercise in Eating Disorder Recovery
The decision to incorporate exercise into eating disorder recovery is not one to take lightly. Some of the risks of reintroducing exercise too early include:
Medical Complications: Those in recovery may have health conditions such as heart irregularities, low bone density, or electrolyte imbalances. Vigorous exercise, especially if done unsupervised, can exacerbate these issues, increasing the risk of serious medical events like fractures, fainting, or cardiac complications.
Relapse into ED Behaviors: Exercise can easily become another method of compensatory behavior, with individuals using it to manage weight, shape, or caloric intake. Without strong emotional and psychological resilience, exercise can trigger a return to disordered thinking and behaviors, undermining recovery progress.
Increased Compulsivity: Individuals with EDs often develop a complex relationship with control and perfectionism. Exercise, particularly if started too soon, can become compulsive and reinforce the rigid thought patterns associated with eating disorders.
Given these risks, healthcare providers and families must proceed with caution, balancing the potential benefits of movement with the primary goal of maintaining health and stability.
When is it Appropriate to Incorporate Exercise Again?
The decision to reintroduce exercise in recovery should be made collaboratively by a comprehensive care team, including a medical doctor, dietitian, and mental health professional. Generally, exercise is not recommended until an individual has met key physical and psychological milestones, such as:
Achieving Medical Stability: According to SEES guidelines, exercise should only be considered once an individual’s vitals, lab results, and other health markers are stable. This means regular heart rate, blood pressure, and electrolyte levels.
Demonstrating Behavioral Stability: The individual should be able to consistently meet their nutritional needs and follow a meal plan without compensatory behaviors. They should also exhibit an understanding of hunger and fullness cues.
Exhibiting Psychological Readiness: Recovery must prioritize developing a healthy mindset toward exercise. Ideally, individuals will have worked through body image challenges, reduced tendencies toward all-or-nothing thinking, and learned coping skills for stress and emotional regulation.
Reintroducing Exercise: A Step-by-Step Process
The SEES guidelines emphasize a gradual, personalized approach to reintroducing exercise. By breaking down the reintroduction of exercise into stages, individuals can learn to associate movement with positive feelings and self-care, rather than as a form of punishment or weight control.
Step 1: Start with Gentle Movement
At the beginning of this journey, it’s essential to take a conservative approach. For example, gentle yoga, stretching, or mindful walking for short periods (10–20 minutes) can be an excellent place to start. These types of movement focus on grounding and connecting with the body rather than exerting it. Encourage clients to tune into their body’s signals, noticing what feels good rather than pushing limits.
Step 2: Monitor Responses and Self-Reflection
During the early stages, individuals should work with a therapist or journal about how exercise affects them emotionally and physically. Reflecting on questions like “How did I feel before, during, and after exercise?” can help determine whether the activity is serving recovery goals. Tracking mood, body sensations, and thoughts can offer valuable insights into the readiness for more structured movement.
Step 3: Gradually Increase Intensity and Duration
Once an individual consistently participates in gentle movement without distress or compulsive urges, the duration and intensity of exercise can be slowly increased. According to SEES guidelines, increases should be minimal (5-10% at a time), allowing the individual to adjust physically and psychologically. During this stage, close communication with the treatment team is vital.
Step 4: Introduce Structure and Routine with a Supportive Framework
Structured exercise routines, such as supervised group fitness classes, are appropriate in later stages when the individual has shown they can safely manage less intensive movement. Routines should emphasize enjoyment, self-care, and mindfulness over calorie burning or weight management. Working with a recovery-oriented personal trainer or physical therapist can also provide guidance and ensure exercise remains safe.
Step 5: Maintain Flexibility and Adjust as Needed
As recovery progresses, exercise can become a fulfilling, balanced part of life, but only if approached with flexibility. The SEES guidelines underscore the importance of staying attuned to warning signs of compulsivity or relapse, which can appear even after long periods of stability. Regular check-ins with a therapist or counselor are recommended to ensure exercise remains a positive, healthy habit.
The SEES Guidelines
The SEES guidelines are invaluable for structuring exercise in a way that prioritizes recovery. Some of the core recommendations include:
Exercise should always be mindful, with an emphasis on enjoying the activity rather than achieving specific fitness outcomes.
Each stage should be personalized based on the individual’s health, readiness, and recovery progress.
Close collaboration with a multi-disciplinary treatment team is essential to provide the best support and safety for each individual.
In Summary
Exercise can be a meaningful addition to an individual’s life in eating disorder recovery, but only when reintroduced thoughtfully and carefully. With structured guidance, exercise can shift from a source of stress and control to a healthy form of self-expression and well-being. The SEES guidelines provide a valuable framework to navigate this journey, helping those in recovery find balance and healing through safe, gradual reintroduction of movement.
For more information, please refer to the SEES guidelines at https://www.safeexerciseateverystage.com/sees-guidelines or consult with a mental health professional who specializes in eating disorders.
If you are seeking eating disorder treatment or mental health therapy for you or your adolescent, Cypress Wellness Collective can help. Cypress Wellness Collective is located in the San Francisco Bay Area where they specialize in Family Based Treatment (FBT), therapy, and nutrition counseling for teens, adults, and families going through eating disorder recovery. They offer in person and virtual appointments throughout all of California. Call today for your free consultation to see if Cypress Wellness Collective is right for you!
References:
Garrett, J., McCabe, K., & Goerlich, C. (2023). Safe Exercise in Eating Disorder Recovery: Guidelines for Practitioners.
National Eating Disorders Association (NEDA). (2023). Exercise and Eating Disorders.