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Eating disorders?

Is there a place for activity and exercise in the treatment plan?

As exercise professionals, we are aware of both the physical and psychological benefits of exercise. However, when considering exercise as a treatment intervention for persons experiencing an eating disorder, we are faced with a few dilemmas. Firstly, we need to build a more substantial evidence base to support the use of exercise within current routine treatment plans (1). Secondly, we must carefully consider that some people with eating disorders actually use exercise as a way of controlling their weight and many do not present with any obvious symptoms (weight loss), and any compensatory behaviours (binging, purging etc) are secretive (1,2,3,4); thirdly, we need to appreciate the prevalence of eating disorders in some professional athletes (runners, dancers and gymnasts etc) and also aerobic instructors (4). The key message may be how we as exercise professionals can promote learning and re-education to ensure safe levels of activity/exercise to ensure maintenance of a healthy lifestyle and to off-set some of the negative effects of eating disorders (e.g. decreased bone density and depression) (5,6, 8, 9) that would be essential for future health? The level 4 physical activity award for persons with mental health conditions addresses each of the issues and offers provisional guidance for professionals wishing to work in this area.

However, exercise and physical activity actually offer numerous physical benefits (improved bone density, decrease risk of CHD and diabetes etc) and psychological benefits (improved mood, reduced anxiety, decreased risk of depression, improved self-esteem, confidence, physical self worth, body image and cognitive functioning (8,9,10,11) all of which are symptoms that may be present in people experiencing eating disorders.

Various exercise modalities have been shown to have a positive effect on depression which is a common co-morbidity with eating disorders. These include: running, walking, weight training, skipping, participation in sports. (8,9,10), exercising in the outdoors (13) and exercise in water (14) There is also an increasing evidence base for movement approaches that embrace the concept of mindfulness (15) such as, chi ball, pilates, yoga, tai chi, Nia, relaxation, meditation etc

As with all other medical conditions, there needs to be a thorough risk assessment (conducted by a medical professional) and there may be some instances where the individual may be stratified as being at high risk, and that any benefits of exercise and activity may be outweighed by the associated risks. Until such time when there is greater evidence base and when risk stratification criteria for specific conditions are standardised across referral schemes, exercise professionals should act with caution and under the guidance of qualified medical professionals.

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