“When can I start exercising?”

“When can I practice with the team again?”

“When can I resume training?”

These questions are a few of the most common concerns that I hear from clients in treatment for eating disorders. There are many positive aspects to exercise or sport; when done appropriately, physical movement can be a very helpful way to combat stress, improve mental health and create/maintain positive interpersonal relationships.

For those struggling with an eating disorder, however relationships with exercise or their sport can be rather complicated. To begin thinking about answers to the above questions, it is important to start by understanding the reasons behind a client’s desire to return back to sport; is it because they genuinely enjoy the sport or miss the camaraderie of their team, or because they are concerned what their physical body might look like if they miss practice or training. I can’t stress enough that there is never a one-size-fits-all rule as to when it might be appropriate for someone struggling with an eating disorder to return to their sport or resume exercise. Proper guidance from a knowledgeable treatment team is absolutely essential, but here are some of the criterion that help me to better understand the appropriateness of exercise for each individual.

Signs that someone is NOT ready to reintroduce exercise:

  • Medical instability as evidenced by lab abnormalities, bradycardia, low weight, etc.
  • Difficulty reaching treatment goals with regards to weight restoration and/or behavior change.
  • Inability or unwillingness to add nutrition to match increased activity.
  • Obsessive thoughts around exercise and viewing the reintroduction of exercise as a way to burn calories and/or work against progress made toward recovery.

Signs someone MAY BE ready to reintroduce exercise:

  • Positive physical and emotional responses to treatment and ability to adhere to treatment recommendations with regards to frequency, intensity and type of exercise.
  • Medical stability – strong vital signs, blood work, progress toward weight goals and other indicators determined by the treatment team.
  • Recovery from physical or overuse injuries, such as stress fractures, which occur more frequently in athletes with eating disorders.
  • Willingness to incorporate extra nutrition to fuel the body for increased physical activity.
  • Active consultation with a comprehensive treatment team that supports the reintroduction of exercise and works collaboratively to develop a plan and monitor physical and emotional progress.

The reintroduction to exercise doesn’t necessarily mean a return to full athletic capacity. It is important to slowly ease back into physical movement so as not to disrupt the great work that has been accomplished while in treatment. Here are some tips to help you transition back into your sport or athletic regimen.

  • Ensure the supervision of a treatment team – medical and mental health professionals, physicians, therapists, sports psychologists, sports nutritionists, exercise physiologists, for example.
  • Develop a written contract or plan that details the extent and types of exercise, the strategy for fueling and the factors that would suggest another break from exercise was required.
  • Start gradually, with mild intensity and low frequency.
  • Maintain focus on the both physical and emotional well-being in the form of nutrition education, psychoeducation and positive reinforcement.
  • Make sure it’s enjoyable. Sometimes this may mean staying away from the gym or specific sport they’re accustomed to. Alternative active methods like hiking, walking the dog, swimming or yoga can be very productive.

Athletes with eating disorders like anorexia are a unique population with distinct needs. If you are an athlete and are concerned about your exercise or eating patterns, we are here to help with our specialized program for athletes with eating disorders.

Emily Slager, M.Ed., LMHC, is director of Walden’s Hickory Drive Clinic. She is responsible for providing clinical, administrative and fiscal oversight as well as development for the clinic. Previously, she was director of residential, partial hospitalization and intensive outpatient programs for adolescents and adults at Walden’s Waltham location. In that role, she oversaw all aspects of these programs including administrative, fiscal and clinical management. Formerly, she was a clinician on Walden’s inpatient eating disorder and psychiatric units. Ms. Slager earned her master’s degree in counseling psychology from Boston College. Her professional interests include the development of eating disorders in athletes and in the lesbian, gay, bisexual and transgender community.