Returning to Exercise when in Recovery
By Alex Raymond, RD, LD
A common question I get from many of my clients is when it’s okay to start exercising again. It’s no surprise that it’s important to go slowly when returning back to physical activity, especially since exercise, food intake, body image, and disordered thoughts are so closely intertwined. I have supported many clients in healthily getting back to regular exercise. I assess my clients on something called “RED-S” or Relative Energy Deficiency in Sports. This helps me to take a closer look at possible health issues that may arise from undernutrition and increased exercise, like GI disturbances, hormone imbalances, nutrient deficiencies, and the “female athlete triad” for women. I can talk through with my clients if returning to exercise is permitted looking through looking solely physical health lens. Additionally, In 2014, The American College of Sports Medicine published an article with a tool that professionals can use to objectively assess the risk of female athlete triad. It’s called The Female Athlete Triad Cumulative Risk Assessment.
Looking at the physical side of things is definitely important, however returning back to movement also has emotional implications. Here are some things questions I ask and talk through with my clients.
What was your past relationship with exercise? It might be helpful to talk through your relationship with exercise throughout your entire life. How has your relationship with exercise changed? When, if at all, did it start to play into the eating disorder? It’s important to try to think back to a time when maybe exercise was more innocent. It’s probable to say that back when you were 3 years old, running around the playground was to have fun and to be silly–there probably weren’t external motivators.
What is the motivator to return back to exercise? It’s important to think about this one for a little and explore every option. What does the eating disorder have to say about being more physically active? If you’re ready to add in more movement, are you also ready to switch up your meal plan? You’ll need to add in another snack or increase exchanges at meals. A healthy mind would be okay with the changes in the meal plan.
How do you think exercise will affect your relationship with food and/or your body? I would definitely take some time to think about this one. It might be even worthwhile to journal about it as well and take 15-20 minutes to describe this relationship and how it will change or has changed.
Do you think about burning calories when you exercise? Yes, it is true that when you move more, your body does expend more energy. However, the purpose of exercise should not be to “burn up” calories. If that is the intention, even in the slightest, it can be a slippery slope for the eating disorder to gain more control.
Have you thought about how much exercise you would like to do? It’s important to start off slow as discussed with you and your treatment team. What sounds like a “normal” amount of exercise to you and does it make sense for where you are in recovery?
What would it be like to hold off on exercise for a little longer?
What is your favorite type of physical activity, and why do you like it? When returning back to exercise, it’s so important to participate in activities you truly enjoy! If you absolutely hate the elliptical, why are you doing it? I always question participating in activities you dislike because it’s very possible that the participation is motivated by the eating disorder voice. Your body deserves respect and love–forcing it to do movements it’s not fond of is the opposite of that.
There is no right or wrong answer for when is a good time to return back to physical activity. It should really be an ongoing conversation you have with your treatment team. At the end of the day, exercise should not be something that gives you permission to eat. It should not be used as a way to punish your body or try to shape it into something different. Exercise should be something that you truly enjoy (which can get tricky with the ED voice and working with a dietitian can help you to sort out this tangled web). It should be something that you allow yourself to do when you have time and when the time feels right. It should be used as a tool to understand your body better and a way to respect your body!
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