Exercise and Eating Disorders
Dysfunctional exercise is prevalent in as high as 80% of individuals with an eating disorder (ED). Such engagement in dysfunctional exercise significantly predicts symptom severity, duration, and increases the likelihood than an individual will relapse. Despite the impact of exercise on treatment outcomes, many treatment protocols do not formally address exercise during the course of treatment. Consequently, many health professionals have adopted the practise of recommending abstinence from exercise during ED treatment. However, increasing support for the benefits of safe exercise to psychological and physical outcomes, has highlighted the need for guidelines to establish a standard of practice for reintroducing safe movement during ED treatment.
The Safe Exercise at Every Stage (SEES) guideline was developed to better facilitate the prescription of exercise in eating disorder populations. As dysfunctional exercise is often present prior to and throughout an eating disorders, exercise engagement must be addressed at all stages of ED treatment and recovery. Addressing exercise engagement throughout treatment requires a step-up/step-down approach, tailoring the recommendations for exercise engagement according to the individual’s current physical and psychological well-being. The SEES guideline provides a framework for thoroughly assessing each individual’s current physical and psychological health status. Furthermore, the SEES guideline augments clinical decision-making in utilising these results to select safe exercise interventions. The incorporation of the SEES guideline as a component of evidence-based treatment for individuals with ED is anticipated to promote an ethical standard level of care and greater consistency in the management of dysfunctional exercise.
We developed the SEES guideline for use by trained exercise and medical professionals working with individuals with ED symptomatology. This guideline has been developed for use across all levels of care including in-patient and medical settings as well as outpatient settings. The SEES guideline is intended to augment the clinical and medical knowledge of clinicians working with these populations. The application of these guidelines to prescribe exercise should only occur within an individual clinician’s scope of practice.
These guidelines have been developed by thorough review of the best available research in conjunction with input by experts in the field of eating disorders and related difficulties. The Appraisal of Guidelines for Research and Evaluation-II instrument was used to support the development of these guidelines in conjunction with the National Health and Medical Research Council (2011) to ensure that SEES meets the highest standards of research.
Healthy exercise engagement and education during eating disorder treatment has been associated with improved quality of life, body composition, central health markers of the illnesses (e.g., drive for thinness, weight and shape concerns, and eating restraint) and improved comorbid physical and psychological symptomatology (e.g., anxiety, depression, muscle degradation, body esteem issues, sleep disturbances, perceived stress, osteoporosis).
ED, anorexia nervosa in particular, are associated with high morbidity and mortality rates as well as range of medical conditions compromising an individual's health. These complications mean that it is critical for exercise prescription in eating disorder treatment to promote the safety of clients as paramount. The SEES guideline has been developed to provide a summary of the current evidence with the hope that this will address concerns related to safety and improve upon clinical knowledge of exercise engagement during ED treatment.
Our relationship with exercise is multidimensional and so our approach to addressing compulsive exercise needs to be too. A holistic approach is used throughout SEES to include the combination of medical, cognitive and behavioural benchmarks in exercise prescription. This decision-making process aims to guide clinicians in supporting their clients to begin and continue safe exercise engagement, contributing to this multifaceted construct of well-being.
Intuitive and Mindful Movement
A healthful relationship with exercise is compassionate, joyous, and involves mindful awareness. Clinicians supporting their clients to build skills in mindful and intuitive movement can provide the opportunity to transition from a dysfunctional relationship with exercise to a healthful one. This use of intuitive movement then facilitates fostering trust in our bodies’ preferences and needs related to exercise, contributing to the likelihood of positive health outcomes over time.
Collaborative approaches promote the individual with an ED as an active member in clinical decision-making. The SEES guideline has been designed to promote collaboration between the individual, their loved ones, and a team of experienced eating disorder professionals to help guide safe exercise engagement at all stages of ED treatment and recovery. This approach aims to facilitate open and honest conversations with clients about exercise, identifying their needs and concerns about exercise engagement.