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Working Out While Recovering From Anorexia

[Listen to an audio version of this blog here.]

Is it possible? Yes. Is it helpful? Not always.

After being diagnosed with Anorexia Nervosa, I was told to stop exercising. I wasn't happy about that, because I was addicted to exercise. Being a Division 1 athlete was serious business, and for five years straight, I worked out like it was my job because it sort of was. I'd been running a lot and slowly starving myself for years prior to my diagnosis. I pushed myself through workouts only to go home and sleep for hours. I bonked countless times in the middle of runs. My gastrointestinal system was so messed up that at one point, I couldn't run more than a couple miles without having to stop to use the bathroom. My athletic performance wasn't anywhere near good, but I was so indoctrinated into my eating disorder that losing weight mattered more to me than running fast. I needed to keep moving so I could avoid any unwanted weight, or so I thought.

After I graduated, I kept trying to run while in treatment. While running after work one day, I nearly passed out on a bike path, injuring my knee. Without the training schedule I was accustomed to in college; without races on the horizon and teammates around, I didn't feel motivated to run. I was tired all the time and I kept experiencing nagging injuries. At the urging of my treatment team, I decided to stop running. I opted instead to do yoga a few day a week, and once my caloric intake was high enough, I added a bit of strength training to my regime. I was gaining badly needed weight, and although it was necessary, it did not feel good.

Giving up heavy exercise was hard because I had been using exercise as a way to purge. This is colloquially known as Anorexia Athletica, which often accompanies Anorexia Nervosa or Bulimia Nervosa as a form of getting rid of calories. Instead of purging in the way of self-induced vomiting or diuretic/laxative abuse, I used excessive or extreme exercise as a way to purge instead. I would run for an hour, use the elliptical for an hour, and lift weights for an hour, all in succession. That was a normal day of working out for me, and I started to believe that I needed to exercise at least that much to maintain my weight, fitness, and sanity. It was extreme and compulsive.

By the time I sought treatment, I was at a low enough weight that I was prescribed a 5-meals-a-day eating program, complete with dense protein shakes. The athlete in me was confused: wasn't exercise supposed to be good? Why did I need all this nutrient-dense food when I couldn't workout? I needed the food because I needed to gain weight, although that was hard for me to believe at the time. Anorexia is a cruel disease that affected not only how I felt in my body but how I saw my body as well. Some signs of Anorexia and Anorexia Athleta include:

- A long-term preoccupation with working out and exercise.

- Rapid weight loss of more than 5 percent of their body weight.

- Feelings of anxiety or guilt for not following a self-imposed exercise regime.

- Exercising rather than going to school or work.

- Working out even when injured or ill.

- Feeling isolated while working out.

- Lying to others about how much or how often you work out.

- Only thinking about food in terms of its relationship with exercise.

- Basing self-worth on how much exercise has been completed every day.

- Blaming weight loss on exercise and training necessary to stay competitive within chosen sporting field as a way of hiding the condition.

Because I was restricting food and obsessively exercising simultaneously, my body had no opportunity to heal, recover, or rest. Overtraining and starving leads to several negative outcomes, including chronic fatigue, reduced athletic performance, increased risk of injury, a suppressed immune system, insomnia, depression, menstrual irregularities, loss of muscle mass, heart irregularities, osteoporosis, and damaged joints/ligaments/tendons.

I obviously needed medical help and guidance, not only in the immediate days and weeks of treatment but long-term. I needed to learn how to nourish myself while exercising, which is why taking a hard step back from intense exercise was incredibly important. Low intensity movement was okay, but I had to break my addiction to working out and let my body rest and recover. In the early stages of treatment, I needed to minimize physical activity to restore my weigh. All the experts around me throughout my recovery emphasized the importance of resting my body and breaking my compulsion.

While it made sense to take a step back from exercise, I also needed to develop a healthier relationship with activity and movement. I didn't want to abstain from physical activity altogether, and I wanted to continue to run in the long-term. So, I worked with my therapist and dietitian to structure a plan that made sense at each stage of recovery, and one that wouldn't push me back into a compulsive or obsessive exercise habit. We started small, with low-intensity exercise a few times a week. We built up to short runs. I started running with friends again, which helped me ease into activity in a supportive, non-competitive environment. Eventually, I decided to sign up for a race again, and as I worked through my training plan, I worked closely with a dietitian to ensure my dietary needs were being met.

It would be impossible to abstain from all physical activity forever, but for me, I had to stop in order to start again. It might be possible to maintain a rigorous training regimine while in treatment, but I'd argue that it's relatively rare. To safely exercise while in treatment, adopt some of these tips from the Meadowglade treatment center.

  1. Try new, fun physical activities rather than sticking to the same old routine that you used when you were in the throes of your eating disorder. Try something you’ve never tried before and avoid getting stuck in the rut that exacerbated your condition.

  2. Listen to what your body has to say. If you feel tired or unwell, stop.

  3. Establish a safety net by bringing structure to your exercise regime. Set yourself a maximum amount of activity time and stick to it. For example, allow yourself 20 minutes per day or one hour 2 times a week to start.

  4. Be honest with yourself. If you’re finding it difficult to control your impulse to exercise excessively while you’re in recovery, acknowledge it and seek advice from your therapist or treatment team.

P.S. If you or someone you know is suffering from an eating disorder, it is extremely important to seek professional help. Contact the NEDA helpline at (800) 931-2237, find an Eating Disorders Anonymous (EDA) meeting near you HERE or find a treatment center near you HERE.


Sarah Rose

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