Should Individuals in Eating Disorder Recovery Have Access to Movement?
Access to movement/exercise in eating disorder treatment spaces and in the outpatient world can be controversial to discuss. When I first began working in the eating disorder space, it was almost taboo to bring it up. As we continue to learn more about how to better serve these clients, I am thankful that discussions on this topic are more welcome. So, let’s lean into this as I share some of my experiences.
First, let me share a little about how I began working within this field, particularly my practice setting at that time. In 2008, I began working as an inpatient physical therapist at a Level 1 Trauma Center and Safety Net Hospital. This center was just beginning to form at about the same time. The protocol, at that time, was to limit how much movement the patients could participate in and, often, they were relegated to more bed rest to preserve their caloric intake. Honestly, this made a lot of sense and I want to be clear that there was no malice with the establishment of this movement restriction. However, what we found was that our patients were too weak and deconditioned to PHYSICALLY move to the next level of care (often an inpatient residential treatment center)! Prolonged bed rest has been shown to cause loss of muscle strength and atrophy, and individuals in recovery from eating disorders are no exception! Physical therapy services were, therefore, consulted and brought onto the interdisciplinary treatment team to maximize/maintain physical function and assist with safe discharge plans.
What we, the rehabilitation team, encountered with these patients was so much more than just maximizing and/or maintaining their level of function to complete activities of daily living. We found that by allowing these individuals to move their bodies, it actually helped with their compliance during nutritional rehabilitation and had no negative effects on their progress. It created this beautiful feedback loop that provided evidence, actual data, to the patient that their hard work was paying off. A past patient of mine summed it up so eloquently when she was able to go up and down the stairs with me after a week into treatment.
She said, “I could not do that last week. Wow, it’s really hard to be in treatment, but that [going up and down the stairs] really helped me to understand how important it is that I eat my snack and my meals. I feel so much stronger!” Such a testament to how guided, skilled movement intervention can be a PART of the healing process for these individuals!
Now, not all patients presented the same way. Some would come onto the unit and have no issue at all with their physical mobility. They still participated in regular physical therapy care and, from a therapy standpoint, we pivoted our efforts toward creating conversations around relationships with movement and exercise while offering creative movement options. We, of course, did all the same things that you might expect from an outpatient physical therapist and could assist with rehabilitation from injuries. But our role extended out a bit further and we were able to discuss how having an eating disorder can be viewed as a metabolic injury and what treatment we can offer for it. All patients took part in regular physical therapy care throughout the duration of their stay and no patients were discharged from physical therapy services. I was able to build some really amazing connections with patients and be a part of a chapter in their recovery story.
A hospital-based setting is like a second home to me and I adored my work on the inpatient eating disorder unit. I was able to build a mobility protocol that all patients were invited to participate in. As this protocol settled in, I began to get curious as to how the movement plans created on our unit could transition with the patient throughout the different levels of care. The next movement specialist* on their team could modify/upgrade them and the deep conversations started on our unit could continue to flourish. Imagine a community of movement specialists dedicated to this work!
Offering our patients the opportunity to practice and process a different relationship with movement can help offer movement engagement that decouples itself from the eating disorder.
At present, this is not the standard of care, and I can appreciate that not all treatment centers or treatment teams/patients have the capacity to have a movement specialist on board. The reasoning behind this I assume to be multifaceted and is beyond the scope of this blog.
My professional goals for my field and what I felt it could offer started to grow beyond what I could accomplish on the eating disorder unit. This brings us to the setting that I currently practice in: outpatient private practice. And it can be a bit trickier for sure! I don’t have the safety of a confined unit with lots of eyes on the patient to keep movement in check. It is my job to build trust, rapport, and nonjudgmental conversations around movement and exercise with my clients. All of the lessons that I shared above are still applicable in the outpatient setting. Movement and exercise CAN be a part of the healing process and, often, clients do better with guidance on how to appropriately implement. Again, they need to practice how to do it differently and learn how to align the movement piece with their personal recovery goals. We are able to have conversations about movement and exercise that maybe this client has never had before on their treatment team, and, I am happy to share that the community of movement specialists dedicated to this work is growing!
Our bodies are made to move but are not only made to move.
It can go both ways, right? Movement can be healing and my hope is to help clients find the “Strength Within” to move based on intuition and what their body truly needs. Let’s continue to create open conversations about movement as a component of eating disorder recovery and normalize having a movement specialist on the treatment team.
*I have chosen movement specialist as a generalist term. I am a physical therapist, but this work is not limited to only physical therapists. A movement specialist could be a physical therapist, exercise physiologist, strength and conditioning coach, etc. (just to name a few). What I believe is more important, is that this individual engages in this work in an eating disorder informed and sensitive way.