Developing a Safe and Healthy Post Treatment Movement Routine | Alsana

How to stay well as you embark on a Post Treatment Movement routine.

Brian Cook, Ph.D.

Engaging in exercise during recovery is complicated. Of course, we want to encourage proper forms of nutritionally supported exercise to experience the benefits of movement. However, we also must avoid the possibility of exercise leading to relapse.

For example, research has found that exercise is a significant predictor of relapse for the approximately 1/3 of individuals with eating disorders that relapse within 2.5 years of discharging from treatment. Importantly, the highest risk of relapse occurs between 4 and 17 months after discharge.

Understanding that exercise is a predictor of relapse, and the highest risk begins around 4 months, may reflect established time frames for exercise effects and developing new behaviors.

Specifically, our body and mind react differently to exercise when we begin a new routine. Exercise physiologists call this phase acute exercise.

Over time, about 4 to 6 months of continued exercise, our physiology adapts and thereby we experience the major physical and mental benefits of exercise. Exercise physiologists call this chronic exercise. Similarly, it takes months to make lasting behavioral changes. Research has shown that adopting new eating and exercise behaviors takes anywhere between 18 and 254 days (approximately 8 and half months!) for most people under real-world conditions.

These changes may actually take even longer during recovery to allow time to heal from the effects of an eating disorder. These time frames also support why the first year after treatment is so challenging.

The problem is that sustained recovery takes time. We often become impatient and want to do more exercise, increase the intensity, or simply go right back to the same routines we did before treatment. We may also experience other negative emotions or frustration that can further lead us to over-do it with exercise in attempt to gain the effects we desire. Unfortunately, increasing amount, duration, intensity, or frequency in a way that does not work with your body’s needs during recovery can lead to relapse. 

Tips For Safely Including Exercise During Recovery

  • Build off what you learned in treatment 

Safely exercising is complex. During treatment, you learned a lot about the role of nutrition, need for rest, how to differentiate injury from soreness, goal setting, challenging exercise beliefs, and so many other important skills that will help support your exercise during recovery. Practice these skills as you listen to your body and work with your body, not against it. Remember, there is no one “best” exercise routine. Rather, find activities that you enjoy.

 

  • Recognize your progress and experiences  

Getting to this point in recovery is a tremendous accomplishment! You put in a lot of hard work, honest reflection, and struggle through adversity. The skills and strategies that you developed along this journey can also be used to keep you on track during recovery. Think about progress you have made and celebrate your successes. Recognizing that you have made important strides along the way helps fuel belief in your ability to continue to safely incorporate exercise into your life.

A great way to build upon your previous successes is to gradually progress with any exercise routine. Going slow allows you time to process emotions, connect with your body during exercise, and reflect and recognize how you can keep exercise as a safe part of your recovery without letting old habits come back. It may be frustrating at times to do less exercise than you once did. But sometimes less is more. Allow yourself the patience to slowly build up the mental and physical resources you will need as you incorporate exercise into your recovery. 

 

  • See yourself in recovery   

Close your eyes and see yourself as you maintain your recovery. How has your view of yourself in recovery changed? How does exercise fit into this? What does successfully including safe forms of exercise look like today, a month from now, or 6 months from now? Try to be as specific as possible when thinking about exactly how different your relationship with exercise is now then before or during treatment.

 

  • Keep helpful relationships  

Many people want to share their view and experiences with exercise. While they often have good intentions, remember that their message may not fit with the medical, nutritional, emotional, and relational aspects of exercise during eating disorders recovery. It is important to have good relationships that we can turn to for support, questions, or when we want to celebrate our successes with someone that can truly appreciate what we are going through. Find helpful relationships that understand what movement in recovery is and is not. Identify friends, family members, loved ones, neighbors, and/or coworkers that can help you, listen to your concerns, and be a source of support that understands that exercise during eating disorders recovery has its own unique challenges.

 

  • Work with your body, not against it 

There will be some days that you want to exercise, but your body just might not be feeling it. Stay in touch and honest with what your body is trying to tell you. Listen when your body is tired, sore, exhausted, or feeling the effects of stress or any other sensation. Your mind may tell you exercise can help with these feelings, but often these sensations are ways that our body tells us that rest is needed. All the great benefits of exercise can’t be realized without rest.

 

  • Find substitutes  

Many people often exercise to ‘clear their head’ or deal with a bad day. Remember that exercise is not the only way to cope with negative emotions, a bad day, or stress in general. Think of different enjoyable activities that can help boost your mood when you need it. For example, you can meditate, write in your journal, or play with your pet. It may help to fill in the blank of this sentence: “Instead of exercise, I will _____________.” For instance, instead of doing a HIIT workout at the end of a stressful day, I will call my best friend and see if they want to meet up.

  • Think of recovery as a journey, not a destination 

Recovery is an ongoing process that requires you to actively participate in managing risks and preventing relapse. Often, we may have to take one step forward, then 2 steps back or 3 steps to the side before making forward progress. Understand that maintaining an exercise routine during recovery will be challenging at times. Anticipating setbacks will you help prepare for when they inevitably happen. View any setbacks as only temporary and a necessary part of the journey. Part of anticipating setbacks can include identifying people, places, or situations that will make movement or exercise difficult.

This is a great opportunity to practice the skills you have developed to manage exercise during your recovery. Some common things that help prevent setbacks are removing cues that might tempt you to fall back to old habits, making a list of situations that tempt you to over-exercise, avoiding boredom with exercise by incorporating new activities, rewarding yourself for sticking to a safe exercise routine, substituting any negatives with positives, and exercising with a close friend or partner that understands eating disorders. Setbacks will happen. Do not allow them to undo all the hard work that you’ve already done. 

 

References

  1. Berends, T., van Meijel, B., Nugteren, W., Deen, M., Danner, U.N., Hoek, H,W, & van Elburg, A. (2016). Rate, timing and predictors of relapse in patients with anorexia nervosa following relapse prevention program: a cohort study. BMC Psychiatry, 16, 316-323.
  2. Björk, T., Wallin, K., & Pettersen, G. (2012). Male experiences of life after recovery from an eating disorder. Eating Disorders: The Journal of Treatment & Prevention, 20(5), 460-468.
  3. Bouchard, C., Blair, S.N., & Haskell, W.L. (2012). Physical Activity and Health. Champaign, IL; Human Kinetics, Inc.
  4. Carter, J.C., Blackmore, E., Sutandar-Pinnock, K., & Woodside, D.B. (2004). Relapse in anorexia nervosa: A survival analysis. Psychological Medicine, 34(4),671-679. 
  5. Johnson, S., & Cook, B. (2013). Building Motivation: How Ready Are You?. In Nigg, C. (Eds). ACSM’s Behavioral Aspects of Exercise. (pp. 103-128). Philadelphia, PA; Lippincott Williams & Wilkins.
  6. Lally, P., van Jaarsveld, C.M., Potts, H.W.W., & Wardle, J. (2010). How are habits formed: Modeling habit formation in the real world. European Journal f Social Psychology, 40, 998-1009
  7. Richard, M., Bauer, S., & Kordy, H. (2005). Relapse in anorexia and bulimia nervosa – a 2.5 year follow-up study. European Eating Disorders Review, 13(3), 180-190.

 

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