Page 40 - Today's Dietitian (March 2020)

excellence is more internally focused. Cook says that more important for individuals who have had their
when excellence is the goal, exercise can become a way muscle and bone compromised because of restrictive
of achieving self-realization or even self-actualization. eating disorders.
He says this is counter to workout programs that pre- Decreased bone mineral density is a common com-
scribe a certain workout on a certain day or squeeze 90 plication of AN, and one that can persist after recov-
minutes of exercise into an intense 15-minute session ery. Eating disorder–related bone loss is multifactorial,
(something that many people—with or without eating including loss of estrogen, high cortisol levels, calcium
disorders—participate in). “How is that respecting the and vitamin D deficiencies, and loss of lean body mass,
internal state that you are at?” he says. which in turn reduces the bone-building effects of
muscle contractions.
Mental Health Benefits Beasley says eating disorder–related bone loss
Along with perfectionism, dysfunctional exercisers are never can be fully reversed but that exercise offers
more likely to show high levels of psychological distress more hope for increasing bone mineral density
and struggle with depression, anxiety, or obsessive- than estrogen replacement or nutrition, at least ini-
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compulsive disorder. A 2016 study found that AN patients tially. During the earlier stages of renourishment,
who had a greater discrepancy between their actual weight even though patients are getting more food and more
and ideal selves—which is related to overestimating body sources of calcium, their gut is still healing, which
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size—was associated with higher levels of driven exercise. limits their ability to absorb the nutrients impor-
While weight restoration in AN is clearly important, tant for bone health. “It’s an uphill battle with the
it’s not the only benchmark of recovery. Eating dis- food and absorption, so I feel like, how can we not
orders have many psychological underpinnings, and add movement? It’s almost the only way that we have
appropriate physical activity can improve mood, body to help patients at this point. Our clients’ bones can’t
image, self-esteem, and self-efficacy. It also can help wait another day.”
patients connect with nature—and humans. A small 2014 study randomized 36 adolescent females
Beasley likes to encourage “movement with a purpose” who were undergoing treatment for restrictive type AN
by including movement as a part of other life activities. to either a supervised eight-week high-intensity resis-
She often does scavenger hunts with patients as a way to tance training program or to a no-exercise control group.
laugh and have fun together while simply moving. Dieti- The three-days-per-week exercise protocol included three
tians on her staff may walk with patients on the nearby sets of eight to 10 repetitions of exercises that work all
trails as part of their session, stopping to sit and rest after the major muscle groups, with warm up and cool down
an appropriate duration. periods. The exercise group improved both strength and
“For too many years, we’ve had this dualistic idea agility compared with the control group, while neither
where people ignore the mind-body pathway,” Cook says. group experienced decreases in weight or BMI. Specifi-
In other words, clinicians have believed that anything cally, upper body strength increased by an average of 37%
above the neck is all made up. He says that any psycho- to 41% and lower body strength increased by an aver-
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logical state has a physiological underpinning, and that age of 52%. Another 2014 systematic review of eight
many metabolites that benefit the brain are part of the small studies (213 patients total, aged 16 to 36) found that
neurobiological cascade that comes from movement. supervised aerobic and resistance training significantly
“Exercise is the straw that stirs the drink.” increased muscle strength, BMI, and body fat percentage
A 2013 review found that yoga and aerobic exercise in AN patients.
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decreased the number of binges in patients with binge
eating disorder and that combining aerobic exercise with Food for Thought
CBT was more effective at reducing symptoms of depres- “There’s a lot of fear about including exercise in treat-
sion than CBT alone. Aerobic exercise, yoga, massage, ment, but movement is life,” Beasley says.
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and basic body awareness therapy significantly lowered In a 2017 article on the ethics of exercise in eating
scores of eating pathology and depressive symptoms in disorders, Cook suggests that “restricting all forms of
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both AN and BN patients. exercise is an ethical issue because doing so eliminates
Cook says exercise requires a holistic view that autonomy, respect, empathy, and dignity for individuals
includes patience, not a “beat yesterday” mentality to with [eating disorders] by preventing them from partak-
achieve the best mind-body benefits. He says people ing in socially acceptable healthy lifestyle behaviors and
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are on board with the idea that exercise can help with taking control of their recovery.” n
depression and anxiety—but that generally requires
a sustained program of exercise for about four to six Carrie Dennett, MPH, RDN, CD, is the nutrition columnist for
months, along with rest days and nutrition. “The point of The Seattle Times, owner of Nutrition By Carrie, and author of
the journey is not to arrive; it’s to trust the process.” Healthy for Your Life: A Holistic Guide to Optimal Wellness.

Physical Health Benefits For references, view this article on our
The established benefits of physical activity for website at www.TodaysDietitian.com.
muscle and bone health in any population may be even

40 TODAY’S DIETITIAN • MARCH 2020