What are the medical recommendations for returning to the gym after inpatient treatment for anorexia nervosa (AN) and bulimia nervosa (BN)?

From the Guidelines

After inpatient treatment for anorexia and bulimia, returning to the gym should be approached cautiously and only with explicit approval from your treatment team, as premature or excessive exercise can trigger relapse and compromise recovery. According to the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1, a comprehensive and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise is crucial for recovery.

When considering exercise, it is essential to prioritize weight restoration and nutritional stability, which should be achieved for several weeks to months before reintroducing physical activity. The guideline recommends individualized goals for weekly weight gain and target weight for patients with anorexia nervosa 1.

Exercise should be reintroduced gradually, starting with low-intensity activities like gentle walking or stretching for short durations (15-20 minutes) 2-3 times weekly, and gradually increasing as medically approved. It is crucial to pair exercise with adequate nutritional intake to support recovery needs, which typically means consuming additional calories on exercise days. Many treatment programs utilize a meal plan that accounts for exercise energy expenditure.

Key considerations when returning to the gym include:

• Avoiding activities that focus on calorie burning, competitive environments, or those previously associated with eating disorder behaviors
• Emphasizing movement for enjoyment, stress reduction, and overall wellbeing
• Ongoing monitoring of vital signs, weight, and psychological responses to exercise by the treatment team
• Prioritizing recovery needs and avoiding excessive exercise that can compromise weight restoration and place dangerous stress on the body.

The American Psychiatric Association guideline emphasizes the importance of a coordinated multidisciplinary team approach to treatment, including medical, psychiatric, psychological, and nutritional expertise 1. By prioritizing caution and working closely with the treatment team, individuals can safely return to physical activity and support their overall recovery from anorexia and bulimia.

From the Research

Medical Recommendations for Returning to the Gym

There are no specific studies that provide medical recommendations for returning to the gym after inpatient treatment for anorexia and bulimia. However, the following information can be gathered from the available studies:

• Inpatient treatment for anorexia nervosa has been shown to be effective in promoting enduring change and restoring patients to a healthy weight 2.
• A comprehensive treatment approach that includes medical, psychological, nursing, and social interventions can improve abnormal eating behaviors and ameliorate psychopathological attitudes and illness-driven behaviors 2.
• Inpatient treatment can increase body weight and decrease eating disorder symptoms in adolescents with anorexia nervosa, and treatment effects can remain stable or improve further within the first year after discharge 3.
• The optimal use of inpatient treatment or combination of inpatient and partial hospital care is disputed, and practice varies widely 4.
• There is no clear difference in weight gain or acceptability of treatment between specialist inpatient care and partial hospital care for bulimia nervosa and other binge eating disorders 4.

Considerations for Returning to the Gym

When considering returning to the gym after inpatient treatment for anorexia and bulimia, the following factors should be taken into account:

• The individual's physical and emotional readiness for exercise
• The risk of relapse or exacerbation of eating disorder symptoms
• The need for ongoing medical and psychological support
• The importance of a gradual and supervised return to exercise to prevent injury or burnout

Key Findings

• Inpatient treatment can be effective in promoting weight gain and reducing eating disorder symptoms 5, 3.
• The use of add-on treatments such as psychotherapy, pharmacological treatment, and nutritional replacement may have potential benefits, but the evidence is limited 6.
• Cyclic enteral nutrition has been shown to be effective in increasing weight recovery in one study 6.
• More research is needed to determine the optimal treatment approach and to develop evidence-based recommendations for returning to the gym after inpatient treatment for anorexia and bulimia 2, 4, 6.