From the Guidelines
Exercise recommendations for bulimia during treatment should be approached cautiously and under professional supervision, with an initial focus on limiting or pausing exercise to prioritize nutritional rehabilitation and normalizing eating patterns, as recommended by the American Psychiatric Association 1.
Key Considerations
- Initially, exercise should be limited or paused entirely during the acute phase of treatment to focus on nutritional rehabilitation and normalizing eating patterns.
- As recovery progresses, gentle, moderate activities like walking, yoga, or swimming can be gradually reintroduced, starting with 20-30 minutes 2-3 times weekly.
- Exercise should be monitored by the treatment team to ensure it doesn't become compulsive or compensatory for caloric intake.
- The focus should shift from exercise for weight control to movement for enjoyment, stress reduction, and overall wellbeing.
- Physical activity goals should emphasize strength, flexibility, and cardiovascular health rather than calorie burning or body reshaping.
Rationale
The American Psychiatric Association recommends a comprehensive treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise for patients with eating disorders, including bulimia nervosa 1. While the guidelines do not specifically address exercise recommendations, they emphasize the importance of a multidisciplinary approach to treatment.
Implementation
Treatment teams should include specific exercise guidelines in the overall treatment plan, adjusting recommendations based on the individual's physical health, psychological state, and recovery progress. This balanced approach helps because many individuals with bulimia have a complicated relationship with exercise, often using it excessively as a purging behavior.
Evidence Base
The most recent and highest quality studies, such as those published in the American Journal of Psychiatry 1, provide guidance on the treatment of eating disorders, including bulimia nervosa. However, specific exercise recommendations are not explicitly stated in these guidelines. Therefore, treatment teams must use their clinical judgment and expertise to develop individualized exercise plans that prioritize the patient's physical and psychological well-being.
From the Research
Exercise Recommendations for Bulimia During Treatment
- The study 2 found that individuals with bulimia nervosa who engaged in adaptive exercise (e.g., for enjoyment) reported lower global eating pathology compared to those who engaged in compulsive-only exercise.
- The same study 2 also found that those who engaged in baseline compulsive exercise reported less loss-of-control eating compared to those who did not engage in exercise.
- Another study 3 found that patients with bulimia nervosa and binge eating disorder experienced the format and content of a treatment combining physical exercise and dietary therapy (PED-t) as beneficial and providing tools to manage symptoms.
- A study 4 investigated the effects of specific training as an addition to conventional treatment of eating disorder symptoms and found that the addition of physical activity could be important in the long-term maintenance of both weight loss and reduction in binge episodes in binge eating disorder patients.
Types of Exercise
- Adaptive exercise (e.g., for enjoyment) may be beneficial for individuals with bulimia nervosa, as it is associated with lower global eating pathology 2.
- Compulsive exercise may also have benefits, such as reducing loss-of-control eating 2.
- Combined Aerobic and Anaerobic Exercise Training (CAAET) has been shown to improve aerobic performance and reduce binge episodes in binge eating disorder patients 4.
Considerations for Treatment
- The study 5 recommends cognitive-behavioral therapy (CBT) as the first-line treatment for adults with bulimia nervosa, with interpersonal therapy as a second-line evidence-based treatment.
- Pharmacotherapy, such as fluoxetine, may be considered adjunctive to psychotherapy in adults with bulimia nervosa 5.
- The addition of physical activity to conventional treatment may be beneficial for long-term maintenance of weight loss and reduction in binge episodes 4.