Occupational Therapy News OTnews February 2020 | Page 30

FEATURE EATING DISORDERS
Exercise: a taboo subject in
eating disorder treatment?
Chloe Findlay, an occupational therapist at Priory Glasgow, looks at
introducing exercise into the eating disorder group programme
A
norexia nervosa is a psychological
condition with a core focus of excessive
thoughts and control of weight and
shape. Restricting food is one key
feature that contributes to weight loss, but many
people with anorexia exhibit other detrimental
behaviours, such as purging or over-exercising.
Standing, pacing, walking to excess, as well as
being drawn to competitive sports, are some of the
many ways over-exercising is demonstrated (Morris
and Twaddle 2007).
Methods have been developed to treat
compulsive exercise within eating disorders in the
form of psychotherapy. Traditionally, the research
focuses on the effects of compulsive exercise within
eating disorders, rather than the positive influence
exercise can have on the treatment of those with
eating disorders (Danielsen et al 2018).
It has been proven that exercise has a substantial
number of benefits to both physical and mental
health, such as mood, strength, tone, sleep and
cardiovascular health (Hausenblas et al 2008).
A study by Calogero and Pedrotty (2004)
found that there was a significant increase in the
weight-gain of participants engaging in an inpatient
exercise programme, as well as a reduction in their
disordered thoughts.
Ng et al (2013) found that having a supervised
training programme improved mood and
perceptions of body image, as well as muscle
strength and stamina, without having an overall
detrimental effect to the body composition and
weight.
The main role of occupational therapists is to
maximise a person’s functioning and independence
by engaging in a variety of meaningful activities.
Overall goal and objectives
The RCOT publication, Getting my life back:
occupational therapy promoting mental health and
wellbeing, influenced the development of a new
group within the service.
The purpose was to present a potential service
development to introduce and promote exercise as a
30 OTnews February 2020
meaningful activity for people with an eating disorder,
led by occupational therapists. The main objectives
were to:
• promote exercise as a healthy and meaningful
activity;
• support patients in building a healthy relationship
with exercise;
• improve strength, muscle, tone and stamina;
• educate patients on the importance of meaningful
exercise; and
• encourage patients to become more aware of
body signals and limits.
Setting up the group
The programme was initially developed after a variety
of interest checklists were completed with patients,
which indicated that returning to exercise as a
meaningful activity was important to them.
Traditionally, exercise within eating disorder
treatment is often viewed as ‘taboo’ and considered
detrimental to recovery. However, the evidence
shows that there is a gap in the market for treatment.
Following a critique of Cook et al (2016) the
group was adapted to fit the needs of the client
group. Currently, the inpatient cohort I work with
have an eating disorder as the presenting issue,
however most of the patients present with other co-
morbidities such as personality disorder, anxiety and
depression.
The group was set up to be a closed group, with
a select number of patients. Following discussion by
the multidisciplinary team – consideration of weight,
physical health, mental stability and risks – a patient’s
attendance was agreed.
Once in agreement, the multidisciplinary team
continued to monitor the patient’s progress in terms
of weight and blood chemistry, to ensure they were
physically well enough to participate, as well as fully
engaging with the overall treatment plan.
The group facilitator conducted assessment for
eligibility and patients were invited to join the closed
group.
The initial group session outlined rules and
boundaries and each participant completed a