Physiotherapy in Eating Disorders Yvonne Hull Physiotherapist, Bristol Eating Disorder Service. [email protected] The Eating Disorders ANOREXIA NERVOSA Incidence of 0.3% Mortality rate of 6-20% Body weight maintained at 85% of expected level Intense fear of gaining weight Body image disturbance Amenorrhea BULIMIA NERVOSA Incidence of 0.1 to 9% Binge eating followed by purging Maybe in the form of vomiting, laxatives, diuretics and over exercising BINGE EATING DISORDER BMI 11 - 15 Discuss damage to joints when muscles emaciated with pt & explain aches Discuss postural changes due to muscle weakness, eg winged scapulae Postural advice in sitting Post meal supervision, sitting compulsory Teach relaxation techniques BMI 11-15 Check on patient’s footwear, in anticipation of walking (painful metatarsal heads) Quads exs & bridging in lying, in anticipation of mobilisation Massage to painful shoulders & heat Rx to relax muscles Gentle exs for specific painful spots, eg lumbar spine BMI 15-17.5 STRETCHES SWISS BALLS Mobilise gently, introduce to different types of exs YOGA PILATES TAI CHI BMI 17.5+ Steer away from solitary exs, go to group/fun activities Avoid previous problem areas, usually high calorie burners Exercise to fit in with patient’s life Refer to healthy exercise group at STEPS Encourage social side, classes at local sports centres Over Exercise/ Activity SURREPTITIOUS Going up and down stairs frequently, or getting off the bus three stops early OVERT To burn off calories and induce weight loss Activity is strenuous and physical often high cardiovascular burner, i.e. running, cycling, swimming Performed in a rigid, obsessive manner Often accompanied by feelings of guilt if not performed to expected high standard, or missed completely RESTLESSNESS Often evident in very emaciated patients Associated with sleep disturbance Evident as rocking, rhythmic movements Over Exercise Control Encourage patient to talk to you about exercise to exercise with others to take classes not to exercise at home not to go back to previously problematic exercise modes to reduce time periods of their day allocated to exercise maybe to stop altogether, pause, and then restart a new exercise routine to try new kinds of exercise Worries Osteoporosis Discuss with all patients prescribed exs DEXA scans sometimes arranged Potassium levels Regular blood tests necessary for bulimics/laxative abusers If pot. level abnormal, STOP all exercise now Motivational Cycle Relapse Maintenance Action Precontemplation Contemplation Determination References Carraro, A., Cognolato,S., Fiorellini Bernardis, A.L. (1998) Evaluation of a programme of adapted physical activity for ED patients. Eating and Weight Disorders. 3, (3), (110-4). Department of Health (2008) Improving Health: Changing Behaviour NHS Health Trainer Handbook. British Psychological Society Health Psychology Team. London: Crown. Hausenblas, H.A., Cook, B.J., & Chittester, N.I. (2008) Can exercise treat eating disorders? Exercise and Sport Sciences Reviews. 36, (!), 43-47 Mehler, P. S. (2003). Osteoporosis in Anorexia Nervosa: Prevention and Treatment. International Journal of Eating Disorders. 33, 113-126. Mond, J.M., Hay, P.J., Rogers, B., & Owen, C. (2006). An update on the definition of “excessive exercise” in eating disorder research. International Journal of Eating Disorders. 39, (2),147-153 Sundgot-Borgen, J., Rosenvinge, J.H., Bahr, R., & Sundgot Schneider, L. (2002) The effect of exercise, cognitive therapy, and nutritional counselling in treating bulimia nervosa. Medicine & Science in Sports and Exercise. 34, (2), 190-195 Thien, V., Thomas, A., Markin, D., & Birmingham, C.L. (2000) Pilot study of a graded exercise programme for the treatment of anorexia nervosa. International Journal of Eating Disorders 28 (1): 101-106 Vitousek, K., Watson, S. & Wilson, G.T., (1998). Enhancing motivation for change in treatment – resistant eating disorders. Clinical Psychology Review. 18, (4), 391-420.