Physiotherapy
in Eating
Disorders
Yvonne Hull
Physiotherapist, Bristol
Eating Disorder Service.
yhull@nhs.net
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.