Safe Return to Sports and Movement

By Sarah Archer, LMFT

Disordered exercise is a prevalent issue, affecting 4 out of 5 individuals with an eating disorder, and is the second most common symptom associated with relapse. Given its prevalence and impact, it is crucial for you and your treatment team to develop a well thought out plan for your child’s return to movement.

Movement will inevitably be a part of your child’s life, whether through physical education classes, social activities with friends, family bike rides, or participation in recreational and competitive sports. Exercise can offer numerous benefits, such as managing symptoms of anxiety and depression, supporting digestion and sleep hygiene, providing structure, fostering social interactions, offering an outlet for competition, building self-esteem, and helping your child master a skill. Additionally, it can serve as a significant motivational factor for recovery, supporting your child in achieving their daily, monthly, and long-term goals.

However, returning to movement can also be stressful and confusing, posing a vulnerability factor in the recovery process. It may trigger the eating disorder directly, expose your child to environments focused on body image, exacerbate perfectionism, and lead to caloric deficits.

Considering these pros and cons, it is essential to ask yourself the following questions:

1. Safety: Is it safe for my child to return to movement? Are they medically cleared? Is it a priority? Are they still engaging in eating disorder behaviors?
2. Genuine Interest: Does my child have a genuine love for movement and sport, or did this interest only arise in the context of the eating disorder?
3. Coping Mechanism: Is movement the only way my child copes with stress, or can they use other strategies?
4. Compliance: Is my child willing to follow a strict movement plan with supervision and adequate refueling?

Discuss these questions with your treatment team to identify your child’s specific pros and cons of returning to movement and sports, as well as their vulnerable areas. Developing a solid, individualized plan will help ensure a safe and supportive environment for your child’s recovery journey. A great step to prioritize safety and follow through is by including movement in a behavior contract. (see below)

Here are some conditions for returning to movement/sports which can be included in a contract:

1. The patient has to be medically cleared by their treatment team (MD, dietician, therapist, parents) prior to beginning any movement. Some considerations at % of goal weight range based on growth charts, Labs/EKG/DEXA scan, and current progress managing eating disorder urges & behaviors.
2. They will follow a titrated movement plan created by a dietician. 
3. All movement must be supervised by a parent or another trusted adult.
4. Dietician will prescribe a caloric refuel based upon intensity and duration of movement which has to be supervised by a parent or chosen adult.
5. Any additional exercise will be approved by the treatment team based on progress and compliance, and will be assessed weekly. 
6. If the patient does not follow the movement plan and/or refuses to be compliant with refuel/supervision, movement will be paused.
7. If the patient loses weight, the treatment team will work with parents on assessing if meal plan needs to be adjusted and/or if movement needs to be reduced.