Whether it's a cancer patient or a diabetic or someone with high cholesterol or someone who is overweight or obese, exercise is a part of many people's health care regiments. One group who might not immediately come to mind when thinking about who can benefit from physical activity, though, are people who are recovering from an eating disorder. Yet accounts from physical therapists and athletic trainers show that structured exercise programs and in some cases, physical therapy, can help these patients on their path to recovery.
An estimated .6% of Americans will suffer from anorexia nervosa sometime in their lives and another estimated .6% will suffer from bulimia nervosa, the two most recognized eating disorders.1 According to Eating Disorders The Journal of Treatment and Prevention, 50% of people who are being treated for an eating disorder have eating disorder not otherwise specified (EDNOS), an umbrella term for patients who may not meet all the medical qualifications to be classified as anorexic or bulimic but still suffer from some type of eating disorder.2
The ACUTE Center for Eating Disorders at Denver Health Medical Center, an in-patient facility, is at the forefront of incorporating physical therapy into the treatment of eating disorders. The goal of the ACUTE center is to medically stabilize patients. The length of hospitalization varies from patient to patient, but it's usually around three weeks. To be admitted patients must either be less than 70% of their ideal body weight or have serious medical co-morbidities.3
Among acute care treatment facilities, it is unusual that physical therapists are included as part of the medical team, at least according to Katherine Ogle, PT, DPT. "Frankly, we haven't met a lot of people who do this," she said. "It was important for the team to incorporate an interdisciplinary approach," added her co-worker, Beth Anne Carlson, PT, DPT, CSCS. Ogle describes the role of physical therapy at the ACUTE Center as a consultant role. With weekly interdisciplinary rounds, the staff discusses the plan of care for each patient. The physical therapists work closely with the doctors, nurses and nutritionists.
Working with this population "warrants a thorough understanding of what patient is going through," said Jonathon Mitchell, MA, CTRS, clinical specialist, rehabilitation therapies, at the University of Iowa Eating Disorders Clinic in Iowa City. Patients take something good for us, i.e. exercise and turn it into punishment. They think: I need to burn calories or be thin. It's the role of therapists to monitor calorie burning.
The University of Iowa Eating Disorders Clinic boasts a "pretty diverse multidisciplinary team," Mitchell said. Although the clinic has both an out-patient and an in-patient component, it specializes in treating the "sickest of the sick" in a hospital setting, according to Mitchell. Occupational therapists, nurse practitioners, recreation therapists, dieticians, psychologists and physicians collaborate on patient care. Recreation therapists like Mitchell, lead structured exercises for wellness.
Patients recovering from eating disorders often have balance defects, causing them to be at a high fall risk; cardiac defects; and low bone density and/or osteopenia, raising their osteoporosis risk. When many patients first come to the ACUTE Center, they are not independent with mobility. "Psychologically, it's important for patients to be mobile enough to leave their room," said Carson. Added Ogle, "A physical therapist is the most appropriate specialist who understands activity to understand at what level it is OK."
"Many of the eating disorder individuals use exercise to lose weight. If it isn't supervised, they will over-exercise," noted Deborah J. Rhea, Ed.D, professor of kinesiology, coordinator for physical education and consultant for mental performance at Texas Christian University, Fort Worth. Patients are also at a risk for bone breaks if a physical therapist, athletic trainer or other health care professional does not work with them on a carefully structured routine.
Certified athletic trainers and others who work with student athletes suffering from eating disorders play a special role in the recovery process. They are sometimes the first to notice a student isn't gaining muscle mass, despite working out. If a student athlete is constantly being treated for different injury; if injuries don't heal; or if weight constantly fluctuates, "a red light should go off," said Rhea.
Texas Christian University has a comprehensive plan for treating athletes. If an ATC suspects something is wrong, he or she refers the student to a physician who will check their electrolytes and examine them. If the doctor suspects an eating disorder, the student is then sent to an eating disorder specialist. If a diagnosis is made, a psychologist, certified athletic trainer, nutritionist, etc. devise a treatment plan that includes pulling the patient off team workouts and modifying their exercise routine. "Try to keep everything as consistent as possible when bringing them out of the eating disorder," Rhea advised. Like other health care professionals, she echoes the importance of team work and having everyone working with and talking to each other.