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Overview of Eating Disorders

Eating disorders include anorexia nervosa, bulimia, and binge eating.1 A combination of genetic, psychological, and social factors results in these disorders. Diminished nutrition, body weight, and muscle mass contribute to endurance impairments. Some clients develop an obsession with exercise in order to limit body weight, which in the long term is not beneficial for their health.2 Clients may have proximal muscle weakness, which can result in gait disturbances and limitations in performing daily activities. Limitations in endurance must be evaluated within the overall presentations of each client's condition.

Comorbidities to Consider

  • Complications for the cardiac, endocrine, and gastrointestinal systems occur owing to altered hydration and electrolyte levels.

Client Examination

Keys to Examination of Clients

  • Ask clients if they have been assessed for cardiopulmonary complications and blood and plasma levels.

  • Clients with long-standing eating disorders may need assessments of bone mineral densities.

  • Consider the need for ongoing psychological and behavioral counseling to address unhealthy habits associated with their eating disorder.3

Recommended Baseline Testing of Fitness Levels

  • Clients can be assessed for their endurance tolerance, proximal muscle strength, flexibility, and posture.

  • Determine the client's beliefs and attitudes about exercise to provide parameters and the types of reinforcement the client will need to maintain the program.

Exercise Prescription


Type: Combine aerobic activities with resistive exercise and relaxation methods

Intensity: Low to moderate intensities using heart rate and perceived exertion levels

Duration: Start at 15–30 minutes

Frequency: Three to five times per week

Getting Started

The initial exercise program will need to be carefully planned and supervised to ensure the client's adherence to a cognitive behavioral therapy program. Clients will need to adhere to nutritional and behavioral standards in order to participate in an exercise program. A combination of aerobic activities, resistive exercises, stretching, and relaxation methods will provide a balanced approach to exercise with an emphasis on lifelong fitness and promotion of positive body image.4 Clients who have developed excessive exercise habits will need to have specific upper limits on their program.5 Clients with cardiopulmonary complications will need ongoing assessment of heart rate and blood pressure to ensure exercise is performed within a prescribed intensity level.

A written record of exercise will help clients develop an understanding of their abilities and self-confidence.5 Aerobic exercises can be performed at 50% to 70% of clients' maximum heart rate for up to 45 minutes.4 Use of a treadmill, cycle ergometer, or elliptical trainer is recommended to help clients record and provide feedback on their parameters of exercise.6 Resistive exercises can be performed at moderate intensities, with an ...

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