How would you train a client who is recovering from bulimia?

Adding my two cents...

As someone already said, make sure she is medically cleared for exercise by her entire health team. If she is seeing a nutritionist, you may want to speak to that person as well to see how things are going on that end.

If you haven't already learned what her triggers are, monitor her carefully for any new addictions, such as exercise. Though we all monitor for signs of overtraining, knowing as much about bulimia as possible and having a complete history of your client are your best weapons.

Encourage and open and honest professional relationship and be clear that you cannot continue to train her if she relapses until she is cleared again. That is going to be very frustrating for her, but it's the nature of the disease. I speak from experience.

Read up on the female athlete triad and check out the resources from the National Eating Disorders Association at http://www.nationaleatingdisorders.org/information-resources/educators-a....

Hello Jocelyn,

I must admit that I don't have any experience training the bulimic population. However, when I read your question, the first thing that came to mind is what resources do I have that address this clinical condition. As an ACSM Registered Clinical Exercise Physiologist, I tend to refer to the ACSM's resources related to clinical exercise for guidelines when training people who present with clinical conditions and bulimia is a clinical condition. As I am at the IDEA convention, I don't have access to my resources, however, I must say I don't remember ever seeing any guidelines regarding exercise and bulimia. The closest thing I have found online is the ACSM Position Stand on the Female Athlete Triad. Here is the link:

http://journals.lww.com/acsm-msse/Fulltext/2007/10000/The_Female_Athlete...

You may feel it might not pertain to your circumstance, however, this stood out for me in their position stand:

"A multidisciplinary treatment team should include a physician or other health-care professional, a registered dietitian, and, for athletes with eating disorders, a mental health practitioner. Additional valuable team members may include a certified athletic trainer, an exercise physiologist, and the athlete's coach, parents and other family members. The first aim of treatment for any Triad component is to increase energy availability by increasing energy intake and/or reducing exercise energy expenditure. Nutrition counseling and monitoring are sufficient interventions for many athletes, but eating disorders warrant psychotherapy."

Bulimia as you know is an eating disorder and I would definitely involve those on her treatment team as you say she is "recovering" and not recovered.

I hope this gives you some direction.

I am sure that female athlete triad link covered some of what you need but important key things I remember is you refer to a physician, and electrolyte balance may have to be fixed prior to participation. You should monitor heart rate and blood pressure during exercise. Probably shouldn't have an emphasis on weight loss goals and there should not be vigorous activity. Make sure that they get couple hundred calories of carbs within 90 minutes post exercise. There should be at least 2-3 days off a week no exercise every day and no exercise with stress fractures. Watch for feeling of light head, irregular heart beat, nausea. I think these are just some of many important factors that should be implemented if you do choose to train this client.

Tough question because the history can be so varied. You have already gotten some good responses.

I looked at your profile, and it seems to me that you are a personal trainer who goes to people's homes. So I assume that your new client does not have to visually compete with all the 'oerfect bodies' found in gyms, and that is helpful because I am sure that she does not have a good relationship to her body but rather a punitive one.

After having screened her as any other client, I would make sure that there are only positive associations with exercise. Feeling successful and developing a 'can-do' attitude often carries over to real life. I would be very careful about the weight loss program part beyond exercise and leave any discussion about food to a nutritionist. Emphasize on feeling healthy and strong.

Last but not least: if she were to suffer a relapse, do not load that on your shoulders. You may see her 2 or three hours per week and have no control what happens to her the rest of the time. The triggers are more likely to come from her familiar environment but it is sometimes more convenient and less painful to look for responsibility elsewhere.

Great question J,
I've worked with one who stopped purging and became a (calorie purging) running addict. Great posts here that this is clinical and monitoring/team work is very important:physical, emotional, mental, intensity, volume, duration, frequency, nutrition. Know what triggers their process. Good luck!

Thank you all for your responses. She has a great team that is monitoring her process and has been cleared for exercise. Her doctor never mentioned watching heart rate, but that makes sense due to the effects of purging. Thank you Shane for mentioning it. I've already noticed that she has a tendency to overdo things and take things to the extreme (tell her to walk and she runs!). I'm keeping an eye on things and stressing how exercising make her feel rather than makes her look. We're keeping all the lines of communication open and trying to problem solve her areas of stress. We talk about food as fuel, but I leave most of the food talk to her nutritionist. As most of you have said this is a process. I thank you for all the feedback and excellent food for thought.