I have a new client who is recovering from bulimia. She is looking for a weight loss program, toning & strength training. She wants to live a healthier life for her family and children. Her last purge was 9 months ago. She’s been suffering from bulimia for over 5 years. I want to help her achieve her goals without triggering a relapse.
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:
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.
I would first make SURE that my client has received a medical consult and has been cleared to exercise. I would also very strongly advise the client to seek the counsel of a registered dietitian or nutritionist. As for our training sessions, I would very closely monitor my client’s response to exercise, and look for signs of overtraining or other adverse reactions.
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!