Exercise: Enough or too much? Knowing when to change gears.

Are you exercising enough or too much? Do you feel you need to be doing more? It’s often hard to judge for yourself. So take a look at these cases, modified from patients I encountered this past month, and see what you think:

Regardless of the activity, do be sure to listen to your body's needs!
  • A competitive skier, who spends 5 hours/day skiing and 90 minutes/day hiking;
  • A college student who runs 30 minutes, 4-5 times/week;
  • A biker who biked 55 miles one day, 107 miles over 3 days;
  • A coach who worked out at the gym 6 days/week, and spends 12 hour days physically active coaching.
  • A woman with anorexia who runs 3-4 days/week for 40 minutes.

If you’re thinking: “It depends”, you’re right. So here are some more details:

  • The skier came to see me wanting to gain weight to improve her strength and performance. She was fully on board with gaining weight and with eating more.
  • The college runner? He pushes the intensity and distance when he’s overeaten or binged and then also overcompensates by eating less.
  • The woman with anorexia? She has been successfully cutting down from her daily, injury-inducing hour-plus runs, while simultaneously increasing her food intake.
  • The sports coach? His activity stays constant regardless of his intake. And his intake hovers between 300 and 400 calories per day. And his weight is stable.
  • As for the biker? That’s me. I’m not making excuses but my husband got us lost on a ride last Sunday and we did way more than planned in our training for a 150 mile fundraising ride; but I did need to get the training in and was planning on a 40 miler. Along the route, after a full breakfast I had a delicious scone—and a generous lunch out. I acknowledged my poor planning when I petitioned my husband to part with one of his bars. He gave in and I ate it, and I was quite thankful.

Now what do you think? Is it becoming clearer?

It’s difficult to fairly evaluate activity levels simply by knowing the type of activity and the duration—whether or not you have an eating disorder or disordered eating. Without evaluating the bigger picture of thoughts and intentions, that is. The skier—with her very high activity but drive to eat enough for performance and health—is the least of my concerns—as long as her eating changes support her intentions. But the coach and the college runner? Activity is clearly used inappropriately in their cases.

But what if intentions arehealthy—you want to maintain your healthy weight or even lose weight from your current higher than usual and healthy place, perhaps to include a moderate level of activity? Yes, I do support increased activity in these patients. With caution, though, in those with a history of eating disorders. And I support increased activity to help improve elevated blood sugars and cholesterol levels. But if you spend your waking hours premeditating how to work out to justify your eating, that’s a problem. If you perceive that it’s healthy to work out—for instance, you have intentions to be a healthy person—but your food intake falls short, resulting in low energy, irritability, early fatigue, inappropriate weight loss or slowed metabolic rate (with low body temp and heart rate)—then those good intentions clearly aren’t enough.

A healthy mind and body

Compelled to exercise at midnight because you can’t sit with the cookies you ate? It’s not enough that your vital signs are stable or that your weight is “better than it used to be”. No, there’s a problem here. Obsessed with the calorie displays on the treadmill, or the number of steps or miles on your pedometer or FitBit? Maybe it’s time to rethink your activity.

From my clinical experience, I’ve seen more previously sedentary people give up moderate activity when their sole goal was dropping pounds. Patients who exercise strictly to manage their weight are challenged to maintain their activity. If they didn’t drop weight in spite of exercising, they think: “why bother”; they ignore all the positives like the sense of achievement in having followed through with their goal, the improvement in mood and in sleep. They forget how nice it was to have time for themselves—or to connect with others around something other than eating. They fail to remind themselves about how their endurance or their strength has improved. So they drop the exercise.

Ok, I also ride to get to great places. Provence, France
I don’t ride to lose weight. I love the outdoors and love the feeling of the breeze on my face, like a dog with his snout poking through the car window. I like how it feels when I’ve accomplished a ride, but also how it feels while I’m riding; yes, I even like the journey. I enjoy the camaraderie of riding with company, but sometimes prefer to go off by myself. And my weight? It tends to remain within a couple of pounds throughout biking season. No doubt, because I am mindful to eat enough, stay strong while cycling—sometimes even when I don’t notice hunger. Sound crazy? There are times—like immediately after my ride or when we take a rest, that stomach hunger isn’t clear. Yet the fatigue might be stepping in, a sign of hunger gone too far, which can be resolved with nourishment. Sometimes the act of pushing fluids to stay well hydrated limits my perception of hunger. The high intake of water or Gatorade can buffer your hunger, making it more challenging to know that eating is necessary.

But if I did ride to support stabilizing a climbing weight, or to turn this trend around—would it be a problem? Perhaps not. Exercise, per se, is not the issue. But using it while denying adequate nourishment surely requires some help.

Back to my patients

Sure, the frequency and duration of activity might be a red flag, but we really need context to gauge its appropriateness.
The skier I have little concern about—in spite of her very high and frequent exercise—because it appears that her head is in the right place. And I was met with no resistance when encouraging practical calorie boosting recommendation to increase her energy and her weight.

For the coach with a very low calorie intake, his weight might be stable, but his intake is very restrictive. And he has a history of losing significant amounts of weight combined with unhealthy thoughts and behaviors—that’s a major problem. There should be no physical activity for him—at least until his intake increases significantly. Exercising, in his case, will only break down the muscle he has long worked to develop.

What are you hoping to achieve by working out?
The 30-minute college runner’s activity concerns me a great deal. Clearly it’s not the amount of exercise, but the way in which it’s used when he is uncomfortable sitting with the distress of eating, when he perceives he’s eaten too much. Yet I’m less worried about my patient running with anorexia—as long as she continues her progress with eating enough and maintaining her weight and medical stability—which she has done beautiful well with.
In some instances it’s quite clear that the exercise prescription needs be refined. If your weight or vital signs are falling out of range—something has to change, starting with reduction or elimination of activity; and if your eating becomes more restrictive, even if your weight is stable (due to slowed metabolic rate with undereating + exercising), activity needs to go. Really.

Many individuals can include exercise and be healthy—even if the exercise supports weight loss (in someone for whom weight loss is deemed appropriate by their medical team).

Talk to a therapist, your doctor, or your dietitian about your activity level. But don’t forget to share your thoughts—not just the details of duration, frequency and intensity of your activity.
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