Physiotherapy for patients with anorexia nervosa

Abstract

The integration of physiotherapy as an adjunctive treatment for patients with an eating disorder within psychiatric health care and rehabilitation may sound unusual. However, physiotherapists have specific expertise in both the 'body' and 'the body in movement', two important issues integral to eating disorder pathology. Based on our clinical practice and the current body of scientific evidence, a rationale and clinical guidance for incorporating physiotherapy into treatment for patients with anorexia nervosa (AN) is presented. Two main indications for physiotherapy are proposed for patients with AN: (1) the distorted body experience with a specific focus on perception, attitudes, and behavior, and (2) the compulsive and excessive engagement in physical activity characteristic of patients with AN. Physiotherapists have a wide array of skills and are encouraged to select those techniques (e.g. relaxation, breathing exercises, awareness exercise, and exercise programs) which are most individually relevant the patient to address the distorted body experience and hyperactivity typically seen in AN.

Exercise and physical therapy help restore body and self in clients with severe anorexia nervosa

“…Mirror exercises have been suggested as a way of improving mental representations of the body and body size issues (e.g., Probst et al, 2013). Despite the role of visual systems in maintaining postural stability, due to the potential for distracting clients from recognizing what goes on within the body, and to avoid visual comparing and judging, the use of a mirror may not be suitable during the early phase of this process.…”

“…Tailoring exercise and physical therapy interventions to the needs of the individual may prove favourable for clients' motivation with respect to bodily recovery, as well as recovery in general. With few exceptions (e.g., Fisher and Schenkman, 2012;Kolnes, 2012;Probst et al, 2013;Scott and Van Blyderveen, 2014), the literature does not address exercise or physical therapy interventions based on findings from body examinations that may uncover bodily restraints and bodily tension in clients. The lack of such assessments may reduce the prospect of developing interventions that meet the needs of the individual patient, both in terms of his or her physical and psychological status.…”

“…However, work based on body assessment and specific bodily concerns in the context of anorexia nervosa is sparse (Fisher and Schenkman, 2012;Hechler et al, 2005). Nevertheless, changing the way in which patients with anorexia nervosa experience their bodies is assumed to be an important indication for physiotherapy, and interventions aimed at modifying body awareness and bodily experiences have been proposed (Vandereycken et al, 1987;Beumont et al, 1994;Probst et al, 2013;Probst et al, 1995). One paper has discussed the potential of body awareness therapies in terms of increasing body contact, initiating novel ways of sensing and interpreting bodily signals, as well as improving emotional awareness through the body (Kolnes, 2012).…”

“…In her exploration of techniques that may increase the perception of the body and relaxation in individuals with anorexia nervosa, Davison (1988) emphasizes the importance of establishing a trusting relationship with the client, and of tailoring the interventions to the specific needs of the individual. With the purpose of influencing the body experience an excessive exercise in patients with anorexia, interventions with the aim of rebuilding a realistic body awareness and curbing "hyperactivity", including massage therapies and exercises with the aim of changing breathing, posture and the ability to relax, have been reviewed by Probst and colleagues (Probst et al, 2013;Probst et al, 1995). Given the wide arrays of qualifications of physiotherapists in, for example, facilitating the experience and awareness of the body, Probst et al (2013) contend that physiotherapy should be an integrated part of the overall treatment of anorexia nervosa.…”

“…With the purpose of influencing the body experience an excessive exercise in patients with anorexia, interventions with the aim of rebuilding a realistic body awareness and curbing "hyperactivity", including massage therapies and exercises with the aim of changing breathing, posture and the ability to relax, have been reviewed by Probst and colleagues (Probst et al, 2013;Probst et al, 1995). Given the wide arrays of qualifications of physiotherapists in, for example, facilitating the experience and awareness of the body, Probst et al (2013) contend that physiotherapy should be an integrated part of the overall treatment of anorexia nervosa. Based on physiotherapeutic examinations of a severely deconditioned patient with anorexia nervosa who was unable to perform daily tasks (e.g., walking and sit-to-stand without assistance), Fisher and Schenkman (2012) outlined a programme of diverse physical therapy interventions during a nine-week hospitalization.…”