The Crucial Role of an Exercise Physiologist in Eating Disorder Recovery

In recent years, the inclusion of movement in eating disorder (ED) treatment has evolved from a blanket restriction approach to one grounded in nuance, clinical insight and trauma-informed care. A growing body of evidence demonstrates the potential benefits of thoughtfully integrated exercise in recovery when overseen by qualified professionals. At the forefront of this work is the Exercise Physiologist, a practitioner uniquely positioned to support physiological restoration, re-establish safe movement patterns, and dismantle harmful beliefs about exercise often embedded in disordered behaviors.

From Risk to Recovery: Rethinking Exercise in ED Treatment

Historically, exercise has been pathologized in eating disorder treatment settings, and for good reason because compulsive and excessive exercise can serve as both a symptom and perpetuating factor of many EDs. However, research now affirms that not all movement is harmful, and that the context, intention, and structure of exercise matter most.

According to Calogero et al. (2022), when carefully monitored and appropriately dosed, exercise can:

• Improve psychological well-being and reduce depressive symptoms

• Support weight restoration in undernourished individuals

• improve bone mineral density and cardiovascular health

• Rebuild strength and physical confidence

• Create mind: body connection & embodiment

• Facilitate connections with like-minded individuals in a safe space

The key lies in how exercise is introduced and who facilitates it. This is where the expertise of an Exercise Physiologist becomes critical.

What Sets Exercise Physiologists Apart?

Exercise Physiologists (EPs or CES) are allied health professionals trained in the science of human movement, physiology and chronic disease management. Unlike personal trainers or fitness coaches, EPs possess advanced knowledge of how the body responds to exercise under conditions of physical or medical compromise...including malnutrition, low bone density, amenorrhea, injury and cardiovascular abnormalities, which are common in eating disorder populations.

In the context of ED recovery, an EP:

• Conducts detailed intake assessments to understand the individual’s medical status, trauma history, and relationship with exercise

• Collaborates with multidisciplinary teams, including therapists, dietitians, and physicians, to ensure exercise is medically and psychologically safe

• Creates trauma-informed, individualized programs that emphasize interoceptive awareness, nervous system regulation, and body trust.

• Shifts focus from aesthetics and calorie expenditure to function, strength, and emotional regulation

Trauma-Informed Movement and the Role of Safety

One of the most significant contributions of an exercise physiologist in ED care is their ability to deliver trauma-informed movement experiences. Many individuals with eating disorders have a history of other trauma, including medical trauma, body-based shame, or abusive fitness environments. EPs trained in trauma-informed care can recognize these patterns and adapt their approach to prioritize emotional safety, consent, and empowerment.

Instead of prescribing punishing workouts, they help clients explore:

• How movement feels rather than how it looks

• How to notice internal cues like fatigue, fullness, or fear

• How to set boundaries and reclaim autonomy over their body

This shift is not just rehabilitative, it’s revolutionary for individuals reclaiming their bodies after years of disconnect.

Bridging the Gap Between Therapy and the Gym

While psychotherapists may help clients explore cognitive distortions about food, body and identity, they often aren’t equipped to navigate the physiology of movement. Likewise, many fitness professionals lack the psychological training to identify compulsive exercise or safely reintroduce movement after medical instability. Exercise Physiologists serve as the bridge between mental health and physical rehabilitation. They are often the first to:

• Detect signs of overtraining or energy imbalance

• Spot orthopedic risks like stress fractures

• Notice emotional shifts tied to performance, competition, or body image

By helping clients find joyful, nourishing, and embodied ways to move, EPs support sustainable recovery, not just symptom reduction.

The Future of Eating Disorder Treatment Must Include Movement

As eating disorder care continues to evolve, interdisciplinary collaboration is key. Calogero et al. (2022) argue that integrating qualified movement professionals like Exercise Physiologists can enhance treatment outcomes, reduce relapse, and build resilience in clients who may otherwise feel afraid of or addicted to exercise.

To ensure safety, EPs working in this field must be:

• Specially trained in eating disorders, trauma, and body image issues

• Able to work within a clinical team and respect scope of practice

• Grounded in non-diet, weight-inclusive, and patient-centered care

When those criteria are met, the inclusion of an exercise physiologist can be not only safe, but transformative.

Citation:

Calogero, R. M., Van Dyke, N., Tylka, T. L., Rodgers, R. F., Cook-Cottone, C., Danielsdottir, S., & Werle, D. (2022). *Exercise in eating disorders: A review of the risks, benefits and recommendations for practice*. Journal of Eating Disorders, 10(1).