Expert: Ryan Hale - 2/8/2010

Question
QUESTION: I am recovering from Anorexia and the key for my turnaround was the desire to be an athlete since my dreams there got messed up and lost with the disease.

Now that I have the right mentality and am eating enough, I have started training again.  Although my body can't handle nearly as much as it did before I starved it, going to the gym and being reminded of where I want to be does wonders for keeping me on track with eating and weight gain.

My question is this:
Is there anything I should be concerned about exercising while underweight BESIDES energy balance?
I know my activity does not thwart my weight gain [and actually helps it] -but could it still be dangerous for an underweight body EVEN IF EATING ENOUGH?

If so, when is the body physically safe to train without risk?

ANSWER: Dee-  wow, what an amazing story.  Congrats on getting better!!  As for your situation, the American College of Sports Medicine recommends moderate to heavy strength training to accomplish a response in your body to increase bone density.  Of course moderate to heavy is relative to your ability now.  I would recommend getting with a good trainer who can assess where you're at and where you should begin for your strength training.  As for cardio, people with eating disorders are at greatest risk of electrolyte imbalance and the resulting heart failure that can occur.  I am assuming that you are eating a proper diet so that is less of a concern.  However, as you get back into cardio, it is often recommended that you keep from doing efforts that take your heart rate to the max.  You can check with your doctor and see what he/she says, but until you achieve near normal weight and have built a bit of a base of fitness, keep your heart rate down below your HR max.  Hopefully that answers your questions.  Please let me know if you have anything further.

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for responding, and so soon! You have no idea how helpful it is to have advice from an expert in both areas: I tend to get the athletic advise on how to rebuild my training, which is very valid but doesn’t take into account what state my body is in…and then the ED Recovery advice which focuses solely on exercise with the purpose of ‘weight control’- where for me as an athlete, that’s totally backwards: I want to weigh more as an athlete, and train to become that as well!
A lot of your advise told me to consult a Dr/trainer, and to be honest, one reason I am asking your opinion [I know you cannot take the place of a Dr.] is because I don’t have those resources.

This is why I’m asking: I know I am now eating enough and continuing to gain while training, I know I am feeling better, but I worry because I DON’T have that monitoring - done leaves me in a still dangerous state even if my current habits and feelings are “normal.”

Currently I’m training about 5hr/week for endurance [I’m a runner and rower, but not quite running yet due to injury] + 3-5x Week either toning or weight training.
By how I “feel” this is right for me- less than half of what I am used to, but a step in that direction from the sickly state I was in.

Is there any way I can “know” what is straining my heart?  
Also, what is my body ready for?  I have so much more strength and energy, yet seem to break down/get injured so readily.

If you have any further advice as to how I can stay in check with my body without access to medical resources, please let me know!

Answer
Dee- for weight training, you'll need to know what your 1 rep or 10 rep max is to know how to structure your training so that you are lifting a percentage of that in your program.  There's no way to tell unless you go through the assessment with a trainer.   Otherwise, it sounds great that you are doing a class with some lifting in it for now.

As for your heart rate, a great way to keep track is with a heart rate monitor.  You can get a basic one for around $60.  Again, without the proper assessment, it's difficult to know what your lactate threshold and max heart rate are.  One formula that gives a rough estimate is the 220 - your age equation.  So, for me that would be 220 - 37 = 183 for my max.  It's actually a little higher than that, but it's a ballpark figure.  That means to work at 80% of my max heart rate I would be at 146-147 beats per minute.  You can work the equation and figure out what 60%, 70% and 80% are so you'll know how hard to work any given day.  Also, write it down on a note card and keep it with you if you have trouble remembering.  However, these are rough estimates and will be different for different people.

As far as the injuries go, your body is still trying to build back up and injuries for someone in your condition may be more frequent.  Make sure you are not over training or doing too much.  You are still in the "build back up," phase.