Exercise and eating disorders: compulsive exercise, recovery and returning to activity safely

Get help straight away

The NHS says a mental health emergency should be taken as seriously as a physical one, and that you will not be wasting anyone's time.

• Call 999 or go to A&E (accident and emergency) if your life is at risk: for example, you have seriously harmed yourself or taken an overdose, or you feel you can't keep yourself safe.
• For urgent help in England, call 111 and select the mental health option, or use 111 online.
• Call Samaritans on 116 123. It is free, any time, day or night.
• Text SHOUT to 85258, any time.
• In the US, call or text 988, the 988 Suicide and Crisis Lifeline, any time.

Sources 1, 2, 3, 4

Go to A&E or contact the eating disorder team straight away

The Royal College of Psychiatrists' guidance on medical emergencies in eating disorders (MEED) tells relatives and carers to go to A&E for assessment, or contact the eating disorder team immediately, for any of these:

• Fainting when standing up.
• Being unable to climb stairs.
• Talking about ending their life.
• Suddenly refusing all food or drink.
• A stomach bug or other illness with vomiting or diarrhoea.

Sources 5, 6

Looking well doesn't mean being safe

MEED also counts struggling to get up from a squat, or to sit up from lying down, without using the arms as a sign of high risk. Someone can look well and full of energy and still be in danger, and normal blood tests don't rule it out.

Source 6

Talk to Beat

Talk in confidence to the eating disorder charity Beat: 0808 801 0677 (England), 0808 801 0432 (Scotland), 0808 801 0433 (Wales) or 0808 801 0434 (Northern Ireland), 3pm to 8pm, Monday to Friday. Calls are free, and Beat also has webchat and email. You don't need a diagnosis to get in touch. Beat isn't a crisis service, so if you're in danger, use the numbers above.

In the US, the ANAD (National Association of Anorexia Nervosa and Associated Disorders) helpline is free on 1-888-375-7767, Monday to Friday, 9am to 9pm Central time.

Sources 4, 7

Exercise can become part of the illness

The NHS lists exercising too much among the signs of an eating disorder. Across 56 studies, about half of people with an eating disorder were exercising excessively at the time. It's about how exercise feels and what it's for, not only how much: driven, rigid, secret, or used to make up for eating or to cope with feelings.

Sources 8, 9, 10

Exercise isn't a treatment

NICE (the National Institute for Health and Care Excellence) recommends talking therapies, and says not to offer physical therapies such as weight training or yoga as part of treatment. It advises people with an eating disorder who are exercising excessively to stop.

Sources 11, 12

It can be risky while your body is short of fuel

Exercise during an eating disorder, or after purging, can bring on fainting, heart rhythm problems, low blood sugar, muscle damage and broken bones. MEED warns that people can seem full of energy right up to a collapse.

Sources 6, 11

Coming back happens in stages, with your team

Teams often use a framework called SEES-2 (Safe Exercise at Every Stage) that starts with breathing and gentle stretching, and steps up only when you're well enough. It hasn't been tested in trials, and it isn't a plan to follow on your own. For many people a pause comes first, and Beat says that's OK.

Sources 13, 14, 10

Get help early

See a GP (general practitioner) as soon as you can if you're worried. Get urgent help for fainting, being unable to manage stairs, refusing all food or drink, a stomach bug, or talk of ending one's life. Beat's helplines are open 3pm to 8pm, Monday to Friday.

Sources 8, 5, 4

What an eating disorder is

The NHS describes an eating disorder as "a mental health condition where you use the control of food to cope with feelings and other situations". The main types are anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED, the most common) and avoidant/restrictive food intake disorder (ARFID). They can affect anyone, at any age and any body size, and Beat says OSFED is "every bit as serious". With treatment, most people can recover.

Sources 8, 15, 6

How common they areStrong evidence

In England in 2023/4, 1.3% of adults had an eating disorder in the past year, probably an underestimate, and 9.1% screened positive for a possible eating disorder on a short questionnaire (up from 6.4% in 2007), including 20.1% of 16 to 24 year olds. In 2023, an eating disorder was identified in 2.6% of 11 to 16 year olds and 12.5% of 17 to 19 year olds. NICE says the risk is highest from 13 to 17, and Beat estimates that about 1 in 4 people with an eating disorder are male.

Sources 16, 17, 11, 18

The names people use

Clinicians call it compulsive, driven, dysfunctional or excessive exercise, and SEES-2 calls it maladaptive movement. Exercise bulimia and anorexia athletica are names people search for, but they aren't diagnoses doctors use: in the International Classification of Diseases (ICD-11) definitions that MEED reproduces, driven exercise is one of the behaviours of anorexia and bulimia. Exercise addiction overlaps: it's about 3.7 times as common in adults with an eating disorder as in those without.

Sources 13, 6, 19

What to look out for

Beat lists these signs that exercise has become unhealthy. They can show even when the amount doesn't look excessive.

• Exercising alone, often in secret.
• Rigid, repetitive or punishing routines that feel impossible to change, skip or swap for something new.
• Exercising to make up for eating, or because of how you feel about your body.
• Exercising when you're ill or injured.
• Feeling guilty, anxious or low if you miss a session.
• Exercise that takes over, getting in the way of school, work, friends or rest.
• Using exercise to cope with difficult feelings.

Sources 10, 20

One question to ask yourself

How anxious would you feel if you couldn't exercise today? Beat suggests that if the thought makes you very anxious, or you notice exercise shifting towards eating disorder goals, it's worth talking to your GP or eating disorder team.

Sources 10, 20

It isn't only workouts

Walking the dog, housework, pacing and standing all count. In hospital, MEED describes "micro-exercising": standing rather than sitting, holding muscles tense, or getting cold on purpose. People treated for compulsive exercise often keep moving in these smaller ways.

Sources 10, 6, 14

How common it isEmerging evidence

In a 2025 review of 56 studies with 21,518 people, 48% of people with an eating disorder were exercising excessively at the time: 48% with anorexia, 45% with bulimia, 38% with OSFED and 11% with binge eating disorder. In 165 people in hospital, 80% of those with restricting anorexia were compulsive exercisers. Studies measured it in different ways, so the figures vary.

Sources 9, 21

Often the first sign, and the last to go

"Driven exercise is often one of the first symptoms of an eating disorder to emerge and one of the last to be tackled as part of recovery", says a workbook from Australia's Centre for Clinical Interventions. SEES-2 says the same.

Sources 20, 13

How it feels matters more than the amountEmerging evidence

A 2026 clinical review says your relationship with exercise, more than how often or how hard you do it, decides whether it helps or harms. In 1,012 young teenagers, a compulsive exercise questionnaire wasn't strongly linked with how often they exercised.

Sources 14, 22

Men, and a drive to be muscular

Compulsive exercise and a drive to be more muscular (sometimes called muscle dysmorphia) may be more common in men and boys with an eating disorder, though not all feel it. MEED asks doctors to ask men specifically about excess training and anabolic steroids.

Sources 18, 6

Feeling energetic doesn't mean you're safeStrong evidence

MEED says the drive to exercise "can override their lack of nutritional reserve, so that they appear very energetic right up to a physical collapse", and that normal blood tests "should not be taken as cause for reassurance".

Source 6

The heartStrong evidence

Fainting or nearly fainting can be a sign the heart and circulation are under strain, and MEED says excessive exercise probably adds to that risk. NICE lists excessive exercise among the reasons to check the heart with an ECG (electrocardiogram). The NHS lists an irregular heartbeat, low blood pressure and heart failure among the complications of anorexia.

Sources 6, 11, 23

Blood sugar and musclesStrong evidence

Driven exercise can cause low blood sugar, and very high levels of creatine kinase (CK), a sign of muscle breaking down, in people who are undernourished.

Source 6

After vomiting or laxativesStrong evidence

Purging can cause dangerously low potassium, which can upset the heart's rhythm, and dehydration. An expert review says exercise shouldn't be done while dehydrated, after purging has drained the body's fluid, or with low blood sugar.

Sources 6, 24

BonesStrong evidence

Weak bones (osteoporosis) are a complication of anorexia, and NICE says recovery, with enough food, is the main way to protect them. NICE advises people with anorexia and osteoporosis to avoid high-impact activities and those that make falls or fractures more likely. An expert review adds that jumping and running are best avoided while periods are absent or sex hormones are low.

Sources 11, 23, 24

Cold and heatEmerging evidence

Keeping warm is part of hospital care in MEED, and an expert review lists overheating as a reason not to exercise.

Sources 6, 24

Talking therapies are the treatmentStrong evidence

For adults with anorexia, NICE recommends eating-disorder-focused cognitive behavioural therapy (CBT-ED), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) or specialist supportive clinical management. For children and young people, it recommends family therapy. For bulimia and binge eating disorder, it recommends guided self-help first, then CBT-ED. With treatment, most people can recover.

Sources 11, 12, 8

Exercise isn't offered as a treatmentStrong evidence

NICE: "Do not offer a physical therapy (such as transcranial magnetic stimulation, acupuncture, weight training, yoga or warming therapy) as part of the treatment for eating disorders." It also says to advise people with an eating disorder who are exercising excessively to stop.

Source 11

Rest isn't bed restStrong evidence

In hospital, MEED says gentle activity, such as watching TV with others or a brief walk with nursing staff or family, "can help reduce distress without any additional risk", and that enforced bed rest is usually "unhelpful and should be avoided". It advises limiting excessive activity with an explanation and alternatives.

Source 6

Supervised exercise, with enough food, looked safe in small trialsEmerging evidence

In anorexia, supervised exercise didn't harm recovery in a 2013 review, where two-thirds of the trials had 20 people or fewer. A 2026 review of 11 trials found it built muscle strength without changing quality of life, and a 2025 review of 7 trials in 211 teenagers found better quality of life. A review of 27 studies reported no harmful effects, and an expert review found people who did supervised exercise during treatment recovered physically as well as those who didn't.

A 2025 review of 17 studies found strength training improved strength and quality of life, and people valued its focus on getting stronger rather than on their body. Its authors say more research is needed before it can be confidently recommended.

Sources 25, 26, 27, 28, 24, 29

Whether it helps eating disorder symptoms or mood is uncertainMixed evidence

A 2025 review of 12 trials found exercise and mind-body exercise no better than comparison groups for depression, harmful exercise habits, eating behaviours or managing emotions, with low to very low certainty. Older, smaller reviews were more positive: in 8 trials with 213 people, aerobic exercise, yoga, massage and body awareness therapy lowered eating disorder and depression symptoms. Yoga reviews disagree: one found small benefits, another mostly small effects that weren't significant.

Sources 30, 31, 32, 33

Treating compulsive exercise itselfMixed evidence

In 11 studies of treatments aimed at compulsive exercise, mostly education and support, all reported improvements. The only tested programme, LEAP (compuLsive Exercise Activity theraPy), added to CBT for 78 adults with anorexia, made no difference to its main outcome, though a later analysis found less rigid, rule-driven exercise. A 2026 review suggests trying new activities, making routines more flexible, exercising with other people, and learning other ways to manage feelings.

Sources 34, 35, 36, 14

Driven exercise after treatment is linked with relapseEmerging evidence

In 51 people followed after hospital treatment for anorexia, 35% relapsed, and exercising excessively straight after discharge was one of the things that predicted it. An expert review says exercise compulsion at the end of treatment predicts a shorter time to relapse. That's why teams work on your relationship with exercise, not only the amount.

Sources 37, 24

What people in recovery say

In interviews, 9 women with an eating disorder said they wanted activity built into their treatment, to keep its benefits and to learn to move in healthy ways, and that overcoming driven activity "can be a long and complicated journey".

Source 38

A framework, not yet testedEmerging evidence

SEES-2 (Safe Exercise at Every Stage, 2025) is a clinical guideline written by eating disorder clinicians with an international steering group. Australia's National Eating Disorders Collaboration lists it, and an Australian sports position statement says teams may use it to plan reviews and a return to sport. A 2026 review notes that the SEES guidelines "have not yet been empirically evaluated". SEES-2 is written for adults; there are separate versions for young people and athletes.

Sources 13, 39, 40, 14

How it works

You move up a stage only when the team judges you're medically stable, treatment is going to plan (including eating), the eating disorder behaviours are easing, periods or hormones have come back on their own rather than with the pill, and, where needed, your bone density has been checked. You move back down if symptoms return or the movement becomes driven again. Reviews are frequent, and SEES-2 says movement "is not compulsory".

Source 13

The stages, in words

SEES-2 has four levels. Your team decides which one fits you, and you can move up or back down:

• First: gentle stretches and breathing, with medical supervision, and cutting back on everyday activity such as pacing.
• Second: gentle, low-impact and social activity, such as walking with someone, gentle yoga or Pilates, swimming or table tennis, supervised by your team or a trusted friend or family member.
• Third: moderate activity such as exercise classes or jogging, and strength training, ideally with a friend.
• Fourth: a plan made for you, which can include sport or exercise you used to do, gradually on your own, with a plan for spotting early warning signs.

Source 13

What movement in recovery should feel like

SEES-2 quotes four principles for mindful movement. It should "Rejuvenate the body, not exhaust or deplete it", "Enhance mind-body connection, but do not allow or induce disconnection", "Alleviate mental and physical stress, not produce more" and "Provide genuine enjoyment and pleasure, not pain and dread".

Source 13

A pause can be the right first step

Beat says it may feel better to stop exercising while you focus on your recovery, and that this is OK too. It suggests calling it a pause, and doing it with support. Studies link driven exercise after treatment with relapse.

Sources 10, 37, 24

Let go of the numbers

Beat: "Do not be led by national guidance or what others are doing." Take off smartwatches and fitness trackers, turn off or delete exercise apps and step counters, and cover the screens on gym machines: Beat says "the read outs are rarely accurate". Cut down on exercise social media too.

Source 10

Keep it social, with a set finish

Exercise with other people rather than alone, and set an alarm for rests and for when to finish. Being with others makes it easier to stop.

Source 10

Keep eating, and take rest days

Beat: "the goal is not to lose weight. You need to remain nourished and hydrated with your usual meals and snacks alongside any exercise you do, as well as on rest days." Rest days are part of every athlete's training.

Source 10

Make it gentler

Choose slower, gentler movement, less high-intensity and high-impact exercise, and shorter sessions. If a gym membership makes missing a session feel impossible, Beat suggests cancelling it.

Source 10

When the urge comes

Try "distract, delay, decide": the urge may pass. Music, a podcast, calling a friend, time with animals, art, relaxation or breathing exercises can help, and so can writing down what triggers the urge so you can plan for it.

Sources 10, 20

Check first if you're unwell

Beat says anyone who is medically unwell, or has recently had heart palpitations, chest pain, dizziness, fainting or light-headedness, or is purging, should talk to their GP, psychiatrist or another health professional before any exercise.

Source 10

More common in some sportsStrong evidence

Disordered eating and eating disorders are more common in athletes, especially in sports judged on appearance, sports where being light is seen as an advantage, and weight-class sports. NICE asks clinicians to note professional sport, dance and modelling. An Australian position statement says athletes "may be underweight, normal weight or overweight" whether or not they have an eating disorder.

Sources 40, 11

Getting back to sportEmerging evidence

Athletes with an eating disorder should be referred to an eating disorder service, with at least a doctor, a sports dietitian and a psychologist involved. A 2026 review says it may be best not to compete during treatment, and that a return-to-play plan should be written and agreed with you, because an unstructured return "may increase the risk of relapse".

Sources 40, 14

REDs and missed periodsStrong evidence

Relative energy deficiency in sport (REDs) is what happens to health and performance when someone doesn't eat enough for their training, in women and men. It can happen with or without an eating disorder. Missed periods come from eating too little for the training, and the combined pill "does not correct the cause" or protect bones. Our women's guide covers REDs.

Sources 41, 40

Coaches and clubs

Body measurements are "personal and confidential medical information", and coaches shouldn't lead them. The International Olympic Committee's REDs assessment tool uses a traffic light to guide whether, and how, an athlete takes part. Our dance and gymnastics pages cover the culture in those sports.

Sources 40, 42

Bulimia

Exercising excessively to make up for eating is one of the ways bulimia shows itself. After vomiting or laxatives, low potassium and dehydration make exercise more dangerous, and MEED notes that bulimia can cause serious blood salt problems at any weight.

Sources 43, 6

Binge eating disorderEmerging evidence

NICE recommends guided self-help, then CBT, and says weight loss isn't a goal of treatment. In 5 small trials in 264 women, exercise programmes reduced binge eating when given alongside psychological treatment, and in a Norwegian trial of 149 women, a programme of exercise and dietary therapy did as well as CBT. SEES-2 says movement at any size should focus on health and enjoyment, not changing your body.

Sources 11, 44, 45, 13

OSFED and atypical anorexia

OSFED is the most commonly diagnosed eating disorder and "every bit as serious". The same exercise risks apply at any body size.

Sources 15, 6

What helps at home

The NHS suggests agreeing as a family not to talk about "portion sizes, calories or anything else about the meal", and doing something together after meals, "such as a game or watching TV", which "can help distract them from wanting to purge or overexercise". Be a role model by eating a balanced diet and doing a healthy amount of exercise.

Source 46

Urgent signs

Go to A&E or contact the eating disorder team straight away for fainting when standing up, being unable to manage the stairs, suddenly refusing all food or drink, a stomach bug with vomiting or diarrhoea, or talk of ending their life. The full list is at the top of this page.

Source 5

Children and teenagers

For children and young people with anorexia, NICE recommends family therapy. SEES-2 is written for adults, so for under-18s the family and the treatment team decide together about activity, physical education (PE) and sport.

Sources 11, 13

School

Schools in England must support pupils with medical conditions, with an individual healthcare plan where needed. For an eating disorder, the plan may limit PE or sport for a while, as the treatment team advises (our suggestion).

Source 47

Type 1 diabetes and an eating disorder

Some people with type 1 diabetes restrict insulin, and exercise can be used to make up for eating. MEED warns that low blood sugar "may occur with carbohydrate restriction or excessive exercise alongside insulin administration". Diabetes and eating disorder teams work on this together; our type 1 diabetes guide covers exercise and blood sugar.

Sources 48, 49

Call 999 or go to A&E

Call 999 (911 in the US) or go to A&E if:

• Someone's life is at risk: for example, they have seriously harmed themselves or taken an overdose, or they can't keep themselves safe.
• Chest pain or discomfort comes on suddenly and doesn't go away, spreads to the arms, neck, jaw, stomach or back, or comes with feeling sweaty, sick, light-headed or short of breath.
• Someone isn't responding normally or is unconscious. Very low blood sugar is one possible cause, and MEED notes that driven exercise can bring it on.

Sources 1, 50, 51, 6

Go to A&E or contact the eating disorder team straight away

For fainting when standing up, being unable to climb stairs, suddenly refusing all food or drink, a stomach bug with vomiting or diarrhoea, talk of ending their life, or struggling to get up from a squat without using the arms. If someone needs urgent medical help and you're not sure where to go, the NHS says call 111 or use 111 online.

Sources 5, 6, 52

See a GP as soon as you can

If you think you, or someone you care about, may have an eating disorder. Signs that involve exercise or the body include:

• Exercising too much, or in secret, or feeling unable to stop.
• Feeling cold, tired or dizzy.
• Pains, tingling or numbness in the arms and legs (poor circulation).
• Feeling your heart racing, fainting or feeling faint.
• Not getting your period, or other delayed signs of puberty.
• Bone pain, or broken bones after minor falls.

Sources 8, 11

Before any exercise, check with your team

If you've recently had heart palpitations, chest pain, dizziness, fainting or light-headedness, or you're purging.

Source 10

Support

Beat's helplines (at the top of this page) are for support and information, not crisis care. Samaritans (116 123) and, in the US, the 988 Lifeline are there any time. ANAD's helpline offers support in the US.

Sources 4, 2, 3, 7

"It can't be an eating disorder if they're not underweight"Strong evidence

Eating disorders happen at any weight. Bulimia can cause dangerous blood salt changes at a normal or higher weight, atypical anorexia happens in the usual range or above, and athletes with an eating disorder "may be underweight, normal weight or overweight".

Sources 6, 15, 40

"They've got so much energy, they must be well enough to exercise"Strong evidence

MEED warns that the drive to exercise can make people "appear very energetic right up to a physical collapse", and that normal blood tests don't rule out danger.

Source 6

"Exercise is healthy, so you can't really overdo it"Strong evidence

Beat says exercise can become "driven, rigid, and compulsive", that overexercising can happen "even if the type and quantity of exercise does not appear to be excessive", and that general exercise guidance can be harmful with an eating disorder.

Source 10

"Yoga or weight training can treat an eating disorder"Strong evidence

NICE says not to offer physical therapies such as weight training or yoga as treatment. Trials show supervised exercise can be safe and build strength, not that it treats the illness.

Sources 11, 26, 30

"Rest means staying in bed"Strong evidence

In hospital, enforced bed rest is usually "unhelpful and should be avoided", while gentle activity or a short walk with others can ease distress.

Source 6

"After an eating disorder, you can never exercise again"Emerging evidence

Many people return to movement and sport in stages, with their team. SEES-2's last stage includes a return to sport, and an Australian position statement describes helping athletes back into sport as part of their recovery.

Sources 13, 40

"The pill will protect your bones if your periods have stopped"Strong evidence

An Australian position statement says the combined pill "does not correct the cause" of missed periods from eating too little, and doesn't protect bone. NICE says recovery, with enough food, is the main way to protect bone.

Sources 40, 11

"Men don't get eating disorders"Emerging evidence

Beat estimates that about 1 in 4 people with an eating disorder are male, and in England 6.1% of men screened positive for a possible eating disorder. Compulsive exercise and a drive to be muscular may be more common in men.

Sources 18, 16

"Exercise bulimia and anorexia athletica are separate conditions"Strong evidence

They aren't diagnoses doctors use. In the definitions doctors work from, excessive exercise is one of the behaviours of anorexia or bulimia. Whatever it's called, the help is the same: see a GP, or talk to Beat.

Sources 6, 8