Today I was reading a study by Carrera et al (2012) that looked at over exercise in anorexia and pondered whether this was a product of low body fat and feeling cold. I can see how that makes sense, one might try and rationalize a seemingly non- rational behavior such as obsessive exercise.
However, my intuition says; No.
Granted, with a BMI of 14 and no body fat I was always cold. Always. Summer, even a warm day, I was cold. I cannot remember ever really feeling warm for over eight years. I would get close when exercising, after about 30 minutes running I would warm up, but my hands and feet would remain blocks of ice. I would run holding my hands under my arms to try and keep them a bit warmer. Whilst at home, I would linger close to the radiator and drink hot water on the days that I was unable to convince myself that the calories in tea were negligible. I burnt my hands a few times whilst running them under hot water taps at work in an attempt to warm them. I remember loving chores such as emptying the dishwasher because the warmth of the newly washed dishes and plates and the steam that rose out of the machine.
And I ran. More than once a day, often more than twice a day.
But I was not running because I was cold, I was cold because I was thin, I was thin because I was running. I was running because I had to. I just had to.
Its all linked up, but not directly. I cannot ever remember thinking to myself, “Gee, I’m cold so I will go a run” …….
Nope, it was never as rational as that, at least not to my conscious mind.
But then, maybe to my body it was rational to move when starving? I feel that I can begin to understand this at a level far deeper than temperature. I will elaborate on this in a paragraph or so.
First lets have a ganders at this study.
Hyperactivity in Anorexia Nervosa: Warming Up Not Just Burning-Off Calories
(Carrera et al 2012)
Here is the abstract:
Excessive physical activity is a common feature in Anorexia Nervosa (AN) that interferes with the recovery process. Animal models have demonstrated that ambient temperature modulates physical activity in semi-starved animals. The aim of the present study was to assess the effect of ambient temperature on physical activity in AN patients in the acute phase of the illness. Thirty-seven patients with AN wore an accelerometer to measure physical activity within the first week of contacting a specialized eating disorder center. Standardized measures of anxiety, depression and eating disorder psychopathology were assessed. Corresponding daily values for ambient temperature were obtained from local meteorological stations. Ambient temperature was negatively correlated with physical activity (p = −.405) and was the only variable that accounted for a significant portion of the variance in physical activity (p = .034). Consistent with recent research with an analogous animal model of the disorder, our findings suggest that ambient temperature is a critical factor contributing to the expression of excessive physical activity levels in AN. Keeping patients warm may prove to be a beneficial treatment option for this symptom.
Why do anorexics exercise so much? I dislike the simplistic hypothesis put forward by researchers such as Bruch (1962)that anorexics exercise in the pursuit of thinness. But then I would, as it is my personal opinion that anorexia is not really about thinness, although thinness is certainly a symptom. I prefer the theories that exercise is an attempt to calm an over- anxious nervous system (Peñas-Lledo et al. 2002) but I do not think that this is the whole story either. I am suspicious that I like this theory as it makes my obsessive exercise regime seem almost rational.
Hyperactivity has also been traced to biological needs related to food restriction and weight loss (Casper 2006). I think about this a lot, I have a feeling that hyperactivity is remnant of some form of foraging behavior and I have seen this hypothesized also. I will review this in my next blog.
The study in question sampled 37 patients at a specialized center for eating disorders in The Netherlands. All female and between 12 -18 years old and diagnosed with anorexia. Such a small sample size is not good for mass generalizations. The patients were divided into groups dependent on their ambient temperature HOT or COLD. The outdoor ambient temperature was taken. Then for three days the patients activity levels were recorded.
The main finding of this study was that ambient temperature had a significant effect on physical activity in anorexic patients. Patients exercise more in the colder months. This is the direct opposite of what happens in the normal population. Generally the trends are that people exercise more in the summer than the winter. My initial thoughts here are the shorter daylight hours in the winter lead to more season affective disorder style depression and in anorexics the depression is self medicated with exercise. However the authors of this study claim that the temperature is the defining factor.
I do not think this is right. I mean, I am sure that there is a correlation between temperature and activity, but I do not think that greater activity is a direct consequence of lower temperature. This is one of those findings that niggles at my mind, I know that this information is valuable but I am not sure where to put it.
When I was anorexic I was in the UK, I knew that I also struggled with SAD, and in my recovery period I chose to up sticks and move to Colorado USA with my American husband. The sunshine did everything that I hoped it would and much more for my mood. However, temperatures in Colorado are often much lower than those in the UK in the winter.
And I keep coming back to that theory on foraging behavior. That is another niggler for sure! I wonder, does the brain associate cold days with a greater need to find calories when the physical body is starving, so cold days enhance the need to move? Potentially then, in those whose physical bodies are adequate in fatty resources the brain sees fit to ‘hibernate and conserve” calories without feeling like it has to forage for more to survive.
For example, the squirrel will hibernate only when it knows that it has enough fat in storage to survive into the spring. As the winter approaches, the squirrel without adequate food stores will scurry in order to find food.
I think that the anorexics brain is telling the body that the body needs to search for food, that it needs to move and forage. I think that this results in excessive exercise. I think that in the winter months for many anorexics this is heightened.
I think this because I know that when I exercised, it just did it because I felt compelled to do it, as if my life depended on it. The thing that I feared most was somebody of something stopping me from exercising, I would do anything to make sure that I exercised. I did NOT enjoy exercising, I hated it, it hurt. I was not exercising to get thinner, it must have been a motivation far deeper than my conscious mind knew of. I cannot think of a single thing that would motivate me to fun for up to 6 hours a day every day like I used to. I simply do not want anything badly enough to submit myself to that. You would have to set my hair on fire to get me to run that long nowadays, and humorous as that sounds it is telling. I was running from something that felt like a big enough threat that I felt like I was running for my life. This has to be linked to the survival instinct in the brain.
Sure enough, the thinner I became the greater I would feel the urge to run. I was not getting thinner because I was running, I was running because I was getting thinner. I would feel massive frustration towards those that would try and make me stop running, and towards myself because I knew that they were theoretically correct, but I knew that I had to run. I just had to run. I had to run to survive.
Symptoms are information. We need to look at what the symptoms are telling us beneath the very obvious. I was not running to get thin, I was running because I was thin, because my brain was telling me “You need to move to find food or you will die”. Because this is so far from the reality of our modern world I think that we overlook the ancient intelligence of the brain and body.