Regular exercise or compulsion?
Regular physical activity plays a crucial role in health maintenance and disease prevention. However, excessive exercise has the potential to have adverse effects on both physical and mental health. While the scholastic and empirical discussion of excessive physical activity focuses on obsessive and compulsive exercising…how can we everyday people recognize the symptoms of an exercise addiction? And once we do, what can we do about it?
We’ve asked the expert in exercise addiction
Today, joining us is Dr. Heather A. Hausenblas, Ph.D. Heather is a physical activity and healthy aging expert, researcher, and author. Her research focuses on the psychological effects of health behaviors across the lifespan. In particular, Dr. Hausenblas examines the effects of physical activity and diet on:
- body composition
- body image
- eating behaviors
- quality of life
- excessive exercise
She has also applied theoretical models to examine the psychological effects of physical activity during pregnancy and postpartum and its relationship to the health of the entire family.
Today, Dr. Heather shares her knowledge in diagnosing exercise dependence. We’ll learn who’s at risk and how exercise addiction can be treated. Again, please use the section below if you have a question at the end. We will do our best to provide you with a personal and prompt answer.
ADDICTION BLOG: Can you help us first define exercise dependence?
DR. HEATHER HAUSENBLAS, PH.D.: May different terms have been used to describe exercise dependence such as exercise addiction, compulsive exercise, running addiction, and obligatory exercise to name just a few. The varied terms have created some confusion in the field.
For clarity, I will use the term exercise dependence along with the term exercise addiction interchangeable in this discussion.
Exercise dependence is defined as a pattern of physical activity that exceeds what most fitness and medical professionals consider “normal,” causes immense psychological anguish (either during, following, or in anticipation of exercise), engulfs an exercise dependent’s personal, professional, and social life, and is experienced by the addict as difficult to control or reduce in frequency-even in the face of illness or injury.
In other words, exercise dependence is a self-perpetuating craving for exercise that results in uncontrollably excessive physical exertion and manifests in mental and physiological distress.
What exactly does this mean?
If a person reports feelings of anxiety and depression when unable to exercise, spends little or no time with family or friends because of physical activity involvement, or continues to run despite a doctor’s advice to allow an overuse injury to heal, he or she could be considered at high risk for exercise dependence.
ADDICTION BLOG: What are the long-term effects of excessive exercise?
DR. HEATHER HAUSENBLAS, PH.D.: We do know that for a very small number of people, physical activity goes into overdrive. Rather than exercise enhancing their lives, it ends up assuming a life of its own. These people continue to exercise despite injuries, mental issues, and physical exhaustion. They may even watch their careers crumble, and their family and friends drift away.
- Joints and muscles are typically the first physical victims of exercise dependence. Sprains, strains, and muscle tears occur at a much higher rate among those who don’t know when to quit at the gym.
- Bones are next. The risk for fractures, breaks, osteoporosis, or a lower-than-average bone mineral density (osteopenia) skyrockets when exercise ends refuse to take necessary off days that would otherwise allow their bodies to recoup.
- Herniated disks, tendinitis, fasciitis, and impingement are among other common overuse injuries about which chronic over exercisers often complain of.
- Next come the internal organs. Recent research has accumulated evidence confirming links between overzealous physical activity and cardiovascular problems. One study on the cumulative effects of adding workouts to already physically demanding lifestyles found higher incidences of coronary disease among men who hit the gym hard on top of a workday spent performing manual labor.
- The bodily duress brought about by excessive activity also prompts the brain’s hormonal control centers to send “shut down” signals to male and female sex organs, halting reproductive processes in the interest of preserving what little reserves the overexerted person has left.
In short, the chronic stress that relentless pursuit of physical activity put on the exercise dependent’s body and mind amplifies her vulnerability to illness and injury. Chronic stress has long been associated with reductions in immune system functioning, heart disease, and depression.
ADDICTION BLOG: What are the main signs that someone is exercising compulsively, instead of training in a healthy way (marathon or triathlon training, for example)?
DR. HEATHER HAUSENBLAS, PH.D.: The more you exercise, the better, right? Like anything we do, more is not necessarily better.
Research shows that when we increase our activity levels, our mental and physical health follow suit-up to a certain point, that is. When we stop taking “off days,” or work out for longer than our bodies can handle, we impair our strength, our stamina, and our overall well-being. By overexerting ourselves, we also risk throwing off our psychological equilibrium.
For the exercise dependent, what begins as a salutary coping or health-maintenance mechanism easily blossoms into a rigid ritual whose emotional and bodily benefits the addict does not believe he can live without. She may start assuming that the self-acceptance, post-exercise calm, or focus her workouts afford her cannot be achieved by any means other than the daily set of crunches, early morning run, or twice daily speed walks to which she keeps adding reps, miles, or minutes.
Her routine may begin to swallow more of her time. Soon, she’s cancelling plans to fit exercise into her day. Or, she’s riddled with anxiety the weekend her in-laws are in town and she can’t spend that full forty-five minutes on the Stairmaster as planned.
Just to circumvent the dysphoria affiliated with missing a workout, the exercise addict may begin ducking out of non-fitness-related obligations, many of which he may have formerly deemed fun.
Soon exercise loses its liberating quality. It becomes the primary – and sometimes sole – means of escaping distress. The discomfort of psychological withdrawal from not going to the gym builds, eclipsing not only the importance, but also the allure of social activities, family demands, or professional pursuits.
Time spent lifting, sweating, exerting, and burning expands. Whereas a fifty-minute cardio and stretch session used to suffice, now the exercise addict requires two hours or more to exit the gym happy. Any less and he can’t focus on the next item on his agenda – be that reading for pleasure after a long day at work, brainstorming in a meeting with the rest of his colleagues, or enjoying a movie or live music performance.
ADDICTION BLOG: How can we rate ourselves if we recognize risky behaviors in ourselves? What are first steps to be taken in treating the disorder?
DR. HEATHER HAUSENBLAS, PH.D.: Exercise dependents may seek treatment when an injury prevents them from continuing their preferred routines, when a loved one urges them to consult a therapist, or when the rigidity of their fitness schedules becomes emotionally or physically unmanageable.
If the physical aches and pains that their overzealous cardiovascular or weight-lifting habits introduce into their lives end up restricting the range of exercises they can perform, they may seek therapy simply to manage the severe emotional turmoil accompanying a forced reduction in their exercise.
The research into why an exercise addict seeks treatment is, at best, scant. Even more limited are the number of studies testing the outcomes of therapies targeted specifically toward overzealous physical activity. Because exercise addiction is such a novel concept in the field of mental health – keep in mind even the American Psychiatric Association has not included exercise addiction, among other behavioral addictions, as a legitimate disorder in its Diagnostic and Statistical Manual of Mental Disorders – there simply hasn’t been as much time and information to develop specialized treatments for it as there has been for other disorders, like eating pathologies or substance dependency.
ADDICTION BLOG: How can you know if a loved one is exercise dependent? Are there objective assessments which exist?
DR. HEATHER HAUSENBLAS, PH.D.: Some people who go to the gym every day are irrefutably addicted. Others appear to be free of addiction, considering they make time for other activities and aren’t obsessive about their routines.
Whether you are addicted to exercise depends on how your daily (or near daily) workouts affect your mental and physical health, your social life, and your ability to function in non-exercise-related endeavors. If you find yourself constantly exhausted, intolerably anxious at the thought of missing a workout, or unable to muster enough energy for activities that don’t involve burning calories or lifting weights, you may have a problem.
Most significantly: exercise dominates the person’s life. They spend more and more time at the gym. They cancel plans with friends or family to sneak in gym sessions. They need more and more time in motion to achieve the initial effects of calmness, reduced guilt, or euphoria that exercise initially provided. Nervousness when not active may be a sign.
And the kicker: exercising despite illness or injury.
Several measurement tools exist that attempt to quantify various aspects of exercise addiction such as the Exercise Dependence Scale and the Exercise Addiction Inventory. To determine the extent of an exercise addicts’ suffering, criteria have been developed. Outlined below, at least three of the following seven criteria must apply for an exerciser to qualify as addicted.
1) Tolerance: The runner needs to increase the time spent running or the intensity of the workout to achieve the originally desired effect (e.g., better mood, more energy). The amount of exercise that once sufficed no longer makes as much of a difference.
2) Withdrawal: In the event a runner can’t squeeze in his preferred routine as planned, negative moods like anxiety, depression, anger, and frustration often creep in. Addicts may also feel compelled to exercise just to offset these negative feelings.
3) Intention effects: Despite planning only to spend thirty minutes on the elliptical or treadmill, a running enthusiast might spend upwards of 50 or more minutes in motion.
4) Loss of control: Even with the awareness the exercise schedule is getting out of hand, an exercise addict is either unable to stop or cut back. More reps are added and more miles are run, even if the exerciser wants nothing more than to go home, have dinner with family/friends, or sit on the couch and relax.
5) Time: A large chunk of an exercise addict’s time during the day is devoted to physical activity. Vacations are often fitness-oriented (like ski and camping trips), employment may be exercise-oriented (like working at a gym or being a personal trainer), and reading material is largely fitness-related.
6) Conflict: Non-fitness related activities fall by the wayside. Time spent relaxing with friends or family is truncated to make more room for exercise. What once brought an exercise addict fulfillment may seem like a nuisance because it gets in the way of his or her run.
7) Continuance: Sprained ankle? Achy knees? Sore muscles? A high fever? Exercise addicts often push past pain and illness to finish a workout – even against their doctor’s orders.
It’s difficult to separate healthy exercise from obsessive exercise. Meeting some of the above criteria doesn’t necessarily mean you’re an exercise addict. A lot of people with a healthy attitude towards exercise, choose to become trainers, work at a gym, run marathons, and even ultra-marathons.
It’s when exercise becomes all consuming – when you start losing friends, forgoing social activities or reneging work opportunities – that your workout schedule becomes cause for concern. In most cases, running and other types of exercise is great for the body, the soul, and the mind. But for a limited number, the passion can turn into a problem.
ADDICTION BLOG: Should you seek professional help or intervention, or can you first address exercise dependence independently?
DR. HEATHER HAUSENBLAS, PH.D.: By no means are exercise addicts expected to forgo gyms entirely or rule out physical activity for the rest of their lives. Recovery from exercise addiction does not follow an abstinence-only model. (To pursue this route might be equally unhealthy, considering the high rates of disease associated with not exercising enough.)
One place to start is simply by changing the types of workouts on which exercise addicts have become so hooked. If running has become compulsive and obligatory, the exercise addict might try switching to cycling, cardio sessions on the elliptical or Stairmaster, or swimming. Strength training can also be introduced to individuals who cling to cardio as their sole means of getting a bit too much of that endorphin-rush fix. For bodybuilders looking to ease up on their weight lifting, the opposite would hold – cardio and cross-training might be better suited to help them learn new patterns of activity. Yoga and Pilates can help many exercise addicts develop a greater body awareness while focusing (and calming) the mind.
When an exercise addict’s weight has dropped to a medically unsound level, physicians recommend postponing exercise until that weight reaches a viable level. This is frequently the result of compulsive running and excess cardiovascular exertion.
The ultimate goal of getting over exercise addiction is unhinging one’s self-worth from working out, finding time for other activities outside the gym, and accepting that not every day can include a two-hour training session without cycling through waves of panic and anxiety.
The true work of recovering from exercise addiction entails not just learning to limit one’s self and to apply the body to endeavors apart from working out. It also involves working with a mental health professional to identify and process the emotional issues underlying why the exercise addict latched onto overzealous physical activity in the first place.
ADDICTION BLOG: Who does exercise dependence mainly affect? Is there a particular demographic who is most at risk?
DR. HEATHER HAUSENBLAS, PH.D.: According to several studies, men appear to report more exercise addiction symptoms than women. One explanation for this disparity boils down to each gender’s means of pursuing their desired physique: Men may take more readily to exercise as it promises to confer a more muscular appearance in line with stereotypical male standards of beauty. Women, on the other hand, may be more inclined to use diet in striving toward their stereotypical female standards of beauty (namely, thinness).
That said, women tend to be at a higher risk of eating disorders than men. And approximately half of all eating disorders are thought to involve exercise as a means to curtail weight gain or to purge excess calories. When exercise is used as a means to achieve or maintain an unhealthily low weight, it is all the more dangerous.
Although personality isn’t the only factor contributing to a person’s likelihood of becoming addicted to exercise, research has demonstrated a higher prevalence of exercise addiction symptoms among:
- those scoring high on neuroticism
- people who display lower levels of agreeability
Psychologists believe the stamina required to maintain an addiction to exercise can feed off a typical extravert’s high energy levels, while perfectionism and neuroticism often lead to compulsive behaviors. Low levels of agreeability are linked with competitiveness and egocentrism.
ADDICTION BLOG: Is exercise dependence often accompanied by other mental health disorders? If so, what are some common co-occurring conditions?
DR. HEATHER HAUSENBLAS, PH.D.: Eating disorders are the most frequent co-occurring pathologies among exercise addicts. Some evidence suggests up to 20% of exercise addicts are also addicted to cigarettes, illegal substances, and alcohol. Exercise addicts also may be more prone to sex addiction and compulsive shopping.
Though the professional lives of exercise addicts may be hampered as a result of the time they spend working out, a number of exercise addicts also have been shown to be prone to “work addiction.” Caffeine use and stimulant or steroid use is also much higher among exercise addicts, who lean on such substances to facilitate the intensity of their overzealous workouts.
ADDICTION BLOG: How is exercise dependence currently treated?
DR. HEATHER HAUSENBLAS, PH.D.: Currently, there are no support groups for exercise addiction comparable to substance abuse and behavioral addiction support. Many eating-disorder treatment centers offer counseling for over exercisers, as exercise addiction is often a component of eating-disordered behavior. Most treatments are cognitive, behavioral based, and individualized.
ADDICTION BLOG: How do you see the field of exercise dependence treatment growing or evolving in the near future?
DR. HEATHER HAUSENBLAS, PH.D.: The scientific study of exercise dependence began in the early 1970s. Since this time, well over a hundred scientific studies have been published on some aspect of exercise dependence.
The field is evolving, the science is becoming more sophisticated, and the interest in the topic in the health field is growing. The recent acknowledgement in the medical community that people can become addicted to behaviors will lead to further development of treatment programs that are scientifically-based.
ADDICTION BLOG: Is there anything else you would like to share with our readers?
DR. HEATHER HAUSENBLAS, PH.D.: For a very small number of people (about 0.4% of the population), physical activity goes into overdrive and becomes an addiction. Rather than exercise enhancing people’s lives, it ends up assuming a life of its own.
Each of us has a unique tipping point beyond which continuing to sweat, lift, push, or pull does more harm than good. People addicted to exercise continue to keep going despite injuries, mental issues, social obligations, and physical exhaustion. They may even watch their careers crumble, and their family and friends drift away because exercise is their top (and sometimes only) priority.
It is important to emphasize that while exercise may represent an addictive behavior for a small number of people who engage in it to an extreme and unhealthy level, habitual exercise (including long distance running) is not inherently abusive. Just because someone runs long distances like half marathons, marathons, and even ultra-marathons does not mean that this person is addicted to exercise. It is the compulsive need and pathological motivation to exercise that distinguishes someone from a regular runner, to a highly committed runner, to an addicted runner.