This 'healthy' habit can ruin your health

During the past few decades, more people than ever have picked up exercising. This development is great news because exercise is tied to a host of health benefits, including enhanced cognitive function. But for those who spend too much time exercising, there can be a dark side: exercise addiction.

A study published in Addiction Behavior Reports notes that exercise in fitness centers is increasingly popular, and questions whether exercise addiction may be a socially accepted behavior in these environments. Although established with the best of intentions, gyms and health clubs can perpetuate exercise dependence because they are readily available for regular exercise, and employ instructors who are trained in promoting fitness and pushing clients to their physical limits, the authors wrote. 

Exercise addiction entails excessive and obsessive exercise patterns that can lead to injury and overload. The prevalence of exercise addiction is between 3% and 9% among adult exercisers worldwide, according to another study in the Journal of Behavioral Addictions. 

Let’s take an evidence-based look at exercise addiction.

Defining exercise addiction

On the basis of Brown’s theory of behavioral addictions, outlined in the Addiction Behavior Reports article, the following six parameters are suggested as characteristic of exercise dependence:

• Salience: Exercise is the most important life activity.

• Conflicts: Interpersonal and psychic conflicts about the harms of excessive exercise exist.

• Mood modification: Exercise serves as a way to moderate emotions.

• Tolerance: Increasing levels of exercise are needed to yield a psychological effect.

• Withdrawal symptoms: Irritability results when exercise is missed or reduced.

• Relapse: Reversion to previous exercise patterns occurs despite intervention to reduce exercise levels.

The difference between a healthy commitment to fitness and a harmful addiction can be difficult to recognize, although diagnostic tools exist, such as the Exercise Addiction Inventory (EAI), which takes the aforementioned six points into consideration.

The authors wrote, “In comparison with other addictive conducts (e.g. alcohol, gambling, or binge eating), exercise is a socially accepted behavior, possibly even when taken to extremes. The striving for a lean and fit body is usually perceived as a sign of a healthy lifestyle and personal success, and family and friends may accept and encourage fitness exercisers to maintain excessive exercise habits.”

Intriguingly, the authors found that exercisers at a high risk of addiction, whose fitness habits were supported by family and friends, experienced significantly less “conflict” per the EAI.  On the other hand, the potentially addicted exerciser who felt less support from family and friends scored higher in terms of “conflict.”  

Relationship with other disorders

Experts draw parallels between exercise addiction and eating disorders with respect to obsessive exercise patterns, control of body shape, and perfectionist personality traits.

Muscle dysmorphia is a variant of body dysmorphic disorder characterized by beliefs of insufficient muscularity and performance of excessive muscle-building exercises, including weightlifting and misuse of anabolic steroids. Athletes with muscle dysmorphia often demonstrate disordered eating habits and low body fat. Experts hypothesize that body dysmorphia may be related to compulsive exercise due to extreme focus on attaining fitness goals, although research needs to be done to test this association.

Unlike exercise addiction, eating disorders and body dysmorphic disorder are recognized as diagnosable conditions. These conditions often co-occur, and some experts have recommended that eating disorders should be conceptualized as addictions, with the high comorbidity recognized. In fact, research has shown that addictive and obsessive-compulsive traits were linked with weight preoccupation and excessive exercise in those with eating disorders, according to the study in Addiction Behavior Reports.

Between 39% and 48% of those with eating disorders also compulsively exercise, thus suggesting an overlap between these disorders. In particular, women who are addicted to exercise exhibit dysfunctional eating habits. Ultimately, exercise addiction and eating disorders may be causally intertwined.

“If exercise addiction comes first, screening tools need to be reliable and sensitive to the specific features of the phenomenon,” wrote the authors.  

According to the results of this study, exercisers who had an eating disorder were less likely to feel support for their exercise by friends and family. The authors suggested that excessive exercise could be the first sign of an eating disorder, and raises an early red flag to identify either an eating disorder or exercise addiction. 

Treatment

Cognitive-behavioral strategies are employed to treat exercise addiction, although little evidence supports this approach. With assessment and treatment, clinicians must consider the evolution of exercise addiction and psychiatric comorbidities, such as drug misuse or eating disorders. Clinicians should note whether the exercise addiction is primary and manifests separately from an eating disorder.

Other interventions include behavioral strategies such as contingency management, which rewards abstinence from certain types of exercise or at least maintaining exercise at lower levels of a once-addictive behavior.

However, in treating exercise addiction, abstinence may not be the goal, because exercise in moderation is considered a healthy habit. Instead, a typical treatment goal would be to return to moderate exercise, according to the authors of an article published in Current Pharmaceutical Design. “In some cases, a new form of exercise may be recommended, for example the runner becomes a swimmer. In other cases the person may continue to do the same form of exercise in a more controlled or moderate manner.”

Finally, although little research has been conducted on the efficacy of psychotropics to treat exercise addiction, the antipsychotic and dopamine antagonist Quetiapine has been used as treatment, the authors noted.