Yes, You Can Get Addicted to Exercise

People are often astonished to discover exercise isn’t always a panacea. Because physical activity confers so many benefitsⁱ to our muscles, bones, liverⁱⁱ, heart, and brainⁱⁱⁱ—not to mention its powerful mood-boosting effects^{iv, v}—the notion that it could be hazardous to our well-being may seem ridiculous. Unfortunately, for approximately 3 percent of the population^vi, striving to stay fit does them more harm than good.

Source: Source: Girls Gone Strong

Exercise addiction is a legitimate problem whose prevalence is thought to be highest amongst triathletes, runners, and individuals who suffer from eating disorders^vii. Its consequences range from the moderately inconvenient (think: shin splints, muscle strains, and fatigue) to the potentially pathological: Irregular heartbeats; enlargement, stiffening, and scarring of heart tissue, as well as the buildup of arterial “plaque” that restricts blood flow and can precipitate heart attacks isn’t uncommon amongst long-term endurance athletes^viii,ix,x—25 percent^xi to 52 percent^xii of whom display signs of exercise addiction.

But what exactly constitutes the unhealthy relationship with physical activity that exemplifies exercise addiction? (And how can we tell if and when our workouts are getting the better of us?) The intent of this blog is to clarify these questions, provide insight into the disorder’s prevalence and risk factors, and discuss treatments being developed to help people keep their physical activity levels within a reasonable (read: healthy) range. (We’ll also include personal stories from exercise addicts to help illustrate the issue and outline tips for fitness professionals, friends, and family members of exercise addicts looking to help someone they suspect has a problem. So stay tuned!) For the purposes of this post, however, we’ll stick to defining the disorder.

In a nutshell, exercise addiction is an overzealous pursuit of physical activity persisted in despite physical, emotional, and social consequences. Its symptoms^xiii are similar to those of any addiction, except the drug of choice in this case is fitness. Such symptoms encompass the following:

1. Tolerance: Needing more and more of the initial activity to achieve sought-after effects (i.e., exercise highs, increases in self-esteem, greater comfort in one’s skin, reductions in anxiety, or other alleviations of negative thoughts and feelings).
2. Withdrawal: Ensuing anxiety, fatigue, irritability, or other unenjoyable emotional and physical experiences on days when one is unable to workout as planned.
3. Intention Effect: Repeatedly exceeding planned-upon limits to the amount of time spent exercising (i.e., promising oneself to towel off and call it a day after an hour spent sweating, only to tack on an additional 30 minutes or more at the 50 minute mark).
4. Lack of Control: Experiencing one’s physical activity habits as difficult or impossible to keep at manageable levels (including the intrusion of compulsions to exercise, and thoughts related to exercising, into social and work situations).
5. Time: Far more time is spent exercising than is recommended by medical or fitness professionals and planning, engaging in, or recovering from physical activity consumes a noticeably large portion of one’s days and weeks.
6. Reductions in Other Activities: Social, work-related, and leisure endeavors are sidelined to prioritize fitness—often, to the detriment of one’s emotional and interpersonal wellbeing.
7. Continuance: One persists in physical activity despite illness, injury, negative psychological outcomes, or medical advice to taper down or take a break.

Just because someone meets one or two of these symptoms doesn’t mean they’re completely addicted to exercise. Rather, one’s dependency upon physical activity is measured along a spectrum of minor to severe.

Many regular exercisers, for instance, may experience some tolerance and withdrawal yet are still capable of keeping obsessive thoughts related to working out at bay as they attend to the demands of work, school, home life, or outings with friends.

It’s the cumulative effect of the above symptoms (atop the rigidity with which someone adheres to a time-consuming and physically exacting exercise routine) that indicates when passion has blossomed into an addiction. Keep in mind, also, that addiction is about wanting more than actually liking^xiv the object of what you’re hooked on, which is very much a part of an exercise addict’s psychology: When your main incentive to hit the gym derives from the desire to alleviate withdrawal symptoms or sate a compulsion, rather than from an inherent enjoyment of your routine, that’s a major red flag for exercise addiction. (More on this in future posts!)

None of this is to say that exercise itself is inherently bad. Though physical activity does come with risk factors (hence why gyms make you sign a waiver ensuring you won’t sue them in the event you get injured or end up requiring a defibrillator) in most cases, the benefits of being active far outweigh its potential costs. And the consequences of being inactive—including reduced longevity^xv, higher incidences of diabetes[xvi], heart disease^xvii, and obesity,^xviii to name just a few—pose a far more severe threat to health and happiness.

But when exercise is repeatedly overdone, the body and the mind (not to mention the social and professional circles these entities are embedded in) take a serious hit. Some research^xix even suggests that engaging in vigorous bouts of exertion exceeding 17 hours per week is as bad for our well-being as never getting up off the couch to begin with.

No one’s advocating the nixing of physical activity altogether. But it’s crucial to keep in mind that moderation in exercise is just as important as pursuing fitness in the first place.

Any workout regimen that infringes on the rest of your life, impairs your ability to be present and enjoy non-exercise related endeavors, and keeps you cycling in and out of the orthopedist’s and physical therapist’s office is not good for you.

We look forward to furthering your understanding of the complex and often misunderstood issue of exercise addiction. So keep your eyes on our blog as we roll out even more information about all things pertaining to exercise addiction!

References

[i] Darren E.R. Warburton, Crystal Whitney Nicol, and Shannon S.D. Bredin, “Health benefits of physical activity: the evidence,” Canadian Medical Association Journal, 174, no. 6 (2006): 801-809, DOI: 10.1503/cmaj.051351

[ii] Ciaran E. Fealy, Jacob M. Haus, Thomas P. J. Solomon, Mangesh Pagadala, Chris A. Flask, Arthur J. McCullough, and John P. Kirwan, “Short-term exercise reduces markers of hepatocyte apoptosis in nonalcoholic fatty liver disease,”

Journal of Applied Physiology, 113, no. 1, (2012): 1-6 DOI: 10.1152/japplphysiol.00127.2012

[iii] Cristy Phillips, Mehmet Akif Baktir, Malathi Srivatsan, and Ahmad Salehi, “Neuroprotective effects of physical activity on the brain: a closer look at trophic factor signaling,” Frontiers in Cellular Neuroscience, 8 (2012): 170. DOI: 10.3389/fncel.2014.00170

[iv] Gordon J. G. Asmundson, Mathew G. Fetzner, Lindsey B. DeBoer, Mark B. Powers, Michael W. Otto, and Jasper A. J. Smits, “Let's get physical: a contemporary review of the anxiolytic effects of exercise for anxiety and its disorders,” Depression and Anxiety, 30, no. 4 (2013): 362-73. DOI: 10.1002/da.22043.

[v] George Mammen and Guy Faulkner, “Physical Activity and the Prevention of Depression: A Systematic Review of Prospective Studies,” American Journal of Preventive Medicine, 45, no. 5 (2013): 649-657. DOI: 10.1016/j.amepre.2013.08.001

[vi] Steve Sussman, Nadra Lisha, and Mark Griffiths, “Prevalence of the Addictions: A Problem of the Majority or the Minority?” Evaluation & the Health Professions, 34 (2011): 3-56. DOI: 10.1177/0163278710380124

[vii] Marilyn Freimuth, Sandy Moniz, and Shari R. Kim, “Clarifying Exercise Addiction: Differential Diagnosis, Co-occurring Disorders, and Phases of Addiction,” International Journal of Environmental Research and Public Health, 8, no. 10 (2011): 4069-4081. DOI: 10.3390/ijerph8104069

[viii] Alicia D’Souza, Annalisa Bucchi, Anne Berit Johnsen, Sunil Jit R.J. Logantha, Oliver Monfredi, Joseph Yanni, Sukhpal Prehar, George Hart, Elizabeth Cartwright, Ulrik Wisloff, Halina Dobryznski, Dario DiFrancesco, Gwilym M. Morris, and Mark R. Boyett, “Exercise training reduces resting heart rate via downregulation of the funny channel HCN4,” Nature Communications, 5 (2013): 3775. DOI: 10.1038/ncomms4775.

[ix] James H. O'Keefe, Harshal R. Patil, Carl J. Lavie, Anthony Magalski, Robert A. Vogel, Peter A. McCullough, “Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise,” Mayo Clinic Proceedings, 87, no. 6 (2012): 587–595. DOI: 10.1016/j.mayocp.2012.04.005

[x] Harshal R. Patil, James H. O’Keefe, Carl J. Lavie, Anthony Magalski, Robert A. Vogel, and Peter A. McCullough, “Cardiovascular damage resulting from chronic excessive endurance exercise,” Molecular Medicine, 109, no. 4 (2012): 312-21.

[xi] Heather A. Slay, Jumi Hayaki, Melissa A. Napolitano, and Kelly D. Brownell. “Motivations for running and eating attitudes in obligatory versus nonobligatory runners,” International Journal of Eating Disorders, 23, no. 3 (1988): 267-275.

[xii] Michelle J. Blaydon and Koenraad J. Lindner, “Eating Disorders and Exercise Dependence in Triathletes,” Eating Disorders: The Journal of Treatment & Prevention, 10, no. 1 (2002): 49-60. DOI: 10.1080/106402602753573559.

[xiii] Heather A. Hausenblas and Danielle Symons Downs, “How Much is Too Much? The Development and Validation of the Exercise Dependence Scale,” Psychology & Health, 17, no. 4 (2002): 387-404. DOI: 10.1080/0887044022000004894

[xiv] Kent C. Berridge, Terry E. Robinson, and J. Wayne Aldridge, “Dissecting components of reward: ‘liking’, ‘wanting’, and learning,” Current Opinion in Pharmacology, 9, no. 1 (2009): 65-73. DOI: 10.1016/j.coph.2008.12.014

[xv] Josephine Y. Chau, Anne C. Grunseit, Tien Chey, Emmanuel Stamatakis, Wendy J. Brown, Charles E. Matthews, Adrian E. Bauman, and Hidde P. van der Ploeg, “Daily Sitting Time and All-Cause Mortality: A Meta-Analysis,” PLoS One, 8, no. 11 (2013): e80000. DOI: 10.1371/journal.pone.0080000

[xvi] Catherine R. Mikus, Douglas J. Oberlin, Jessica L. Libla, Angelina M. Taylor, Frank W. Booth, and John P. Thyfault, “Lowering physical activity impairs glycemic control in healthy volunteers,” Medicine and Science in Sports and Exercise, 44, no. 2 (2012): 225-31. DOI: 10.1249/MSS.0b013e31822ac0c0.

[xvii] F. C. Bijnen, C.J. Caspersen, and W.L. Mosterd, “Physical inactivity as a risk factor for coronary heart disease: a WHO and International Society and Federation of Cardiology position statement,” Bulletin of the World Health Organization, 72, no. 1 (1994): 1-4.

[xviii] Kirsi H Pietiläinen, Jaakko Kaprio, Patrik Borg, Guy Plasqui, Hannele Yki-Järvinen, Urho M. Kujala, Richard J Rose, Klaas R Westerterp, and Aila Rissanen, “Physical inactivity and obesity: A vicious circle,” Obesity, 16, no. 2 (2008): 409-414. DOI: 10.1038/oby.2007.72.

[xix] Arnaud Merglen, Aline Flatz, Richard E. Bélanger, Pierre-André Michaud, and Joan-Carles Suris, “Weekly sport practice and adolescent well-being,” Archives of Disease in Childhood, 99 (2013): 208-210. DOI: 10.1136/archdischild-2013-303729