Exercise addiction: when a wellbeing tool becomes part of the problem
Case study / by SJ Whitaker
Exercise and sport are important and enjoyable, but can commitment become an obsession?
We give a big ‘thumbs up’ in our society to sport and exercise. It is good for us – and we are told that, as a nation, we could all be fitter. We are constantly being bombarded with images and information about the body beautiful, heart health, weight issues and the value of cycling, running, walking, dancing, playing sports – basically anything that gets us moving.
The physical health benefits are clear, including heart health and stronger bones and joints, which impact lifelong health. Less widely appreciated perhaps is the positive impact on our mental health, mood, and a general sense of wellbeing.
Striking a balance
The government defines mental wellbeing as being ‘part of overall wellbeing’ and a ‘positive state of mind and body, underpinned by social and psychological wellbeing’. It is linked with physical and mental illness, and includes good relationships, a sense of resilience and a feeling of ‘meaning, purpose and control’. Exercise and sport can help promote all of these things.
One major benefit is the lifting of mood. Exercise has the ability to increase the levels of serotonin and dopamine in the brain, and numerous studies have found that this increases happiness, lowers stress levels and also improves our mental agility in terms of attention, problem solving and memory.
Who wouldn’t want this?
Well, the trouble with us humans is that we usually crave more of anything that gives us pleasure or makes us feel good. This is not always a bad thing, but it can get out of control, or turn against us in ways we had not anticipated. Feeling good is like a drug and if we skip an exercise or sporting session, we could begin to feel anxious or guilty about not exercising. The brain might even tell us that we are immediately going to lose our fitness level and put on kilos of weight. Our focus on physical appearance might become an end in itself. Such thoughts and feelings can point to the start of a compulsion to exercise, and over-exercise.
Defining exercise addiction
Adam Morris, Managing Director of BelievePerform (Mental Health and Wellbeing in Sport) has written about the difficulty in diagnosing exercise addiction. There can appear to be a fine line between pushing ourselves in a healthy way, ‘committed exercising’ and ‘exercise addiction’. People with exercise addiction begin to depend on exercise for rewards other than a general level of fitness or sporting prowess, such as controlling their mood, boosting self-esteem, or to lose or maintain weight. People suffering from eating disorders, especially anorexia or bulimia often depend on exercise as a means to purge themselves of excessive calories or maintain a lower-than-average body weight. It is also thought that over-exercising can lead a person on to developing an associated eating disorder.
As with other addictive practices, there is no one standard definition of exercise dependence. However, Morris cites a set of standards based on the DSM-IV diagnostic criteria for substance misuse (American Psychiatric Association, 1994) in which exercise dependence must contain three of the following eight symptoms:
Tolerance: increasing the time spent exercising, in order to feel greater benefits.
Withdrawal: when the person stops exercising they experience negative withdrawal symptoms, such restlessness or anxiety.
Intention effects: Constantly reviewing and changing the time they feel they need to exercise.
Loss of control: An inability to stop or reduce the time spent exercising without withdrawal symptoms.
Time: Spending too much time and attention on exercising – before, during and after.
Conflict: Exercise becomes the most important aspect of a person’s life, so that social or recreational activities suffer.
Continuance: The inability to stop the exercise practice, even when the individual is aware of the negative effect on their physical, emotional, social and psychological wellbeing.
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How is exercise addiction diagnosed in athletes?
These symptoms apply to the vast majority of us, but for athletes diagnosing exercise addiction can be further complicated by the need to be motivated, dedicated and push their bodies to attain sporting superiority.
Adam Morris points to a number of factors we might consider, including the personality of the athlete and whether they have an addictive or compulsive personality type. Perfectionism, for example, has been strongly linked with the possibility of developing exercise addiction. He cites Freimuth, Moniz and Kim’s 2008 study that developed a model for distinguishing phases of addiction. They look at ‘motivation, consequences and frequency’ of exercise:
Phase One is called 'Recreational Exercise', where an individual takes part in recreational exercise because they enjoy it, find it worthwhile, and/or want to improve their fitness level. There may be a social aspect too.
Phase Two is identified as 'At Risk Exercise'. This is a turning point, where a person’s drive to exercise changes from gratification to stress-relief: using exercise to escape from uncomfortable feelings.
Phase Three enters the territory of 'Problematic Exercise', where an individual is constantly striving to achieve greater goals, and exercise is the pivotal point of the day. They may begin to lose a sense of balance and control, experiencing some withdrawal symptoms if unable to exercise.
The final Phase Four is when exercise becomes the sole aim and purpose of a person’s life, and can be termed 'Exercise addiction'. The bad feelings associated with not exercising (withdrawal) must be avoided at all costs, which in turn affects an individual’s daily functioning and can affect both social and work life.
By acknowledging the differences associated with each phase we are able to understand the athlete’s motivations, behaviours and relationship with exercise within their chosen sport.
What does your relationship with exercise look like?
The subject of exercise addiction is complex and certainly beyond the scope of this article, but the points raised here might lead us to examine our own relationship and behaviour around exercise. It could help us to spot early warning signs. However, ‘denial’ is known to be a key aspect of any addiction, so if you are already in the grip of exercise addiction, you might find it hard to admit, and may need help to gain clarity and see the problem for what it is.
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