Exercise addiction—though not formally recognized as a mental health disorder in the DSM—entails a progression of increasingly obsessive and compulsive maladaptive beliefs, thoughts, and behaviors geared towards sustaining chronic, problematic exercise. If gone without intervention, one may suffer from increasingly severe physical, emotional, cognitive, and social consequences.
Though considered an incurable condition, many have achieved and maintained recovery through treatment by resolution and management of symptoms.
What Is an Exercise Addiction?
Typically, when one thinks of addiction it is usually associated with something clearly detrimental to one’s health—alcohol, drugs, smoking, et cetera. The act of exercising, however, is something heralded as being among the healthiest things a person can do. When one is overweight, exercise is recommended. When one is struggling with emotional health, exercise is recommended. Looking for a prosocial activity? Exercise is good for that as well.
Given all that we know about exercise and its impact on our health, could it be possible that too much of a good thing is a bad thing? Well, that is exactly what more recent research has begun indicating. Although research on exercise addiction is more so up-and-coming than something with extensive support, it is estimated that approximately 3% of adults in the United States meet the criteria for exercise addiction.1
Despite there being no formal diagnosis of exercise addiction in the current DSM-5 or any of the previous text revisions, researchers have begun associating clinical symptoms in association with the thoughts, emotions, behaviors, and consequences studied among those who present with exercise addiction or compulsive exercise.2
Exercise Addiction Statistics
Because exercise addiction is not currently a diagnosable disorder, statistics are somewhat limited. Although studies have been conducted by professional researchers at universities and government agencies, much more has been conducted by various organizations interested in the topic.
Here are some key statistics on compulsive exercise and exercise addiction:
- Prevalence of exercise addiction for adults in the United States is about 3%13
- Prevalence rates for competitive athletes and gym-goers is significantly higher:
- Runners: 25%
- Marathon runners: 50%
- Triathletes: 52%
- Endurance athletes: 14.2%
- Fitness center attendees: 8.2%13
- 15% of exercise addicts are also addicted to cigarettes, alcohol, or illicit drugs14
- 25% of exercise addicts may have other addictions such as sex addiction or shopping addiction14
Hausenblas and Downs (2002, 2004) identify clinical symptomatology for substance use disorders from the DSM IV-TR (previous text revision).
The red flags associated with exercise addiction are as follows:
- Tolerance: increasing the amount of exercise in order to feel the desired effect, be it a “buzz” or sense of accomplishment
- Withdrawal: in the absence of exercise the person experiences negative effects such as anxiety, irritability, restlessness, and sleep problems
- Lack of control: unsuccessful at attempts to reduce exercise level or cease exercising for a certain period of time
- Intention effects: unable to stick to one’s intended routine as evidenced by exceeding the amount of time devoted to exercise or consistently going beyond the intended amount
- Time: a great deal of time is spent preparing for, engaging in, and recovering from exercise;
- Reduction in other activities: as a direct result of exercise; social, occupational, and/or recreational activities occur less often or are stopped
- Continuance:continuing to exercise despite knowing that this activity is creating or exacerbating physical, psychological, and/or interpersonal problems.2,3,4,5,6
The amount of what is considered healthy exercise does vary from person to person, dependent upon a variety of factors—typically those associated with one’s physical ability to engage. Somewhere in the area of 60-90 minutes of more rigorous exercise is typically recommended per week while 30 minutes of daily physical exercise has proven useful toward preventing health conditions such as diabetes, high cholesterol, and hypertension.7
Slightly adjusting to more or less may still come with a host of benefits while not exercising at all or engaging too much may be detrimental.7 With that said, exercise addiction is not defined by exercising every day but to what extent it becomes detrimental to one’s well-being.
How Exercise Affects the Brain
Exercise affects the brain on multiple levels. It impacts the brain chemically by releasing endorphins, which are the natural opioids produced within our bodies. These make us feel good.8 It also increases heart rate—pumping more oxygen to the brain.9
Exercise releases hormones that facilitate healthier growth of brain cells and also stimulates the growth of new connections between brain cells in the cortical areas of the brain, enhancing neuroplasticity. Exercise has an antidepressant type effect that decreases symptoms associated with negative emotions and stress while contributing to the natural euphoric sensation many refer to as a “runner’s high.”9
Beyond the physiological effects, exercise also affects the individual on a cognitive and emotional level. Exercise is generally associated with goals, which the brain associates with meaning. When we are doing something meaningful, we generally feel better about ourselves. As we meet our goals (e.g., weight loss, faster times, ability to lift more weight, etc.) it increases our self-esteem and confidence.10 When we look in the mirror, we like what we see. It gives us more confidence. We carry ourselves higher, others notice and compliment us, and the cycle repeats itself.10
Further, we receive additional benefits when working out with others. Such prosocial activities enhance interpersonal relationships, are fun, and are healthier than some of the other things we could be doing with friends. It decreases symptoms associated with diagnosable mental health disorders including major depression, anxiety, post-traumatic stress disorder (PTSD), and eating disorders, among others.10 That said, when exercising at the recommended level, it can be one of the healthiest things we can do for ourselves.
Signs of Exercise Addiction
Although the signs of exercise addiction are similar for children, teens, adults, and seniors; the presentation may look a bit different.
The timeline for one to progress into exercise addiction does vary, but generally includes the following signs:
- Missing a workout leads to feelings of irritation, anxiety or depression
- Working out when sick, injured or exhausted
- Workouts start to impact relationships
- Other priorities suffer
- Happiness is re-defined
- Continually extending workouts
- Working out excessively
- Exercise loses the element of play and fun11
- Reducing activities in other areas of life to make time for exercise14
- Spending long periods of time preparing for, and recovering from, exercise14
- Negative social consequences15
- Exercising despite medical contraindications15
- Interference with relationships or work15
At this point the purpose of exercising has changed from something healthy and fun to a maladaptive pattern of problematic thoughts, beliefs, and behaviors.
It is important to consider what subpopulations within each age group are most at risk for exercise addiction. Within younger populations research has indicated an increased likelihood of exercise addiction in school athletes, fitness attendees, and those with eating disorders. A study of 471 adolescents and early adults aged 11-20 years found prevalence rates for exercise addiction as follows: 4.0% in school athletes, 8.7% in fitness attendees, and 21% in patients with eating disorders.12 With adults and seniors those particularly vulnerable include fitness attendees, those with mental health and other addictive disorders, body image issues, exercising to cope with loss and trauma, et cetera.
Compulsive Exercise Symptoms
Symptoms associated with exercise addiction or compulsive exercise do vary widely and are dependent on personal predispositions, the type and amount of exercise, et cetera. It is important to note that even those who exercise as recommended may experience these symptoms at any point. The key difference, however, is that despite the onset of symptoms and their increased severity, exercise continues regardless of the consequences.2,3,4,5,6
Common symptoms associated with exercise addiction include but are not limited to:
- Pain and injury from overuse13
- Social impairment13
- Anxiety13
- Depression13
- Heart problems13
- Irregular periods with possible reproductive issues13
- Extreme weight loss13
- Feeling buzzed after exercising14
- Experiencing withdrawal symptoms after long period without exercise14
- Experiencing uncontrollable desires to exercise14
- Experiencing an inability to stick with a reduced exercise routine14
- Becoming more prone to injury15
- Joint damage15
- Loss of muscle mass15
- Sprained ligaments15
- Strained or torn muscles or tendons15
- Organ failure16
- Suicidal ideations16
If any of the above-mentioned symptoms are present, it is important to reconsider one’s workout regimen and consult with a mental health or medical professional as necessary.
Causes & Triggers of Exercise Addiction
Exercise addiction generally begins with a desire to improve one’s physical fitness.15 For vulnerable populations, the benefits of exercise become so desirable that they are continually left wanting more.
Common causes and triggers that contribute toward one’s susceptibility for exercise addiction include the following:16
- The presence of an eating disorder (e.g., anorexia nervosa, bulimia, binge eating disorder, orthorexia)
- Low self-esteem
- Body dysmorphia (may also lead to a plastic surgery addiction)
- A craving for endorphins
- Depression and anxiety
- Having extreme weight loss goals
- Type “A” or “perfectionist” personality
- Substance use and other addiction disorders (potentially developing a cross addiction)
Note that each cause and trigger in-and-of itself is problematic and warrants its own attention. Exercise addiction, then, serves to exacerbate the problem—making things even worse. The relationship between the underlying triggers and exercise addiction is self-reinforcing and will need to be addressed holistically for a comprehensive recovery effort.
When Regular Exercise Becomes Compulsive
Exercise addiction is generally progressive and may be conceptualized across four stages: healthy exercise, at-risk exercise, problematic exercise, and exercise addiction.17 The initial stage oftentimes begins with healthy exercise that “is motivated by health and adds to the quality of life.”17 Here, an individual may have healthy goals such as losing weight, improving vitals, engaging in a prosocial hobby, getting outdoors or into the gym, et cetera.
The second stage, at-risk exercise “is used as means to reduce anxiety and other mood states.”17 This stage should be met with caution, as reduction of anxiety and other mood states is considered a benefit and associated with healthy exercise. The problem here is that when the premise of the negative emotions goes unaddressed or unresolved and exercise becomes the only coping skill, people may increase exercise to alleviate symptoms that are continually increasing.
The goal is to address the underlying triggers associated with the anxiety or depression. Although exercise is a healthy outlet, these underlying triggers must be addressed in order to properly recognize, and treat the anxiety or depression.
Problematic exercise, the third stage, “is defined by negative consequences like injuries and when an individual organizes days around exercise.”17 Symptoms are now present and beginning to increase in number and severity. When one enters the final stage, addiction, exercise “is necessary to avoid guilt or anxiety, continues despite injuries, and interferes with daily life functions.”17 It has now reached the point of obsessive thoughts and compulsive behavior. Breaking the cycle at this point requires thoughtful and strategic intervention.
Treatment for Exercise Addiction
Fortunately, there are many treatment options available for exercise addiction. Depending on the severity of the addiction and personal preference, treatment may be any one or a combination of outpatient therapy, residential treatment, and/or support groups. Because exercise addiction is not a formally recognized mental health disorder according to the DSM-5, insurance companies may not reimburse fees, and unfortunately, costs for treating compulsive exercise may have to be paid out of pocket.
Therapy
Treatment for exercise addiction is much more complicated than simply cutting back or abstaining from working out.16 Rather, it requires a multidisciplinary approach that addresses e biological, psychological, social, and spiritual domains. As each compromising factor is addressed, the individual becomes better able to adapt and cope while decreasing problematic beliefs, thoughts, and behaviors.
When engaging in therapy, Northwestern University’s online Master of Arts in Counseling program recommends the following strategies for adjusting unhealthy exercise behavior:
- Define realistic fitness goals.
- Discuss what constitutes healthy exercise.
- Connect clients with counselors, dietitians, and other health professionals.
- Suggest alternative activities that keep the body moving.
- Educate clients about the physiological responses to exercise.18
Common Types of Therapies
Cognitive behavioral therapy (CBT) is a recommended approach, as it addresses said problematic beliefs, thoughts, and behaviors and replaces them with healthy and positive thoughts and behaviors.16 Here the patient and professional work together to modify problematic beliefs (e.g., “My body is ugly.”), remove negative/obsessive thoughts (e.g., “I only worked out for 4 hours today and can still do another half hour.”), and engage in behavioral experiments that ultimately lead toward positive thinking and behavioral change (e.g., reducing negative thoughts and the time and intensity spent working out). CBT is also used to treat most other mental health and substance use disorders that are co-occurring with exercise addiction.
Dialectical behavior therapy (DBT), is another recommended approach. Like CBT, it offers even more structure and instils an element of mindfulness. Read more about the difference between CBT and DBT here. If necessary, consulting with a dietitian or nutritionist may also be necessary to ensure that one partakes in a healthy diet.
Intended Treatment Outcome & Timeline
Motivation to change is the primary factor associated with intended treatment outcome and timeline. When one is motivated to change and puts forth the necessary effort, change is most likely to occur. This includes fully participating in treatment inside and out of appointments, distancing from addictive thoughts and behaviors, being honest with oneself and others (especially when struggling), and engaging in necessary lifestyle changes.
Lifestyle Changes
Lifestyle changes are necessary to initiate and sustain change. If the decision has been made to participate in treatment, then one will benefit most from a 100% commitment. While treatment may entail more days and hours in the beginning, it will likely decrease over time. Initial lifestyle changes may include planning your workouts to meet a healthy schedule and intensity level, eating whole foods, addressing mental health and addiction issues, adopting new hobbies, and maintaining a positive outlook on self and life in general. Drugs, alcohol, and other non-prescribed mind-altering substances should also be avoided.
Medication
Depending on the individual and the severity of the addiction, psychiatric medication may prove beneficial.16 The decision as to whether medication is appropriate is made between the patient and prescribing physician (preferably a psychiatrist who specializes in such medications). For those with co-occurring disorders (combination of mental health and addiction disorders) that warrant medication, it is important to take these as prescribed while informing the provider of all conditions and symptoms present.
How to Get Help for an Exercise Addiction
Getting help may begin by conducting a search of local providers. This may be done by conducting a query online for “exercise addiction treatment” in your local area. From there it is recommended to closely review the websites for providers and make note of those that stand out.
Because treatment is highly personal and not a “one size fits all” approach, it is important to proceed with those that not only address the addiction but also meet one’s additional needs and preferences. hen reviewing providers, it is recommended to contact the ones that stand out via phone call or email. Be sure to ask any relevant questions.
Such questions may include but are not limited to:
- Do you specialize in exercise addiction?
- What are the treatment outcomes for others you have treated?
- Do you work with co-occurring disorders?
- What is the projected timeline for treatment?
- Does managed care cover any fees?
- What are my out of pocket costs?
The better the fit, the more likely one is to be motivated to change.
How to Get Help for a Loved One
When attempting to help a loved one:
- Begin by becoming as informed as possible about exercise addiction.
- Note the signs and symptoms you have observed from your loved one.
- Conduct some preliminary research on treatment options.
- Engage in a supportive, informed discussion. Being informed provides credibility to your stance as well as offers resources to actually begin the helping process.
Remember that you are getting help because you care about this person. It is important to remain supportive and objective during this process.Remember that the addiction has reached a point beyond one’s personal control. and the individual may be unaware or in denial of the problem. Accordingly, you may be met with some resistance, which is normal.
It is also important to model the behavior you wish to see. If you are also struggling with exercise addiction, seeking help for yourself sets a positive example.
Living with Exercise Addiction
As with any other addictive disorder, exercise addiction is treatable but not curable. This means that even if symptoms are manageable, minimized and even eliminated, the underlying disorder is still present. As a result, living with exercise addiction does require intent and consistency and recovery is always an active task. Recovery should always be at the forefront of one’s mind.
Common techniques that can help you manage your exercise addiction include but are not limited to the following:
- Participating in treatment as necessary
- Attending support groups
- Speaking with others, especially when struggling
- Avoiding triggers pertaining to people, places, and things
- Addressing any mental health and/or addiction concerns
- Eating whole foods to nourish your body.
- Having a positive outlook on life
- Adopting new hobbies that are not associated with exercise
Most people may engage in some variation of the suggestions made above or any other healthy strategy that works. Again, the key here is that the strategy is healthy, consistent, and intentional.
Exercise Addiction Tests, Quizzes, and Self-Diagnosis Tools
Exercise addiction tests, quizzes, and self-diagnosis tools help determine whether one presents with the signs and symptoms of exercise addiction. It is important to note that official diagnosing should be conducted by a trained, licensed professional.
Tests Performed by Professionals
The Exercise Addiction Inventory (EAI) is an evidence-based screening tool used by many professionals. It is relatively straightforward and aligns with the signs and symptoms associated with the addiction.
Respondents rate each of the following questions on a likert scale from 1 = “always” to 6 = “never”:
- Exercise is the most important thing in my life.
- Conflicts have arisen between me and my family and/or my partner about the amount of exercise I do.
- I use exercise as a way of changing my mood.
- Over time I have increased the amount of exercise I do in a day.
- If I have to miss an exercise session I feel moody and irritable.
- If I cut down the amount of exercise I do, and then start again, I always end up exercising as often as I did before.19
Scores of “1 or 2 on three or more of the seven criteria are classified as exercise dependent. Those scoring in the 3-4 range are classified as symptomatic and those scoring in the range of 5-6 are classified as asymptomatic.”19
Quizzes and Self-Diagnosis
Quizzes and self-diagnosis tools may be found online by conducting a search of “exercise addiction quizzes” or “exercise addiction self diagnosis.” Some of these tools are adaptations of the EAI provided above while others differ quite significantly. Again, it is important to exercise caution when utilizing such tools. One may wind up causing even more damage with a misinterpretation of results. If there is any question regarding the results or they indicate a potential problem, the next step should be following up with a professional.
For Further Reading
The following are helpful additional resources for those impacted by an exercise addiction:
