Compulsive Exercise Can Result in Exercise Dependence
I have always called myself an extreme health nut. I thought it was a positive, a good thing… eating really really overly healthy and cutting out pretty much all fat and carbohydrates. … It’s quite weird, you’d go out for a run or a really long power walk and you feel really good. And in control, you’re in control of what you’re doing and what you’re eating, kind of caught up in yourself really. I didn’t think I was damaging my body at all. (Gabby)
Pirkko Markula, Ph.D., is a professor of socio-cultural studies of physical activity at the University of Alberta, Canada, as well as a Pilates instructor and contemporary dancer. She is a founding member of the Body, Movement, and Culture research group of qualitative research. In her research, she uses qualitative research methods to examine women’s exercise experiences, their understandings of health, body image, and the ideal, fit body.
Editor: Saad Shaheed
This is how one of the participants in Holly Thorpe’s recent study of recreational women runners described her relationship with exercise. She exercised a great deal, so much so that, like others in this study, experienced the chronic loss of menstruation. Although exercise improves physical and psychological health, too much exercise proved to be harmful.
Thorpe focused on a condition called the ‘Female Athlete Triad,’ a term coined by the American College of Sports Medicine (ASCM) in 1992. This condition is characterized by loss of menstruation (Amenorrhea), bone mineral loss (Osteoporosis), and disordered eating. Thorpe became interested in the topic through her own exercise experiences. She describes:
“Over the past six or seven years, I have developed a deep love of running, gradually increasing my (typically) daily runs from 30 minutes to 45-60 minutes, sometimes longer…When my monthly menstrual periods slowly disappeared, I didn’t think too much of it…Many of my fellow physically active friends had similar experiences and told me not to worry, supposedly ‘it’s normal when you’re running most days’…The more research I did, the more concerned I became about the health of my bones and future fertility.” (Thorpe, 2014, p. 673)
In addition to physical problems, excessive exercise can be detrimental to psychological health.
Regular exercise has negative psychological consequences when it turns into ‘exercise dependence’ also referred to as exercise addiction, excessive exercise, compulsive exercise, or obligatory exercise (e.g., Kerr, Lindner & Blaydon, 2007). In exercise dependence “moderate to vigorous physical activity becomes a compulsive behavior” (Edmonds, Ntoumanis & Duda, 2006, p. 888). Unlike athletes who train to compete several hours a week, someone who experiences exercise dependence spends a great deal of time exercising when it is not necessary for one’s career or work. Hausenblas and Symonds Downs (2002a) explain that if leisure-time physical activity turns into “uncontrollable excessive exercise behavior” it leads to significant impairment or distress.
But When is an Exercise Routine Excessive?
Because excessive exercise impacts both psychological and physical well-being, it is difficult to determine exactly “how much is too much” (Hausenblas & Symonds Downs, 2002a, p. 118). To further complicate things, exercise dependence has multiple dimensions and includes multiple symptoms such as an inability to stop exercising, disturbed psychological functioning, exercising despite medical contraindications, and interference with social life and relationships (Bamber & al., 2000). It often appears together with an eating disorder. Most researchers, however, agree that three or more of the following symptoms have to be present for the condition:
(1) tolerance: a need for significantly increased amounts of exercise;
(2) withdrawal: anxiety or fatigue if not able to exercise;
(3) intention effects: exercising more than was intended;
(4) loss of control: unable to cut down or control exercise;
(5) time: a great deal of time is spent exercising;
(6) conflict: important social, occupational, or recreational activities are given up or reduced because of exercise;
(7) continuance: exercise is continued despite persistent or recurrent physical or psychological exercise-related problems (e.g., injury or illness). (Hausenblas & Symonds Downs, 2002a)
These psychological symptoms are assessed by using questionnaires such as the exercise dependence scale (EDS), the exercise dependence Questionnaire (EDQ), or the exercise addiction inventory (EAI).
In a series of studies, Bamber and her colleagues (2000, 2003) had their participants complete both the exercise dependence Questionnaire (EDQ) and the eating disorder examination self-report questionnaire (EDE-Q) to indicate the presence of each condition. They then interviewed women who had exercise dependence (4 participants) or exercise dependence and an eating disorder (4 participants).
Although only two of these women were competitive athletes (a high jumper and a middle-distance runner), all diligently followed regular exercise routines. Annie’s typical training, for example, included riding her exercise bicycle for 32 minutes, followed by 30 minutes of calisthenics and 30 minutes of weight training every morning. She walked up to four hours daily and spent her afternoons as a part-time professional horse rider training up to two hours a day in addition to grooming.
There was no obvious reason to exercise so much, but the women attested to not being able to function properly without their training. Jenny, for example, reported feeling depression, headaches, blurred vision, lack of concentration, and insomnia if not able to exercise. She explained:
“you are just depriving me of something that is essential to me [if I can’t exercise] . . .you might as well say, ‘stop eating’ or ‘stop breathing . . .I should be really depressed, I should be suicidal . . .I just wouldn’t be able to cope with just sitting in here . . .without exercising . . .you would probably have to put me in hospital.” (Bamber & al., 2003, p. 398)
Missing even one exercise session was a source of anxiety for these women. Peta recalled her reaction to one missed swimming session: “I was mad at myself, I felt really angry, I couldn’t concentrate on anything and I felt moody and aggressive…I just felt so agitated and so out of control” (Bamber & al., 2003, p. 396).
Even injury of illness would not stop them from exercising. Annie, for example, explained:
“I have knackered my knee joints and I have got arthritis in my knees and ankles from too much exercise, and I have crumbling hip joints from over-exercise, so I know I have got permanent knee and shin injuries that I have given myself from over-exercise, but I still continue to do it.” (Bamber & al., 2003, p. 396)
Others admitted that they have lost control over their exercise indicating that “the more I do it the more it seems that I need to do it” (Bamber & al, 2003, p. 395). Because exercise was so central to their lives, it was more important than their social life. The women turned down engagements that interfered with their exercise routines and thus, had little social life. One participant disclosed: “My exercise is my social life, I don’t have a social life outside that” (Bamber & al., 2003, p. 395).
Bamber and her colleagues (2003) discovered that all women who exhibited exercise dependence also had an eating disorder. They exercised to be ‘good,’ but to be good, one needed to be thin. For example, if Meg was unable to exercise, she “would simply not eat” (Bamber & al., 2000, p. 428). Women in Thorpe’s research were similarly afraid of becoming fat if not exercising and then used running to control their eating:
“If I knew I wasn’t going to exercise, I would cut down my food intake, or conversely, if I knew I was going to be able to exercise I might allow myself to eat more. It was always an equation going on in my head. … The food was a reward for exercise, and the exercise was the reward for having eaten. If I had a day without exercise… I really felt like I could feel fat starting to grow.” (Amanda)
In another study, Cox and Orford (2004) interviewed five women who exercised between 7 and 24 hours a week and based on the EDQ, exhibited symptoms of exercise dependence. The researchers found that ‘control’ was important for these women.
When continually pushing through intense exercise, they gained control over their bodies. This control mechanism, they believed, was better than dieting, their previous control mechanism that could easily go out of control. One participant, Gill, advised all women with eating disorders “to exercise, because I’ve found in a lot of cases structuring exercise, along with…starting to eat and getting that confidence of the body, replaces that control issue that a lot of anorexics have” (p. 175). While exercise had helped Gill overcome issues with eating, she did caution that “there are some women who use exercise as part of their anorexic pattern…but…for me, it worked and for other women, it’s worked and it does” (p. 176). Now exercising, Gill appreciated her physical strength and had found a connection to feminism: “I hit that big feminist flush. . . I think I started to appreciate that. . . this whole push that women are the weaker sex, that is just so much crap” (p. 176). Other participants found exercise empowering because of the physical strength and self-confidence that helped to protect them against external violence.
Intense exercise also made these women think differently about the ideal body shape. Instead of a thin body, they preferred having “reasonably defined muscles” (Cathy). For example, Cathy described that while she was still “very, very critical” of her own body, her perfect body “wouldn’t be thin it would be fit” and Denise was rather “strong” than “skinny and lean” (p. 179). They shaped their strong bodies ‘for themselves’ rather than for other people, specifically men. Fear of losing the body they had achieved, nevertheless, kept them exercising or strove them to increase their routines.
With such benefits, these women saw exercise only as a positive aspect of their lives. Although some admitted being addicted to exercise, theirs was ‘a healthy addiction.’ Cathy, for example, stated: “to exercise is healthy…to take drugs is unhealthy so it’s socially unacceptable… I want to be fit, I wouldn’t want to take an excessive amount of LSD…You don’t have the same amount of control.” (p. 181). Elaine added: “(It’s) a damn sight healthier than some of the other addictions I’ve had. . . because. . . you know on the whole it does me good…I think it’s good, I don’t want to change it” (p. 181).
Based on these studies, women’s relationships with their bodies, eating, and exercise are complicated and it is difficult the get the balance right. It seems like the compulsion of control runs through both eating disordered behavior and exercise dependence: both are ways to control and shape bodies (Bamber & al., 2000). In these conditions, seemingly healthy behaviors of exercise and dieting turn into unhealthy obsessions.
It is difficult to detect when exercise becomes a problem. The exercise dependent women found exercise, even if obsessive, time-consuming and injury-prone, ultimately ‘healthy’ – a belief supported by the moral judgment attached to inactivity and obesity as signs of ‘laziness.’ For example, when Bamber and her colleagues (2003) asked “Would other people say that you exercise excessively?” the response was “Only the lazy ones in this world” (p. 399). One participant in Cox and Orford’s (2004) study, Gill, explained perceiving herself “as being a very lazy person” (p. 183) if missing her exercise.
So far I have just talked about women as being affected by exercise dependence. It has, however, become a growing concern for men. For example, Cox and Orford (2004) included male subjects in their study to find that they were very concerned about creating the ideal muscular, fit body shape.
The estimates of how common exercise dependence vary considerably. Zmijewski and Howard found 45.9% of college undergraduates presenting three or more symptoms of exercise dependence and Lejoyeux and colleagues (2008) found a prevalence rate of 42% of their sample of a Parisian fitness club. Other studies reported significantly lower rates. In the United States, Hausenblas and Symonds Downs (2002b) found (using the EDS) about 2.5% of the exercising population affected by exercise dependence. Szabo and Griffiths (2007) estimated, using the EAI, that 3.6% of general gym goes may experience exercise addiction. These studies included both women and men. Berczik and her colleagues (2011), however, assert that “even if only 1% of the exercising population suffers from an exercise addiction, it represents a very large number of people needing help” (p. 6).
Against the fact that 33% of American women do not exercise regularly (AHA, 2013 Fact Sheet) and 36% of women are obese (obesity.org, 2012), exercise dependence seems like an insignificant problem. Nevertheless, exercising excessively can turn into a psychological dependency that needs to be taken seriously. For example, we need to be careful of the uncritical promotion of any amount of exercise as singularly healthy behavior. We should also question the admiration of extremely high-intensity exercise routines as suitable for everyone. An appropriate dosage of exercise can be healthy and fun, but when exercise controls our minds and bodies, it, like an eating disorder, turns into illness