Is Exercise Addiction a Real Thing?

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Exercise is a wonderful thing. It’s associated with a long list of benefits, including weight loss, disease prevention, and mood improvement. But like all healthy things, more doesn’t always mean better. While concern over the country’s obesity rates mounts, and doctors continue to encourage healthy doses of physical activity, some avid exercisers may be taking their workout routines too far. Some researchers speculate that an obsessive commitment to fitness can lead to a full-blown addiction that carries not only serious physical risks, but psychological ones as well.

As high-intensity workouts like CrossFit gain popularity, researchers and reporters are wondering: Can you really be addicted to exercise? And if you are, is it really a problem, or a “healthy” addiction to have?

What is an addiction?

The word “addiction” is likely to conjure up images of drugs, alcohol, gambling, and other behaviors we’ve grown accustomed to associating with uncontrollable dependencies. Addiction isn’t just a strong urge to do something; it’s a complicated, chronic issue involving brain chemistry related to reward, motivation, memory, emotion, and more. An addict feels compelled to pathologically seek out rewards or feelings of relief through various substances and behaviors.

Can you really be addicted to exercise?

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered the gold standard guide for classifying and diagnosing psychological issues. Exercise addiction is not recognized by the DSM. While exercise is listed as a “compensatory” behavior for bulimia nervosa, an eating disorder that revolves around compulsive overeating followed by purging, this only applies to some bulimics.

People who have experienced the negative consequences of too much exercise and the researchers who have compiled data on those individuals argue that exercise addiction deserves its own diagnosis. But not all health care providers or researchers are convinced that a preoccupation with workouts can be classified as a true clinical addiction, believing that excessive exercisers are just dedicated and committed. These health care professionals may sidestep the term “addiction” and describe problematic exercise behaviors as compulsive, excessive, or obligatory.

But what could be problematic about a lot of exercise?

It’s hard to believe there could be anything bad about a normally healthy habit many of us don’t engage in enough. However, it’s tricky to know how much exercise is too much, and it can be difficult even for doctors to determine when a dedicated exerciser has veered into unhealthy territory.

According to exercise addiction researchers, the effects of an exercise addiction are both physical and psychological. The physical manifestations may include injuries from overexertion and overuse. But while exercise always carries an inherent risk, and athletes sustain injuries all the time, the more telling signs of an exercise addiction aren’t always visible.

How much is too much?

In a social climate where high-intensity workouts from spin classes to CrossFit to bootcamps reign supreme, it’s hard to draw the line between what qualifies as dedication and what might be classified as an addiction.

The National Institute of Health and American College of Sports Medicine recommend about 30 minutes of moderate-intensity physical activity most days of the week for most adults. While most exercise addicts will surpass those guidelines, the key factor in determining addiction isn’t the amount of physical activity a person engages in, but how much he or she depends on that amount to get through the day, and how severely he or she suffers when exercise isn’t possible.

While a dedicated exerciser likely views daily workouts as important, he or she doesn’t suffer withdrawal symptoms like anxiety or irritability the way an addicted exerciser is likely to if he or she misses a workout. A dedicated exerciser is more likely to rest and recover when necessary, while an exercise addict may continue to work out despite injuries. In addition, exercise addicts may prioritize workouts above all other areas, even if personal relationships or quality of work begin to suffer as a result.

How do you know if you’re an exercise addict?

Many dedicated exercisers may relate to some of the points below, but if you identify with most or all of them, it could indicate a problematic relationship to exercise:

  • Being extremely rigid about the kind of workouts that have to be done, and resisting doing anything different from the ritualized routine
  • Experiencing serious withdrawal symptoms like mood swings, irritability, or insomnia if something gets in the way of exercise
  • Having a preoccupation with exercise that significantly and negatively impacts health, relationships, career, and/or other important priorities
  • Feeling like the amount of exercise that used to be enough doesn’t cut it anymore, and the duration or intensity has to be increased in order to feel a sense of accomplishment, relief, or “buzz”
  • Feeling like the only thing that relieves the negative feelings of withdrawal is more exercise
  • Being aware that there’s a compulsion to exercise, but not being able to control it, and continuing to do it, despite any negative consequences

Are there any real physical dangers?

Stiffness and soreness come with the territory for most dedicated exercisers, but exercise addicts may also suffer long-term physical consequences if they continue to engage in their patterns.

Hormonal changes are one long-term consequence of exercise addiction. Excessive exercise can lead to decreased testosterone in men and increased cortisol (a hormone produced in response to stress) in both genders. Long-term overexposure to cortisol can increase the risk of developing problems like anxiety, depression, heart disease, and weight gain. Additionally, women who over-exercise are at risk for amenorrhea, the abnormal absence of menstruation.

Too much exercise can be damaging to the heart, cause injuries like shin splints and broken bones, lead to exhaustion, and in extreme cases, cause a person to become depressed.

Who’s at risk?

While anyone can fall into problematic exercise behaviors, people with perfectionist personalities may be especially prone to addiction. Additionally, people who have poor body image or low self-esteem are more likely to develop a dependency on exercise. It’s incredibly common for people with eating disorders to also cope with exercise. One study involving 21 psychiatric hospital patients receiving treatment for anorexia concluded that almost half of them showed signs of an exercise dependency.

Having another addiction may also be a risk factor for developing an exercise addiction. A review of 83 studies examining 11 addictions estimated that 25 percent of people addicted to exercise also exhibit signs of other addictions like eating, gambling, sex, and shopping, while 15 percent of people addicted to exercise are also addicted to smoking, alcohol, or illicit drugs.

It’s difficult to know how many people are affected by exercise addiction because there’s no official diagnosis for it. The same meta-analysis of 83 studies estimated the prevalence of exercise addiction in the general population to be around 3 percent, which translates to over 9 million people in the US.

What’s the treatment?

If you or someone you know is addicted to exercise, one of the first steps in recovery is acknowledging that there is a problem and that exercise is adversely affecting other areas of life. Without that recognition, an exercise addict won’t be motivated to seek help or consider exercise to be problematic enough to merit treatment.

Education is a key part in overcoming exercise addiction. Many addicts aren’t aware of how their “healthy” habit could cause significant physical harm or severely impact other areas of their lives. While it’s not necessary to completely abstain from exercise in order to overcome an addiction, it’s crucial to re-learn how to exercise in a moderate way, and learn to engage in different kinds of activities that are not rigid, ritualized workouts.

Cognitive behavioral therapy (CBT) has also been shown to be helpful in shifting addictive patterns. “CBT can be helpful in the treatment of exercise addiction because it’s designed to help patients change their thoughts and behaviors,” says One Medical Group’s Ellen Vora, MD. “These changes can in turn profoundly affect a patient’s mood and habits.”

If you think you have an addiction to exercise, talk to your health care provider or consider seeking out a mental health professional who may be able to help you learn CBT techniques.

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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.