How to Identify an Exercise Addiction and Intervene

Getting regular exercise is an important part of staying healthy. But sometimes people feel compelled to exercise and are unable to stop even when they suffer from pain or injury.

That’s when exercise can become an unhealthy and potentially dangerous addiction.

Consider Mary, a young woman who, after graduating from college, joined a fitness club to meet people and improve her health. At first, she enjoyed the increased stamina, weight loss and a healthier appearance—not to mention a rush of energy after a hard workout. She kept adding fitness classes until, one day, she injured her knee. A doctor told her to rest for several weeks but after a couple days she couldn’t take it and went back. During her first class, she tore her anterior cruciate ligament (ACL).


 Approximately 45 percent of people with an eating disorder also experience exercise compulsion.

Mary’s case was studied by Dr. Michele Kerulis, professor of counseling with Counseling@Northwestern.

“Exercise addiction is a process addiction, which is a behavioral addiction or compulsion to interact or to act in a certain way,” Dr. Kerulis explained. Other types of process addictions include excessive shopping or being a “workaholic.” A process addiction “interferes with somebody's life in negative ways,” she said, but the person with the problem does not quit despite attempts and negative consequences like injuries.

Some studies suggest that approximately 3 percent of people who exercise regularly are addicted. When a person exercises, the brain releases a number of neurotransmitters such as endorphins that can relieve pain and improve his or her mood. If an addiction or dependence is present, missing just one day can result in number of negative psychological and physical consequences such as depression, reduced vigor, increased tension, anger, fatigue, and confusion. Many of those who engage in this maladaptive pattern of exercise start out with positive intentions of improving their health and physical performance.

However, exercise addiction can often coincide with other disorders such as anorexia or bulimia. Approximately 45 percent of people with an eating disorder also experience exercise compulsion. In cases where an eating disorder is present, the person may be triggered by a distorted perception of their body and use excessive exercise, in addition to other maladaptive eating habits, as a means of managing weight-loss.

Body image issues that lead to addictive exercise behaviors can also manifest themselves in other ways. Some people—usually men—suffer from a pathological concern with muscle size and body leanness, called muscle dysmorphia. They look in the mirror and see a body that is too small or weak and turn to overexercise as a means of fixing what they perceive to be wrong.   

Understanding the goals of the person engaging in unhealthy exercise habits, whether they are performance-driven or body image-driven, is an important step in addressing the addiction.

How to Identify Unhealthy Exercise

1. Healthy Exercise

Is motivated by health and adds to the quality of life.


2. At-Risk Exercise

Is used as means to reduce anxiety and other mood states.


3. Problematic Exercise

Is defined by negative consequences like injuries and when an individual organizes days around exercise.


4. Exercise Addiction

Is necessary to avoid guilt or anxiety, continues despite injuries, and interferes with daily life functions.

Organizing exercise in avoidance of daily responsibilities is problematic. Some people who train for specific events will plan their days around a training plan.

Source:  Freimuth, M., Moniz, S., & Kim, S. R. (2011). Clarifying exercise addiction: differential diagnosis, co-occuring disorders, and phases of addiction. International Journal of Environmental Research and Public Health. 8, 4069-4081.

Too Much of a Good Thing

Erin Bahadur, a personal trainer in Chicago, was in recovery from a heroin addiction when she started ramping up exercise and rationing food as a way to maintain control over her life.

“When I couldn't deal well with emotions or things that were going on, I could always control exercise and try to change what people saw on the outside because that was always a good way for me to hide what was going on inside,” Bahadur said. “So I started exercising—a lot.”

Bahadur kept separate Google calendars to track her running. She would always try to run further or faster. And she monitored everything that she ate.

“That kind of gave me a sense of control, which was something that drugs and alcohol kind of did, too,” Bahdur said.

Bahdur replaced one addiction with an activity that most people perceive to have health benefits. But that misperception of how much exercise is healthy can make identifying this type of addiction a challenge.   

Sports medicine experts prescribe a varied, and reasonable, exercise routine. The American College of Sports Medicine (ACSM) recommends 150 minutes of moderate exercise each week, incorporating weight lifting, cardiorespiratory exercise, and neuromotor training like yoga. Additionally, it recommends limiting time sitting around.

How to Spot the Signs of an Addiction

Time

Does a person spend an inordinate amount of time exercising?

Intention

Does the person exercise longer than they initially set out to?

Tolerance

Does a person need to increase the amount of exercise to achieve his or her desired goals?

Withdrawal

Does a person feel anxious or fatigued if they do not exercise?

Continuance

Does a person continue to exercise despite injuries?

Conflict

Is a person skipping other commitments like social functions or work in order to exercise?

Loss of Control

Has a person attempted to stop or reduce exercise and failed?


Source: Hausenblas, H. A., & Downs, D. S. (2002). Exercise dependence: A systematic review. Psychology of Sport and Exercise, 3(2), 89-123. http://psycnet.apa.org/ record/2002-12436-001

However, every person’s body is different and people may use their bodies differently based on occupation. Elite athletes devote countless hours to their chosen sports and exercise significantly more than the average person. But Dr. Kerulis notes that “their workouts are developed by individuals who are professionals and who understand the body and recovery time. They understand how to develop very specific muscle movements and strengthen muscles sets to perform a specific action.”

Without those controls, she said, an athlete can “actually harm those systems instead of helping those systems.”

That was Bahadur. The morning after a personal-best 12 miles, she said to herself: “Well now I have to do it again. So, I went and ran again. Then the next morning … I couldn't put weight on one of my legs. I ended up with a stress fracture.”

Injuries are one sign that an athlete has overexercised, and continuing to exercise after an injury could suggest an addiction. Other signs to look out for include an increased tolerance to exercise requiring athletes to workout harder and longer to achieve the same results; feelings of anxiety or guilt when a workout is missed; the need to organize one’s day around an exercise schedule; and withdrawal from important functions in order to devote more time to working out.

Bahadur said her boyfriend—now husband—was a voice of support. He didn’t tell her to stop exercising.

“But he would make comments like, it's not like you have to keep doing this and going so hard,” she said.

Dr. Kerulis, a certified consultant through the Association for Applied Sport Psychology, a member of the United States Olympic Committee Sport Psychology Registry, and a content expert in sport and exercise psychology, said loved ones should always express concern when they see unhealthy behavior.

“I think it's perfectly acceptable for friends or family members to have open conversations with their loved ones to say, I noticed something different in you and I'm concerned about this behavior,” she said.

She suggested looking for clues of when excessive exercise gets in the way of a loved one’s daily life. For example, if they are skipping work or school to work out or going against a doctor’s orders to rest.

“Just say, ‘I'd like to have a conversation with you about this because I'm worried that you might continue to get hurt.’ ”

Many times, health and fitness instructors can also play an important role in spotting unhealthy habits and intervening. During her time as a fitness instructor, Dr. Kerulis noticed participants who would attend too many classes in addition to completing other workouts. Because they were pushing their bodies too hard, the athletes’ muscles would stop functioning in a way that enhanced the movement and instead respond in a protective way, tightening around a knee joint, for example, to stabilize the knee instead of the quadriceps and hamstring working to lift the leg.

Health and fitness professionals should have the expertise to recognize these signs, said Dr. Kerulis. And they have a responsibility to work with their clients to address problematic behavior. Dr. Kerulis offers these five strategies for providing help to a client who may be exercising excessively.

Strategies for Adjusting Unhealthy Exercise Behavior

Define realistic fitness goals.

If you have somebody that comes to your gym and says that they want to lose 20 pounds in the next two weeks, that’s not a realistic goal. Understanding a client’s goals can help to identify if they could be on the track to engaging in problematic behavior. Creating realistic goals will enable fitness instructors to help them develop a plan that allows them to achieve what they want in a healthy way.

Discuss what constitutes healthy exercise.

Some people believe that the more they exercise, the better it is for their bodies. Dr. Kerulis says to ask clients what they know about the fitness industry and what they believe a healthy exercise plan looks like. Use the American College of Sports Medicine guidelines as a way to teach them the how to develop a healthy exercise plan.

Connect clients with counselors, dietitians, and other health professionals.

For people who have an exercise addiction, outside help may be necessary. There are both inpatient and outpatient treatment options for those suffering. Dr. Kerulis says that there has to be “clarity with treatment providers, with physicians, with counselors, and with dieticians to really understand the psychological complexities behind engaging in compulsive exercise.” The purpose of engaging in a compulsive behavior, she says, is to decrease internal discomfort and internal anxiety. She advises working with a counselor to help identify and understand those triggers.

Suggest alternative activities that keep the body moving.

Everything from dancing to kayaking to playing with children can keep the body moving without being tied to minutes and calories. Work with clients to identify positive behaviors that will function to ensure the body and cardiovascular system stay healthy.

Educate clients about the physiological responses to exercise.

Sometimes it’s not enough to provide an exercise plan. Clients may need to understand the ways that their muscles respond to either enhance a movement or to protect the body in order recognize the negative effects of overexertion.

 

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Citation for this content: Northwestern University's online Master of Arts in Counseling program.