Extremely healthy or excessive: When exercise becomes addiction
I get grumpy if I don’t move for more than a day or two and during the week, I prioritise exercise over social engagements.
I’m not alone, I’m not even on the extreme end of the scale. Only a couple of years ago I was flabbergasted by people like Janette and Alan Murray-Wakelin, a couple in their 60s who ran the circumference of Australia – 365 marathons in 365 days – subsisting solely on raw fruit and vegetables.
Nowadays, I barely bat an eyelid hearing about another person undertaking another inhuman feat of endurance.
When we let our bodies do what they are made to do and move them, we reap extraordinary benefits. Exercise boosts our brain power, delays the ageing process, it sparks our energy, enhances our mood and mental health, improves our sex lives, helps keep our weight in check and is linked with preventing a plethora of chronic diseases. Besides, it is bloody good fun.
Of course, too much of a good thing is harmful. But what is the line?
By the time Katherine Schreiber went to university, her life revolved around the gym.
She was consumed with anxiety if she skipped a session and, as far as Schreiber was concerned, exhaustion, being too busy or illness were not valid excuses.
With the rigidity around her exercise regime, her friendships suffered, she lost career opportunities and rarely travelled.
By the time she was 26 years old, she had two herniated discs, a stress fracture and had was constantly exhausted.
Schreiber has shared her story in a new article for the British Medical Journal which explores exercise addiction and aims to highlight the risks.
Although the majority of the population needs to move more, and exercise addiction affects only about 3 per cent of the population, some are more at risk than others. Among runners and triathletes reported incidence are as high as 25 per cent and 30 per cent respectively.
“Exercise addiction should not be confused with a high level of commitment to a physical activity or a healthy habit,” say the article’s authors, Heather Hausenblas, a professor of kinesiology at Jacksonville University and James Smoliga, an associate professor of physiology at High Point University.
“Overuse injuries and overtraining regularly occur in ambitious but non-addicted athletes. Exercise addicts are distinguished from other high volume exercisers, whose intrinsic desire to exercise is under control and does not regularly result in emotional, social, or occupational disruptions.”
Symptoms of excessive exercise include stress fracture and tendinopathy, anaemia, amenorrhoea (when a woman’s period stops), or other endocrine, metabolic, or immune dysfunction.
“Indicators of overtraining – such as unexplained decreases in performance, persistent fatigue, and sleep disturbance – may be reported,” the authors add.
“Patients may continue to exercise despite injury or illness and give up social, occupational, and family obligations to exercise. Patients may report withdrawal effects when their exercise schedule is disrupted – such as inability to sleep and concentrate, restlessness, anxiety, sadness, or irritability.
“Symptoms may be exacerbated when patients are requested to limit or refrain from exercise (such as during recovery from an injury).”
It can be a blurry line between commitment to a cause and addiction, says Dr Amy Reichelt of RMIT, who specialises in addiction and behavioural control.
“Nowadays, people who exercise do see it as being a big part of their life and they’ve obviously made life choices that fit exercise around it – you make time in your schedule and sometimes you’ve built your schedule around going to the gym after work or going for a run in the morning,” she says, adding that it’s natural to feel miffed when a habit – be it exercise or our morning coffee – is disrupted.
Exercising when we’re tired or even a little crook is also not extraordinary.
“They talk about patients continuing to exercise despite injury or illness and that’s very common – even if you’re not feeling very well or you’ve hurt yourself to continue trying to go to the gym because you don’t want to lose the physical edge that you’ve built up.”
In an age where more of us are committing to certain fitness goals that require time and dedication, it can be hard to delineate between what’s healthy and what’s not.
“I do see how for somebody who is training for something they can become quite obsessed with it,” Reichelt says.
“The exercise addiction is when it starts to interfere with important aspects of life and emotional connection to exercising has become negative, in a way … So if the behaviour is interfering with your general lifestyle and if you’re exercising despite being told not to because of injury then it’s having a detrimental effect on people’s wellbeing.”
Just because a behaviour is “healthy” doesn’t always mean we have a healthy approach to it.
“I thought it was quite interesting that people with tendencies for anxiety and impulsiveness and extroversion have a higher risk for exercise addiction,” Reichelt says. “Those tend to be – particularly impulsiveness – risk factors for drug addiction. Exercise does make you feel good. It releases endorphins in the brain it has a positive reinforcing effect, particularly for people who are trying to lose weight … I think among young people it could be quite a big deal.”
For those who have slipped into an unhealthy habit with exercise, the goal is not to prevent them from working out, the authors say, but to help them recognise the addictive behaviour and “reduce exercise routine rigidity”.
“I think it’s important for people to exercise and engaging in healthy lifestyle is really fundamental particularly because of the benefits it can have physically and psychologically,” Reichelt says. “But I think it’s important for people who have become injured or who have been told by a health care professional that they are exercising excessively to listen to them.”
Facts about exercise addiction
- Addiction to exercise might form part of a broader eating disorder or may occur in isolation.
- Inability to stop or reduce exercising, for example in response to an injury, may indicate addiction.
- Treatment broadly follows the principles of treating other addictions, for example cognitive behavioural therapy and exercise reprogramming.
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