Exercise Addiction: Understanding How & Why It Happens
Exercise is often referred to as the ultimate drug, and unfortunately, it can also have drug like qualities as exercise addiction is very real. Given that physical exercise can increase strength, improve body composition and reduce the risk of metabolic diseases- it is often thought that there is no such thing as too much exercise. With the growing number of men and women across the globe who are over their ideal body weight and the increased inactivity that modern life imposes upon us, the call to exercise more is one that every major health and fitness related authority recommends. In a way, exercise is the drug that every doctor is keen to prescribe. A drug that comes seemingly without any adverse side effects, but the reality is that exercise, like everything else in life done to excess, does have a negative side, and that dark is the possibility of exercise addiction. In my practice as a personal trainer in New York City over the past 27 years, I have seen exercise addiction first hand among hundreds of athletes, gym goers and bodybuilders. Being aware that exercise addiction was a very real possibility for me as well was a factor in the creation of my own philosophy of implementing high intensity training only three times a week for no more than 10-20 minutes per workout session. The relative infrequency of the workouts has helped me and many of my clients not fall into the open trap of exercise addiction and has helped several athletes who one could easily identify as being exercise addicted find a balance in making training a healthy and non destructive part of their lives. In this article we explore not only what exercise addiction is, but how to tell if you are an exercise addict. As with any addiction, self identification is extremely difficult, much less pursuing treatments and behavioral changes on your own, but it is my hope that this article at least helps shed some light on the fact that exercise addiction is not only real, but pervasive in Western societies. Do be sure to share this article with anyone who you think might benefit from reading it!
Exercise, for most is a pleasurable activity and can the quest for that pleasure can be pursued without any consideration for the negative consequences it can inflict when done in excess. While one might be tempted to assume that any devoted or accomplished athlete must suffer from some form of exercise addiction, a comprehensive overview of what addiction is and how it relates to physical activity shows that this isn’t always the case. Some athletes and enthusiasts who regularly engage in intense physical exercise of any kind- be it weight training, yoga, bodybuilding, running, aerobics, athletics or martial arts training, may suffer from exercise addiction. However everyone who trains at an advanced level is not an exercise addict, as addiction has little to do with how much or how intensely you exercise. In the following paragraphs we will take a look at the phases of exercise addiction and identify its occurrence while clearly distinguishing healthy exercise patterns from negative and addictive behaviors.
Exercise Addiction: Defining What Addiction Is And What It Isn’t
While the American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (DSM-5) does not list exercise addiction as a separate disorder- it’s upcoming fifth edition does lay down criteria for what are known as behavioral addictions. Exercise addition falls within the subset of behavioral additions and is quite distinct from healthy exercise habits. In order for a behavior to be classified as an addiction the following basic criteria must exist:
- Withdrawal Symptoms: When the activity is stopped the individual becomes anxious, irritable, restless and has difficulty sleeping. 
- Lack of Self Control: The individual has difficulty reducing the intensity or frequency of exercise or is unable to stop exercising for a certain period of time.
- Mood Modification: This refers to the subjective experiences that people report when exercising that can be seen as a coping strategy (i.e., they experience an arousing ‘‘buzz’’ or a ‘‘high’’, or paradoxically tranquilizing feel of ‘‘escape’’ or ‘‘numbing’’).
- Increased Tolerance: The individual needs to keep increasing the volume, frequency or intensity of exercise in order to feel the desired effect- be it euphoria, a sense of accomplishment or increased self-esteem.
- Intention Effects: The individual is unable to stick to his or her intended routine and frequently trains longer than intended.
- Time: A significant amount of time is spent preparing for, recovering from or engaging in physical exercise.
- Continuance: Behavior where the individual continues to exercise in spite of the fact that he or she is aware that the activity is creating or exacerbating physical or interpersonal problems. For example- continuing to train in spite of serious injury, or breaking off relationships with loved ones in order to engage in the activity.
- Reduction In Other Activities: Behavior where social, occupational and or recreational activities are stopped as a direct result of physical exercise.
- Relapse: In spite of significant time away from the addictive exercise activity, the tendency exists for the same patterns of addictive behavior to resurface. Even after years of abstinence and or control.
Exercise Addiction Is Not A Matter Of Intensity Or Frequency
Given the above criteria, what immediately stands out is that frequency and intensity are not qualifying features of exercise addiction. [4,5] An athlete preparing for a competition, for example, may devote a significant amount of time to the activity at hand while cutting back sharply on his or her non exercise or sport related activities. He or she may even experience some feelings of withdrawal at the end of the competitive cycle, when the frequency or intensity of training is reduced. However, even though several of the criteria for exercise addiction are met, this behavior does not necessarily constitute addiction, as there are other phases that must occur before a behavior can be categorized as addictive.
Exercise Addiction: The Steps Leading To Exercise Addiction
Originally thought to be an obsessive compulsive disorder (OCD), exercise addiction distinguishes itself from impulse control disorders in several important ways. With compulsive disorders the individual obsesses about performing ritualistic activity that revolves around unrealistic outcomes. Take the common OCD example of an individual who can’t stop washing their hands out of a need to remain germ free. It’s not possible nor is it realistic to not have some germs on your hands, nor is it rational to spend significant amounts of time worrying about contracting disease from germs on your hands. In any case, the desired outcome of the obsessive behavior is unrealistic. Contrast this with the addict thinking about their next high and how they will feel as a result. In addiction, the individual ruminates about a very realistic, (although negative), outcome from his or her behavior, regardless of the consequences. This, along with the development of tolerance, withdrawal symptoms and relapse readily separates exercise addiction from anxiety-related compulsive disorders. To determine behavior that can be classified as exercise addiction, it must conform with the following four phases of addiction. Phases that are best illustrated by the following example:
Brianna found that she was putting on a few extra pounds and decides to join a gym with hopes of losing weight and getting in shape. Going to the gym every evening after work she discovers that she really enjoys how much her training program improves her strength and appearance and the way it makes her feel. The workouts help her forget the stress of her everyday life and provide a much needed break from some of her problems and worries. In time, a trainer at the gym suggests that she enters a bikini competition and so she increases her training to a routine of cardio and weight training twice a day for several months. After successfully competing and placing well in the show, she likes how she looks and feels and decides to continue training twice a day and she increases her time on the treadmill as it helps her keep her mind clear. Friends and family are concerned that she spends so much time in the gym and she is noticeably absent from important social gatherings if they occur during her scheduled gym times. Her knees and shins hurt but she ignores it thinking “no pain-no gain.”One day she feels a sharp pain in her ankle- she has suffered a severe sprain and her physician recommends that she stop training for a while. After the first day of not training she feels irritable and has a sense that something isn’t right. She misses training terribly and is becomes more and more depressed. Against medical advice, she returns to the gym to do some weight training, but several days later she decides to get back on the treadmill. She runs until her ankle gives out completely.
Exercise Addiction: Phase 1- Recreational Exercise
In the above example, Brianna goes through distinct phases on her way to developing behavior that can be defined as addictive. Phases that are key barometers of whether someone is engaged in healthy activity or negative addictive behavior. In the first phase there is Recreational Exercise, where Brianna’s primary motivation for training is an appreciation of the physical changes to her body and the pleasure that comes with physical activity. This behavior is under control with little or no risk of negative consequences, aside from manageable muscle soreness after the workout, and occurs within the parameters of the individual’s schedule. Such activity can be stopped at any time with little or no consequences. Unlike addictive behavior this phase of healthy recreational exercise enhances quality of life unlike exercise addiction which makes life unmanageable.
Exercise Addiction: Phase 2 At Risk Exercise
In the second phase At Risk Exercise occurs. This happens when the individual discovers through recreational exercise that training can have a profound effect on his or her mood and self esteem. In the cited example, Brianna finds that she can temporarily escape the problems of her life while exercising and that she feels much better about herself as well. It is a well documented fact that exercise can increase self esteem and decrease the negative effects associated with depression and anxiety. (See my article on Exercise & Depression). This mood altering effect occurs with both aerobic type activities such as running as well as anaerobic exercises such as weight training. ]6,7,8,9,10]
One commonly cited explanation is that during exercise our bodies release endorphins, which are naturally occurring opiates that create a feeling of euphoria and well being. ‘The runner’s high’ or the physical rush of feeling alive that is often described by those who push their bodies to the limit a regular basis. Unfortunately, with some individuals, over time the increased endorphin production from regular exercise results in a reduction (down-regulation) of the amount of endorphins produced while not exercising. Thus they feel compelled to exercise as a way of maintaining a natural balance in the brain.  Other proposed mechanisms explaining the connection between mood improvement and regular exercise are the thermogenic and catecholamine hypotheses. In the thermogenic hypothesis, the increase in body temperature is thought to be responsible for decreased anxiety.) Whereas in the catecholamine hypothesis, catecholamines which are linked to changes in mood, alertness, movement, cardiovascular and hormonal responses, are thought to be the cause of elevated mood during physical activity. 
Regardless of the biology behind mood elevation, the problem lies in the individual’s primary motivation for exercising. With healthy physical activity, enjoyment of the activity and its benefits are the driving reasons to exercise. However with at risk exercise, motivation comes not from enjoyment of the activity but from the stress relief it creates, the improved self-esteem and relief from anger, depression and boredom.[4,13,14] Studies show that the likelihood of exercise addiction is far greater among those who exercise to escape negative feelings or change their appearance to improve self esteem as compared to those who train to improve fitness and performance. The more physical activity becomes the sole means of relieving stress the more likely addiction is to occur. The transition between at risk exercise is also marked by periods where negative physical consequences such as repetitive injuries become increasingly common. In the example given, Brianna’s ankle injury is a direct negative consequence of her extreme exercise routine.
Exercise Addiction Phase 3- Problematic Exercise
The third phase is known as Problematic Exercise and it occurs when the individual begins to rigidly schedule their daily lives around their exercise program.  In the example given, Brianna begins to miss more and more social events with friends and family, especially those that would interfere with her scheduled workouts. With problematic exercise the individual also tends to experience withdrawal symptoms, as evidenced by Brianna’s feelings of depression and irritability when she stops training temporarily due to injury. In this stage there is the beginning of a loss of control as the motivation to exercise becomes the desire to escape the withdrawal symptoms that come with stopping.
Exercise Addiction: Phase 4- Addiction
The fourth and final phase is Exercise Addiction. At this point life revolves around training and in spite of feeling the physical rush that comes with exercise, the individual continues to increase the volume, frequency or intensity of training- regardless of any negative outcomes. In the example, Brianna goes from someone who exercised to improve her life, to someone for whom exercise makes life almost unbearable as she feels compelled to train primarily to avoid dealing with the lows that come with withdrawal. So much so that it exacerbates the gravity of her ankle injury. At this stage there are almost always negative outcomes in the form of injuries and the inability to meet social obligations and role obligations. In many cases this behavior leads to clinical depression.
Exercise Addiction Risk Factors: Why Do Some People Become Addicted?
Why some people succumb to exercise addiction while others do not is an important question to ask. Study reviews estimate that exercise addiction occurs in only 3% of the general population.  A figure that makes it relatively rare but its incidence has been found to be much higher among certain groups such as ultra-marathon runners and sports science students.[16,17,18] While there are no large scale studies conducted with this particular population, given the relationship between addictive behaviors and disorders among exercisers who have a high need for perfection and control over their bodies and lives, I would assume the rate of exercise addition to be higher as well among competitive bodybuilders, fitness, figure and bikini competitors. A high incidence that my own personal experiences with individuals in the sport and among regular gym goers over the past two decades leads me to believe to be all too true. Rates of addiction have indeed found to be quite high among regular gym goers as one French study found 42% of the members of a club in Paris exhibiting signs of exercise addiction. Research has shown that there are a number of risk factors that can predispose someone regularly involved in highly engaged levels of training to exercise addiction. Risk factors that hold true for any form of addiction such as genetic and neurological predispositions, negative peers, low self-esteem, juvenile delinquency, parental drug use and low levels of social conformity.
Some research has shown that exercise addicted individuals also tend to have other addictive behaviors that co-occur with their exercise addiction. Buying addiction, work addiction and sex addiction has been identified as common among those addicted to exercise [19,20,21,22] and some estimate that 15-20% of exercise addicted individuals are addicted to nicotine, alcohol or illegal drugs. Experts propose that addictions are seldom singular in nature and athletes suffering from exercise addiction are especially susceptible to developing or suffering from substance abuse related addictions using stimulants to improve performance and body composition such as amphetamines, ephedra, cocaine or caffeine. [24-25] The use of anabolic steroids has also been similarly linked to the use of cocaine and illicit substance abuse[26,27] and while there is little research available again my experience has been that some steroid users show very real signs of co-addictions and eating disorders.
Exercise Addiction & Eating Disorders
Eating disorders are the most common disorders that co-occur with exercise addiction with anywhere from 39-48% of people with eating disorders also suffering from exercise addiction.[28,29,36] For many the primary motivation for exercise is weight loss in the extreme- termed anoerxia athletica[37,31] and it is often paired with vomiting, use of laxatives and diet pills to avoid any potential weight gain from regular calorie consumption.This is a very serious problem for many women, however it is becoming clear that men do suffer from eating disorders as well. The problem is that while eating disorders are regularly diagnosed and treated, the co-occurring exercise addiction is often left unchecked. Repetitive injuries can often be a sign of exercise addiction, however they are usually not identified by clinicians as such due to the lack of material on hand regarding this form of addiction.
Treating Exercise Addiction
Treating exercise addiction is difficult and presents some very real practical challenges as unlike other addictions where abstinence is usually the ultimate goal, exercise is a positive activity and an important part of overall health. Thus in addition to several forms of cognitive therapy, the emphasis is on finding a balance and a return to moderate recreational exercise as opposed to stopping completely. In some cases other forms of exercise may be suggested as well- for example a runner may be advised to take up swimming or a weight trainer advised to try hiking and other outdoor activities. Since exercise is often prescribed as a remedy for those suffering from depression, care must also be taken in ensuring that such at risk populations do not develop addictive behaviors by using exercise as their sole coping mechanism and by having physical activity dominate their lives. Essentially trading depression for a potentially harmful addiction. Nevertheless exercise remains a valuable tool in treating depression, but there is a need for more large scale studies documenting exercise addiction. It is hoped that this article will at the very least provide an overview of exercise addiction and help avid exercisers distinguish it from highly engaged forms of exercise. Like all addictions and disorders, if you do suspect that you have a problem, the earlier you get help the better the outcomes tend to be. It’s hard to look at a habit of regular exercise as a problem, but exercise can indeed sometimes be too much of a good thing. Below is a standardized short form for basic evaluation of potential exercise addiction-
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