Exercise Addiction

A primary duty of fitness professionals is to ensure that clients exercise safely and effectively to successfully reach their goals. This involves proper exercise technique, correct exercise choice and a progressive fitness program combined with the motivational guidance and leadership of the fitness professional. However, some clients and their personal trainers may be unhealthily overexercising and find themselves becoming addicted to exercise.

Do you have a “model client” who originally did almost no exercise, but now exercises too much? Have you recently accepted a new client who is already in excellent physical shape, but who wants your assistance in the pursuit of perfection? Does one of your clients consistently ignore both your advice and that of her physician, and continue to exercise vigorously even though doing so worsens an injury or illness? If so, you may have a client who is addicted to exercise.

There are several names for this problem: a Medline keyword search will reveal literature on exercise addiction, excessive exercise, compulsive exercise, exercise dependence, overexercising and obligatory exercise. They all address essentially the same problem: that of people who exercise to a point that is detrimental to their health. To avoid unnecessary complication, in this article, the term “exercise addiction” will be utilized. This article will attempt to elevate awareness and education of this deleterious aspect of exercise, and provide fitness professionals with direction on how to deal with this unwanted behavior.

What are the common clinical indicators of a dependence (addiction) and compulsion behavior? Common, clinically significant psychological indicators that a behavior may have become abnormal include the following:

• The behavior is no longer under voluntary control.
• The behavior causes distress for self and/or others.
• The behavior interferes with normal life functioning.
• The behavior is engaged in to prevent symptoms of withdrawal.
• The behavior escalates (indicating an increased tolerance of the behavior’s effects).

Because exercise is normally a healthy behavior, an addiction to exercise—unlike, for instance, an addiction to a drug—may be difficult to recognize. Most human behaviors are considered normal and beneficial unless they are taken to extremes. Therefore, if concerns arise, a personal trainer who wonders whether a client is addicted to exercise may want to gather more information from the client and refer him or her to a qualified healthcare provider, before taking further action.

To help figure out whether a exercise addiction problem is present, consider the following questions.

Does the person indicate that the activity is no longer under his voluntary control?

Lack of voluntary control in this case means that a client who already follows a comprehensive exercise routine increases the frequency, intensity and duration of exercise beyond the prescribed amount, on a regular basis. This person may feel a compulsion to engage in regular exercise beyond healthy doses. This client may or may not recognize that he is addicted to exercise and may not realize this additional time is negatively impacting other important activities in daily life.

Is the exercise addiction causing distress for the person or others? Is it causing emotional distress?

An athlete in training—especially one who is still in school or who must work—may consider it legitimate to spend all of her spare time exercising. In this case, family and friends often accept the heavy training schedule because a specific performance is the goal, and a more normal lifestyle will resume after the event. However, what about the client who punishes herself for gaining a few pounds over the holidays, or the exercise enthusiast who exercises constantly and feels she can never exercise enough? Additionally, family and friends may be distressed by the fact that the person no longer interacts as much with them. The American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), lists significant problems with relationships as one of the diagnostic criteria for dependent, compulsive and pathological behaviors (APA 2000).

Is the amount of exercise causing physiological distress? Most people who exercise regularly will occasionally overdo it. This is not a sign of addiction. A problem may be indicated when the person constantly overexercises. Has the person’s exercise routine increased so much that it has become detrimental to his physical health? Are his dietary needs being met? If you have designed a periodized training routine, does the client comply with the scheduled reductions in training? If you ask him questions like those listed above, does he respond to your concerns in a logical, healthy way, by honestly considering the merits of reducing the type or amount of exercise? Is the client willing to adjust water, nutrient and food intake in order to remain healthy? If so, he may be just very serious about exercise, not addicted to exercise. If he continues to overexercise, and/or undereat, further assessment by a healthcare professional is merited.

Is the exercise addiction interfering with normal life functioning?

Again, keep in mind that there are healthy people who are so enthusiastic about exercise that it becomes a major part of their life, and they spend the majority of their free time engaged in it (Ackard, Brehm & Steffen 2002). This is okay! However, those who are desperate to reach an unattainable goal of perfection through exercise may be addicted.

Is the time and effort spent exercising interfering with personal relationships? In addition to quality time with family and friends, does the client appear to have an active interest in a romantic relationship with a significant other? Again, these concerns might be temporarily set aside in the pursuit of a specific goal, but they should remain important to the person.

Does addiction to exercise increasingly interfere with work or school? When a person is first starting an exercise routine, especially in the morning or during a lunch hour, she may be late to work a couple of times, and then adjust her schedule as needed. A person who is serious about developing and maintaining a healthy lifestyle may even eventually change job schedules or reduce the amount of overtime worked, in order to accomplish the goal. This is normal.

On the other hand, frequent, “unexcused” absenteeism from work or school due to time spent exercising is not normal. If this behavior continues or escalates in the face of increasing problems at work, and/or dropping grades at school, it may be an indicator of addiction to exercise. Again, the DSM-IV lists interference with occupational or social activities as one of the criteria for abnormal behaviors (APA 2000).

Does exercise addiction create a disproportionate financial drain? Exercise equipment and clothing can be expensive, and are often used as motivators by those who are exercising. However, a situation in which a person is missing so much work (due to exercising, recovering from or preparing to exercise) that he can no longer successfully pay the bills, and/or is spending more than he can afford on equipment, may be an indicator that a problem exists.

Does the client exercise in order to prevent withdrawal symptoms?

This issue is not as straightforward for exercise as it is for other addictions. It must be addressed in the context of the client’s life and exercise history, because anyone who has been exercising regularly is going to notice a set of symptoms if exercise is stopped. Exercise in proper amounts is a physically and psychologically healthy activity that elevates mood and reduces stress, anxiety and depression. So is there a way to know if the client is exercising to be healthy, as opposed to exercising to prevent withdrawal symptoms?

Essentially, this can be assessed by looking at a combination of why the client exercises and what the client’s reaction is to the inability to exercise (Ackard, Brehm & Steffen 2002; Cockerill & Riddington 1996). The client with an exercise addiction may feel and express such an increased amount of stress due to lack of exercise at her normal intensity (or frequency and duration) that it begins to look as though she has built up a need for the psychological and physiological responses to exercise (Davis & Woodside 2002). This client is likely to continue to exercise at her present level in spite of advice not to do so, and she may use unhealthy means to cope with the increased stress (substance abuse, temper tantrums, etc.) caused by withdrawal from her normal amount of exercise. This may especially occur with clients who use excessive exercise as their primary mechanism for mood enhancement or as a coping mechanism for stress or depression (Anshel 1991).

Is the amount and intensity of the exercise behavior escalating?

This is another issue that must be dealt with in the context of the person’s exercise history. For example, someone who just recently began an exercise routine that, say, included 20 minutes of low-intensity cardio 3 days a week with a couple of rounds of circuit work on alternating days of the week can legitimately and easily increase duration, frequency and intensity in scheduled healthy amounts. On the other hand, a client who has developed an addiction to exercise may already be exercising at an optimal level, yet still increase the intensity, duration and frequency of exercise because he has built up tolerance to the psychological and physiological effects of exercise (Davis & Woodside 2002). Examples of this include people with the desire to achieve perfection in performance and those with perfectionistic body image issues (Flett & Hewitt 2005). The desire for size or strength can have a similar effect; an exerciser might feel that he could be larger or stronger if he just lifted more. This condition has been termed “big-arexia” in the popular press. Watch for unsafe technique and/or improper substance use in these cases.

Also, those who use exercise as a primary coping mechanism for chronic stress or depression may be especially at risk for exercise addiction (Anshel 1991). Because the body adjusts to each increase in exercise, the person may feel the need to exercise more and more to achieve the physiological changes that result in stress reduction or depression management.

STOP! You’re a personal trainer and fitness professional—not a psychologist!

First, and most important: Do not attempt to label the client (or yourself) an exercise addict. There are several reasons for this:

• Only a licensed psychologist or psychiatrist can actually make a diagnosis of exercise addiction.
• A client may be extremely insulted by the suggestion that he has a psychological problem. Saying so outright is unlikely to get good results.
• Labeling devalues the client’s worth as a person by making it seem as though nothing else about him matters.
• If you label the client, you make it harder for yourself to approach him with a neutral, professional manner.

What should you do? Take a step back! Watch the client for a few weeks. Excessive exercising may be a temporary response to a passing source of stress such as getting fired or divorced or having a personal crisis. If the person returns to healthy exercise levels, then this was not a true exercise addiction. If you are in doubt, consult with a trusted colleague of the client, but remember to maintain confidentiality.

If you decide to approach the client, try to keep the interactions relaxed, positive, conversational and very low-key. You needn’t say anything at all about being “worried about an exercise addiction.” Instead, say something like “I may be off base, but you seem a little stressed these days. Is anything going on?” The reply that you receive, and the conversations that follow it, will help you to make an informed decision.

As with all sensitive interactions with individuals, perhaps role-playing in your mind ahead of time is warranted. Rehearse discussing the issue without saying anything about addiction or needing to see a psychologist, etc. Remember the scope of your practice. It is important to keep in mind that a true exercise addiction is rare. Most people who are avid exercisers are physically and psychologically healthy (Cockerill & Riddington 1996; Ackard, Brehm & Steffen 2002). Successfully handling a situation like this requires compassion, professionalism, a sincere understanding of your client and a true respect for your scope-of-practice boundaries.

If you suspect your client might be addicted to exercise, ask yourself the following questions as you observe her behavior (see details about each question in the “Is There a Problem?” segment of this article). Once you have gathered enough information, and if you still have concerns, refer the client to a qualified healthcare provider. Respect the boundaries of your scope of practice: You are a fitness professional, not a psychologist or counselor!

1. Is the time and effort spent exercising interfering with personal relationships?

2. Does exercise increasingly interfere with work or school?

3. Does exercise create a disproportionate financial drain?

4. Does the client exercise in order to prevent withdrawal symptoms?

5. Is the amount and intensity of the exercise behavior escalating?