We are advised that exercise is good for us and of course it is. It contributes to the improvement of health and wellbeing generally but it has also been shown to have a positive effect on mood and self esteem. In light of these benefits, moderate exercise is now frequently prescribed to help ease some forms of depression. However, these same rewarding aspects are what lead some people to develop exercise-related problems. What researchers remain unsure of is when and whether such a problematic relationship qualifies as an addiction.
Similarities with substance and behavioural addictions
As yet there are no officially endorsed diagnostic criteria for exercise addiction. While scientific debate continues, clinicians tend to rely on diagnostic indicators similar to those applied to substance use disorder and behavioural addictions such as those involving gambling, pornography, internet gaming and so on. These indicators include:
- Tolerance – needing to engage in more and more exercise to achieve the same desired effects
- Withdrawal – experiencing unpleasant physical, mental and emotional symptoms when not exercising
- Loss of Control – the need to exercise is taking over, overriding will and directing choice
- Intention effects – spending longer exercising or exercising with greater intensity than intended
- Time spent – an increasing number of hours are given over to exercise, to thinking about and planning it
- Narrowing of focus – other aspects of life are relegated and diminished in importance
- Continuance – A person continues to exercise excessively despite mounting evidence of problems, imbalances in normal functioning and harms such as injury and illness
When it is time to seek help
High frequency and intensity of exercise do not in themselves indicate an addiction. Concern arises when the motivation for exercising shifts from simple enjoyment or becoming fitter to the relief of distress or dysphoria and to raising self-esteem. The relationship becomes more addiction like if it develops into the sole means of coping and emotional self-regulation. The same concern applies if the organisation of daily life shifts to fit around the demands of exercise rather than exercise fitting comfortably into the day. These developments, taken in conjunction with evidence of injury and illness caused by a depleted immune system, signal that time has come to seek help.
Recovery: from unhealthy to healthy exercise
It is essential to consider that excessive exercise may be part of another problem such as an eating disorder, as these commonly co-occur. Exercise may be being used compulsively as a means of weight control. In these circumstances, given the potential risks to mental and physical health, the option for residential treatment where medical facilities are available and well integrated with psychological therapies, should be considered.
Abstaining from exercise is not applicable as some exercise is essential to good health. Cognitive Behaviour Therapy (CBT) may be the best model to help the person recognise and self-manage the dividing line between excessive and moderate, healthy exercise. This will require insight into what drives the addiction-like behaviour and social support for change.