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Exercise Dependence Central Annals of Sports Medicine and Research Review Article *Corresponding author William F. Gayton, Department of Psychology, University of Southern Maine, Portland, Maine 04103, Exercise Dependence: The Dark USA, Tel: 207-780-4251; Email: Submitted: 19 July 2016 Accepted: 16 August 2016 Side of Exercise Published: 18 August 2016 ISSN: 2379-0571 William F. Gayton*, Andrew C. Loignon, and Will Porta Copyright Department of Psychology, University of Southern Maine, USA © 2016 Gayton et al. Abstract OPEN ACCESS Along with the considerable health benefits regular exercise confers, it also Keywords carries inherent risk if pursued compulsively or to an extreme. Exercise addiction, also • Exercise often referred to as exercise dependence, remains a topic of study, but one without • Health risks a universally accepted definition. Researchers in the field have suggested utilizing the • Physical activity DSM criteria for Substance Use Disorder as they have found similar symptomatology in • Exercise dependence exercise addiction. This includes compulsion, withdrawal symptoms, and negative social consequences, as well as an array of unique health risks. An individual experiencing exercise addiction is much more likely to ignore signals from their body, such as pain and injury, and thus put themselves at risk of serious physical trauma. Sports medicine professionals are in a unique position to diagnose exercise dependence among the athletes they encounter in treatment. Once the diagnosis is made they must work to either avert full blown dependence, or assist those already further along in managing their symptoms and coming to grips with the addictive nature of their physical activity. This review provides an introduction to exercise dependence, as well as management and prevention recommendations for sports medicine professionals to utilize. INTRODUCTION resulting i and psychosocial (impairment of social and occupational There is considerable research available suggesting that n both negative physical (e.g. tolerance, withdrawal) functioning) consequences. They recommended using the DSM- regular exercise has both physical and psychological benefits. including the potential to help the patient control weight, lower IV criteria for substance dependence as a means of defining In general, physicians see exercise as having many benefits, blood pressure, reduce total blood cholesterol levels, improve exercise dependence. Three or more of the following would be respiratory functioning, reduce the risk of heart attack, and over time people began to show an increased need for more andnecessary more exercisefor the diagnosis in order to getbe made:the same (1) effectstolerance: they where were promoted exercise as a way of elevating mood, enhancing self- esteem,improve providing sleep [1]. a Mentalsense of health mastery professionals and control, have dealing recently with symptoms of withdrawal including irritability, guilt over missed workouts,receiving earlieranxiety withover losingmuch conditioning,less exercise; gaining (2) withdrawal:weight and research clearly indicates that exercise is something most of us shouldmild depression, practice on anda regular reducing basis, state there anxietyare also [2].indications While thatthis exercises in larger amounts or over a longer period of time than depression; (3) intention effects: where the individual often The dark side of exercise has been referred to as exercise exercise may have a “dark side” and can be taken to an extreme. dealwas intended;of time is (4) spent a persistent in activities desire necessary to cut down to obtainor unsuccessful exercise efforts to cut back or control exercise behavior; (5) a great purposeaddiction, of compulsive this paper exercising,is to introduce obligatory exercise exercising, addiction fitness as an fanaticism, and most recently as exercise dependence [3]. The (e.g. signs up for road races on both Saturdays and Sundays whenever possible); (6) person feels compelled to exercise even issue that sports medicine professionals can play a significant in the face of negative psychosocial consequences to self, family, roleDefinition in identifying, managing, and preventing. occupation, lifestyle etc. Such consequences include neglect of work responsibilities, marital difficulties/divorce and ignoring (spousefriendships; is threatening (7) persistent divorce exercise because even of in the the impact face of exercisesignificant is HausenblasA number and of Symons different Downs definitions [4] systematically have been proposedreviewed butthe physical (continuing to exercise with heel spurs) or psychosocial no universally accepted definition of this phenomenon exists. research on exercise dependence and proposed that exercise have developed a six item inventory designed to measure the risk having on the marriage) problems. Terry, Szabo, and Griffiths [5] dependence be defined as a maladaptive pattern of exercise of exercise addiction. Sports medicine professionals dealing with Cite this article: Gayton WF, Loignon AC, Porta W (2016) Exercise Dependence: The Dark Side of Exercise. Ann Sports Med Res 3(7): 1085. Gayton et al. (2016) Email: Central the possibility of a client experiencing exercise dependence issues simply telling them to stop exercising is not likely to have any maintains and enhances their self-esteem, the likelihood that maySigns want of Addictionto include the use of this inventory in their workup. theyeffect will whatsoever. stop exercising If exercise based is the on primaryrecommendations way that an from individual sport One of the most common signs mentioned in the literature includes the experience of withdrawal symptoms if exercise is prevented for some reason and relief from withdrawal symptoms medicine professionals is unlikely. Thus, as with other behavioral addictions, utilizing abstinence as a treatment can present irritability, anger, guilt over missed workouts, anxiety over losing theirdifficulties identity [23]. or Peoplehave always who becomeused exercise exercise as dependenta primary way either of conditioningwhen exercise or is resumed.gaining weight,Withdrawal depression, symptoms resentment include tension, from have given up activities that were formally used to help define missed work-out sessions, restlessness, stress, lack of energy and encouraged to resume previous activities while patients in the seconddefining group themselves. need to Individuals be encouraged in the to formergo out andgroup try need new waysto be decreased self esteem [6-9]. Blumenthal, O’Toole, and Chang [10] new friendships is often necessary since exercise dependent reported that 86% of a group of obligatory runners felt guilty individualsof maintaining usually and haveenhancing developed self-esteem. a tendency The todevelopment hang out and of if they missed a scheduled run and 72% reported feeling tense, irritable, or depressed if unable to run. The need to exercise appears to control the individual’s behavior and he or she must interact with other exercise dependent individuals [24]. exercise regardless of the negative social consequences to self, failure2. Try to make to get this them distinction to understand allows the that patient the toproblem conclude is thatthe neglectfamily, occupation,or loss of shared and lifestyle interests [11]. [12], Such and consequences ignoring friendships include nature of their involvement with exercise, not the exercise itself. A neglect of work responsibilities, marital difficulties, divorce, the you are blaming exercise per se and that contradicts everything activity include: stress fractures, knee injuries, tendonitis, individuals that we know about exercise dependence, including menstrual[13, 14]. Commondysfunctions, medical constant complaints fatigue, of insomnia, excessive repetitive physical they have heard or read about the value of exercise. Discuss with point include: Do you choose to exercise or do you feel compelled the signs of dependence. General questions you could ask at this injuries,Exercise hematuria, dependent frequent individuals colds or flu,present and other special illnesses problems [15]. to exercise? If you are not able to exercise, how do you feel? Do you or anyone close to you feel that your level of exercise has become a problem? thoughwhen tired, it is medicallyill or injured contraindicated as they frequently and are verywill ignorereluctant pain to or signs of impending injury. They continue to exercise even gradually3. Provide begin education to think of about themselves the eventual as invulnerable impact of torepetitive medical bestimplement way to any identify treatment exercise recommendation dependent patients that requires is by limiting noting injuries and likely outcomes. People who are exercise dependent their exercise behavior [16]. One author has suggested that the knee injuries, tendonitis, hematuria, constant fatigue, and to resume a full exercise regime prior to what is recommended problems. The reality of Achilles heel injury, stress fractures, persistent sport injuries [17]. In addition, they are more likely increased risk of colds and flu need to be spelled out in some exerciseclinically dependent[7]. These beganbehaviors to show put exerciseincreased dependent tolerance peopleto the detail. Specifically, the dangers of resuming exercise before the at high risk of repetitive injury. Over time people who become injury is fully healed needs to be emphasized. Recurrent injuries individuals also started to develop a subjective awareness of to the same
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