Do you know that sting of guilt when you have scheduled a workout but then do not follow through because you much rather want to enjoy a relaxed evening with your friends? A temporary feeling of guilt is a common sentiment that we all have when we plan to exercise but then lose our motivation or something gets in the way of our training schedule. However, for some people it is not as easy to move on from this guilty conscience or to altogether skip exercising for a day or two. You might have heard a friend referring to someone who is “addicted” to exercising or is completely “dependent” on working out for several hours every day. In the literature there are various synonyms for this phenomenon, namely exercise addiction, compulsive exercise, exercise dependence and exercise abuse. And the names say it all: exercise addiction is a condition that involves a constant preoccupation and involvement with training and exercise.
Our parents, the media and the scientific literature preach us relentlessly that exercising is good for us, both for our body and our mind. However, it is rarely mentioned that exercise behavior can be unhealthy when it becomes a compulsive habit. A few years ago I worked in a psychotherapy clinic in Germany and there I met a patient who was admittedly addicted to exercising. The patient´s day started with a 10km run before breakfast; around noon she would cycle for two more hours, being followed by 3km of swimming in the local swimming pool. She finished her day by running another hour before bed time. Naturally, she did not have time for much else in her life and barely managed to keep up with her university work, let alone her social life. Surely this is a very extreme example of exercise addiction but it illustrates a prominent symptom of this condition: exercise causes dysfunctions in these peoples´ lives, meaning that they feel obligated to train even at the expense of their social life or their work schedule, eventually leading to the abandonment of other interests besides sports. Being prevented from exercising for as little as 24 hours can lead to physiological and emotional withdrawal symptoms such as irritability, frustration, tension, sleeplessness and headaches. The aforementioned patient recognized these withdrawal symptoms and admitted that whenever she could not follow her strict exercise plan due to family obligations or her university schedule she would feel guilty, irritated and physically restless until she “made up” for her missed exercise in the following days.
With the average Joe it is relatively easy to uncover signs of exercise dependence. However, with athletes and especially elite athletes it is not as simple to recognize warning signs of exercise addiction as high training loads and the constant occupation with one´s sport are common and even desired in the competitive sport world. Elite athletes might train 4-8 hours every day and are expected to compete despite injuries, fatigue and adverse situational circumstances. But how does exercise addiction present itself in the elite sport world? Researchers have proposed that athletes addicted to exercise experience the aforementioned physiological and emotional withdrawal symptoms and are convinced that their performance immediately deteriorates when missing one workout. They continue training despite substantial injuries and illnesses and develop an increased tolerance to higher and higher training loads that they impose on themselves. Oftentimes these athletes find themselves socially isolated as a result of their excessive exercise regimens and they tend to get into conflicts with people in their environment suggesting them to reduce their training loads.
Factors that were found to be strongly associated with exercise addiction in top athletes were a lack of social support as well as strong pressure from coaches and teammates. Naturally, top athletes are already under considerable environmental pressure to perform when they are competing on high levels and they commonly put a lot of pressure on themselves. Therefore it is important that coaches, parents and teammates are aware of the dangers of putting unreasonable pressure on elite athletes and rather provide them with the social support necessary to perform at a high level. And with training hours the saying “the more the better” does not necessarily apply: it has been proposed that exercise addiction is linked to the overtraining syndrome and a decrease in athletic performance.
Don´t get me wrong, there surely is a “positive addiction” to exercising, meaning that the exercise routine can easily be included into the daily life and leaves space for commitments to family, friends, work and personal time. But one has to be aware that there is a fine line between a healthy commitment to exercising and a perceived obligation and compulsion to fulfill a certain training regimen. So what we learn from this blog entry is a paradox: exercise, something that has the reputation of being exclusively beneficial for our mental and physical health can have the opposite effect if it is done in excess, and this holds true both for the recreational and the top athlete. To conclude, we should learn from Hippocrates who acknowledged “if we could give every individual the right amount of exercise, not too little and not too much; we would have found the safest way to health.”