Exercise Addiction: Symptoms, Diagnosis, Epidemiology, and Etiology

Abstract

Regular physical activity plays a crucial role in health maintenance and disease prevention. However, excessive exercise has the potential to have adverse effects on both physical and mental health. The scholastic and empirical discussion of excessive physical activity focuses on obsessive and compulsive exercising, and uses several labels. However, in this review, we argue that the most appropriate term for this phenomenon is exercise addiction, emphasizing that excessive physical exercise fits the typical and most common characteristics of behavioral addictions. The aim of this review is to synthesize the current knowledge on symptomology, diagnosis, epidemiology, and etiology of exercise addiction.

RÉSUMÉ

Dépendance de l'exercice physique: Symptômes, diagnostics, épidémiologie et étiologie

L'activité physique régulière a un rôle crucial dans la subsistance de la santé et prévention des maladies. Au même temps, l'exercice fait à l'excès peut être déficitaire au niveau physique et mental. La discussion scientifique et empirique sur l'activité physique est concentrée sur l'exercice obsessionnel-compulsionnel utilisant des étiquettes divers pour cette phénomène. Néanmoins, dans cette revue de la littérature, nous disputons que, l'expression la plus appropriée est ‘dépendance le l'exercice’ qui exprime que l'exercice physique fait à l'excès est en effet une dépendance du comportement qui se révèle des attributs caractéristique pour ce maladie. Le but de cette revue est de synthétiser les connaissances courantes sur les symptômes, diagnostics, épidémiologie et l’étiologie de la dépendance de l'exercice.

RESUMEN

Adicción al ejercicio: síntomas, diagnosis, epidemiología y etiología

La actividad física regular juega un rol crucial en mantener la salud y en la prevención de enfermedades. Por otra parte, ejercicio excesivo puede tener efectos adversos sobre la salud física y mental. La discusión académica y empírica sobre el ejercisio físico excesivo se centra en ejercisio obsesivo y compulsivo y se utilizan varias denominaciones. Sin embargo, en esta recensión se argumenta que el término más apropiado para este fenómeno es la adicción al ejercicio, haciendo hincapié en que el ejercicio físico excesivo ajusta a las características típicas y comunes de las adicciones comportamentales. El objetivo de esta recensión es sintetizar los conocimientos actuales sobre la sintomatología, diagnosis, epidemiología y etiología de ejercicio excesivo.

Keywords :

• exercise addiction
• behavioral addiction
• epidemiology
• etiology
• obsessive-compulsive behavior
• positive addiction

THE AUTHORS

Krisztina Berczik, M.A., is a Ph.D. student at the Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary. Her main research interest is exercise addiction. She is a practicing clinical psychologist, and her special field is the psychological training for athletes.

Attila Szabó completed his Ph.D. at the University of Montreal in Canada. Subsequently, he taught at Nottingham Trent University (UK) in the area of Psychology and Sport Sciences for nearly nine years. In 2006, Attila received an honorary readership from the University of Pécs, and in 2009 –upon completing his habilitation –he obtained the “Dr habil.” title in Psychology from Eötvös Loránd University in Budapest. He is currently Associate Professor and Deputy Director of the Institute for Health Promotion and Sport Sciences at Eötvös Loránd University, where he leads the research unit at the National Institute for Sport in Hungary.

Mark D. Griffiths, Ph.D., is a chartered psychologist and Director of the International Gaming Research Unit. He is internationally known for his work into gambling, gaming, and other behavioral addictions. He has published over 300 refereed research papers, three books, 65 book chapters, and over 1000 other articles. He has won 10 national and international awards for his work, including the John Rosecrance Prize (1994), CELEJ Prize (1998), Joseph Lister Prize (2004), and the US National Council on Problem Gambling Research Award (2009).

Tamás Kurimay, M.D., Ph.D., graduated from Semmelweis University, Budapest, Hungary, in 1979. As a clinician, he has a postgraduate specialty in psychiatry, psychotherapy (including family and cognitive therapy), addictionology, and rehabilitation in supervision. He has over 60 scientific publications, and is author and co-author of more than 15 books and chapters related to these topics. He has been teaching at Semmelweis University for 21 years. Since 2001, he has been the Head of Saint John Hospital, Psychiatric Departments in Budapest. He is the Chair of the Family Research and Intervention Section of World Psychiatric Association, as well as the president of the Hungarian Psychiatric Association. Currently, he works as a governmental expert for EU. In psychiatry and addiction research, his main interests are in how to utilize and influence the bio-psycho-social systems and networks, including families.

Bernadette Kun, Ph.D., is a psychologist working at the Department of Clinical Psychology and Addiction at the Institute of Psychology, Eötvös Loránd University, Budapest, Hungary. She has a Ph.D. in Personality and Health Psychology and her main interest is the emotional regulation processes in substance use and behavioral addictions. She also works at the National Office for Drug Prevention, where she is head of a project aiming the development of the Hungarian addiction treatment system.

Róbert Urbán, Ph.D., is an Associate Professor of Health Psychology at the Institute of Psychology, Eötvös Loránd University, Budapest, Hungary. His main research fields are in health-related behaviors, with a special focus on smoking, psychometric analysis/scale development, and psychosocial epidemiology.

Zsolt Demetrovics, Ph.D., is a clinical psychologist and a cultural anthropologist and has a Ph.D. in addiction. He is Director of the Institute of Psychology at the Eötvös Loránd University, Budapest, Hungary. His primary research is focused on the psychological characteristics and background of legal and illegal substance use and behavioral addictions.

GLOSSARY

• Behavioural addiction: Behavioural addictions, also known as process addictions, non-chemical addictions, or non-substance-related addictions, include both compulsion to and dependence on activities that have harmful consequences to the individual's well-being and social life.

• Compulsive exercise: An analogue to exercise addiction but it lacks the element of dependence, since addiction involves both compulsion and dependence.

• Exercise abuse: Over-exercising to the point where the exercise behaviour may become dangerous to one's health and well-being.

• Exercise addiction: An abnormal reliance on exercise behaviour to cope with chronic stress or the hassles and challenges of the everyday life and featuring the core components of addiction found in more traditional addictions.

• Exercise dependence: An analogue to exercise addiction but it lacks the element of compulsion, since addictions involve both dependence and compulsion.

• Negative addiction: Addiction that has negative consequences to the individual and her/his social environment.

• Obligatory exercising: An analogue to compulsive exercising, highlighting the obligatory (compulsive) element of exercise addiction; however, it lacks the aspect of dependence, which is also an integral part of exercise addiction.

• Positive addiction: Opposite to negative addiction, believed to counteract the former. However, by definition, all addictions are negative and, therefore, the term is highly disputed in the literature.

• Primary exercise addiction: Exercise addiction in which the fulfilment of the scheduled bout of exercise provides mental relief and/or satisfaction to the individual. In the case of primary exercise addiction, the co-existence of any eating disorder can be excluded.

• Secondary exercise addiction: A behavioural manifestation in which exaggerated volume of exercise is undertaken as a means of weight loss in addition to severe and strict dieting. It is often a co-morbidity of eating disorders.

Notes

2 The reader is referred to Hill's (1965) criteria which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or were merely associated. Editor's note.

3 The reader is reminded that whatever the dimensions of a selected and consensualized “addiction,” the empirical literature notes that the “addicted” represent heterogeneity and not homogeneity, which has implications for intervention planning, implementation and assessment. Editors note.