January 14, 2020

Compulsive Exercise or Overtraining? How Much is Too Much? – Alex Colianni

compulsive exercise treatmentFor anyone who exercises, it’s important to ask ourselves broadly: are there any negative consequences occurring from the exercise for which we are completing?
If the answer is “yes”, then we again must ask ourselves: what is the purpose behind the exercise that I am doing?
In other words, one must consider the intentions behind why they are doing the physical activity or exercise. Keep in mind that negative consequences due to exercise are not always physical; there can also be social/psychological consequences.
When is exercise a problem?
Compulsive exercise can be defined as a craving for physical training, resulting in uncontrollable excessive exercise behavior with harmful consequences, such as injuries and impaired social relations.[1] Compulsive exercise is more commonly associated with anorexia nervosa and bulimia, but can also be seen in loss of control eating disorder patients.
Compulsive exercise, particularly when done by someone who has a history of eating disorder behaviors (restricting, purging, binge eating, or body image issues) can be a major health concern.
To be clear, the term “exercise” for most individuals who are compulsively exercising consists of:
  • Moderate to vigorous cardiovascular exercise (individual cardiovascular exercise, group fitness, CrossFit, cardio boxing, cardio kickboxing, circuit classes, etc.).
  • Resistance training (HIIT training, Tabata, Circuit training, etc.)
Unfortunately, no agreed upon definition exists regarding overtraining syndrome, but research done by Halson and Jeukendrup defines overtraining as: “An accumulation of training and/or non-training stress resulting in long-term decrement of performance capacity with or without related physiological and psychological signs and symptoms of overtraining in which restoration of performance capacity may take several weeks or months.”[2] 

Most people experiencing overtraining syndrome tend to be professional or amateur athletes. Put more simply, overtraining has some negative physical consequences — from lack of adequate recovery time between exercise/activity sessions. Overtraining may or may not also have psychological signs and symptoms.

What is compulsive exercise?
Compulsive exercise is most often done to regulate mood and compensate for eating (making it a form of purging). Many compulsive exercisers believe that exercise is not occurring or worth doing if they are not hyperventilating (breathing heavy) and/or sweating significantly.
Compulsive exercise has a number of serious negative physical health outcomes, including:
  • Anxiety
  • Depression
  • Guilt[3]
  • Decreased immune system response
  • Increased resting heart rate
  • Increased blood pressure
  • Orthopedic overuse injuries
  • Overreaching
  • Overtraining syndrome
Many patients believe that if they are not having any physical consequences to their exercise then they cannot be compulsively exercising and this is absolutely not true!
Typical psychological symptoms of someone who compulsively exercises include the following:
  • Exercise significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications
  • Intense anxiety, depression, irritability, feelings of guilt, and/or distress if unable to exercise
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
  • Discomfort with rest or inactivity
  • Exercise used to manage emotions
  • Exercise as a means of purging (needing to “get rid of” or “burn off” calories)
  • Exercise as permission to eat
  • Exercise that is secretive or hidden
  • Feeling as though you are not good enough, fast enough or not pushing hard enough during a period of exercise; overtraining
  • Withdrawal from friends and family[4]
It is important to understand the difference between compulsive exercise (a form of purging) in someone with an eating disorder history and overtraining.
What is overtraining syndrome?
The major difference between compulsive exercise and overtraining syndrome/overreaching is that compulsive exercise does NOT necessarily need a negative physical consequence to occur, whereas overtraining syndrome will always see some type of negative physical consequence.
Let’s define a few terms.
  1. Overload: A planned, systematic, and progressive increase in training to improve performance.[5]
  2. Overreaching: Unplanned, excessive overload with inadequate rest. Poor performance is observed in training and competition. Successful recovery should result from a short term (a few days to a couple weeks) rest period. [6]
  3. Overtraining Syndrome: Untreated overreaching that produces long-term decreased performance and impaired ability to train.[7],[8]
Common overtraining physical health/medical consequences include:
  • Bone density loss (osteopenia or osteoporosis) 
  • Loss of menstrual cycle (in women)
  • Female Athlete Triad (in women)
  • Relative Energy Deficiency in Sport (RED-S)
  • Persistent muscle soreness
  • Chronic bone & joint pain
  • Increased incidence of injury (overuse injuries, stress fractures, etc.)
  • Persistent fatigue and sluggishness
  • Altered resting heart rate
  • Increased frequency of illness & upper respiratory infections[9]
Adults who are not professional or amateur athletes are rarely diagnosed with overtraining syndrome. The average person will most likely quit the activity or exercise they have begun before they get to the point of overtraining syndrome.
Getting help for compulsive exercise
A number of patients in treatment for eating disorders have, at some point, also struggled with compulsive exercise. It is important for those in treatment to assess their views of exercise and to identify when exercise is getting to be unhealthy or compulsive — and to help prevent getting to the point where physical health consequences occur.
If you have a history of compulsive exercise, and are still struggling, help is available. I encourage those reading this who think they may exercise compulsively to take the compulsive exercise test. For those looking for help, I encourage you to learn more about treatment options for compulsive exercise.
Alex Colianni is a Clinical Exercise Physiologist at Eating Recovery Center, Illinois. Alex works primarily with loss of control eating disorder patient in the Binge Eating Treatment and Recovery Program within ERC in Chicago. He helps patients create activity plans that will help lead them to becoming active as a lifestyle change.

[1] Lichtenstein MB, Hinze CJ, Emborg B, Thomsen F, Hemmingsen SD. Compulsive exercise: links, risks and challenges faced. Psychology Research and Behavior Management. 2017;10:85-95. doi:10.2147/PRBM.S113093.
[2] Halson, SL, and Jeukendrup, AE. Does overtraining exist? An analysis of overreaching and overtraining research. Sports Medicine 34(14): 967-981, 2004
[3] Hausenblas HA,Symons Downs D. Exercise dependence: A systematic review. Psychol Sport Exerc 2002; 3: 23–80
[4] https://www.nationaleatingdisorders.org/learn/general-information/compulsive-exercise
[5] McArdle, W. D., Katch, F. I., & Katch, V. L. (2015). Exercise physiology: Nutrition, energy, and human performance.
[6] McArdle, W. D., Katch, F. I., & Katch, V. L. (2015). Exercise physiology: Nutrition, energy, and human performance.
[7] McArdle, W. D., Katch, F. I., & Katch, V. L. (2015). Exercise physiology: Nutrition, energy, and human performance.
[8] Raglin J, Bardukas A. Overtraining in athletes: the challenge of prevention. A consensus statement. ACSM’s Health Fitness J 1999;3(2):27.
[9] https://www.nationaleatingdisorders.org/learn/general-information/compulsive-exercise
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