Exercise Addiction: Definition, Symptoms, Causes, Effects, and Treatment

Exercise addiction is a compulsive exercise behavior that leads to negative physical and mental effects. Individuals with exercise addiction are preoccupied with exercise thoughts and become irritable upon missing a workout session and exercise till injury. 

Exercise addiction stems from the constant need for euphoria, being habitual of using exercise as a stress-coping mechanism, and eating and personality disorders. Such situations cause bone and muscle damage, weight loss, depression, and personality disorders in the long run. 

Exercise addiction has multiple treatment options, i.e., cognitive behavioral therapy, dialectical behavioral therapy, psychosocial therapy, and psychodynamic therapy. 

What is Exercise addiction?

Exercise addiction is a dysfunctional behavior characterized by excessive training, loss of control over exercise behavior, and negative life consequences that can be physical, psychological, social, or a combination of the three, as defined by Ignatius Darma Juwono & Attila Szabo in their study published in the  International Journal of Mental Health and Addiction. 

Exercise addiction is defined as a pattern of uncontrolled exercise that involves a craving for overwhelming exercise with addictive symptoms, according to a study by Wan-Jing Chen in the Chronic Diseases and Translational Medicine Journal. 

What is the difference between exercising addiction and healthy fitness?

The difference between exercise addiction and healthy fitness is that exercise addiction is an excessive exercise behavior characterized by 10 hours or 600 minutes of exercise per week. Whereas, healthy fitness refers to the ability to perform daily activities optimally while doing 2.5-5 hours or 150-300 minutes of moderate-intensity or 1.25–2.5 hours or 75-150 minutes of vigorous-intensity aerobic physical activity per week, according to the WHO guidelines. 

What is the difference between Exercise addiction and Obsessive compulsive disorder (OCD)?

The difference between exercise addiction and obsessive compulsive disorder (OCD) is that exercise addiction is an uncontrollable exercise performance with physical, psychological, and social consequences. In contrast, obsessive-compulsive disorder (OCD) is a disease of uncontrollable obsessive thoughts and compulsive behaviors besides exercise.

Although both exercise addiction and OCD can show compulsive behavior, health experts like Judson Brewer and Marc Potenza state in their study that behavioral addictions, like exercise addiction, are more impulsive than compulsive, unlike OCD, which is a purely compulsive disorder. 

What are the Signs and Symptoms of Exercise addiction?

The signs and symptoms of exercise addiction are the following. 

1. Excessive exercise
2. Exercising till exhaustion or injury
3. Irritability after missing a workout session
4. Preoccupation with exercise
5. Weight loss
6. Using exercise to avoid life stressors
7. Relationship problems due to exercise

1. Excessive exercise

Excessive exercise is defined as exercising more than the normal healthy limit. Exercising for 10 hours or 600 minutes per week is considered excessive exercise, according to a study by Aviv Weinsteina and Attila Szabo published in the Dialogues in Clinical Neuroscience. 

One of the common symptoms of exercise addiction is spending too much time working out. Individuals engaging in excessive exercise observe a negative impact on their daily activities like education, work, or family. 

2. Exercising till exhaustion or injury

Individuals with exercise addiction work out until they have no energy left or till they get an injury. Exercise addicts take the ‘no pain, no gain’ phenomenon to an extreme level without acknowledging the natural capacity of their bodies. 

Regular passing out or blackouts, delayed onset muscle soreness (DOMS), bruises, subluxations or dislocations, or tears are the signs of exercising till exhaustion or injury. 

3. Irritability after missing a workout session

Irritability is an emotional process characterized by negative affective states like anger, frustration, and annoyance. 

Individuals with exercise addiction become irritable after missing out on a workout session. The irritability after skipping a workout session is a common diagnostic symptom of behavioral addictions like exercise addiction, according to a study by Dr. Aviel Goodman, a Psychiatrist in the British Journal of Addiction. 

4. Preoccupation with exercise

Preoccupation is a stress-related constant thinking that is time‐consuming and associated with negative emotions.

Individuals with preoccupation thoughts fulfill a major symptom in the diagnostic criteria of Dr. Aviel Goodman. Exercise addicts are preoccupied with the thoughts of workout sessions and their looks. However, a study done by Mia Beck Lichtenstein and her colleagues and published in the ‘Psychiatry Research’ found no difference in preoccupation in exercise addiction and non-exercise addiction group. 

5. Weight loss

Weight loss is the decrease in body weight through voluntary or involuntary circumstances. 

An important sign of exercise addiction secondary to eating disorders is excessive weight loss. Individuals with eating disorders like anorexia nervosa go on a strict diet and workout excessively to fulfill their objective of losing weight, according to a study by Krisztina Berczik and colleagues published in the Substance Use & Misuse journal. 

6. Using exercise to avoid life stressors

A life stressor is any event that causes stress. 

Individuals using exercise as a coping mechanism form an addiction to exercise. They fall into a vicious cycle where they need to engage in exercise regularly to survive stressful times. For them, exercise serves as a form of escape response to a source of disturbing, persistent, and uncontrollable stress, according to a study by David F Duncan published in the American Journal of Psychiatry.

7. Relationship problems due to exercise

Exaggerated exercise behaviors cause negligence of important everyday activities like relationships. Individuals with exercise addiction are preoccupied with workouts, skip important family occasions instead of rescheduling workouts, and constantly engage in exercise to avoid life and relationship problems instead of facing them.   

William P Morgan, a Kinesiology faculty member at the University of Wisconsin–Madison, states in a study in The Physician and Sportsmedicine that exercise becomes an addiction when it starts interfering with relationships and work. 

What are the causes of exercise addiction?

The causes of exercise addiction are physiological, i.e., endorphins and dopamine release; psychological, i.e., stress-coping mechanism, eating disorders, personality traits, and obsessive-compulsive disorder.

1. Physiological: Endorphins and Dopamine Release

Exercise addiction is caused by the dependency on excessive release of endorphins, aka happy hormones and dopamine after workout. Individuals engaging in exercise feel a state of euphoria and high energy, which becomes addictive, as stated by Krisztina Berczik et al. in a study published in the Substance Use & Misuse journal in 2012. 

2. Psychological: Stress-coping mechanism

Exercise addiction is caused due to the use of exercise as a coping mechanism in stressful times. The individual justifies their exaggerated exercise routine by rationalizing exercise as a healthy coping mechanism. According to a study by Attila Szabo in 1995, exercisers lose control over simple stressful events and become addicted to exercise in the long run. 

3. Eating disorders 

Individuals with eating disorders are prone to exercise addiction because they’re highly concerned about their weight. Secondary exercise addiction is a type of exercise addiction caused when a person with an eating disorder develops exercise addiction. A study by Laura Di Lodovico, Caroline Dubertret, and Aurely Ameller found that runners at risk of eating disorders are also at risk of exercise addiction. 

4. Personality traits

Personality traits like perfectionism, obsessive-compulsive disorder, narcissism, and neuroticism cause exercise addiction. These personality traits lead to high self-esteem, grandiose fantasies, idealism, obsessiveness, and self-critical thoughts, which contribute to exercise addiction, as mentioned by Julianna Bircher et al. in a study published in the Baltic Journal of Sports and Health Sciences in 2017.   

What are the effects of Exercise addiction?

The effects of exercise addiction are musculoskeletal system damage, physical weakness, depression, and personality disorders. 

1. Musculoskeletal System Damage

Excessive exercise can hurt the musculoskeletal system, including bones, muscles, and tendons. Too much exercise causes overuse injuries like stress fractures and tendinopathy, as mentioned by Mia Beck Lichtenstein et al. in a 2014 study published in Psychiatry Research. 

2. Physical weakness

Exercising too much with a poor diet can lead to physical weakness symptoms like weight loss and anemia. If the weight loss is more than the healthy BMI, it is a negative effect of exercise addiction. 

Exercise addiction can cause anemia in individuals with poor diet, according to Heather A. Hausenblas, Katherine Schreiber, and James M Smoliga’s study published in the BMJ in 2017.  

3. Depression

Exercise addiction can cause depression because of relationship difficulties and social withdrawal. A study done by Manuel Alcaraz-Ibáñez et al. in 2021 on leisure exercisers concluded that exercise addiction is moderately related to depression. 

4. Personality Disorders

Exercise addiction can lead to personality disorders like perfectionism and obsessive-compulsive disorder. Exercise addiction is a compulsive disorder, so it can give rise to similar personality traits. 

How does Exercise addiction affect your physical health?

Exercise addiction affects your physical health by causing injuries and physical damage to the bones and muscles. People with exercise addiction take inadequate rest between sessions, which leads to stress and eventual burnout. Exercise addiction may also lead to malnutrition and anemia due to inadequate food intake and excessive workouts. 

How can Exercise addiction affect your mental health?

Exercise addiction affects your mental health by causing depression, relationship difficulties, and personality disorders. People with exercise addiction are inflexible in their thinking, according to a study, ‘Exercise Addiction: Preliminary Evidence on the Role of Psychological Inflexibility,’ published in the International Journal of Mental Health and Addiction in 2018. 

Individuals with exercise addiction show a high prevalence of depressive disorders (56%), personality disorders (47%), and obsessive-compulsive disorders (31%), according to a study, ‘Mental disorders in individuals with exercise addiction—a cross-sectional study’, published in Frontiers Psychiatry in 2021. 

How does Exercise addiction affect your brain?

Exercise addiction affects the brain by releasing endorphins, which elevate mood and bring pleasure. Intense regular exercise may result in the brain down-regulating endorphin production. Resultantly, one has to exercise more often and more intensely to maintain the same balance in the brain, according to a study ‘Understanding Exercise Addiction’ published in the Journal of Contemporary Psychotherapy.

Exercise addiction affects the frontal symmetry of the brain in women, as stated by Jennifer Gapin et al; in the study ‘The Relationship Between Frontal Brain Asymmetry and Exercise Addiction’

What are the stages of exercise addiction?

The four stages of exercise addiction are recreational exercise, at-risk exercise, problematic exercise, and exercise addiction. 

1. Recreational exercise

Recreational exercise is a pleasurable or rewarding activity, according to the book ‘Recognizing Destructive Behavior Before It’s Too Late’

Recreational exercise is the first stage of exercise addiction, in which health and fitness are the main sources of motivation, but in a controlled manner. This stage focuses on improving the quality of life, and the individual can stop the exercise sessions if they want to. 

2. At-risk exercise

At-risk exercise is the second stage of exercise addiction, where a person increases the frequency and intensity of workouts for mood-modifying effects. Their motivation is to use exercise to relieve them from stress and hardships and use it as an escape from the challenges of life. Therapist Cynthia Catchings says that exercise releases endorphins and dopamine, which elevates the mood. The constant need for these mood elevations is the culprit for the at-risk exercise stage. However, this phase is not problematic, but one needs to be mindful of going to the next phase. 

3. Problematic exercise

Problematic exercise is the third stage of exercise addiction. In this stage, individuals plan their daily activities around exercise, continue exercise even with an injury, and show withdrawal symptoms if the exercise routine is disrupted. These individuals have withdrawal symptoms like mood swings and irritability. 

4. Exercise addiction

The last stage is exercise addiction, where an individual engages in exercise without considering negative life consequences. An individual’s life with exercise addiction revolves around exercise, which causes neglect of family and work responsibilities. These individuals manifest signs of withdrawal in the shape of anger and depression. 

Which health conditions are associated with exercise addiction?

Body image disorders, perfectionism, neuroticism, narcissism, obsessive-compulsive traits, and addiction to other substances are the health conditions associated with exercise addiction.  

1. Eating disorders

An eating disorder is a mental health issue characterized by abnormal eating behaviors, e.g., anorexia nervosa and bulimia nervosa. Individuals with eating disorders use exercise addiction as a weight control method to achieve a good body image. Exercise addiction with eating disorders has health risks that can affect a person’s physical, mental, and social health. 

Individuals with an eating disorder are 3.5 times more likely to form exercise addiction than those without an eating disorder, according to a study, ‘A comparative meta‑analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders’ published in ‘Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity’

2. Body image disorders

Body image disorder is a mental health issue characterized by intense focus and preoccupation with one’s physical flaws. Individuals with body image disorders can have exercise addiction because they’re highly concerned about their weight and body shape. 

A study done by Ornella Corazza et al. in the United Kingdom and the Netherlands in 2019 found a prevalence of 38.5% of body image disorders and 11.7% of exercise addiction in gym persons. The study further discusses that individuals with body image disorders had a higher risk of exercise addiction. 

3. Perfectionism 

Perfectionism is a personality trait characterized by continuous striving for excellence, extremely high standards, and overly critical evaluations. Perfectionism is associated with exercise addiction due to perfectionists’ unrealistic standards and goals during exercise sessions. 

There is a positive relationship between exercise addiction and perfectionism, as confirmed by a study by J. González-Hernández et al. published in the International Journal of Mental Health and Addiction in 2021.

Athletes in high-intensity sports with perfectionist patterns are at a greater risk of exercise addiction, according to another study by J. González-Hernández et al. published in the International Journal of Mental Health and Addiction in 2023. 

4. Neuroticism

Neuroticism is a negative personality trait associated with anger, anxiety, self‐consciousness, irritability, emotional instability, and depression. Neuroticism is associated with exercise addiction because individuals with a high risk of exercise addiction report symptoms of depression and emotional stress just like neurotics, as mentioned in a study ‘Exercise addiction is associated with emotional distress in injured and non-injured regular exercisers’ published in Addictive Behaviors Reports in 2018. 

5. Narcissism

Narcissism is a mental health condition of grandiosity, self-love, and inflated self-views. Narcissism is associated with exercise addiction because traits like high self-esteem, superiority, and narcissism impact exercise frequency, according to a study by Julianna Bircher et al. published in the Baltic Journal of Sports and Health Sciences in 2017.  

Both labile self-esteem and high narcissism increase the risk of exercise addiction, according to another study ‘Unraveling Exercise Addiction: The Role of Narcissism and Self-Esteem’ published in the Journal of Addiction in 2014. 

6. Obsessive-compulsive traits

Obsessive-compulsive traits include a pattern of uncontrollable and recurring thoughts, which leads to repetitive behaviors and actions. Exercise addiction is strongly linked with obsessive compulsiveness because such individuals are obsessed with an ideal exercise routine and body figure, according to a study by Catherine So Kum Tan et al. published in 2023 in ‘Behavioral Sciences.’

7. Addiction to other substances

Drug addiction increases the tendency to develop behavioral addictions like obsessive sex or porn. This increased tendency to develop behavioral addictions may cause exercise addiction. 

However, the evidence contradicts this hypothesis. A study by Attila Szabo et al. in 2018 found that substance addiction reduces the risk of exercise addiction. 

What is the most used exercise addiction screening test?

The mostly used exercise addiction screening test is the Exercise Addiction Inventory (EAI). Other exercise addiction screening tests are the Expanded Exercise Addiction Inventory (EAI-3) and Exercise Dependence Scale (EDS). These exercise addiction screening tests are used to diagnose exercise addiction. 

Both the Exercise Addiction Inventory (EAI) and Exercise Dependence Scale (EDS) have found to be valid and reliable assessment tools for exercise addiction, according to a study, “Psychometric properties and concurrent validity of two exercise addiction measures: A population wide study” published in the Journal Psychology of Sport and Exercise.

The Exercise Addiction Inventory (EAI)

The Exercise Addiction Inventory (EAI) is useful in identifying the risk of exercise addiction. The Exercise Addiction Inventory (EAI) is a 6-item instrument that assesses six common symptoms of addiction (salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse). It has a high validity and reliability, according to the founders Mark D. Griffiths, Attila Szabo, and Annabel Terry.  

However, the Expanded Exercise Addiction Inventory (EAI-3) is more useful because it assesses other harmful behaviors as well, like guilt, exercise despite injury, and experienced harm. 

What are the types of Exercise addiction treatment?

The types of exercise addiction treatment are cognitive behavioral therapy, motivational interviewing, psychosocial therapy, psychodynamic therapy, and dialectical behavioral therapy. The time to recover from exercise addiction varies from person to person but can take up to 6-9 months.

1. Cognitive-behavioral therapy 

Cognitive behavioral therapy, a type of talking therapy, helps individuals manage their emotions healthily.

Cognitive behavioral therapy treats exercise addiction by helping individuals reconstruct their maladaptive beliefs concerning exercise, as mentioned by Leon Outer et al. in their study published in the Performance Enhancement & Health Journal.  

2. Motivational interviewing

Motivational interviewing is an individual-centered counseling technique to address the problem of ambivalence about change.

Motivational interviewing helps exercise addicts with low treatment compliance to make positive changes by deciding to change their addictive behavior, according to a study by Mia Beck Lichtenstein et al. published in European Psychiatry in 2020. 

3. Psychosocial therapy

Psychosocial therapy is a treatment protocol to help individuals with emotional or behavioral disturbances cope with social interactions with family, colleagues, or community.

Individuals with exercise addiction face social withdrawal and relationship difficulties, which can be treated by psychosocial therapy. A study published by Panchanan Acharjee and his colleagues in the Bangladesh Journal of Psychiatry in 2014 also states that psychosocial approaches to behavioral addictions, like exercise addiction, help reduce relationship problems. 

4. Psychodynamic therapy

Psychodynamic therapy is a talking therapy that focuses on a patient’s dysfunctional past and its impact on their present state and symptoms. 

Exercise addiction can be treated with psychodynamic therapy if the individual and the therapist share a close relationship. A close relationship assists in recognizing and modifying negative emotions of the past in addicts, according to Dr. Edward Khantzian, a Psychiatry professor at Harvard Medical School. 

5. Dialectical Behavioral Therapy (DBT)

Dialectical behavioral therapy is like cognitive behavioral therapy but specializes in intense emotions. 

Exercise addiction, like other behavioral addictions, can be treated through dialectical behavioral therapy, as recommended by Heather A. Hausenblas et al. in her study published in The BMJ in 2017. 

Is exercise addiction a type of behavioral addiction?

Exercise addiction is not officially a type of behavioral addiction, but it fulfills the diagnostic criteria for behavioral addictions. All behavioral addictions have common symptoms like being preoccupied with behavior, neglecting personal and family commitments to engage in a behavior, using obsessive behavior as an escape from painful reality, and irritability after missing engaging in a behavior. These symptoms are present in exercise addiction, which proves that exercise addiction is a type of behavioral addiction.

Is Exercise addiction a disease?

No, exercise addiction is not a disease officially. However, it is considered a type of behavioral addiction, which is a medical disease. 

Is Exercise addiction genetic?

Yes, exercise addiction can be genetic. Genes that control rewarding behavior associated with drugs also control other rewarding behaviors like exercise, according to a study by Aviv Weinstein and Yitzhak Weinstein published in the Current Pharmaceutical Design Journal. 

Is Exercise addiction a disability?

No, exercise addiction is not a disability. However, exercise addiction can become a disability if it starts affecting your daily life activities to a dangerous point.  

Do energy drinks contribute to exercise addiction?

Yes, energy drinks contribute to exercise addiction because energy drinks mostly contain caffeine and other central nervous system stimulants that boost physical and mental performance. A boosted physical performance pushes the individual to consume more energy drinks for better performance and starts the vicious cycle of exercise addiction. 

Why is exercising addictive?

Exercise is addictive due to the release of endorphins and dopamine in response to exercise. Endorphins and dopamine elicit a reward response, elevate mood, and reduce depression and anxiety. People with other addictions and personality disorders may form exercise addictions to gain this temporary reward.