Many questions remain
Exercise addiction (EA) is marked by exaggerated training and loss of control over exercising. Many studies now describe issues related to the concept of EA, but EA is still not included in the current edition of the DSM. A recent study attempted to evaluate reasons why relatively little information has emerged to pinpoint diagnostic signs of EA, and to review its connection with other psychopathology, particularly eating disorders.
A team headed by Dr. Aviv Weinstein from the University of Ariel, Israel, and a team from ELTE Eötvös Loránd University, Budapest, Hungary, reviewed 1000 studies of EA published over the past 12 years (Dialogues Clin Neurosci. 2023. https//doi.org/10.1080/19585969). They carefully searched for differences between overexercising and exercise addiction. In addition, their study included possible links between EA and eating disorders.
The group first evaluated the physiologic signs of EA. In one study, 50 professional football players were followed during seasonal training and then during 7 days of exercise deprivation. During the deprivation phase, athletes with high scores on EA measures had lower brain bioelectric activity, increased muscular tension, augmented sympathetic activity, and increased anxiety and depression (Human Physiol. 2011. 37:509). In another study of 53 male athletes, EA scores correlated with eating disorder symptoms, negative energy balance, and higher cortisol levels (Open Sport Exer Med. 2019. 5: e000439). However, a study of 176 people who performed aerobic and anaerobic exercises at least 3 times per week reported no differences in EA scores or other symptoms between those who were aerobic and anaerobic exercisers (Addict Behav Rep. 2021. 14:100369).
The researchers found differences in dysfunctional symptoms, quality of life, mood, and sleep among both females and males who regularly participated in exercise programs. Males showed greater dedication to training and gaining strength and vigor compared with females. Women in the anaerobic group reported more disorderly eating patterns and had higher levels of depression than men. However, as far as the time of exercise training, such as 3 hours a week, no gender differences were seen.
The primary treatment that has been suggested for dysfunctional exercise is cognitive behavioral therapy, but the researchers found little evidence that it was effective. Hallward and colleagues have argued that treating EA is essential to treating eating disorders (Eat Disord. 2022.30:411).
Dr. Weinstein and his team noted that a central question remains: Is EA a behavioral addiction or a common symptom of various underlying psychiatric morbidities? Another problem involves the multiple questionnaires used to assess EA, which may inflate and “over-pathologize” EA. Appropriate assessment methods do not seem to be fully established. The authors believe that the varying tools used to assess EA and different structures of studies have led to confusing results. Weinstein and colleagues’ review includes topic-by-topic identification of research needs and suggested action steps, so the concept of EA can be fully understood.