Latimer: Beyond healthy into compulsive exercise

With all of the attention being placed on North America’s obesity epidemic and sedentary lifestyle, it is easy not to notice the flip side of that problem—when fitness becomes an unhealthy obsession.

Naturally, we hear a lot every day about exercising for good health, to achieve a goal weight or to boost strength and endurance. Engaging in a regular exercise routine is healthy and an important part of a balanced life.

That being said, we likely have all met people—or seen their posts on social media sites—who take exercise and fitness beyond what is likely healthy or balanced and into the realm of compulsion.

Excessive exercise has long been observed as a co-existing problem within the context of eating or body dysmorphic disorders. Many times, people experiencing one of these conditions will exercise compulsively as part of their quest to control their bodies.

Exercise is a problematic issue in this context. Across all disorders, compulsive exercisers require longer hospital stays, they have more relapses and their long-term outcome is worse than those who do not exercise compulsively. Also, the compulsive exercise usually begins before an eating disorder and is often the last symptom to subside when the eating disorder is treated.

We now also know that excessive or compulsive exercise can occur independently of eating disorder. So-called exercise addiction has been difficult to define and measure because what may seem excessive to some, could be perfectly healthy for others.

We know that those who exercise compulsively do not want to exercise as much as they do. They often realize it is too much, they know they will hurt themselves or even die if they continue and yet they are unable to stop.

With this in mind, the focus has now shifted from defining this addiction in quantitative terms to more qualitative ones —examining what is motivating the exercise.

Using this qualitative framework, some new studies out of the UK have set out to determine whether compulsive exercise can be measured.

In order to understand compulsive exercise better, researchers undertook a large literature review and then used the data to create a Compulsive Exercise Test, which they have been using in several studies in young women, athletes and patients with eating disorders.These studies found avoidance, weight control exercise, lack of enjoyment and exercise rigidity were pronounced among those with eating disorders.

Using this information they have also created an intervention called the LEAP program, which takes a cognitive behaviour therapy approach to compulsive exercise.

The goal with this intervention is to work with patients to help them determine what exercise is healthy and help them regain control of their behaviour. A four-year study using this program is wrapping up and preliminary results are promising.

It will be interesting to see more results from this group and others as to how we can promote healthy lifestyle while preventing the development of compulsive exercise as well as how we can help those experiencing this compulsion both within the context of an eating disorder and on its own.


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