there such a thing as too much exercise?
By Carolyn Costin, MA, M.Ed., MFCC
What is it?
Signs & Symptoms
Approaching Someone in Need
What is Over-Exercise
Accompanying with the steady increase in the number of people
with eating disorders has been a rise in the number of people
with exercise disorders: people who are controlling their bodies,
altering their moods, and defining themselves through their
over involvement in exercise activity, to the point where instead
of choosing to participate in their activity, they have become
"addicted" to it, continuing to engage in it despite adverse
consequences. If dieting taken to the extreme becomes an eating
disorder, exercise activity taken to the same extreme may be
viewed as an activity disorder, a term used by Alayne Yates
in her book Compulsive Exercise and the Eating Disorders
In our society, exercise is increasingly being sought, less
for the pursuit of fitness or pleasure and more for the means
to a thinner body or sense of control and accomplishment. Female
exercisers are particularly vulnerable to problems arising when
restriction of food intake is combined with intense physical
activity. A female who loses too much weight or body fat will
stop menstruating and ovulating and will become increasingly
susceptible to stress fractures and osteoporosis. Yet, similar
to individuals with eating disorders, those with an activity
disorder are not deterred from their behaviors by medical complications
People who continue to overexercise in spite of medical and/or
other consequences feel as if they can't stop and that participating
in their activity is no longer an option. These people have
been referred to as obligatory or compulsive exercisers because
they seem unable to "not exercise," even when injured, exhausted,
and begged or threatened by others to stop.
The terms pathogenic exercise and exercise addiction have been
used to describe individuals who are consumed by the need for
physical activity to the exclusion of everything else and to
the point of damage or danger to their lives. The term anorexia
athletica has been used to describe a subclinical eating disorder
for athletes who engage in at least one unhealthy method of
weight control, including fasting, vomiting, diet pills, laxatives,
or diuretics. For the rest of this chapter, the term activity
disorder will be used to describe the overexercising syndrome
as this term seems most appropriate for comparison with the
more traditional eating disorders.
and Symptoms of Activity Disorder
The signs and symptoms of activity disorder often, but not always,
include those seen in anorexia nervosa and bulimia nervosa.
Obsessive concerns about being fat, body dissatisfaction, binge
eating, and a whole variety of dieting and purging behaviors
are often present in activity disordered individuals. Furthermore,
it is well established that obsessive exercise is a common feature
seen in anorexics and bulimics; in fact, some studies have reported
that as many as 75 percent use excessive exercise as a method
of purging and/or reducing anxiety. Therefore, activity disorder
can be found as a component of anorexia nervosa or bulimia nervosa
or, although there is yet no DSM diagnosis for it, as a separate
There are many individuals with the salient features of an activity
disorder who do not meet the diagnostic criteria for anorexia
nervosa or bulimia nervosa. The overriding feature of an activity
disorder is the presence of excessive, purposeless, physical
activity that goes beyond any usual training regimen and ends
up being a detriment rather than an asset to the individual's
health and well-being. In her book, Compulsive Exercise
and the Eating Disorders, Alayne Yates lists the proposed
features of an activity disorder, a summary of which is listed
of an Activity Disorder
like eating disorders, are expressions of and defenses against
feelings and emotions and are used to soothe, organize, and maintain
self-esteem. Individuals with the eating disorders (anorexia nervosa
and bulimia nervosa) and those with activity disorders are similar
to one another in many respects. Both groups attempt to control
the body through exercise and/or diet and are overly conscious
of input versus output equations. They are extremely committed
individuals and pride themselves on putting mind over matter,
valuing self-discipline, self-sacrifice, and the ability to persevere.
- The person maintains
a high level of activity and is uncomfortable with states
of rest or relaxation.
- The individual
depends on the activity for self-definition and mood stabilization.
- There is an intense,
driven quality to the activity that becomes self-perpetuating
and resistant to change, compelling the person to continue
while feeling the lack of ability to control or stop the behavior.
- Only the overuse
of the body can produce the physiologic effects of deprivation
(secondary to exposure to the elements, extreme exertion,
and rigid dietary restriction) that are an important component
perpetuating the disorder.
- Although activity
disordered individuals may have coexisting personality disorders,
there is no particular personality profile or disorder that
underlies an activity disorder. These persons are apt to be
physically healthy, high-functioning individuals.
- Activity disordered
persons will use rationalizations and other defense mechanisms
to protect their involvement in the activity. This may represent
a preexisting personality disorder and/or be secondary to
the physical deprivation.
- Although there
is no particular personality profile or disorder, the activity
disordered person's achievement orientation, independence,
self-control, perfectionism, persistence, and well- developed
mental strategies can foster significant academic and vocational
accomplishments in such a way that they appear as healthy,
They are generally hard-working, task-oriented, high-achieving
individuals who have a tendency to be dissatisfied with themselves
as if nothing is ever good enough. The emotional investment these
individuals place on exercise and/or diet becomes more intense
and significant than work, family, relationships, and, ironically,
even health. Those with activity disorders lose control over exercise
just as those with an eating disorder lose control over eating
and dieting, and both experience withdrawal when prevented from
engaging in their behaviors.
Individuals with anorexia nervosa and bulimia nervosa and those
with activity disorders usually score high on the EDI subscales
of perfectionism and asceticism and have similar distortions in
their cognitive (thinking) styles. The following list includes
examples of the thinking patterns of people with activity disorders
that are similar to the mental distortions in those with eating
Distortions in Activity Disorder
Dichotomous, Black and White Thinking
If i don't run,
I can't eat.
I either run an
hour or it's not worth it to run at all.
- Like my mom, people
who don't exercise are fat.
- I either run an
hour or it's not worth it to run at all.
- If I can't exercise,
my life will be over.
- If I don't work
out today, I'll gain weight.
- If I can go to
the gym, I am happy.
- I feel great when
I exercise, so if I exercise I'll never be depressed.
- I must run every
morning or something bad will happen.
- I must do 205
sit-ups every night.
- I can't stop
at 1 hour and 59 minutes, it has to be exactly 2 hours, so
when the fire alarm went off I couldn't get off the Stairmaster,
I had to keep going, even if the gym was burning down.
- People are looking
at me because I'm out of shape.
- People admire
- I am a runner,
it's who I am, I could never give it up.
- People who exercise
get better jobs, relationships, and so on.
- People who exercise
don't get sick as much.
- My doctor tells
me not to run, but she is flabby so I don't listen to her.
- No pain, no gain.
- Nobody really
knows the effects of not having a period anyway, so why should
Symptoms of Activity Disorder
A key in determining if a person is developing
an activity disorder is if she has the symptoms of overtraining
(listed below) yet persists with exercise anyway. Overtraining
syndrome is a state of exhaustion in which individuals will
continue to exercise while their performance and health diminish.
Overtraining syndrome is caused by a prolonged period of energy
output that depletes energy stores without sufficient replenishment.
The only cure for the
above symptoms is complete rest, which may take a few weeks to
a few months. To a person with activity disorder, resting is like
giving up or giving in. This is similar to an anorexic who feels
like eating is "giving in." When giving up their exercise behaviors,
those with activity disorder will go through psychological and
physical withdrawal, often crying, yelling, and making statements
- Reduction in performance
- Decreased concentration
- Inhibited lactic
- Loss of emotional
- Increased compulsivity
- Soreness, stiffness
- Decreased maximum
- Decreased blood
- Adrenal exhaustion
- Decreased heart
rate response to exercise
- Hypothalamic dysfunction
- Decreased anabolic
- Increased catabolic
(cortisol) response (muscle wasting)
- I can't stand
not exercising, it's driving me crazy, I'd rather die.
- I don't care
about the consequences, I have to work out or I'll turn into
a fat blob, hate myself, and fall apart.
- This is worse
torture than any effects of the exercise, I feel like I'm
- I can't even stand
being in my own skin, I hate myself and everyone else.
It is important to
note that these feelings diminish over time but need to be carefully
Approaching an Individual with an Activity Disorder
In January 1986, the Physician and Sports
Medicine Journal discussed the subject of pathogenic (negative)
exercise in athletes and listed recommendations for approaching
athletes practicing one or more pathogenic weight control techniques.
The recommendations can be reformulated and extended for use
when approaching individuals with activity disorders who are
not necessarily considered athletes.
for Approaching the Activity Disordered Individual
- A person who has
good rapport with the individual, such as a coach, should
arrange a private meeting to discuss the problem in a supportive
- Without judgment,
specific examples should be given regarding the behaviors
that have been observed that arouse concern.
- It is important
to let the individual respond but do not argue with him or
- Reassure the individual
that the point is not to take away exercise forever but that
participation in exercise will ultimately be curtailed through
an injury or by necessity if evidence shows that the problem
has compromised the individual's health.
- Try to determine
if the person feels that he or she is beyond the point of
being able to voluntarily abstain from the problem behavior.
- Do not stop at
one meeting; these individuals will be resistant to admitting
that they have a problem, and it may take repeated attempts
to get them to admit a problem and/or seek help.
- If the individual
continues to refuse to admit that a problem exists in the
face of compelling evidence, consult a clinician with expertise
in treating these disorders and/or find others who may be
able to help. Remember that these individuals are very independent
and success oriented. Admitting they have a problem they are
unable to control will be very difficult for them.
- Be sensitive to
the factors that may have played a part in the development
of this problem. Activity disordered individuals are often
unduly influenced by significant others and/or coaches who
suggest that they lose weight or who unwittingly praise them
for excessive activity.
One outstanding difference between the
eating disorders and activity disorders seems to be that there
are more males who develop activity disorders and more females
who develop eating disorders. Exploring the reason for this
may provide a better understanding of both. What are the causes
that contribute to the development of an activity disorder?
Why do only some individuals with eating disorders have this
syndrome and others who have this syndrome don't have eating
disorders at all? What we do know is that the risk factors for
developing an activity disorder are varied, including sociocultural,
family, individual, and biological factors, and are not necessarily
the same ones that cause the disorder to persist.
In a society that places a high value on independence and achievement
combined with being fit and thin, involvement in exercise provides
a perfect means for fitting in or gaining approval. Exercise
serves to enhance self-worth, when that self-worth is based
on appearance, endurance, strength, and capability.
Child-rearing practices and family values contribute to an individual
choosing exercise as a means of self-development and recognition.
If parents or other caregivers endorse these sociocultural values
and they themselves diet or exercise obsessively, children will
adopt these values and expectations at an early age. Children
who learn not only from society but also from their parents
that to be acceptable is to be fit and thin may be left with
a narrow focus for self-development and self-esteem. A child
reared with phrases such as "no pain, no gain," may
endorse this attitude wholeheartedly without the proper maturity
or common sense to balance this notion with proper self- nurturing
Certain individuals seem predisposed to need a high level of
activity. Individuals who are perfectionists, achievement oriented,
and have the capacity for self-deprivation will be more likely
to seek out exercise and become addicted to the feelings or
other perceived benefits the exercise provides. Additionally,
individuals who develop activity disorder seem outwardly independent,
unstable in their view of themselves, and lacking in their ability
to have fully satisfying relationships with others.
Just as with eating disorders, researchers are exploring what
biological factors may contribute to activity disorders. We
know that certain individuals have a biologically based predisposition
to obsessive thoughts, compulsive behaviors, and, in women,
amenorrhea. We know that in animals the combination of food
restriction and stress causes an increase in activity level
and, furthermore, that food restriction with increased activity
can cause the activity to become senseless and driven.
Furthermore, parallel changes have been detected in the brain
chemicals and hormones of eating disordered females and long-distance
runners that may explain how the anorexic tolerates starvation
and the runner tolerates pain and exhaustion. In general, activity
disordered men and women seem to be different biochemically
than nondisordered individuals and are more easily led and trapped
into a cycle of activity that is resistant to intervention.
for an Activity Disorder
The principles of treatment for individuals with activity disorders
are similar to those with eating disorders. Medical issues must
be handled, and residential or inpatient treatment may be necessary
to curtail the exercise and to deal with depression or suicidality,
but most cases should be able to be treated on an outpatient
basis unless the activity disorder and an eating disorder coexist.
This combination can present a serious situation rather quickly.
When lack of nutrition is combined with hours of exercise, the
body gets broken down at a rapid pace, and residential or inpatient
treatment is often required.
Sometimes hospitalization is encouraged to patients as a way
to relieve the vicious cycle of nutrient deprivation combined
with exercise before a breakdown occurs. Activity disordered
individuals often recognize that they need help to stop and
know that they cannot do it with outpatient treatment alone.
Eating disorder treatment programs are probably the best choice
for hospitalizing those with activity disorder. An eating disorder
facility that has a special program for athletes or compulsive
exercisers would be ideal. (See the description of The Monte
Nido Residential Treatment Facility on pages 251–274).
for an Activity Disorder
It is important to keep in mind that activity disordered people
tend to be highly intelligent, internally driven, independent
individuals. They will most likely resist any kind of vulnerability
such as going for treatment unless they become injured or face
some kind of ultimatum. Excessive activity protects these individuals
against desiring to get close, to take in something from another,
or to depend on anyone.
Therapists will have to maintain a calm, caring stance with
the goal of helping the individual define what he or she needs,
rather than focusing on taking things away. Another therapeutic
task is to help the individual receive and internalize the soothing
functions the therapist can provide, thus promoting relationships
THERAPEUTIC ISSUES TO DISCUSS IN THE TREATMENT OF ACTIVITY DISORDER
- Overactivity of
mind or body
- Body image
- Overcontrol of
from the body
- Body care and
- Unrealistic expectations
- Tension tolerance
- The meaning of
- Intimacy and