There is a dependency on physical exercise that can cause physical, psychological, and social problems, but scientific literature likely exaggerates its prevalence. This conclusion was drawn in a review published in April in the Journal of Behavioral Addictions. The study was conducted by scientists from ELTE Eötvös Loránd University and Széchenyi István University in Hungary, as well as from Flinders University in Australia.
The analyzed works showed that the percentage of people at risk of developing an addiction ranges from 3% to 42%. In certain groups, this figure reached 6.1% among Spanish cyclists, 15.4% among Italian marathon runners, and 7.6% among elite Danish athletes. The authors explain this variability by differences between the studied populations and sports types, the use of small and selected samples, and the interpretation of screening questionnaires as diagnostic tools.
The authors, Attila Szabo, Zsolt Demetrovics, and Bhavya Chabra, explained to the Einstein Agency that exercise addiction screening tools are not diagnostic means; they only determine susceptibility or the possible presence of symptoms. They added that high scores are often associated with enthusiasm, perfectionism, or commitment to sports, which may reflect motivational traits rather than pathology. Therefore, true exercise addiction is likely rare.
One of the most commonly used tools is the Exercise Dependence Scale (EDS). This scale assesses seven aspects of attitude towards training, including the need for gradual increase in exercise volume, discomfort when interrupting sessions, difficulties in controlling practice and continuation despite negative consequences.
Everton Krivoy, a fitness specialist at the Einstein Hospital Israelita Sports and Rehabilitation Center, emphasized that a high score on the scale does not automatically mean a diagnosis. He noted that structuring one's daily routine around training and maintaining a high level of dedication are part of many athletes' lives. Even a large amount of physical activity is not classified as a disorder if it does not lead to any impairments.
Krivoy points out trends where the frequency of training is presented as proof of discipline, and the absence of training as a sign of weakness. He states: 'If you are dedicated to the pursuit, you know when you need to rest and can cancel a session without emotional distress. The problem arises when physical exercise excessively affects mood, or when a person cannot stop, even when sick or injured.'
How the concept has changed
The discussion of possible exercise addiction began back in 1970. That year, American psychiatrist Frederick Backland noticed changes in sleep, increased anxiety, and sexual tension in students who were prohibited from exercising.
In 1976, psychiatrist William Glaser, also from the USA, introduced the term 'positive addiction' to describe an intense connection with activities considered beneficial, such as exercise and meditation. Three years later, sports psychologist William Morgan challenged this interpretation, pointing to the harm caused by excessive loads, and viewing it as a possible behavioral dysfunction.
According to the characterization proposed by Szabo, Demetrovics, and Chabra, physical exercise can take a central place in one's daily routine and be used for mood regulation. Attempts to reduce activity can also lead to relapses. Researchers also distinguish between primary patterns, where the reward lies in the exercise itself, and secondary patterns, where excessive practice serves as a solution to another problem.
Researchers note that 'pressure related to appearance and performance, along with conditions such as anxiety and depression, is generally at the root of such behavior.' Associated conditions mentioned include eating disorders, body dysmorphic disorder, and muscle dysmorphia.
Risks and treatment
The harm caused by excessive loads is independent of the presence of addiction. Prolonged combination of overload and insufficient recovery can lead to overtraining syndrome, characterized by persistent decrease in performance, fatigue, and changes in hormonal and neurochemical mechanisms, according to the consensus of the European College of Sport Science and the American College of Sports Medicine.
When energy expenditure from exercise is not compensated by energy intake, Relative Energy Deficiency in Sport (RED-S) can occur. The International Olympic Committee consensus, published in 2023 in the British Journal of Sports Medicine, indicates that this condition is associated with hormonal imbalances, poor bone health, and other physiological consequences.
Studies conducted over many years with athletes engaged in intensive endurance sports have revealed an increased risk of certain arrhythmias, particularly atrial fibrillation. A review published in Applied Physiology, Nutrition, and Metabolism assessed this risk as three to five times higher in this group compared to healthy adults.
Very intense exercise can also cause exertional rhabdomyolysis, characterized by muscle cell breakdown and capable of causing kidney failure in severe cases. A review published in the Clinical Journal of Sport Medicine in 2023 analyzed 772 patients and found that most cases occurred after running, especially marathons, and weightlifting.
In cases of loss of control or onset of disorders, the recommendation is not complete abstinence from physical activity. The goal is to restore control over behavior, incorporate adequate rest periods, and study factors associated with compulsive behavior.
The review authors advise: 'For those demonstrating risk signs, the most suitable option is a clinical interview followed by observation, which allows studying what sustains this behavior instead of relying solely on the screening tool result. It is crucial to recognize the danger, and if the individual cannot identify it themselves, their social circle should help.'
Cognitive-behavioral therapy is the most studied approach, although evidence for treating exercise addiction remains limited. Other interventions may be prescribed depending on the severity of the condition and co-occurring conditions. For Everton Krivoy, treatment involves restoring balance in the relationship with training. He emphasizes: 'The idea is not to stop, but to ensure greater flexibility and understand that it is normal to skip training days.'
