Exercise Addiction - Does it have an impact on injuries?
Exercise is all good right? Well yes and the majority should be doing more of it! However like anything there is a point where it becomes too much. We get an endorphin 'high' associated with exercise so it's only natural that we want to chase this high. Again, perfectly fine. What happens though when this becomes everything? Exercise addiction.
First a quick disclaimer...
In this article I wanted to discuss this as a concept as (rightfully so) getting more active is something we seen pushed in the media and as health professionals we discuss this too with our patients. The aim of this is not to scare or stop you from having these conversations with your patients - quite the opposite. It's about discussing exercise in a healthy way the same as we would discuss (for example) weight loss. It's about not only having conversations with individuals who need to get more active but also those who might have an unhealthy relationship with exercise. I want to stress again - this is a minority in the general population but can be much more prevalent in athletes.
What is exercise addiction and how do we define it?
Exercise addiction is characterised by constantly increasing the amount of exercise and getting withdrawal symptoms such as restlessness when unable to do this. The main factor thaty makes it an addition rather than just increasing your fitness is the continuance of exercise despite pain and injury i.e. the individual won't stop for anything, using it to regulate mood and emotions and a loss of control over exercise e.g. exercise at the detriment of other activities/commitments.
As you can see it's a fairly broad and generally less helpful definition. I would pick out some key points from that to consider as more of the defining factors:
- Detriment - is it stopping them from doing other things e.g. family events, meeting friends
- Constantly increasing - the importance here is not the gradual increase or training for a goal it's the need to constantly exceed the goal and also not seeing it as an achievement to reach the goal
- Continuance despite injury/pain - it's natural to want to get back to exercise after injury when it's something you enjoy but it's a red flag if you can't stop for any period of time or reduce your training for an injury/to prevent pain
- Feeling of having to do it - it has become an obligation and is excessive
It is however important to note here that there is no one accepted definition of exercise addition as it is not currently recognised formally except for in the literature where the study of it has been ongoing for many years.
I exercise a lot what about me?
Just because someone exercises a lot in general or is trying to increase their fitness does not mean they have exercise addiction. A healthy habit is one that you are in control of and want to do rather than feel you need to do. Also the BMJ puts this perfectly into perspective here:
Exercise addicts are distinguished from other high volume exercisers, whose intrinsic desire to exercise is under control and does not regularly result in emotional, social, or occupational disruptions.
What impact does it have on the likelihood of injury?
Increases this dramatically!!
Consider injury prevention advice with a slow gradual increase in training, ensuring adequate rest days to allow for recovery and monitoring your training load and fatigue levels. Now consider that you feel you have to exercise and have to keep pushing the boundaries. All of these principles go out of the window and therefore people with exercise addiction are increasingly likely to injure themselves.
Also as we've touched on above - individuals with exercise addiction are facing an addiction like any other. They will push through an injury and keep exercising. It's a compulsive habit for them and sits within the obsessive-compulsive spectrum of behaviour disorders.
What impact does it have on recovery from injury?
Again massive impact!
Often with an MSK injury (as is most likely to occur in this group) you want a period of rest to allow for healing and gradual loading. It isn't very often with an MSK injury that we (as FCPs) would advocate for increasing the load and amount of exercise continuously and not stopping or allowing rest when pain sets in. Individuals with exercise addiction are going to continue to push themselves. Withdrawal symptoms may also present if they have had to reduce their exercise volume.
Injury has also been shown to be a stressful time for any athlete and increases their risk of mental health disorders and that added anxiety during this time can have a real negative impact on recovery from injury - subscribe today to see my next article which runs through this topic! For an individual with exercise addiction an injury is likely to be very stressful and anxiety-inducing and lead to a lot of further complications.
Types
Exercise addiction is split into primary and secondary categories:
- Primary Exercise Addiction is when the maladaptive behaviour is driven primarily by a need to exercise
- Secondary Exercise Addiction is when the maladaptive behavior is driven by another factor for example a feeling of a need to lose weight due to an eating disorder
How can we influence it?
Ask about exercise!
The simplest way is to ask about their exercise habits. See why they do the exercise they do and how much they do. Also ask about their training, how is it going? Are they seeing improvements? Even asking if they've had to miss a training/workout session (e.g. have you had to stop exercising due to what you are seeing me with today?) and how that's making them feel.
Also, look for signs of overtraining which include persistent fatigue, decreases in performance and sleep problems. As we said above, look for signs they are training through injuries such as pain not stopping them from training.
There do exist some validated questionnaires for then assessing the level of exercise addiction but these are not diagnostic tools. Look for excessive behaviour or the use of exercise as a coping mechanism and refer on (with consent) or at least discuss your concerns with a colleague or GP.
The Exercise Addiction Inventory is a good quick screening tool but again is not a diagnostic criteria:
For us as FCPs it's just about having an awareness of this and being able to identify individuals who might have maladaptive behaviours like we would if someone presented as low in mood or told us factors that made us suspect an eating disorder for example.