The standard definition is a compulsive drive to engage in excessive physical activity that can result in either physiological or psychological issues. An example of a physiological issue could be an overuse injury, and a resulting psychological issue could be the tell-tale withdrawal effects. We’ve classified two types of exercise addiction:

• Primary exercise addiction: a sole primary addiction to exercise without an eating disorder.

• Secondary exercise addiction: Excessive exercise addiction accompanied by an existing eating disorder. The exercise addiction is secondary to the eating disorder. Oftentimes people use excessive exercise to try to control or maintain their weight. This type is rooted in a compulsive drive.

Typically, people are most at risk in early adulthood, between the ages of eighteen and thirty-five. And while men and women are equally at risk for developing exercise addiction, men tend to be more at risk for primary exercise addiction, and women tend to be more at risk for secondary exercise addiction. This is related to the fact that women are more susceptible than men to developing an eating disorder. There are very different motivations and psychological underpinnings that are associated with compulsively exercising. From a research standpoint, we typically separate them out. Men and women tend to display these characteristics and work through them differently.

Twenty years ago, when I became interested in this topic, there wasn’t a good way to measure exercise addiction from a scientific standpoint that was psychologically valid. I worked alongside Dr. Danielle Downs, who at that time was a PhD student, and we spent a lot of time developing a conceptual framework. We began looking at the literature on dependency, and examining the criteria of all the mental disorders in the Diagnostic and Statistical Manual of Mental Disorders. It’s important to note that exercise addiction—just like sex, internet browsing, and shopping addiction—is not included in the DSM-5 as a mental disorder. They all require further research.

So we developed a scale based on the DSM criteria for substance abuse and called it the Exercise Dependence Scale. It has since been translated into fifteen different languages. The framework consists of seven criteria; however, an individual doesn’t need to have all of them to qualify. An individual must have at least three to either potentially qualify or be considered at risk. If they have at least three, we then do a more detailed interview in order to determine whether they have an exercise addiction. The seven criteria are:

1. Tolerance: The individual needs to increase the time spent exercising or increase the intensity of the workout to achieve the originally desired effect. In other words, the individual no longer experiences the effects (better mood or more energy) from the same amount of exercise as before.

2. Withdrawal: The exerciser will experience negative symptoms—such as increased anxiety, depression, frustration and negative mood—when they are unable to exercise. As a result, many will feel driven to exercise to relieve or forestall the onset of these negative symptoms.

3. Intention effects: This occurs when an individual exercises more than they intended to. They will often exercise for a longer duration or with greater intensity or frequency than intended. They may plan on working out for thirty minutes but instead spend upwards of an hour or two, often missing appointments as a result. For example, an individual may plan to do one spin class, but instead, three hours later, they’re still there.

4. Loss of control: Exercise is maintained despite a persistent desire to cut down or control it. The worse the addiction pathology becomes, the less they are able to control their thoughts, behavior, and response to the gym. Their primary focus throughout the day remains on when they will be able to go to the gym. Even if they are aware their exercise regimen is getting out of control, they are unable to cut back or stop. The individual loses the ability to regulate their thoughts and regimen around exercise.

5. Time: Considerable time is spent on activities essential to exercise maintenance. Even on vacation, individuals spend extreme amounts of time engaged in physical activity. When an individual begins prioritizing their time to exercise, often their friend groups begin to narrow.

6. Conflict: There is a considerable reduction in non-fitness-related activities, such as socializing, time with family, or recreational pursuits. These important activities fall by the wayside or are dropped because they conflict with exercise. An activity that once brought an exerciser joy may feel like more of an inconvenience since it gets in the way of exercising.

7. Continuance: Exercise is maintained despite the awareness of a persistent physical or psychological problem. In other words, the individual continues to exercise or push through the pain of an injury, despite a physician or physical therapist telling them to take time off. They will take pride in sticking to their regimen no matter what, saying something like, “I haven’t missed a day of exercise in two years.”

The primary criterion I look for is continuance. Someone who is addicted to exercise will continue to exercise through the pain, or switch to a different type of activity that may not be as painful. They’re simply unable to stop exercising, regardless of the injury. A regular exerciser would be able to take time off to let their body heal.

Another critical indicator is the withdrawal affect. It’s common to experience an elevated mood and decreased levels of anxiety when you exercise. However, someone who is addicted often exercises to avoid extreme feelings. If for some reason they’re unable to exercise, feelings of severe anxiety, depression, and cognitive difficulties often arise as a result. When the individual feels those emotions building, they are driven to exercise in order to avoid those feelings.

Individuals who are at risk for developing an exercise addiction tend to have addictive personalities. We often see individuals who turned to exercise addiction as a substitute for a different kind of unhealthy addiction—such as alcoholism, shopping addiction, or drug addiction. They began exercising excessively thinking it was a healthier alternative.

Although moderate exercise is indeed healthy, when taken to extremes, it can become very dangerous. With exercise addiction, many hold a belief that it’s a healthy addiction to have. But being addicted to anything can wreak havoc on a person’s well-being.

Exercise addiction can often arise from a life stressor. For example, when a young adult goes off to college, this transition can be incredibly stressful. These types of stressors can make a person feel that they’re losing control over a part of their life. These feelings can serve as the catalyst for driving an individual to compulsively exercise in order to regain a sense of control over their life, even if that that behavior ultimately harms them physically and emotionally.

Many exercise addicts also exhibit symptoms of obsessive-compulsive disorder (OCD) or an overall heightened anxiety. These individuals may use exercise as a means to control their anxiety, as opposed to drinking alcohol or other types of behaviors.

It’s a tough line to draw. A criticism I have with a lot of researchers is that they tend to define excessive exercise or exercise addition solely based on the amount of exercise an individual is doing. I disagree with that approach, since there are many other aspects you have to consider. You need to examine the psychological issues surrounding the compulsive aspect of it and understand the motivation behind it.

The overall time spent exercising is certainly an important part of the evaluation, but an accurate diagnosis should rely more on the psychological aspects of the behavior. For example, an athlete or someone who is training for a triathlon may exercise four, five, or six hours a day but not be addicted. These individuals are able to take days off, let their body recover, and adjust what they’re doing if personal demands or injuries get in the way. You have to take a look at the motivation behind the extreme amount of exercise and not just the length or amount of time.

It’s when it begins to become more compulsive and interfere with social obligations, family obligations, work obligations, that it veers into an addiction. In the case of true addiction, exercise becomes all-consuming, to the point that a person is thinking about exercising all day. They often exercise multiple times during the day, and their sessions become longer and longer. If for some reason, an average person is not able to exercise during the day—be it a busy schedule or other obligations—they wouldn’t skip out on going to dinner with family or friends to go exercise. They would just pick it up the next day. For someone who’s addicted to exercise, they would skip dinner with their family or friends to make sure they get their exercise in. The exercise becomes their top priority.

Yes, there are some personality risk factors that we look out for. These include individuals with low self-esteem, higher levels of neuroticism accompanied by frequent mood swings, extroverted or outgoing personalities, as well as individuals who tend to be less agreeable, which may indicate egocentricity. In addition, we look out for individuals who report high levels of self-identity with their exercise regime.

Researchers have tried to better understand these risk factors in order to help people gain a better understanding of how to identify them earlier. As with other dependencies, a strong relationship exists between those who experience exercise addiction and other addictions, whether it be with alcohol, drugs, or shopping.

We live in a society that takes many things to the extreme. In terms of exercise, we’ve seen a surge in the popularity of extreme fitness programs such as CrossFit gyms, mud runner races, etc. These types of extreme exercise have become highly visible in part due to social media. And they often promote unrealistic body images and endurance levels and extreme concepts of what it means to be healthy. Often people who view these images, compare themselves to unrealistic standards, and feel bad about themselves. The more often people see these those kinds of images, and self-identify with them, the more they might be at risk. That said, not everyone feels this way.

From a health standpoint, it’s healthier to be fit, exercise regularly, and be slightly overweight than to be underweight and not exercising at all. The most important thing is that people are moving and engaging in moderate physical activity.

There’s no one-size-fits-all type of treatment that is going to work. Some will take a multipronged approach in which they may see a counselor or a psychologist, for example, and go through cognitive behavioral therapy. They may work also with a personal trainer to help them bring their exercise down to a healthy level and work with a psychologist to treat the underlying issues that have resulted in this compulsive exercise. I strongly encourage individuals to see a therapist to help them cognitively restructure and reframe how they perceive exercise.

As hard as it may seem, it’s important to approach them and express your concern about the amount they’re exercising. They may resist, and it may take a while, but opening an honest conversation with them about their addiction is often the first step in guiding them to seeking appropriate professional help.

We’re currently examining the different risk factors for excessive exercise. We’re looking at what we call different kinds of correlates or determinants of the behavior, specifically focusing on personality and self-identity. We’re also examining how different parenting styles may put an individual more or less at risk for exercise addiction.

For example, we are coming to understand that an overpowering or overbearing parenting style tends to put an individual at an increased risk for exercise addiction. The more we can understand, the better we’re able to identify and potentially treat this condition.

Interestingly, there haven’t been any longitudinal studies that have followed up with individuals ten to fifteen years after they were addicted to exercise to see how they are doing now. The few case studies that have been performed suggested that eventually people’s bodies will break down. You can’t engage in six, seven, eight hours of exercise for a decade without there being some type of overuse injury.

The individuals that I have seen recover were able to bring their time spent exercising down to a normal amount, yet they still say it’s a daily struggle. This is similar to other types of addictions. People still struggle to keep their exercise within a normal range and still say it consumes much of their thoughts. Yet, they are healthier because of it.

Generally, researchers are more interested in why people don’t exercise, and how we can get them to exercise more, since 80 percent of the adults in North America don’t exercise enough. It’s a very small portion of individuals who we classify as exercise addicted, but that still equates to hundreds of thousands of people. It’s incredibly important to understand exercise addiction so we can help those who are struggling with it.

In the last edition of the DSM, published in 2013, it was finally acknowledged that you can become addicted to behaviors. In the first edition, the only behavior acknowledged was gambling. They did mention in the manual that there are other behaviors that people can become addicted to—such as exercise or shopping online—but they didn’t believe there was enough research to include them in the DSM. That said, I believe by the time the next manual comes out, or an updated version, there will be enough research to support the idea that individuals can become addicted to exercise.

This is not just a phenomenon here in North America. We’re seeing similar incidence of excessive exercise in Europe and other parts of the world, as well. A recent study validated our scale and translated it into Turkish; the results they’ve found in Turkey are similar to what we’ve seen in the US. This is what you would expect of a true mental health disorder, like anxiety and depression.