Exercise - when is too much?

Most of us worry about not getting enough exercise and the health consequences that go with inactivity, but the other extreme, over exercise also can interfere with health and quality of life. In fact, exercising too much can sometimes be dangerous, as it is often associated with eating disorders, anxiety, depression and perfectionism.

But when is it too much? There is no consensus in the mental health field of what level of exercise is too much, but there is agreement that an unhealthy preoccupation with exercise and extreme discomfort experienced when unable to exercise, referred to as exercise “craving,” indicates a problem.

Specialists who treat eating disorders refer to a tendency to over exercise as Activity Disorder or Compulsive Exercise. It bears similarity to an addiction in that people continue to engage in exercise despite adverse consequences. They may depend on physical activity for self-definition and mood stabilization. People who are preoccupied with exercise may find that it interferes with their work, their relationships and other valued aspects of life.

Lately, eating disorders specialists are recognizing that these disorders are an increasing problem and health risk for younger, preadolescent children and for women in midlife. The highest risk factor for developing an eating disorder is genetics, and this genetic vulnerability is often triggered by the all-too-common practice of dieting and excessive exercise that many of us engage in to try to attain the unrealistic ideals of beauty and attractiveness in our culture.

There is an intense, driven quality to the activity that becomes self-perpetuating and resistant to change. People who over-exercise may report that they feel a lack of ability to control or to stop the behavior. However, many people who over exercise do not think they are overdoing it. They tend to experience a sense of moral obligation to exercise and may feel guilty if they do not complete their regimen.

Here are some typical comments from people who over exercise:

• “My whole day is planned around exercise.”
• “If I am supposed to do 100 sit-ups and I do 99, I feel like a failure. I have to start over.”

Despite their lack of concern, other people in their life may notice that they cancel other obligations in order to exercise, become very irritable or upset if their regimen is challenged and risk their health and safety to maintain their program.

Activity disorder goes hand in hand with eating disorders and is a common symptom of anorexia nervosa. Symptomatic exercise often plays a central role in the progression of the disorder and is equally dangerous to food restriction. One study showed that 78 percent of patients with anorexia nervosa engaged in over-exercise. Like under-eating, excessive exercise is a biologically driven symptom.

Medical dangers from excessive exercise vary for males and females. Males tend to abuse steroids, take special vitamins, and weight gain powders that are not carefully monitored or controlled by the FDA and may be unsafe. They tend to develop torn muscles and ligaments, sometimes to the point where they may be unable to walk. Steroids can be lethal. Females who exercise too much may stop menstruating and ovulating, develop osteoporosis, stress fractures and dehydration.

Excessive exercise can also interfere with school and career, and disrupt relationships. People with these tendencies may avoid social situations because they are self-conscious about their appearance. Basically, they are unable to relax and enjoy life.

People who have been chronically abusing exercise may develop fatigue, reduction in performance, decreased concentration, inhibited lactic acid response, loss of emotional vigor, increased compulsivity, soreness, stiffness, (encouraged by saying ‘no pain, no gain’), and decreased heart rate response to exercise. The only cure is complete rest, which may take weeks to months.

If you are concerned about someone you know and think they may have a problem with excessive exercise, it is recommended that you talk to them about it in a supportive, non-judgmental way. When you express concern, try to assess if the person feels unable to voluntarily control or decrease activity. You may need to discuss the issue multiple times, because they are likely to deny a problem. They may also get a lot of positive reinforcement for their activity from coaches, or others who praise their activity and appearance. Point out how exercise is interfering with other aspects of their life or health and provide evidence.
Treatment for excessive exercise includes cognitive behavioral therapy and sometimes, medication. With treatment and support, it is possible to regain a healthy relationship with exercise.