Compulsive exercise is a condition described since 1970s. It is characterized by a craving for physical training, resulting in uncontrollable excessive exercise behavior with harmful consequences, such as injuries and impaired social relations. It has not been accepted as a mental disorder in either International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. The aim of this literature review was to critically examine the research on links (comorbidity), risks (negative consequences), and challenges faced (problems in a treatment context). This review found that compulsive exercise is associated with eating disorder pathology, perfectionism, neuroticism, narcissism, and obsessive compulsive traits. The most prominent negative consequences were injuries, social impairment, and depression, but more research is needed to uncover the potential dysfunction resulting from compulsive exercise. As the condition is not recognized as a psychiatric disorder, studies on treatment interventions are sparse. Problems with compliance have been reported; therefore, motivational interviewing has been proposed as a treatment approach, in combination with cognitive behavioral therapy. This review summarizes and discusses findings on links/comorbidity, risks/negative consequences, and treatment challenges. We suggest that future studies should pay attention to both prevention and counseling in sports settings, where compulsive exercise appears, as the condition may be associated with harmful consequences.

BackgroundFitness exercise is popular and associated with improved health and social status. Taken to extremes, however, exercise can become an addiction. One suggested symptom of exercise addiction is “conflicts” with family and friends. However, it may be difficult to recognize excessive exercise patterns if they are accepted and encouraged by relatives. The aim of this study was to explore if fitness exercisers with a high risk of addiction experienced the same level of exercise support as exercisers with a low risk of addiction. Furthermore, we wanted to examine if social support affected the subjective reporting of “conflicts”.MethodA total of 577 fitness exercisers completed the Exercise Addiction Inventory (EAI) and two questions asking about “exercise support from family and friends” and “present eating disorder”.ResultsExercisers at high risk of exercise addiction reported the same level of support from relatives as those at low risk. Exercisers with high levels of exercise support reported significantly fewer conflicts, even if they were at high risk of addiction. If an eating disorder was present, the level of exercise support was significantly reduced.ConclusionExercise addiction might be difficult to identify with the general behavioral addiction symptom “conflict”, since exercise is socially accepted even in subjects with high risk of exercise addiction. If an eating disorder is present, the exercise routines seem to be interpreted as socially undesirable. Screening for exercise addiction with the EAI should take into account that fitness exercisers rarely report conflicts, which could result in false negative cases.

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IntroductionExercise addiction is a condition described by a craving for physical training resulting in excessive exercise behaviour and withdrawal symptoms. It has not been accepted as a mental disorder and further research is needed to examine the pathology of the condition.ObjectivesExercise addiction is suggested to have links to other mental disorders and risks in terms of negative consequences such as injuries. Treatment for exercise addiction faces several challenges as the condition is associated with ambivalence, and studies based on controlled interventions are missing.AimsThe aim of this study was to examine and interpret the existing research on links, risks and challenges faced in treatment interventions.MethodsA literature review was conducted in the databases PubMed, PsycINFO and Scopus with the terms: “exercise addiction, excessive exercise” and/or “comorbidity, eating disorder, depression, anxiety, personality, pain, injury, illness, social isolation, stress, intervention, treatment”.ResultsExercise addiction seems to be associated with eating disorder pathology, obsessive-compulsive behaviour and personality traits characterized by perfectionism, narcissism and neuroticism. Overload injuries (e.g. stress fractures) and impaired interpersonal relations are reported. In a treatment context, low compliance is described as a challenge. Thus, motivational interviewing is recommended, and also cognitive behavioural therapy is suggested for treatment. None of these interventions have yet been scientifically evaluated in addicted exercisers.ConclusionThis review concludes that exercise addiction has links to psychopathology and increases the risk of injuries. More research is needed to estimate the level of psychosocial and physiological distress in these athletes. Controlled treatment interventions have to be conducted.Disclosure of interestThe authors have not supplied their declaration of competing interest.