Exercise and Use of Enhancement Drugs at the Time of the COVID-19 Pandemic: A Multicultural Study on Coping Strategies During Self-Isolation and Related Risks

Abstract

Introduction: Little is known about the impact of restrictive measures during the COVID-19 pandemic on self-image and engagement in exercise and other coping strategies alongside the use of image and performance-enhancing drugs (IPEDs) to boost performance and appearance.Objectives: To assess the role of anxiety about appearance and self-compassion on the practice of physical exercise and use of IPEDs during lockdown.Methods: An international online questionnaire was carried out using the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and the Self-Compassion Scale (SCS) in addition to questions on the use of IPEDs.Results: The sample consisted of 3,161 (65% female) adults from Italy (41.1%), Spain (15.7%), the United Kingdom (UK) (12.0%), Lithuania (11.6%), Portugal (10.5%), Japan (5.5%), and Hungary (3.5%). The mean age was 35.05 years (SD = 12.10). Overall, 4.3% of the participants were found to engage in excessive or problematic exercise with peaks registered in the UK (11.0%) and Spain (5.4%). The sample reported the use of a wide range of drugs and medicines to boost image and performance (28%) and maintained use during the lockdown, mostly in Hungary (56.6%), Japan (46.8%), and the UK (33.8%), with 6.4% who started to use a new drug. Significant appearance anxiety levels were found across the sample, with 18.1% in Italy, 16.9% in Japan, and 16.7% in Portugal. Logistic regression models revealed a strong association between physical exercise and IPED use. Anxiety about appearance also significantly increased the probability of using IPEDs. However, self-compassion did not significantly predict such behavior. Anxiety about appearance and self-compassion were non-significant predictors associated with engaging in physical exercise.Discussion and Conclusion: This study identified risks of problematic exercising and appearance anxiety among the general population during the COVID-19 lockdown period across all the participating countries with significant gender differences. Such behaviors were positively associated with the unsupervised use of IPEDs, although no interaction between physical exercise and appearance anxiety was observed. Further considerations are needed to explore the impact of socially restrictive measures among vulnerable groups, and the implementation of more targeted responses.

Exercise Addiction and Muscle Dysmorphia: The Role of Emotional Dependence and Attachment

“…Mooney et al (2017) found in a sample of gym and fitness club users a risk of EA, appearance anxiety, and low self-esteem, as well as an inclination to use products to supplement their physical exercise protein (41%), caffeine (30%), nitric oxide (13%), and anabolic steroids (7%). In this same line, Dores et al (2021) found in a large sample, including the participants from Spain (15.7%), during the lockdown because the COVID-19, strong relations between physical exercise and use of image and performance-enhancing drugs, and, as in other studies, anxiety about appearance also increased the probability of using these drugs.…”

Exploring the Relationship Between Mental Well-Being, Exercise Routines, and the Intake of Image and Performance Enhancing Drugs During the Coronavirus Disease 2019 Pandemic: A Comparison Across Sport Disciplines

“…Although excessive exercising has been previously correlated with excessive IPEDs use during the COVID-19 physical distancing (Dores et al, 2021 ), this is the first study assessing the differences across various sport disciplines in terms of EAI, AAI, and SCS and their level of engagement in physical activity (AG vs. NAG).…”

“…This scale has 12 items reflecting on attitudes toward oneself (e.g., “when something painful happens, I try to take a balanced view of the situation”), resulting in its total scores ranging from 12 to 60. A high internal reliability was observed for the total sample (Cronbach's α = 0.82), and the questionnaire has been translated in different languages (Dores et al, 2021 ).…”

“…Supporting evidence emerged from a recent study on the use of IPEDs among the general adult population ( N = 3,161) during the COVID-19 pandemic. It was found that 28% of the participants reported use of such products with 6.4% of them starting a new use during the pandemic (Dores et al, 2021 ). Interestingly, the only predictor of change in IPEDs consumption was the score on or above the cut-off point on the Exercise Addiction Inventory (EAI) (OR = 2.272), indicating that excessive exercising could potentially induce excessive IPEDs use worldwide (Dores et al, 2021 ).…”

Editorial: Prescribing Psychotropics: Misuse, Abuse, Dependence, Withdrawal and Addiction

“…Moreover, the web has been contributing to the diffusion of new synthetic compounds, such as designer benzodiazepines and illicit fentanyl analogs, which are associated with a high abuse potential and severe adverse effects including coma and death (26)(27)(28). Finally, since the beginning of 2020, due to drug shortage issues resulting to the COVID-19 pandemic, a shift in misusing behavior relating to both prescription and OTC medicines has been recorded (10,13,(29)(30)(31)(32)(33).…”