Exercise and movement can be an important aspect for maintaining our wellbeing. Just as nourishing our bodies with food, wearing sunscreen, and visiting the doctor are part of personal care, so is moving our bodies. Whether it’s sports, fitness classes, gardening, or going for a morning stroll, exercise can nurture our mobility while jumpstarting the production of positive brain endorphins that make us feel good mentally and physically.

However, movement can also become a coping mechanism to deal with stress, and while it’s beneficial to have healthful coping skills, they can become harmful if overused. When exercise becomes a compulsive response to triggers, the consequences to one’s physical and mental health often outweigh the typical benefits of movement. In some cases, compulsive exercise is indicative of a larger issue, like an eating disorder. 

Because exercise exists on a spectrum from healthy to unhealthy, it can be difficult to identify when movement becomes compulsive and harmful. Recognizing the signs of compulsive exercise and seeking support are important steps toward fostering a balanced and healthy relationship with movement. 

Compulsive Exercise Explained

Is there a clear difference between “normal” exercise and compulsive exercise? There is, but it can be hard to spot. Compulsive exercise describes an uncontrolled and obsessive relationship with working out. A compulsion refers to a behavior that happens without conscious thought or control, driven by an overwhelming urge rather than genuine enjoyment or health benefits.

Compulsive exercise is best identified when the behavior becomes an obstacle to day-to-day life. This definition can be subjective, but there are clues to watch for. For example, individuals struggling with compulsive exercise may prioritize workouts over personal relationships, career responsibilities, or physical well-being. They may also experience intense guilt or anxiety when unable to exercise.

An article from the Journal of Eating Disorders created two criteria for compulsive exercise to support a clinical assessment of the behavior.

1. The individual has an obsession or rigid rules that drive their motivation for overexercising.
2. The exercise is performed to prevent a specific consequence, such as weight gain or feelings of inadequacy.

Signs of Compulsive Exercise

Even with a clear definition, it can still be difficult to know if one’s exercise habits may have crossed the line into compulsive behavior. Not only will individual experiences vary, but it can also be hard to see in a loved one. However, it can be helpful to know some of the signs to look out for. Here are some indicators that you or a loved one may be struggling with compulsive exercise:

• Exercise and eating habits are intertwined: For example, someone may restrict food more on days they don’t exercise and/or view exercise as “permission” to eat or as “punishment” for eating
• Ignoring physical warning signs: Exercising despite fatigue, illness, or injury.
• Disregarding external conditions: Exercising at inappropriate times of the day or in extreme weather conditions.
• Overtraining: Following a monotonous routine without adequate rest days or balancing training intensity.
• Emotional dependence: Experiencing guilt, anxiety, or decreased self-esteem when unable to exercise.
• Interference with daily life: Spending excessive time exercising to the detriment of work, relationships, or personal responsibilities.
• Hyperfocus: Becoming preoccupied with the next opportunity to exercise.

It’s also essential to consider the context. For instance, what might be excessive for one person could be typical for another, particularly for athletes who train at a high intensity. But, as we’ll go into in a later section, athletes themselves may be at a higher risk for developing an eating disorder. This nuance can make compulsive exercise difficult to spot without a thorough understanding of the individual’s habits and motivations.

Physical Consequences of Excessive Exercise

While exercise is often praised for its physical benefits, overtraining can lead to serious health problems, including:

• Relative Energy Deficiency in Sports (RED-S): A condition caused by inadequate energy intake to support physical activity, leading to hormonal imbalances and impaired physiological function.
• Chronic bone and joint pain: Caused by overuse and lack of recovery time.
• Decreased bone density: Increasing the risk of fractures and osteoporosis.
• Higher frequency of injuries: Overuse injuries like stress fractures and muscle strains become more common when rest and recovery are neglected.
• Persistent fatigue and muscle soreness: Resulting from insufficient recovery.
• Reproductive health issues: Loss of menstrual cycles in women or decreased testosterone levels in men.

Compulsive Exercise and Athletes

Identifying compulsive exercise becomes even trickier for athletes who face intense training regimens and the pressure to excel in their sport. Competitive athletes often engage in rigorous training routines that may superficially resemble compulsive exercise. However, the key difference often lies in the individual’s mindset and motivation.

Athletes may develop unhealthy patterns when training becomes less about performance and more about fulfilling an obsessive need. The high amount of pressure that athletes experience can intensify their relationship to training to the point of compulsive exercise. For example, an athlete who pushes through injury or illness to adhere to rigid training schedules may be at risk. Coaches and teammates can play a critical role in recognizing these patterns and encouraging a more balanced approach to training.

The Relationship Between Compulsive Exercise and Eating Disorders

Compulsive exercise is not recognized as a standalone mental illness in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders), but it is often a symptom of an underlying condition, such as an eating disorder. Exercise can serve as a compensatory behavior in individuals with eating disorders like Anorexia Nervosa or Bulimia Nervosa.

Consequences of Compulsive Exercise and Eating Disorders 

Compulsive exercise is often used to “compensate” for food intake or feelings of guilt associated with eating. For individuals with Anorexia Nervosa, this might mean engaging in excessive exercise to “burn off” calories, often to the point of physical exhaustion or injury. For those with Bulimia Nervosa, compulsive exercise can accompany cycles of binge eating, creating an intense strain on the body and mind. Even observed alone, compulsive exercise should be treated with sincerity as it can potentially be a gateway to other compensatory behaviors such as laxative misuse or self-induced vomiting.

Research consistently shows that individuals with eating disorders who engage in compulsive exercise face heightened challenges in recovery. Specific findings include:

• Prolonged Hospital Stays: Compulsive exercisers often require more intensive medical interventions due to the physical toll on their bodies. Prolonged hospital stays are frequently necessary to address severe malnutrition, electrolyte imbalances, and injuries caused by overuse.
• Increased Suicidality: A 2020 study published in Psychiatry Research found that individuals with eating disorders who also exhibit compulsive exercise behaviors have a higher risk of suicidality. 
• Longer Recovery Times: Compulsive exercise adds another layer of complexity to eating disorder recovery. The rigid and obsessive nature of this behavior often makes it difficult for individuals to adopt healthier coping mechanisms, potentially slowing their progress toward recovery.

Underlying Psychological Factors

The causes of disordered eating behaviors or compulsive exercise are multifaceted. Like many mental illnesses, eating disorders and their associated behaviors result from a combination of genetic and environmental factors. One aspect of supporting someone with an eating disorder is to understand the psychology at play. Here are possible experiences that may be a part of an eating disorder diagnosis or exercise compulsion.

• • • Body Image Dissatisfaction: Unrealistic societal beauty standards often drive individuals to believe that their worth is tied to their appearance. Compulsive exercise becomes a means of achieving or maintaining a perceived “ideal” body type.
    • Perfectionism: Many individuals with eating disorders exhibit perfectionistic tendencies. Compulsive exercise is often part of this drive for perfection, as individuals set rigid and unattainable standards for their physical activity.
    • Control Mechanisms: For many, compulsive exercise offers a sense of control in a world that feels chaotic. The predictability and structure of exercise routines can provide temporary relief from underlying anxieties, reinforcing the behavior.
    • Obsessive/Compulsive Traits: People who compulsively exercise share traits with those diagnosed with Obsessive-Compulsive Disorder (OCD) in that there is a stimulus that triggers the need to exercise and distress if the need can’t be met. However, despite similarities, compulsive exercise or an eating disorder don’t inherently indicate an OCD diagnosis.

Treatments for Compulsive Exercise

While compulsive exercise is not an independent diagnosis, addressing it can be part of a broader treatment plan. This article from Sports Medicine Open considered input from athletes who have experienced eating disorders, eating disorder clinicians, and coaches to provide treatment considerations for athletes who deal with compulsive exercise and eating disorders. Some of the treatment approaches they recommended include:

• Mindfulness-Based Interventions: Techniques like meditation or yoga can help individuals reconnect with their bodies and develop a healthier relationship with movement.
• Cognitive Behavioral Therapy (CBT): CBT and other types of psychotherapy can address the thoughts and beliefs driving compulsive exercise, helping individuals replace harmful patterns with healthier behaviors.
• Education on Overtraining: Providing information about the negative consequences of overtraining can empower individuals to make informed choices about their exercise habits.
• Collaborative Care Plans: Involving athletes, coaches, and clinicians in creating balanced training schedules that prioritize recovery.
• Fatigue Measures: Using objective metrics to assess when the body needs rest.

More research is needed to develop standardized approaches to treating compulsive exercise behaviors. However, seeking support early can make a significant difference in recovery.

Find Treatment & Reclaim Your Relationship with Movement

If you or someone you know is struggling with compulsive exercise, it’s important to remember that professional help is available. Recognizing the signs of a compulsive behavior and seeking treatment are courageous steps toward reclaiming a balanced and healthy relationship with movement.

At The Alliance, we are here to connect those struggling with personalized care. Whether you’re dealing with compulsive exercise, an eating disorder, or related challenges, our team is here to help. Reach out to our therapist-staffed helpline for support in finding care that fits your needs.