How much exercise is “too much” exercise?
There are no specific, global standards for judging whether exercise behavior is excessive; therefore, what may be appropriate levels of exercise for one person may be unhealthy levels of exercise for another. There are, however, methods for assessing “exercise dependence.” Recommended guidelines for healthy exercise generally include activity that occurs 3–6 days per week for approximately 30–60 minutes per day. However, even moderate exercise can be excessive for a patient weakened by anorexia and malnutrition, so anorexia patients should discuss with their doctor if exercise is appropriate. Exercising in a weakened physical state can be extremely dangerous and can lead to electrolyte imbalances, heart arrhythmias, and other serious medical complications.
Here are some questions to ask yourself to help determine if you are exercising excessively:
• Are you exercising more than 5 days a week for more than 1 hour per day?
• Are you exercising more than your coach, doctor, or parents recommend?
• Do you exercise in order to lose weight because you feel obligated to, or because you enjoy the activity?
• Do you try to squeeze in “hidden” exercise (e.g., running an extra flight of stairs or doing extra jumping jacks) in order to compensate for calories consumed?
• Do you take care to increase the amount of calories consumed in order to fuel your body for physical activity?
Emily Cooper, medical director and founder of Seattle Performance Medicine gives this helpful tip to her patients: “If you can’t fuel it, don’t do it!”
• Does the amount of time you spend exercising interfere with other important areas of your life?
• Do you exercise when you are injured or ill? Healthy exercise tends to be social and enjoyable and is engaged in irrespective of the amount of food eaten. In contrast, unhealthy, excessive exercise tends to be obligatory, performed in isolation, and is undertaken with the primary goal of losing weight or burning off calories that have been ingested. Exercise that is excessive or interferes with physical or emotional health may be an indicator of something known as exercise dependence.
Exercise Dependence
The term exercise dependence (also known as “compulsive exercise” or “exercise addiction”) describes physical exercise that is excessive in frequency, duration, or intensity. It is characterized as a craving for physical activity that results in extreme exercise and generates negative physiological symptoms (such as injury) and negative psychological symptoms (such as guilt, depression, irritability, restlessness, tension, anxiety, and sluggishness) (Hausenblas and Symons Downs 2002). According to the DSM-IV-TR, exercise becomes excessive when it significantly interferes with important activities, when it occurs at inappropriate times or in inappropriate settings, or when a person continues exercising despite an injury or other medical complication.
Researchers at the University of Florida and Pennsylvania State University developed a useful measure to assess for exercise dependence. It evaluates seven different aspects of exercise dependence, including tolerance, withdrawal effects, continuance of exercise despite injury or other physical problems, lack of control, reduction of other activities (e.g., spending time with family or friends), time spent exercising, and intention (e.g., exercising for longer than was planned). Treatment teams may use a measure such as this in order to determine if one’s level of exercise meets the criteria for exercise dependence.
Exercise Dependence Scale-21
Instructions: Using the scale provided, please complete the following questions as honestly as possible. The questions refer to current exercise beliefs and behaviors that have occurred in the past 3 months. Please place your answer in the blank space provided after each statement.
1 2 3 4 5 6
Never Always
1. I exercise to avoid feeling irritable._____
2. I exercise despite recurring physical problems._____
3. I continually increase my exercise intensity to achieve the desired effects/benefits._____
4. I am unable to reduce how long I exercise._____
5. I would rather exercise than spend time with family/friends._____
6. I spend a lot of time exercising._____
7. I exercise longer than I intend._____
8. I exercise to avoid feeling anxious._____
9. I exercise when injured._____
10. I continually increase my exercise frequency to achieve the desired effects/benefits._____
11. I am unable to reduce how often I exercise._____
12. I think about exercise when I should be concentrating on school/work._____
13. I spend most of my free time exercising._____
14. I exercise longer than I expect._____
15. I exercise to avoid feeling tense._____
16. I exercise despite persistent physical problems._____
17. I continually increase my exercise duration to achieve the desired effects/benefits._____
18. I am unable to reduce how intensely I exercise._____
19. I choose to exercise so that I can get out of spending time with family/friends._____
20. A great deal of my time is spent exercising.____
21. I exercise longer than I plan._____
SOURCES: Hausenblas, H. A., and Symons Downs, D. (2002). How much is too much? The development and validation of the Exercise Dependence Scale.
Psychology & Health 17:387–404. Used with permission.
Symons Downs, D., Hausenblas, H. A., & Nigg, C. R. (2004). Factorial validity and psychometric examination of the Exercise Dependence Scale-Revised.
Measurement in Physical Education
When a Child or Teen Is Over exercising
When it comes to excessive exercise, knowing when to intervene and what steps to take can be complicated. Parents should consult their family physician to determine if their child is within a healthy weight range for his or her level of physical activity. If he or she is underweight or shows signs of an eating disorder, your doctor may recommend placing limits on duration and intensity of exercise permitted (e.g., a physician may recommend “rest days” of inactivity). The challenge for parents is to enforce any recommended restrictions. It may be especially difficult if exercise has been a source of pleasure and mastery for a teen athlete. Be firm in your enforcing of limits, knowing that it is in your child’s best health interests. Try to include your child in the discussion, rather than imposing restrictions in a way that hinders open communication. If your child is part of a team sport, you may consider allowing continued attendance at team events so your child can maintain a connection to the team. A note of interest: You may be surprised at the outcome of your intervention. Some teens report feeling relieved when they are encouraged to reduce their exercise intensity, and others report discovering talents, strengths, and abilities of which they were previously unaware.
Even if a child is within the normal weight range, excessive exercise itself can be harmful. Be sure that the child’s physician approves any exercise routine and that he is not involved in more activity than his coach or trainer recommends. Parents may also need to contact a child’s coach and/or physical education teacher to ensure that they have a flexible approach to training and to elicit their support in monitoring compliance with physician recommendations. Keep in mind that when recommended, abstaining from exercise is usually only a temporary restriction; when a physician gives approval, parents
can begin to loosen any exercise restrictions that have been set in place. Often, parents find it best to allow some mild activity to be reinstated as incremental treatment goals are
met; however, this varies case by case. Finally, parents should stay in contact with their family physician and report any noncompliance with treatment recommendations and exercise restrictions. Studies show that noncompliance with exercise restrictions may be an indicator of an eating disorder or risk for relapse.
A Healthy Example at Home
A balanced approach to diet and exercise in the home can go a long way toward developing healthy attitudes in kids and teens. Here are some general guidelines to keep in mind:
• Do a self-check on your own attitudes about exercise and physical fitness. Parents who themselves exercise excessively may unintentionally influence their children to follow similar exercise patterns. A balanced, healthy approach is best.
• If your child is an athlete, be sure not to put too much pressure on him or her to excel in sports. It can be damaging when a parent’s goal for their child’s level of physical activity is unrealistic or motivated by the parent’s need to see their child be a “successful athlete.”
Be supportive of your child’s interests but not in a way that might encourage excessive exercise. Also, if you suspect that a coach or physical education teacher is putting undue pressure on your child to excel in athletics, speak to the coach and express your concerns.
• Parents, as well as other significant role models (e.g., coaches, siblings), should be careful not to make critical comments concerning appearance, weight, or body-type that may lead to excessive exercise or diet behaviors.
• Do not mistake apparent high levels of energy for good health. Malnourished patients may seem “fidgety” or appear to have a great deal of energy for athletic activity. Over-activity and restlessness is common with anorexia. In fact, activity level may increase as patients continue to lose weight
• Speak with your child about the dangers of over exercising. Anorexia patients are especially prone to bone fractures and other health complications. Instead of building muscle, too much exercise can actually damage muscles and can put undue stress on heart function, especially if the body is not getting enough nutrients.
• Know your child’s physical limitations.
Lynn shares:
I never had an outside perspective to moderate my excessive exercise tendencies. There was likely a place for moderate exercise during recovery in my case, but it was a long time before I learned how to do “moderate.” As a consequence, I dealt with constant injuries that slowed the healing process and the potential return to my sport. In recovery, I had to ask myself why I was running so hard that day or what I was running from. Early on it is hard to give yourself an honest answer. The goals of the exercise get mixed up in the goals of the disease, and they may be almost impossible to distinguish. Here is where some outside perspective can be most valuable. It is like recovering from an injury. You may need some time for healing before getting back to your athletic goals. Often athletic performance is a way to feel good about yourself, but it doesn’t work if that sense of self-esteem is not already in place. Taking some time off to heal body, mind, and soul may be just what it takes to restore your athletic pursuits. Without this healing, and if you remain in the disease, it will likely end those pursuits prematurely-as it did for me-and the resulting long-term consequences can plague you into your older years. When you do return, you may find that you have a whole new perspective and enjoyment of your sport and the freedom to reach for your goals apart from the controlling obsessions of the disease. The enjoyment and lifetime potential in recovery are far beyond what you had before in anorexia
Term:
Withdrawal Characteristic – symptoms that occur after the cessation of long-term use, or the sudden discontinuation of a drug or habit-forming action.
Over-activity and restlessness is common with anorexia
