Reviewed by Amy Baker Dennis, PhD, FAED and Riley Nickols, PhD, CEDS-S

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Excessive exercise is not recognized as a clinical diagnosis in the DSM-5 TR, but many people struggle with symptoms associated with this term.1 Researchers have defined excessive exercise as exercising to the extent where a person loses control and feels a compulsive need to continue the exercise behaviors even when it impairs their ability to function in various areas of their life and/or causes physical injury.2,3 If you are concerned about you or a loved one’s relationship with exercise, please speak with a treatment professional.

Since excessive exercise is not recognized as a formal diagnosis, researchers and clinicians use many different terms to describe these behaviors (e.g. excessive exercise, compulsive exercise, unbalanced exercise) and continue to debate whether it is a distinct disorder or a feature of different types of eating disorders. For example, is “excessive exercise” a compensatory behavior in bulimia nervosa, a feature of muscle dysmorphia, or a form of obsessive-compulsive disorder?2,4,5 One study found that excessive exercise does not exist in isolation, but is a byproduct and/or symptom of an eating disorder.6 Despite differing terms used to describe the destructive role of exercise on an individual’s health and functioning and the debate over how to categorize these behaviors for diagnosis, it is clear that excessive exercise is often maladaptive and serves to support and uphold an individual’s eating disorder.

Warning Signs and Symptoms of Excessive Exercise2,4

  • Exercise that significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications
  • Intense anxiety, depression, irritability, feelings of guilt, and/or distress if unable to exercise as planned
  • Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury
  • The type, volume, and intensity of exercise is often monotonous, inflexible and is not in line with what is scientifically proven to be safe and effective methods of training
  • Discomfort with rest or inactivity
  • Exercise used to manage emotions
  • Exercise as a means of purging (needing to “get rid of” or “burn off” calories)
  • Exercise as permission to eat
  • Exercise that is secretive or occurs despite recommendations otherwise
  • Significant difficulty or an inability to modify exercise routine when advised
  • Feeling as though you are not good enough, fast enough or not pushing hard enough during a period of exercise; overtraining
  • Withdrawal from friends and family

Health Consequences of Excessive Exercise4,7,8

  • Bone density loss (osteopenia or osteoporosis)
  • Loss of menstrual cycle (in women), low testosterone (men)
  • Relative Energy Deficiency in Sport (RED-S)
  • Persistent muscle soreness
  • Decreased training response
  • Chronic bone & joint pain
  • Increased incidence of injury (overuse injuries, stress fractures, etc.)
  • Persistent fatigue, sluggishness, and poor sleep quality
  • Altered resting heart rate
  • Increased frequency of illness & upper respiratory infections

Treatment Considerations

Treating excessive exercise requires working with a multidisciplinary team of health and mental health professionals who have expertise in the treatment of both eating disorders and excessive exercise. This treatment team may include a physician, psychiatrist, psychotherapist, and dietician. Given the serious physical and psychological consequences that can result from eating disorders and excessive exercise, it is important to seek professional help as soon as possible.

Learn more about treatment here.
Learn more about finding treatment providers in your area here.

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Sources

[1] Trott, M., Jackson, S. E., Firth, J., Jacob, L., Grabovac, I., Mistry, A., Stubbs, B., & Smith, L. (2021). A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders. Eating and weight disorders : EWD, 26(1), 37–46. https://doi.org/10.1007/s40519-019-00842-1

[2] Alcaraz-Ibáñez, M., Paterna, A., Sicilia, Á., & Griffiths, M. D. (2020). Morbid exercise behaviour and eating disorders: A meta-analysis. Journal of behavioral addictions, 9(2), 206–224. https://doi.org/10.1556/2006.2020.00027

[3] Szabo, A., Demetrovics, Z., & Griffiths, M. D. (2018). Morbid exercise behavior: Addiction or psychological escape? In H. Budde & M. Wegner (Eds.), The exercise effect on mental health: Neurobiological mechanisms (pp. 277–311). New York: Routledge. PDF: https://drive.google.com/file/d/1zon8vnEL84vSI2cuTAZkD153mTQUyk3T/view

[4] American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787

[5] Weinstein, A., & Szabo, A. (2023). Exercise addiction: A narrative overview of research issues. Dialogues in clinical neuroscience, 25(1), 1–13. https://doi.org/10.1080/19585969.2023.2164841

[6] Bamber, D., Cockerill, I. M., Rodgers, S., & Carroll, D. (2000). “It’s exercise or nothing”: a qualitative analysis of exercise dependence. British journal of sports medicine, 34(6), 423–430. https://doi.org/10.1136/bjsm.34.6.423

[7] Lichtenstein, M. B., Hinze, C. J., Emborg, B., Thomsen, F., & Hemmingsen, S. D. (2017). Compulsive exercise: links, risks and challenges faced. Psychology research and behavior management, 10, 85–95. https://doi.org/10.2147/PRBM.S113093

[8] Mountjoy, M., Sundgot-Borgen, J. K., Burke, L. M., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A. K., Meyer, N. L., Sherman, R. T., Tenforde, A. S., Klungland Torstveit, M., & Budgett, R. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British journal of sports medicine, 52(11), 687–697. https://doi.org/10.1136/bjsports-2018-099193