Individual Factors and the Context of Physical Activity in Exercise Dependence: A Prospective Study of ‘Ultra-Marathoners’

Mental Health in Ultra-Endurance Runners: A Systematic Review

BACKGROUND

Among ultra-endurance runners (UER), the mental, behavioral, and physical demands of training/competition can result in maladaptive outcomes. Mental health issues are common in athletes and can impact psychology, physical health, and performance.

OBJECTIVE

To synthesize information regarding the incidence/prevalence and factors associated with mental health issues among UER.

METHODS

Systematic searches were performed in PubMed, SPORTDiscus, Scopus, Cochrane databases, CINAHL, Web of Science, and Medline Ovid using key terms related to UER (e.g., trail running, road running) and psychological issues (e.g., exercise addiction, depression). Inclusion criteria included original articles published in peer-reviewed journals in English, using qualitative or quantitative approaches. We considered papers reporting incidence/prevalence and associated factors with mental health outcomes in UER of both sexes, all ages, and levels of competition (e.g., elite, nonprofessional runners). The Joanna Briggs Institute Analytical Cross-Sectional Studies critical appraisal tool was used for quality assessment.

RESULTS

A total of 282 studies were identified, and 11 studies were included in the final selection. A total of 3670 UER were included in the studies. The prevalence of mental health issues among UER ranged between 32.0% and 62.5% for eating disorders, from 11.5% to 18.2% for exercise addiction, 18.6% for depressive symptoms, and 24.5% for sleep disturbance. Exercise addiction was not related to weekly volume, but a strong relationship with exercise in an unstructured space, age, and body mass index was shown.

CONCLUSION

Mental health issues among UER are common, especially eating disorders, exercise addiction, sleep disturbances, and depressive symptoms. Further high-quality studies are needed to examine underlying factors and find preventative strategies to protect UER.

REGISTRATION

The protocol of this systematic review was registered at the PROSPERO-CRD42022338743.

Prevalence and Association of Exercise Dependence and Eating Disorder Risk in Collegiate Student-Athletes

CONTEXT

Exercise dependence (EXD) is a compulsive and addictive behavior that can negatively affect physical and mental health, leading to significant impairment or distress. Exercise dependence has been associated with symptoms of eating disorders (EDs). Student-athletes are an at-risk population for EXD and EDs given the physical and psychological demands of competitive sports.

OBJECTIVE

To examine the EXD and ED risks in student-athletes across sex and sport category and to determine the association between EXD and ED.

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

National Collegiate Athletic Association Division I and II student-athletes (n = 1885; age = 19.8 ± 1.4 years; females = 69.6%, n = 1312; males = 30.4%, n = 573).

MAIN OUTCOME MEASURE(S)

A web-based survey including demographics, the Exercise Dependence Scale-21, the Eating Attitudes Test-26, and questions about pathogenic behaviors.

RESULTS

Overall, 4.9% (n = 92) of the student-athletes were categorized as at risk for EXD (females = 4.8%, n = 63/1312; males = 5.1%, n = 29/573), with differences across sex and sport categories (all: χ28,1885 = 99.1, P < .001). The ED risk in student-athletes (Eating Attitudes Test-2, pathogenic behavior use, or both) was 22.7% (n = 428; females = 25.5%, n = 334/1312; males = 16.4%, n = 94/573), with differences by sex (χ24,1885 = 10.1, P = .039). Multiple logistic regressions indicated a significant association between the risks of EXD and ED for all student-athletes; athletes at risk for EXD were also at greater risk for EDs (odds ratio = 5.104; 95% CI = 3.237, 8.046) than nondependent-asymptomatic athletes (odds ratio = 2.4068; 95% CI = 1.5618, 3.7089).

CONCLUSIONS

Although physical activity has become a public health intervention to improve overall health in populations, EXD can be considered a problem related to physical activity. Exercise dependence can negatively affect physical and mental health, whereas EDs may be psychiatric disorders influenced by EXD, as exercise can be a compensatory behavior to achieve weight loss. To minimize the overall risk of EDs in student-athletes, additional education and awareness are needed. Special attention should be given to any student-athletes, in particular females, who display signs of EXD.

Exercise Dependence in Practitioners of Martial Arts and Combat Sports

BACKGROUND

The aim of this study was to analyse prevalence exercise dependence among practicing martial arts and combat sports.

METHODS

There were 166 respondents. The Exercise Dependence Scale-EDS was used.

RESULTS

The martial arts practitioners obtained a lower result in the 'intention effects' (p < 0.05; η² = 0.03), 'continuance' (p = 0.04; η² = 0.03), 'lack of control' (p < 0.05; η² = 0.03), 'reduction in other activities' (p = 0.04; η² = 0.03), and 'total score' (p = 0.04; η² = 0.03) than the combat sports athletes. Both the respondents with a high training rank (p < 0.05) and subjects with above 5 years of training experience (p = 0.03; η² = 0.03) achieved the higher mean in the 'time' subscale. Women obtained lower results in the case of 'tolerance' (p = 0.04; η² = 0.04). The regression coefficient indicates that the higher respondent's age, the lower total score she/he will achieve in the EDS.

CONCLUSIONS

The findings have practical implications for identifying subjects 'at-risk for exercise dependence' symptoms, and may aid coaches and individuals in the implementation of a prevention program, to seek suitable support.

Can Cycling Be Addictive? A Qualitative Interview Study Among Amateur Female Cyclists

Exercise and healthy eating are proposed as a recommended lifestyle by the World Health Organization with several positive outcomes, including a decrease in pathologies such as diabetes and reduction in mortality rates. However, research suggests that there is the potential for exercise behaviour to become addictive among a small minority of individuals, which detrimentally impacts their lives. The risk of exercise addiction increases for endurance sports, of which cycling is considered one, given the intense physical and psychological demands, due to elevation and distance, in amateur cycling events. Understanding the risk factors specific to cycling is worthy of investigation, as it is not clear whether cycling can become an addiction. Using the ‘addiction component model’ as a framework, qualitative analysis was used to determine whether symptoms of addiction were present among a sample of eight female cyclists. Through the use of thematic analysis, the results showed that symptoms of addiction were reported by participants. Three themes were generated from research interviews comprising ‘addiction components’ (i.e. salience, conflict, mood modification, tolerance, withdrawal, and cycling despite health problems), ‘enabling infrastructure’ (i.e. supportive work, supportive family and friends), and ‘striving for excellence’ (i.e. needing to be the best, pushing too far, and having unrealistic expectation), currently measured in the ‘addiction component model’. There were also novel themes including ‘cycling above health’ where the participant continues to cycle against medical advice; ‘enabling infrastructure’ where work, family, and friends are accepting of cycling; and ‘striving for excellence’ where the participants ‘needing to be the best’ when comparing themselves to their peers, ‘pushing too far’ to achieve the goal set, and finally ‘unrealistic expectations’ resulting in negative comparison to peers. These findings suggest that addiction to cycling should be investigated further, and implications may necessitate clinical intervention to find alternative coping mechanisms when exercise is not available to an individual as there is a likelihood that individuals will continue to exercise in spite of injury and against medical advice.

Prevalence and Correlates of Exercise Addiction in the Presence vs. Absence of Indicated Eating Disorders

Despite the many benefits of regular, sustained exercise, there is evidence that exercise can become addictive, to the point where the exerciser experiences negative physiological and psychological symptoms, including withdrawal symptoms upon cessation, training through injury, and the detriment of social relationships. Furthermore, recent evidence suggests that the etiology of exercise addiction is different depending on the presence or absence of eating disorders. The aim of this study was to explore to what extent eating disorder status, body dysmorphic disorder, reasons for exercise, social media use, and fitness instructor status were associated with exercise addiction, and to determine differences according to eating disorder status. The key findings showed that the etiology of exercise addiction differed according to eating disorder status, with variables including social media use, exercise motivation, and ethnicity being uniquely correlated with exercise addiction only in populations with indicated eating disorders. Furthermore, body dysmorphic disorder was highly prevalent in subjects without indicated eating disorders, and could be a primary condition in which exercise addiction is a symptom. It is recommended that clinicians and practitioners working with patients who present with symptoms of exercise addiction should be screened for eating disorders and body dysmorphic disorder before treatments are considered.

Examining the relationship between fitness-related self-conscious emotions, disordered eating symptoms, and morbid exercise behavior: An exploratory study

BACKGROUND AND AIMS

Theoretical models of morbid exercise behavior (MEB) suggest that it may emerge as a result of complex interactions between a range of psychosocial factors. However, in spite of fitness-related self-conscious emotions involving such factors, their relationship with the risk of MEB has never been investigated. Consequently, this study had two objectives. First, to explore the relationship that fitness-related self-conscious emotions have with (a) symptoms reflecting MEB as assessed by the Exercise Addiction Inventory (EAI) and the Exercise Dependence Scale-Revised (EDS-R) and (b) exercise frequency. Second, to examine whether these relationships might vary according to disordered eating symptoms.

METHODS

A sample of 646 undergraduate students (59% males; M_age = 21.25; SD_age = 2.94) completed a self-reported questionnaire.

RESULTS

After controlling for age, sex, and disordered eating symptoms, it was found that shame, hubristic pride, and authentic pride positively explained MEB; for their part, guilt (negatively) and authentic pride (positively) explained exercise frequency. The positive relationships between pride and MEB were weaker (in the case of the hubristic facet) or stronger (in the case of the authentic facet) under higher levels of disordered eating symptoms. The independent variables explained 29% (EAI), 28% (EDS-R), and 27% (exercise frequency) of the variance in dependent variables.

DISCUSSION

Tempering fitness-related emotions of shame, guilt, hubristic pride, and authentic pride may contribute to healthier exercise behavior.

When Passion Appears, Exercise Addiction Disappears

Abstract. There are approximately 1,000 published articles on exercise addiction, which is characterized by exaggerated training yielding adverse effects. In contrast, there are less than 20 identified cases of exercise addiction in the literature. Recently, it was reported that there is an association between exercise addiction and passion. To test the impact of the latter on exercise addiction, we reanalyzed the combined data from two recent studies. High- and low-exercise volume groups differed in exercise addiction even after controlling for age and sex ( p < .001). However, after adding obsessive and harmonious passion as continuous predictor variables, the statistical significance vanished, whereas both predictors emerged as significant ( p < .001). Further, when controlled for the effect of passion, the correlation between exercise addiction and weekly exercise volume turned out to be negative. Therefore, a conceptual confound between the presumed risk of exercise addiction and passion could render the results of several hundreds of published works questionable. The current findings send an important message to scholars in the field: Studying exercise addiction without controlling for passion may yield false results.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Investigation of the Exercise Dependence of Athletes Doing Kickboxing, Taekwondo, and Muay Thai

Debates about the conditions in which the frequency and intensity principles of regular exercise, depending on the fact that a sports background can be accepted as extremism, are still a controversial topic. The purpose of this research was to investigate the exercise dependence of athletes who practice Kickboxing, Taekwondo, and Muay Thai. The study included 141 athletes, consisting of 87 men and 54 women. The Exercise Dependence Scale-21 (EDS-21), composed of 21 items developed by Hausenblas and Downs and adapted into the Turkish version by Yeltepe and İkizler, was applied to the athletes. As a result of the research, while athletes showed more sensitivity to the EDS (=71.41), this scale was also defined as symptomatic. It was found that five athletes (3.5%) were asymptomatic-nondependent, 117 athletes (83.0%) were symptomatic-nondependent, and 19 athletes (13.5%) were at risk for exercise dependence. It was determined that athletes were at risk for exercise dependence as follows: Eight athletes were doing Kickboxing, ten athletes were doing Taekwondo, and one athlete was doing Muay Thai. A significant difference was observed according to years of regular training and number of trainings per a day. Other variables presented no significant differences. It was possible to say that years of regular training could be effective in revealing exercise dependence.

Exercise Addiction in Practitioners of Endurance Sports: A Literature Review

Practice of endurance sports/activities has gained most devotees over recent decades, thanks to its capacity to maintain and improve health. However, their characteristics and accessibility have facilitated the emergence of addictive behaviors. Excessive practicing can lead to adverse physical and psychological effects seriously prejudicial to health, to the extent that individuals are unable to control this behavior. Recognizing that exercise addiction is still a controversial concept, the aim of the present review is to analyze the state of research into addictive exercise behaviors, specifically centering on running and endurance sports. To this end, a search covering article written in English and dated from 2010 onward was carried out in the Pubmed, Scopus, Web of Science and EBSCOhost databases. Of a total of 2,675 articles in the four databases, 25 were eligible for the final review. The studies reviewed confirmed that excessive practice could encourage the appearance of addictive behaviors and health problems. Most research has reported no age or sex differences in exercise dependence among endurance sport practitioners; however, obsessive passion and dedication to sports activities may be predictors for addiction to exercise. Owing to terminological confusion and the variety of tools used to measure addiction, figures for prevalence differ widely among studies, with values quoted ranging from 3 to 42%. Furthermore, it is clear that there are problems in delimiting, defining and diagnosing this sort of behavior, which has led to addiction to exercise not yet being considered a behavioral disorder.

Addiction, Passion, or Confusion? New Theoretical Insights on Exercise Addiction Research From the Case Study of a Female Body Builder

Exercise addiction is widely studied in sport science and psychology, but at this time it is not recognized as an independently diagnosable mental or psychiatric disorder. Indeed, studies on exercise addiction assess a level of risk for disordered exercise behaviour, characterized by lack of control and negative personal consequences. It is argued that commitment and passion are two overlapping features of high exercise involvement which obscure the fine line between healthy and unhealthy exercise. The present case study examined a successful female body builder who initially claimed that she was addicted to exercise. During an interview she also completed three questionnaires and her appraisal of well-being in eight life domains were assessed at present, as well as retrospectively before her intensive involvement with exercise. She was screened under the Non-Substance Related Disorders category of Substance-Related and Addictive Disorders classification of DSM-5 for gambling, by replacing the word "gambling" with "exercise". Although she was susceptible to exercise addiction, attained high scores on obsessive passion, exhibited more than four symptoms on the DSM list, she exhibited no signs of loss of control and she mainly reported positive experiences associated with her exercise behaviour. She has obtained a nearly maximum score on commitment to exercise and high score on harmonious passion. Almost all aspects of her life have changed in positive direction after getting intensely involved in exercise. This case illustrates that the current scholastic path to the study of exercise addiction may be obscured by ambiguous assumptions and unilateral quantitative focus.

Propiedades Psicométricas del Exercise Addiction Inventory (EAI) en una Muestra de Estudiantes Brasileños Universitarios

El objetivo de este estudio fue validar el Inventario de Adicción al Ejercicio (EAI) en el contexto brasileño. Participaron en el estudio 251 estudiantes universitarios (hombres= 132, mujeres= 119, Medad = 22.34, DT = 4.65). Los resultados mostraron un adecuado ajuste del modelo a los datos: χ2 (9, N = 251) = 17.45, p = .04; χ2/gl = 1.94; CFI = .96; IFI = .96; RMSEA = .061 (IC 90% = .01, .10); SRMR = .041. La estructura factorial se mostró invariante respecto al género. Se obtuvieron adecuados valores de consistencia interna (= .70) y estabilidad temporal (CCI= .80). Dieciséis (6.4%) participantes fueron clasificados en riesgo de adicción, 198 (78.9%) como sintomáticos y 37 (14.7%) como asintomáticos. Se obtuvieron evidencias que permiten sugerir la validez y la fiabilidad del EAI en el contexto brasileño. No obstante, investigaciones con poblaciones más diversas deberían determinar la aplicabilidad general del EAI.

Prevalence of Exercise Addiction Symptomology and Disordered Eating in Australian Students Studying Nutrition and Dietetics

BACKGROUND

Previous research has reported the existence of disordered eating in students studying nutrition and dietetics. However, the occurrence of exercise addiction, previously linked to disordered eating, is poorly understood in this group.

OBJECTIVE

The main objective of this study was to explore the prevalence of self-reported symptoms of exercise addiction and the association with disordered eating in a sample of students studying nutrition and dietetics. A secondary objective was to compare the prevalence of exercise addiction to students enrolled in another health-related degree.

DESIGN

We conducted a cross-sectional study in 165 undergraduate students.

PARTICIPANTS/SETTING

Participants were students of both sexes enrolled in nutrition and dietetics and occupational therapy degree programs at an Australian university in August 2013.

MAIN OUTCOME MEASURES

Participants completed four validated questionnaires for assessment of exercise- and eating-related attitudes and behaviors measuring scores for exercise addiction, weekly volume of physical activity (PA), eating disorder symptoms, and cognitive restraint. Stretch stature and body mass were measured and body composition was assessed using dual energy x-ray absorptiometry.

STATISTICAL ANALYSES PERFORMED

Independent t test, Mann-Whitney U test, and χ² test were completed to compare groups of students based on sex, degree, or eating attitudes. Spearman's correlation was performed to explore associations between continuous variables (exercise addiction scores, PA volume, and scores for eating attitudes and cognitive restraint).

RESULTS

Approximately 23% of nutrition and dietetics students were found to be at risk of exercise addiction (20% females and 35% males; P=0.205), while the majority demonstrated some symptoms of exercise addiction. A similar proportion of at risk individuals was found in the female occupational therapy group (19%; P=1.000). In females (nutrition and dietetics and occupational therapy combined), the exercise addiction scores were associated with three other outcome measures: PA volume (r_s=0.41; P<0.001), eating attitudes scores (r_s=0.24; P=0.008), and cognitive restraint (r_s=0.32; P<0.001). Comparative analysis indicated that female students with high cognitive restraint had greater exercise addiction scores than those with low cognitive restraint (20.3 [4.8] compared to 17.8 [4.2]; P=0.003).

CONCLUSIONS

Results suggest high prevalence of exercise addiction in this sample of undergraduate health-related degree students and its link to amount of PA and disordered eating in females. Future research should include larger samples of both sexes to build the existing understanding on these maladaptive behaviors.

Exercise addiction risk and health in male and female amateur endurance cyclists

Background and aims To determine the relationship between the risk of exercise addiction (REA) and health status in amateur endurance cyclists. Methods In 859 (751 men and 108 women) cyclists and 718 inactive subjects (307 men and 411 women), we examined the REA (Exercise Addiction Inventory), training status (volume, frequency, experience, and performance), socioeconomic status, quality of life (QoL) (SF-12), quality of sleep (Pittsburgh Sleep Quality Index), anxiety and depression (Hospital Anxiety and Depression Scale), and cardiometabolic risk: body mass index, physical activity (International Physical Activity Questionnaire), physical condition (International Fitness Scale), adherence to the Mediterranean diet (Mediterranean Diet Adherence Screener), alcohol and tobacco consumption. Results In total, 17% of the cyclists showed evidence of REA and 83% showed low REA. REA occurred independent of age, sex, training, and socioeconomic status (all ps > .05). Regardless of REA, the cyclists displayed a better physical QoL and a lower cardiometabolic risk than the inactive subjects (all ps < .05). The cyclists with REA displayed worse values of mental QoL, quality of sleep, and anxiety than cyclists with low REA (all ps < .05). The REA group had better values of mental QoL and anxiety and similar values of quality of sleep than the inactive subjects. The differences in mental QoL between the REA and low REA groups were significantly greater in women (p = .013). There was no Addiction × Sex interaction in the other analyzed variables. Conclusion Our results suggest that an increased prevalence of REA limits the benefits that amateur endurance cycling has on mental health and quality of sleep.

Frequent exercise: A healthy habit or a behavioral addiction?

It is well known that regular physical activity helps improve overall health and fitness and reduces the risk of many chronic diseases. However, excessive exercise might be harmful. Exercise addiction (EA) is a pattern of uncontrolled exercise that involves a craving for overwhelming exercise with addictive attributes. So far, little is known about this unique behavioral addiction. The aim of the current study is to introduce the diagnosis and assessment of EA, and to summarize several developing theoretical models. Eating disorders, body image disorder, low self-esteem, and high narcissism are related to high risk of EA. The paper also discusses the distinction between EA and highly involved physical activity.

Avaliação da dependência à prática de karatê e a sua relação com o tempo de treino

INTRODUÇÃO: a prática de artes marciais tem se tornado uma atividade em grande ascensão, seja no âmbito recreacional ou competitivo. Embora sejam inegáveis os benefícios da prática regular de exercícios físicos, crescem as evidências do excesso de treino entre atletas e desportistas de diferentes modalidades, chegando mesmo à dependência da prática em situações negativas e patológicas. Este excesso, denominado Dependência da Prática de Exercícios (DPE), pode se apresentar na forma primária ou secundária.OBJETIVO: avaliar a Dependência da Prática de Karatê (DPK) em atletas e desportistas para determinar a prevalência e o grau de dependência e sua associação a comportamentos de risco.MÉTODOS: foram recrutados 46 indivíduos de ambos os sexos, com média de 45,4(10,6) anos, 74,8(10,7) kg, 173,1(7,2) cm, cujo índice de massa corporal de 24,89(2,93) kg/m2 os classificou como eutróficos. Nós consideramos medidas antropométricas, índices de uma escala de dependência adaptada para DPK, e informações sobre a percepção da autoimagem corporal.RESULTADOS: foi constatado um índice significativamente maior de DPK em atletas mais experientes, porém quanto à insatisfação da autoimagem corporal, esta foi significativa apenas no grupo de praticantes menos experientes.CONCLUSÃO: a aplicação da Escala de DPK mostrou-se útil na detecção de dependência em praticantes de karatê em relação ao tempo de treino, embora não se tenha indicação de desdobramentos negativos advindos deste quadro de dependência. Recomenda-se a aplicação desta escala para as diferentes artes marciais, a fim de determinar, nos diferentes estilos, as motivações e possíveis consequências de um engajamento patológico no esporte.

A cross-cultural re-evaluation of the Exercise Addiction Inventory (EAI) in five countries

Research into the detrimental effects of excessive exercise has been conceptualized in a number of similar ways, including ‘exercise addiction’, ‘exercise dependence’, ‘obligatory exercising’, ‘exercise abuse’, and ‘compulsive exercise’. Among the most currently used (and psychometrically valid and reliable) instruments is the Exercise Addiction Inventory (EAI). The present study aimed to further explore the psychometric properties of the EAI by combining the datasets of a number of surveys carried out in five different countries (Denmark, Hungary, Spain, UK, and US) that have used the EAI with a total sample size of 6,031 participants. A series of multigroup confirmatory factor analyses (CFAs) were carried out examining configural invariance, metric invariance, and scalar invariance. The CFAs using the combined dataset supported the configural invariance and metric invariance but not scalar invariance. Therefore, EAI factor scores from five countries are not comparable because the use or interpretation of the scale was different in the five nations. However, the covariates of exercise addiction can be studied from a cross-cultural perspective because of the metric invariance of the scale. Gender differences among exercisers in the interpretation of the scale also emerged. The implications of the results are discussed, and it is concluded that the study’s findings will facilitate a more robust and reliable use of the EAI in future research.

Association of symptoms of attention-deficit/hyperactivity disorder with symptoms of excessive exercising in an adult general population sample

BACKGROUND

An increasing number of studies suggest that physical activity can alleviate symptoms of ADHD in children. In adults there are currently insufficient data available on this subject. Interestingly, ADHD and forms of excessive exercising have both been shown to occur more frequently in adult athletes. The aim of the present study was to empirically investigate the association of ADHD and excessive exercising in the adult general population.

METHODS

For diagnosis of adult and childhood ADHD a large representative sample of the German general population (n = 1,615) completed a retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD. Excessive exercising as well as putative mediating variables such as eating related psychopathology, depression, and anxiety were assessed using standardized self-rating instruments.

RESULTS

Individuals with childhood only ADHD had a significantly higher frequency of excessive exercising (9.0%) than individuals without ADHD (2.7%). Excessive exercising was significantly associated with childhood only ADHD compared to no ADHD with an odds ratio of 3.239 even after controlling for socio-demographic variables, BMI, eating related and general psychopathology.

CONCLUSIONS

Our data show that excessive exercising is significantly overrepresented in individuals in which ADHD symptoms in childhood have not persisted into adulthood. We thus hypothesize that a subgroup of individuals might suppress ADHD symptoms by excessive sporting activities. Although in healthy adults physical activity has been associated with immediate and long term improvements in cognitive functioning, studies empirically investigating associations between the effects of physical activity and adult ADHD are rare. Further studies are warranted to explore the potential role of physical activity in the treatment of ADHD in adults.

The exercise paradox: An interactional model for a clearer conceptualization of exercise addiction

BACKGROUND AND AIMS

Exercise addiction receives substantial attention in the field of behavioral addictions. It is a unique form of addiction because in contrast to other addictive disorders it is carried out with major physical-effort and high energy expenditure.

METHODS

A critical literature review was performed.

RESULTS

The literature evaluation shows that most published accounts report the levels of risk for exercise addiction rather than actual cases or morbidities. The inconsistent prevalence of exercise addiction, ranging from 0.3% to 77.0%, reported in the literature may be ascribed to incomplete conceptual models for the morbidity. Current explanations of exercise addiction may suggest that the disorder is progressive from healthy to unhealthy exercise pattern. This approach drives research into the wrong direction.

DISCUSSION

An interactional model is offered accounting for the adoption, maintenance, and transformation of exercise behavior. The here proposed model has an idiosyncratic black-box containing the antecedents and characteristics that are unique to the individual, which cannot be researched via the nomothetic approach. Subjective aspects in the black-box interact with stressful life events that force the person to cope. The range of coping may be wide. Escape into exercise depends on personal (subjective) and situational (objective) factors, but the subjective components are inaccessible for a priori scholastic scrutiny. It is our view that currently only this dual interactional model may account for the fact that exercise addiction emerges suddenly and only in a few individuals from among those at high risk, estimated to be around 3.0% of the exercising population.

Exercise addiction in Spanish athletes: Investigation of the roles of gender, social context and level of involvement

BACKGROUND AND AIMS

In nomothetic research exercise addiction is studied on the basis of symptoms which are most often linked to exercise volume. However, other factors may also affect individuals' susceptibility to the disorder. The aim of this research was to examine the influence of gender, social context (team or individual sport), and level of athletic training on symptoms of exercise addiction.

METHODS

Two groups of university athletes - sport- (n = 57) and non-sport orientation (n = 90) - and a group of elite ultra-marathon runners (n = 95) completed the Exercise Addiction Inventory (EAI). The psychometric properties of the Spanish EAI were determined.

RESULTS

EAI scores were higher in men than women (p = .018). Participants in team sports reported higher EAI scores than individual athletes (p = .005). Elite runners scored higher on the EAI than university athletes (p = .005), but their scores were unrelated to the volume of training. The prevalence of "at risk" for exercise addiction was 7%-10% in university athletes and 17% among the ultra-marathon runners. The Spanish EAI showed good psychometric properties.

DISCUSSION

The results of the current inquiry show that several factors - including gender, level of athletic training, and social context of the training - affect exercise addiction and, in line with the literature, the volume of exercise did not emerge as an index of susceptibility to exercise addiction.

Motivation and exercise dependence: a study based on self-determination theory

The objective of this study was to use self-determination theory to analyze the relationships of several motivational variables with exercise dependence. The study involved 531 exercisers, ranging in age from 16 to 60 years old, who responded to differentquestionnaires assessing perception of motivational climate, satisfaction of basic psychological needs, motivation types, and exercise dependence. The results of multiple mediation analysis revealed that ego-involving climate and perceived competence positively predicted exercise dependence in a directed and mediated manner through introjected and external regulation. Gender and age did not moderate the analyzed relationships. These results allow us to better understand the motivational process explaining exercise dependence, demonstrating the negative influence of the ego-involving climate in the context of exercise.

Exercise addiction: symptoms, diagnosis, epidemiology, and etiology

Regular physical activity plays a crucial role in health maintenance and disease prevention. However, excessive exercise has the potential to have adverse effects on both physical and mental health. The scholastic and empirical discussion of excessive physical activity focuses on obsessive and compulsive exercising, and uses several labels. However, in this review, we argue that the most appropriate term for this phenomenon is exercise addiction, emphasizing that excessive physical exercise fits the typical and most common characteristics of behavioral addictions. The aim of this review is to synthesize the current knowledge on symptomology, diagnosis, epidemiology, and etiology of exercise addiction.

Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction

This paper sets out to clarify the unique features of exercise addiction. It begins by examining how this addiction can be distinguished from compulsions and impulse control disorders both of which, like an addiction, involve excessive behavior that creates adverse effects. Assessment of exercise addiction also requires that clinicians be attuned to other forms of excessive behavior, especially eating disorders that can co-occur with exercise. Finally in an effort to clarify exercise addiction, this paper uses the four phases of addiction to examine the attributes of exercise that define it as a healthy habit distinct from an addiction. The paper ends with a discussion of the implications of these topics for effective assessment and treatment.

Dependence and physical exercise: Spanish validation of the Exercise Dependence Scale-Revised (EDS-R)

The purpose of this study was to validate the Spanish version of the Exercise Dependence Scale-Revised (EDS-R). To achieve this goal, a sample of 531 sport center users was used and the psychometric properties of the EDS-R were examined through different analyses. The results supported both the first-order seven-factor model and the higher-order model (seven first-order factors and one second-order factor). The structure of both models was invariant across age. Correlations among the subscales indicated a related factor model, supporting construct validity of the scale. Alpha values over .70 (except for Reduction in Other Activities) and suitable levels of temporal stability were obtained. Users practicing more than three days per week had higher scores in all subscales than the group practicing with a frequency of three days or fewer. The findings of this study provided reliability and validity for the EDS-R in a Spanish context.