Exercise Addiction

Symptomatic bradyarrhythmias in the athlete-Underlying mechanisms and treatments

Bradyarrhythmias including sinus bradycardia and atrioventricular (AV) block are frequently encountered in endurance athletes especially at night. While these are well tolerated by the young athlete, there is evidence that generally from the fifth decade of life onward, such arrhythmias can degenerate into pathological symptomatic bradycardia requiring pacemaker therapy. For many years, athletic bradycardia and AV block have been attributed to high vagal tone, but work from our group has questioned this widely held assumption and demonstrated a role for intrinsic electrophysiological remodeling of the sinus node and the AV node. In this article, we argue that bradyarrhythmias in the veteran athlete arise from the cumulative effects of exercise training, the circadian rhythm and aging on the electrical activity of the nodes. We consider contemporary strategies for the treatment of symptomatic bradyarrhythmias in athletes and highlight potential therapies resulting from our evolving mechanistic understanding of this phenomenon.

Major Dietary Patterns, Exercise Addiction, and Eating Disorders Among a Sample of Physically Active Young Adults

Background

Regular exercise has been widely acknowledged for its numerous health benefits, including improvements in physical fitness, body function, and mental well-being. However, excessive exercise and unhealthy dietary patterns can lead to adverse effects on individuals' physical and psychological well-being. This study aimed to examine the association of dietary patterns, exercise addiction, and eating disorders among physically active young adults.

Method

In this cross-sectional study, a total of 200 physically active young adults aged 18-35 years were included. The participants' dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ) consisting of 80 food items. To determine dietary patterns, factor analysis was employed. Exercise addiction was evaluated using The Exercise Addiction Inventory (EAI) and Exercise Dependence Questionnaire (EDQ), and eating disorders were assessed using The Eating Disorder Examination-Questionnaire Short (EDE-QS).

Result

Three main dietary patterns were identified: western, healthy, and traditional dietary patterns. The western dietary pattern was associated with increased waist-to-hip ratio (P = .01) that remained significant after adjustment for confounders (eg, age, gender, BMI, and physical activity P = .03), while the adherence to traditional dietary pattern was linked to higher waist circumference and body shape index (P < .05). Participants that followed the healthy dietary pattern showed a higher score of EAI and body shape concern (P = .04). Furthermore, in structural equation modelling (SEM), eating disorder was identified as a significant positive predictor of exercise addiction (r = .17, P < .05).

Conclusion

According to our finding, those with the higher adherence to healthy dietary pattern had higher scores of exercise addiction and body shape concern. Also, eating disorder was a potential predictor of exercise addiction among young physically active individuals. Further research and targeted interventions are needed to better understand these complex relationships and develop effective strategies to promote healthy behaviors and mitigate the risk of adverse outcomes.

The Arabic Version of Compulsive Exercise Test among Saudi Population; Translation and Validation

Compulsive exercise is a condition characterized by uncontrollable exercise behaviour that may lead to severe and harmful physical and psychological consequences. Indeed, compulsive exercise is among the early symptoms of eating disorders that may affect different age groups. Globally and among Arab countries, compulsive exercise is common, while the screening methods used to assess compulsive exercise are limited. Thus, the Compulsive Exercise Test (CET) has emerged as a tool to assess cognitive, behavioural, and emotional factors related to compulsive exercise. The CET is a self-report, Likert-type scale comprising five distinct subscales. The increase in the CET scores is more likely associated with worsened pathology. Since the Arab countries lack such an assessment tool, we aimed to translate the CET into Arabic, validate the translated version, confirm the factor structures, and assess the internal consistency of the different subscales. Herein, we used the forward-backward translation method as recommended by the World Health Organization (WHO). The overall validity index of the translated version showed a score higher than 0.78, while the scale-level content validity index based on the average calculating method (S-CVI/Ave) and the agreement method (S-CVI/UA) were 0.91 and 0.58, respectively. Moreover, we recruited 399 Arabs living in Saudi to measure the internal consistency, and the value of the substantive internal consistency with Cronbach's α was 0.81. Subsequently, four of the Arabic-CET subscales had substantive internal consistency with Cronbach's α values higher than or equal to 0.70. Furthermore, the exploratory factor analysis results supported the substantial use of the five-subscale model. Taken together, our study supports using the Arabic-CET version to measure exercise compulsiveness among Arabs.

Effects of exercise interventions on negative emotions, cognitive performance and drug craving in methamphetamine addiction

Introduction

Methamphetamine is currently one of the most commonly used addictive substances with strong addiction and a high relapse rate. This systematic review aims to examine the effectiveness of physical activity in improving negative emotions, cognitive impairment, and drug craving in people with methamphetamine use disorder (MUD).

Methods

A total of 17 studies out of 133 found from Embase and PubMed were identified, reporting results from 1836 participants from MUD populations. Original research using clearly described physical activity as interventions and reporting quantifiable outcomes of negative mood, cognitive function and drug craving level in people with MUD were eligible for inclusion. We included prospective studies, randomized controlled trials, or intervention studies, focusing on the neurological effects of physical activity on MUD.

Results

Taken together, the available clinical evidence showed that physical activity-based interventions may be effective in managing MUD-related withdrawal symptoms.

Discussion

Physical exercise may improve drug rehabilitation efficiency by improving negative emotions, cognitive behaviors, and drug cravings.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024530359.

Recent insights in the correlation between social media use, personality traits and exercise addiction: a literature review

Introduction and aim

The excessive involvement in physical activity without stopping in between sessions despite injuries, the continuous thinking to exercise feeling insane thoughts and experiencing withdrawal symptoms are all characteristics of the Exercise Addiction (EA), an addictive behavior. While the primary exercise addiction is directly caused by compulsive exercise, many studies highlighted the relationship between Eating Disorders (ED) and EA, defining the secondary EA. The correlation between EA, social media use (SMU) and other individual traits remains a relatively underexplored domain. Therefore, this review aimed to examine the latest evidence on the relationship between EA, SMU, and some personality traits such as perfectionism and body image.

Methods

Electronic databases including PubMed, Medline, PsycARTICLES, Embase, Web of Science were searched from January 2019 to October 2023, following the PRISMA guidelines.

Results

A total of 15 articles were examined and consolidated in this review. EA was found to be related to different individual traits such perfectionism, body dissatisfaction, depression, obsessive-compulsive personality disorders. While controversial results were found regarding the relationship between EA and SMU.

Conclusion

The interaction between mental health, exercise addiction and social media use is complex. Excessive engagement in these latter may result in negative mental health consequences despite their potential benefits. Understanding individual differences and developing effective interventions is crucial to promoting healthy habits and mitigating the EA risks, ultimately enhancing mental well-being. Further research should focus on the identification of risks and protective factors with the eventual aim of developing and implementing effective prevention strategies.

"I needed something to hook me." A narrative study on adherence to Pilates

INTRODUCTION

Exercise adherence is necessary for achieving long-term benefits. Along with other elements, stories and narratives can play a role in understanding and promoting adherence. The aim of the present study was to explore how stories and narratives may affect adherence to Pilates.

METHOD

8 Pilates practitioners who had been participating in a Pilates program for 6 or more years were interviewed. Data obtained were analysed using thematic narrative analysis, (focusing on the whats of stories) and holistic narrative analysis (examining how narratives acted on adherence).

RESULTS AND DISCUSSION

Results highlight pain, Pilates as a health-related method, and the social relations as characters, plots and scenarios of stories enhancing long-term participation in Pilates. Exercise is medicine and eudaimonic well-being are presented as narratives articulating the coherence to practitioners' adherence. They act for participants subjectivizing their Pilates practice into a serious commitment to health.

CONCLUSION

Stories and narratives are relevant to give meaning and sense to the adherence to Pilates. A focus on stories can be added as a strategy to promote adherence to Pilates.

Psychometric properties of the exercise addiction inventory (EAI) questionnaire among physically active young adults

BACKGROUND

Exercise addiction (EA) is a pathological behavior pattern in which a person loses control over his exercise habits and exercises excessively and suffers negative consequences for his health and even his social life. One of the best tools to measure EA is EAI. The aim of this study was to examine the psychometric properties of the EAI among Iranian physically active young adults.

METHODS

Participants were randomly selected from sports clubs in Tabriz, Iran. A total of 200 questionnaires were completed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted along with tests of convergent validity. Reliability was assessed using Cronbach's alpha and test-retest methods.

RESULTS

EFA indicated a one-factor structure explaining 40.43% of variance. CFA confirmed the one-factor model with good fit (Root Mean Square Error of Approximation [RMSEA] = 0.076; Comparative Fit Index [CFI] = 0.968). Internal consistency was acceptable (Cronbach's alpha = 0.71) and convergent validity was adequate. Test-retest reliability was also adequate (intraclass correlation coefficient [ICC] = 0.71).

CONCLUSION

The results of our study show that the Persian EAI has satisfactory psychometric properties and can be used as a valid tool to assess EA.

Neuropsychological insights into exercise addiction: the role of brain structure and self-efficacy in middle-older individuals

This study aimed to investigate the relationship between exercise addiction and brain structure in middle-older individuals, and to examine the role of self-efficacy in mediating physiological changes associated with exercise addiction. A total of 133 patients exhibiting symptoms of exercise addiction were recruited for this study (male = 43, age 52.86 ± 11.78 years). Structural magnetic resonance imaging and behavioral assessments were administered to assess the study population. Voxel-based morphological analysis was conducted using SPM12 software. Mediation analysis was employed to explore the potential neuropsychological mechanism of self-efficacy in relation to exercise addiction. The findings revealed a positive correlation between exercise addiction and gray matter volume in the right inferior temporal region and the right hippocampus. Conversely, there was a negative correlation with gray matter volume in the left Rolandic operculum. Self-efficacy was found to indirectly influence exercise addiction by affecting right inferior temporal region gray matter volume and acted as a mediating variable in the relationship between the gray matter volume of right inferior temporal region and exercise addiction. In summary, this study elucidates the link between exercise addiction and brain structure among middle-older individuals. It uncovers the intricate interplay among exercise addiction, brain structure, and psychological factors. These findings enhance our comprehension of exercise addiction and offer valuable insights for the development of interventions and treatments.

Family Functioning Styles and Exercise Addiction: Disengaged, Enmeshed, and Rigid Family Patterns Are Associated with Exercise Addiction

Physical exercise is a widely recommended practice for promoting health, but for some individuals, this activity can result in pathological and morbid behaviour. Therefore, the study of the factors contributing to the onset, development, and progression of exercise addiction is particularly relevant. Within this framework, the present study assessed the effect of family functioning, body image concerns, age, and gender on exercise addiction. A sample of 300 regular exercisers (Mage = 30.3 years, SD = 11.6; 69.7% females, 30.3% males) participated in the study and completed the Family Adaptability and Cohesion Evaluation Scales-IV, Body Image Concern Inventory, and Exercise Addiction Inventory. Data were analysed by implementing a series of moderated moderated-mediations. Results showed that three significant models were relevant. First, positive associations of disengaged (p < 0.05), enmeshed (p < 0.05), and rigid (p < 0.01) family functioning with exercise addiction were found. Furthermore, body image concerns mediated all these relationships, and the interaction between gender and age significantly moderated the effects of body image concerns on exercise addiction (p < 0.05). Such data may be useful for a deeper understanding of the variables associated with the development of exercise addiction, suggesting key elements on which it might be useful to focus in clinical and/or preventive activity.

Chinese version of exercise dependence scale-revised: psychometric analysis and exploration of risk factors

Introduction

Exercise addiction (EA) is a dysfunctional behavior characterized by exaggerated training which has adverse effects on physiology and psychology. To examine the reliability and validity of the Chinese version of the Exercise Dependence Scale-Revised (EDS-R) and the social and psychological aspects related to EA, a large sample behavioral study was conducted.

Methods

College students were selected as the target group. All of them were asked to finish the scales about exercise, including the Chinese version of EDS-R and the Motives for Physical Activity Measure-Revised scales. A confirmatory factor analysis, Mann-Whitney U test, and hierarchical regression test were performed to test the reliability and validity of the Chinese version of EDS-R and find the explanatory variables of EA.

Results

A total of 837 (556 female) students with a mean age of 20.38 years were recruited in the present study. The Chinese version of EDS-R showed good reliability and validity (McDonald's ω = 0.973, CR = 0.99, AVE = 0.80) in Chinese college students. EA was positively correlated with exercise frequency and ability motivation across the study sample. Besides, the Mann-Whitney U test revealed that the exercise motivation difference is the primary cause of the gender gap in EA.

Conclusion

The Chinese version of EDS-R is a relatively robust and accurate instrument to assess the risk of EA. Additionally, exercise frequency and motivation may be the potential risk factors for EA. The screening of risk factors is of great significance for the early detection and prevention of EA.

The Associations between Obsessive Compulsive Personality Traits, Self-Efficacy, and Exercise Addiction

Exercise addiction refers to maladaptive exercise patterns involving compulsivity and addiction-like behaviors. Exercise addiction has been found to relate to negative physical and mental health outcomes such as heart abnormalities, physical injuries, and interpersonal conflicts. Based on the social cognitive theory, this study investigated the extent to which the interplay of obsessive compulsive personality disorder (OCPD) traits and self-efficacy beliefs would influence the development and maintenance of exercise addiction. A total of 1228 college students in the United States responded to an online survey. Based on cut-off scores of the Revised Exercise Addiction Inventory, the prevalence estimates of exercise addiction were 4.0% for males and 1.8% for females. Results showed that males are more prone to exercise addiction than females. Also, OCPD traits and self-efficacy significantly predicted exercise addiction after controlling for age and sex. Self-efficacy acted as a moderator in influencing the relationship between OCPD traits and exercise addiction, especially for females. At high levels of self-efficacy, more OCPD traits were significantly associated with a higher risk of exercise addiction. However, at low levels of self-efficacy, there was no association between OCPD traits and exercise addiction. The findings suggest that public education and intervention for exercise addiction should attend to the interplay between personality factors and sex.

Ultra culture-ultra reality: a content analysis of YouTube depictions of ultra endurance sport and comparisons to scientific literature

Introduction

Interest in ultra endurance sport (UES) is increasing, with relevant events growing in popularity. However, these activities may encompass more complex characteristics and demands that do not correspond to scientifically validated correlations between physical activity and improved health. It is unknown whether high volume training for UES can have adverse implications, although certain sociocultural aspects of western society, such as an emphasis on autonomy and self-directed success, may encourage participation as a representation of personal achievement. As media depictions of UES can be highly influential, we aimed to explore prominent messages to better comprehend the values and aspirations of established and aspiring ultra endurance athletes (UEA).

Methods

Using qualitative, conventional content analysis techniques, we evaluated n = 15 popular YouTube videos on various UES to synthesize the most common themes. A YouTube search was conducted, and videos were selected based on sport and relevance. Subsequently, videos were analyzed and coded to discern the most frequently repeated themes.

Results

Five recurring themes were identified: discussion of the mental aspects of UES participation; the adoption of folk-tale storytelling; dietary habits of UEA; a focus on pain and suffering; the use of words associated with mental illness as a colloquial descriptor of UES/UEA.

Discussion

YouTube depictions of UES participation appear to accentuate suffering and co-occurring phenomena as attractive qualities. These resonate with sociocultural ideologies in western contexts, which emphasize fitness and personal success, but appear inconsistent with evidence around potentially adverse health-related implications of UES.

Conclusion

Discrepancies between popular portrayals of UES and scientific evidence suggest a need for greater community education and information sharing about sport-specific risk factors for physical and mental health conditions and appropriate training protocols. Further research is also required to better define the relationship between motivations for UES participation and overall health using interdisciplinary approaches.

Mediating Roles of Psychological Distress, Insomnia, and Body Image Concerns in the Association Between Exercise Addiction and Eating Disorders

Purpose

Exercising can promote good health. However, excessive exercising may have downsides. This study examined the association between exercise addiction and eating disorders and whether the identified association was mediated by psychological distress, insomnia (including sleep quality), and body image concern.

Methods

A total of 2088 adolescents (mean age of 15.3 years) participated in this cross-sectional study by questions assessing exercise addiction, eating disorders, psychological distress, insomnia, sleep quality, and body image concern.

Results

There were significantly positive relationships between the variables (r=0.12-0.54, p<0.01) with effect sizes from small to large. The four potential mediators (ie, insomnia, sleep quality, psychological distress, and body image concern), individually and in total, significantly mediated the association between exercise addiction and eating disorders.

Conclusion

The findings suggest that exercise addiction in adolescents may influence eating disorders through multiple pathways, such as insomnia, psychological distress, and body image concerns. Future research should examine these relationships longitudinally and use gathered information to inform intervention development. Clinicians and healthcare workers are encouraged to assess exercise addiction when treating individuals with eating disorders.

Effects of Mindfulness on Obligatory Exercise During the Return of Injured Athletes to Sports: The Mediating Roles of Self-Criticism and Competitive State Anxiety

Purpose

Despite the Advances in sports training methods and medicine, they have not reduced the recurrence rate of athletes' injuries significantly, and obligatory exercise may be an important reason for their re-injury. The purpose of this study was to investigate the effects of mindfulness on obligatory exercise behavior, self-criticism, and competitive state anxiety in athletes recovering from injury, and explain their interactions.

Patients and Methods

The study adopted the snowball and convenience sampling methods. From November to December 2022, a total of 265 high-level sports players in South China were selected, and ultimately, 208 valid data samples were obtained. Maximum likelihood estimation was used to analyze the data and test the hypotheses proposed using 5000 bootstrap samples to test the mediating effects of the structural equation model.

Results

The results demonstrated that there were positive correlations between self-criticism and obligatory exercise (standardized coefficients = 0.38, p < 0.001), as well as competitive state anxiety and self-criticism (standardized coefficients = 0.45, p < 0.001). Mindfulness and obligatory exercise were correlated negatively (standardized coefficients = -0.31, p < 0.001), but there was no significant relation between competitive state anxiety and obligatory exercise (standardized coefficients = 0.05, p > 0.01). Self-criticism and competitive state anxiety mediated mindfulness's positive effects on obligatory exercise in part (standardized indirect effect = -0.16, p < 0.01), and this explanatory power was higher than in any previous study (R2 = 0.37).

Conclusion

The irrational beliefs in Activating events-Beliefs-Consequence (ABC) theory play an important role in explaining athletes' obligatory exercise, and mindfulness has a positive effect on reducing obligatory exercise behavior.

Sociocultural predictors of obligatory exercise in young men: A Polish-Chinese comparison

Background

Obligatory exercise has been shown to have negative physical and mental effects on exercisers and is more prevalent among young people. However, there is limited research on obligatory exercise among young men. Social comparison theory offers a novel perspective to explore the relationship between sociocultural factors and obligatory exercise among young men, which offers an opportunity to understand potential factors contributing to obligatory exercise among young men across different cultures.

Method

We recruited a purposive sample of young people aged 18-30 from Poland (n=79) and China (n=194). Participants completed self-report measures including the Sociocultural Attitudes Toward Appearance Questionnaire3, Inventory of Physical Activity Objectives, and Obligatory Exercise Questionnaire. In the data analysis stage, we examined the strength of the relationships between the independent variables and the dependent variable through multiple regression analysis, and tested the role of the mediating variables.

Results

The main analyses revealed that Internalization-Athlete was a common direct predictor of obligatory exercise for both Polish and Chinese young men; that there were direct sociocultural predictors of obligatory exercise that were only used in relation to Polish or Chinese young men; and that social adaptation goals for motivation for physical activity mediated the development of obligatory exercise for Polish and Chinese young men, and that there were cross-cultural differences.

Conclusion

Attention should be paid to their attitudes towards the idea of a muscular and athletic body and socially adapted physical activity motivations when understanding young men's obligatory exercise, while also considering cross-cultural differences.

The role of the orbitofrontal cortex in exercise addiction and exercise motivation: A brain imaging study based on multimodal magnetic resonance imaging

BACKGROUND

Excessive exercise may also lead to exercise addiction (EXA), which is harmful to people's physical and mental health. Behavioral and neuroimaging studies have demonstrated that addictive disorders are essentially motivational problems. However, little is known about the neuropsychological mechanism of EXA and the effects of motivation on EXA.

METHODS

We investigated 130 regularly exercised participants with EXA symptoms to explore the neurobiological basis of EXA and its association with motivation. The correlation between EXA and gray matter volume (GMV) was evaluated by whole-brain regression analysis based on voxel-based morphometry. Then, regional brain function was extracted and the relationship between brain structure-function-EXA was analyzed. Finally, mediation analysis was performed to further detect the relationship between the brain, motivation, and EXA.

RESULTS

Whole-brain correlation analyses showed that the GMV of the right orbitofrontal cortex (OFC) was negatively correlated with EXA. The function of the right OFC played an indirect role in EXA and affected EXA via the GMV of the OFC. Importantly, the GMV of the right OFC played a mediating role in the relationship between ability motivation and EXA. These results remain significant even when adjusting for sex, age, body mass index, family socioeconomic status, general intelligence, total intracranial volume, and head motion.

LIMITATION

The results should be interpreted carefully because only the people with EXA symptoms were included.

CONCLUSION

This study provided evidence for the underlying neuropsychological mechanism of the important role of the right OFC in EXA and revealed that there may be a decrease in executive control function in EXA.

Running addiction

BACKGROUND

Running is a common physical activity of an aerobic nature that is carried out mostly outdoors and presents a healthy lifestyle. However, the positive effect of running often masks the downsides of potential addiction that can compromise an individual's physical, mental, and social functioning. Most often there is a thin and unclear line separating passionate athletes and running addicts. Thus, it is necessary to educate the running community to raise awareness of the negative effects of over-training, prevent complications and injuries and to seek the necessary help.

METHODS

The study sample consisted of runners from the Croatian population of both genders, aged 18 to 75, who have been running for more than a year. The respondents were divided into groups according to the favorite length of the racing race. Groups were compared in terms of nutritional supplements usage, running-related injuries, as well as the impact of Covid-19 pandemic on their running volume. Difference between groups in Exercise Addiction Inventory (EAI) questionnaire outcome scores was also accessed.

RESULTS

The statistical analysis included the answers of 644 people of both genders, among which 309 (48%) men and 335 (52%) women. The average age of the respondents was 42 years (18-75), and the average age of running was 5 years (1-42). Only among the respondents who started running most recently (1 to 10 years), and those who run the longest races (longer than 100 km) were found to use nutritional supplements significantly more (71.43%, P<0.001) and sustained injuries associated with running more than rest of the groups (100%, P=0.013). Due to the pandemic, only respondents who have been running for the longest time (31-42 years) and prefer to run races from 21 to 42 km significantly reduced the amount of training (75%, P=0.037). The risk for addiction was significantly positively associated with the use of dietary supplements, the favorite length of the race and the frequency of injuries, while there was no association with the length of running.

CONCLUSIONS

Running is a high-risk sport for addiction development. All the benevolent attitudes and positive effects of running often mask the downsides of addiction that can compromise an individual and his or her physical, mental, and social functioning. Due to the high percentage of addiction risk of 25%, it is necessary to educate the racing community to raise awareness of the negative effects of overtraining, prevent complications and seek the necessary help.

Psychological well-being and exercise addiction: The treatment effects of an REBT intervention for females

Whilst there is growing research on the benefits of Rational Emotive Behaviour Therapy (REBT) for athletic performance and wellbeing, there has been little attention on the effectiveness of REBT for the exercising population. Recent evidence suggests that REBT may be helpful for males who show signs of exercise addiction, but the effects for females are currently unknown. The current study aims to build on the extant research by adopting a single-case research design to examine the effects of REBT on irrational beliefs, exercise addiction symptomology, psychological distress, and unconditional self-acceptance (USA) of three female exercisers. Self-report data were collected at pre-, during, and post-REBT timepoints. Visual analyses revealed reductions in irrational beliefs and psychological distress, and increases in USA, maintained two-weeks post-REBT. Exercise addiction symptomology also reduced during the intervention, and this was maintained for two out of the three exercisers post-REBT. Social validation data supported these findings. The study adds weight to the efficacy of REBT in improving exercise addiction and its comorbidities.

Normal bone mineral density and bone microarchitecture in adult males with high and low risk of exercise addiction

Exercise addiction describes a pattern of excessive and obsessive exercise and is associated with hypoleptinemia and low testosterone that may have adverse skeletal effects. We used a validated questionnaire to identify males with high and low risk of exercise addiction. In a cross-sectional design, males (aged 21–49 years) with high (n = 20, exercise addictive) and low risk (n = 20, exercise controls) of exercise addiction had examinations of bone mass, bone microarchitecture, and estimated bone strength performed using dual-energy x-ray absorptiometry of the hip and spine and high-resolution peripheral quantitative computed tomography of the distal radius and tibia. Findings were compared between the groups and to a population-based sample of healthy men aged 20–80 years (n = 236). We found similar hip and spine bone mineral density in exercise addictive and controls. Cortical and trabecular bone microarchitecture and estimated bone strength in radius and tibia did not differ significantly between the groups. Multiple regression analyses adjusting for age, body weight, free testosterone, and hours of weekly training did not alter findings. Also, bone indices from both groups were within 95% prediction bands derived from the population-based sample for the vast majority of indices. Neither group had no associations between circulating leptin or free testosterone and bone outcomes. In conclusion, in a study on younger males, we found no associations between high risk of exercise addiction and various indices of bone mass and bone quality indicative of altered skeletal health.

Brain default mode network mediates the association between negative perfectionism and exercise dependence

BACKGROUND AND AIMS

Perfectionism is correlated with the occurrence of exercise dependence. We aim to reveal the role of functional connectivity (FC) between gray matter (GM) and white matter (WM) networks in the association between perfectionism and exercise dependence.

METHODS

In this cross-sectional study, one hundred ten participants with exercise dependence underwent behavioral evaluation and resting-state functional magnetic resonance imaging. Perfectionism and exercise dependence were quantified using the Frost Multidimensional Perfectionism Scale (FMPS) and Exercise Dependence Scale (EDS). We used a K-means clustering algorithm to identify functional GM and WM networks and obtained the FCs of the GM-GM, GM-WM, and WM-WM networks. Partial correlation and mediation analyses were performed to explore the relationships among FCs, FMPS, and EDS.

RESULTS

We identified ten stable GM networks and nine WM networks. Of these, FCs existed between the corona radiata network (WM1) and default mode network (DMN, GM8), WM1 network and WM DMN (WM4), WM1 network and midbrain WM network (WM7), and WM4 network and inferior longitudinal fasciculus network (WM9). The WM1-GM8 and WM1-WM4 FCs were positively correlated with the EDS and negative FMPS. The mediating effects of the WM1-GM8 and WM1-WM4 FCs were established in the association between the negative dimensional FMPS and EDS.

DISCUSSION AND CONCLUSIONS

The WM1 network anatomically linked the subregions within the GM8 and WM4 networks, and WM1-GM8 and WM1-WM4 FCs mediated the association between negative dimensional FMPS and EDS. These findings indicated that DMN function might be involved in the increased risks of exercise dependence promoted by negative perfectionism.

Running-related demands and vigor in long-distance runners: The moderating role of resources and recovery

Long-distance running is a demanding sport and runners use a variety of coping strategies to deal with these demands. In this study, we investigated running-related demands, resources, and recovery and, as an indicator of well-being, vigor. Specifically, following the Demand-Induced Strain Compensation Recovery Model, we tested to what degree the relation between running-related demands and vigor was moderated by two coping strategies available in running: running-related resources (e.g., training control, running mate/coach support) and running-related recovery (i.e., detachment from running). Demands, resources, recovery, and vigor were all surveyed across three separate dimensions (i.e., physical, cognitive, emotional) in a cross-sectional sample of 623 recreational long-distance runners. Hierarchical regression analyses were used to determine to what degree the demands-vigor relation was moderated by resources and recovery. Evidence for moderations was found for the cognitive and emotional dimensions of vigor, revealing four significant moderating effects of resources or recovery on the demands-vigor relation. Three of these effects involved emotional resources or recovery. Contrary to expectations, results also showed that in two cases higher recovery was associated with lower vigor, rather than higher, when runners experienced high demands. In all, we found modest support for the role of resources and recovery in altering the nature of the demands-vigor relation in recreational long-distance runners. This study highlights the importance of the emotional dimension of demands, resources, and recovery, as those facets were most important in predicting vigor in runners. Practical implications are addressed with regard to emotional resources and recovery for long-distance runners.

Factorial Validity and Psychometric Properties of Exercise Dependence Scale Revised Among Lebanese Exercisers

The aim of this manuscript is to discuss the reliability and the factorial, convergent and discriminant validities in measurement model of the 21-item Exercise Dependence Scale Revised (EDS-R) used for diagnosing exercise addiction. A study was conducted among 695 (364 male and 331 female) Lebanese bilingual young adults (aged 18-25) who filled the English version of this questionnaire, along with a general questionnaire. This study showed that, despite an acceptable fit index confirming the 7-factor structure and invariance across gender, exercise duration and age groups; the EDS-R lacks in reliability and convergent and discriminant validities in measurement model, due particularly to the "Reduction in other activities" subscale. The construction of the EDS-R is then to be discussed.

Exercise Addiction - Status, Identification and Treatment

The term "exercise addiction" has been used in the scientific literature since the late 1970s. It is used to refer to persistent excessive exercise despite negative physical, psychological and social consequences, with unsuccessful attempts to reduce or stop the behavior. In this article, the evidence for exercise addiction as a behavioral addiction is presented. Symptoms and psychiatric comorbidities are explained, and recommendations for identification and treatment of exercise addiction are presented.

Psychological impact of COVID-19 restrictions among individuals at risk of exercise addiction and their socio-demographic correlates: A Saudi Arabian survey study

Exercise addiction (EA) has been described as a condition of psychological dysfunction characterized by excessive and obsessive exercise patterns, show withdrawal symptoms when unable to exercise, and experience numerous conflicts and other negative consequences in their social and professional lives, due to the extremely high volumes of exercise. The main objective of the present study was to assess the risk of exercise addiction among a Saudi Arabian sample of regular exercisers and to investigate possible associations between their inability to exercise during the COVID-19 pandemic lockdown (due to the closure of public gyms, swimming pools, and health clubs) and depression, anxiety, and loneliness. A total of 388 regular-exercising Saudis participated in an online cross-sectional survey over three months (December to February 2021). The study sample comprised 89.9% (males) and 10.1% (females), with a mean age of 28.59 years (SD ± 6.69). A 36-item online self-report survey was used for data collection. The prevalence of being at risk of exercise addiction among participants of the present study was 13.1%. Positive significant associations were noted between risk of exercise addiction and depression (r = .41; p < .01), risk of exercise addiction and anxiety (r = .20; p < .01), and risk of exercise addiction and loneliness (r = .17; p < .01). The findings of the present study suggest that those individuals at risk of exercise addiction might also be at an elevated risk of developing negative psychological impact owing to the disruption of the amount of exercise engaged in due to COVID-19 pandemic-related restrictions and therefore these high-risk individuals should receive appropriate psychological support to help them overcome the negative impact of the ongoing pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-02892-8.

Relating Compulsivity and Impulsivity With Severity of Behavioral Addictions: A Dynamic Interpretation of Large-Scale Cross-Sectional Findings

BACKGROUND AND AIM

Impulsivity and compulsivity are two key temperament traits involved in behavior regulation. The aim of this study was to test several existing theories in explaining the role of impulsivity and compulsivity in symptom severity in various behavioral addictions.

METHODS

Data were collected from a (representative) general population sample (N = 2,710, mean age:39.8 years (SD:13.6), 51% woman), and from people who are at increased risk of having a behavioral addiction (N = 9,528 in total, mean age: 28.11 (SD:8.3), 34.3% woman), including people with problematic gaming and internet use, pathological gambling, exercise dependence, compulsive buying and work addiction. Symptom severity, reward driven impulsivity and relief driven compulsivity were assessed.

RESULTS

For non-problematic groups, impulsivity is present to about the same extent as compulsivity, whereas for problematic groups, compulsivity dominates over impulsivity in all groups (except for gambling). The strength of the correlation between impulsivity and compulsivity is higher in more severe forms of the disorders (from r = 0.18 to r = 0.59 in the representative population).

DISCUSSION

Based on these data, it appears that relief-driven behavior (negative reinforcement) dominates over reward-driven behavior (positive reinforcement) in more severe cases of a behavioral addiction.

CONCLUSION

This is the first large-scale study to find empirical support for the neuroscientific theory on the dominance of compulsivity ("needing") over impulsivity ("wanting") in more severe cases of a behavioral addiction. Although longitudinal research is needed, a possible shift from impulsivity to compulsivity takes place, similar to substance use addictions, which maintains the circle of addiction.

Symptoms of exercise addiction in aerobic and anaerobic exercises: Beyond the components model of addiction

Background

Above the six symptoms in the components model of exercise addiction, other symptoms may also reflect the risk of exercise addiction (REA). Based on past research, these additional symptoms (AS) include training when injured, missing social engagements, disordered eating, staleness, and distorted perception of the exercise volume. The manifestation of these AS, along with the REA, may vary in different exercise forms. Since research shows that aerobic exercise is associated with greater well-being and stress reduction than anaerobic exercise, based on the interactional model of exercise addiction, the prevalence of the REA may be higher in aerobic than anaerobic exercisers.

Methods

This cross-sectional investigation examined the REA and AS in regular exercisers performing aerobic and anaerobic activities. Adults (n = 176), exercising at least three times per week for at least one year, were tested. The between-groups and gender differences, along with the connection between AS and REA in the two exercise forms, were studied.

Results

Aerobic and anaerobic exercisers did not differ in the dependent measures. Women in the anaerobic group reported eating more disorderly than men. The REA groups (asymptomatic, symptomatic, and at-risk) differed in all AS. A consistent but weak connection was disclosed between the RAE and AS.

Conclusions

The REA and the studied AS do not differ between aerobic and anaerobic groups, but women in the latter group reported eating more disorderly when exercise is not possible. Expanding the components model with other pertinent symptoms could yield a more thorough picture about the REA.

The Effects of Physical Exercise on Mental Health: From Cognitive Improvements to Risk of Addiction

(1) Background: we aimed to investigate the effects of physical activity on cognitive functions and deficits of healthy population and other needy groups. Secondly, we investigated the relation between healthy habits and psychopathological risks. Finally, we investigated the impact of COVID-19 pandemic on exercise addiction and possible associated disorders. (2) Methods: From April 2021 to October 2021, we conducted a review aimed at identifying the effects of physical exercise on mental health, from cognitive improvements to risk of addiction; we searched for relevant studies on PubMed, Web of Science, EMBASE, PsycINFO and CINHAL. (3) Results: For the first purpose, results indicated multiple effects such as better precision and response speed in information processing tasks on healthy populations; improvement of executive functions, cognitive flexibility and school performance in children; improvement of attention and executive functions and less hyperactivity and impulsiveness on children with attention deficit hyperactivity disorder (ADHD); improvement of executive and global functions on adults; improvement of overall cognitive functioning on patients with schizophrenic spectrum disorder or bipolar disorder. Data also demonstrated that exercise addiction seems to be related to low levels of education, low self-esteem, eating disorders and body dysmorphisms. Eventually, it was found that people with lower traits and intolerance of uncertainty show a strong association between COVID-19 anxiety and compulsive exercise and eating disorder. (4) Conclusions: these findings underline on one side the beneficial effects of physical activity on cognitive function in healthy individuals in a preventive and curative key, while on the other side the importance of an adequate evaluation of psychological distress and personality characteristics associated with exercise addiction.

The Relationship between Alexithymia, Dysmorphic Concern, and Exercise Addiction: The Moderating Effect of Self-Esteem

As with other addictions, exercise addiction can severely impact individuals' lives and have significant psychophysical consequences. Consequently, the study of the mechanisms involved in this psychopathological condition has great clinical and practical relevance. Therefore, the goal of the present study was to explore the risk factors and protective factors for exercise addiction, with a particular focus on the roles of alexithymia, body image concerns, and self-esteem. A sample of 288 regular exercisers (mean age = 28.35 years, SD = 8.26; 72% females, 18% males) completed the Exercise Addiction Inventory, 20-Item Toronto Alexithymia Scale, Body Image Concern Inventory, and Rosenberg Self-Esteem Scale. Data were analyzed by implementing a moderated mediation model. Results showed a significant and positive association between alexithymia and exercise addiction, totally mediated by body image concerns. Furthermore, self-esteem showed a relevant moderating effect, such that at high levels of self-esteem the effect of alexithymia on body image concerns became insignificant. Such data have important implications, highlighting some core variables on which it might be useful to keep a focus in order to elaborate tailored interventions, from both preventive and treatment perspectives.

Relationship between Physical Activity and Physical and Mental Health Status in Pregnant Women: A Prospective Cohort Study of the Japan Environment and Children's Study

To discuss appropriate physical activity (PA) levels during pregnancy, this prospective cohort study examined the relationships between PA levels before and during pregnancy and physical and mental health status. Fixed data for 104,102 pregnant women were used from the Japan Environment and Children’s Study, of which data for 82,919 women were analyzed after excluding women with multiple birth and pregnancy complications. PA levels were measured using the International Physical Activity Questionnaire-Short Form. The 8-Item Short Form Health Survey was used to measure outcomes. Logistic regression with multiple imputations showed that moderate PA for over 720 min/wk and vigorous PA before pregnancy were associated with poorer mental health in the first trimester (adjusted odds ratio (AOR): 1.087–1.376. Walking in the second and third trimesters was associated with better physical and mental health (AOR: 0.855–0.932). Moderate PA over 1080 min/wk and vigorous PA in the second and third trimesters were associated with poorer mental health (AOR: 1.223–1.873). Increases over 4135.4 MET–min/wk and decreases in PA levels were associated with poorer mental and physical health (AOR: 1.070–1.333). Namely, pregnant women receiving health benefits prefer continuous walking in addition to avoiding vigorous PA and excessive changes in PA levels during pregnancy.

When Much Is Too Much-Compared to Light Exercisers, Heavy Exercisers Report More Mental Health Issues and Stress, but Less Sleep Complaints

BACKGROUND

Physical inactivity has become a global somatic and mental health issue. To counterbalance, promoting regular physical activity appears plausible, above all among adults, where physical inactivity is particularly high. However, some, but sparse, research also indicates that excessive exercising might be associated with unfavorable mental health dimensions. Here, we tested the hypothesis that excessive exercising was associated with more mental health issues. To this end, we assessed mental health issues, stress, mental toughness, and sleep disturbances among heavy and light adult exercisers.

METHODS

A total of 200 adults (mean age: 35 years; 62% females) took part in the study. Of those, 100 were heavy exercisers (18-22 h/week), and 100 were light exercisers (1-6 h/week). Participants completed questionnaires covering sociodemographic information, mental health issues, perceived stress, mental toughness, and sleep disturbances.

RESULTS

Compared with light exercisers, heavy exercisers reported higher mental health issues, more stress, but also higher mental toughness scores and less sleep disturbances. Higher age, lower mental toughness scores, heavy exerciser-status, and more sleep disturbances predicted higher mental health complaints.

CONCLUSIONS

Compared with light exercising, heavy exercising might be associated with more mental health issues. As such, it appears that the association between exercise frequency, intensity, and duration and psychological well-being might be related to an optimum point, but not to a maximum point. In a similar vein, heavily exercising athletes, their coaches, parents, and representatives of sports associations should get sensitized to possible adverse psychological effects of excessive physical activity patterns.

Protective and Risk Factors in Exercise Addiction: A Series of Moderated Mediation Analyses

For a minority of individuals, exercise may become excessive and lead to an addictive behaviour. To better understand the processes by which exercise could become an addiction, the present study examined the risk and protective factors of exercise addiction among regular exercisers, by investigating the role of drive for thinness, bulimia, body dissatisfaction, body image concerns, and self-esteem. A sample of 319 Italian regular exercisers (M_age = 30.78 years, SD = 11.98) completed the Italian versions of the Exercise Addiction Inventory, Eating Disorder Inventory-3 Referral Form, Body Image Concern Inventory, and Rosenberg Self-Esteem Scale. Data were analyzed by implementing a series of moderated mediations. Drive for thinness, bulimia, and body dissatisfaction were positively associated with exercise addiction. An indirect path was found in each of these relationships, which included the mediation of body image concerns, as well as a significant moderation of self-esteem in the associations between drive for thinness, bulimia, body dissatisfaction, and the mediator. High self-esteem appeared to be a protective factor. The higher the level of self-esteem, the less indirect the effects of thinness drive, bulimia, body dissatisfaction, and body image concerns were on exercise addiction. Such findings contribute to a better understanding concerning the risk and protective factors of excessive exercise, and may have important practical implications in structuring interventions to reduce risk of developing exercise addiction, as well as orienting future research.

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.

Examining the Relationship between Exercise Dependence, Disordered Eating, and Low Energy Availability

Both dietary and exercise behaviors need to be considered when examining underlying causes of low energy availability (LEA). The study assessed if exercise dependence is independently related to the risk of LEA with consideration of disordered eating and athlete calibre. Via survey response, female (n = 642) and male (n = 257) athletes were categorized by risk of: disordered eating, exercise dependence, disordered eating and exercise dependence, or if not presenting with disordered eating or exercise dependence as controls. Compared to female controls, the likelihood of being at risk of LEA was 2.5 times for female athletes with disordered eating and >5.5 times with combined disordered eating and exercise dependence. Male athletes with disordered eating, with or without exercise dependence, were more likely to report signs and symptoms compared to male controls-including suppression of morning erections (OR = 3.4; p < 0.0001), increased gas and bloating (OR = 4.0-5.2; p < 0.002) and were more likely to report a previous bone stress fracture (OR = 2.4; p = 0.01) and ≥22 missed training days due to overload injuries (OR = 5.7; p = 0.02). For both males and females, in the absence of disordered eating, athletes with exercise dependence were not at an increased risk of LEA or associated health outcomes. Compared to recreational athletes, female and male international caliber and male national calibre athletes were less likely to be classified with disordered eating.

Regional gray matter volume associated with exercise dependence: A voxel-based morphometry study

Although regular physical exercise has multiple positive benefits for the general population, excessive exercise may lead to exercise dependence (EXD), which is harmful to one's physical and mental health. Increasing evidence suggests that stress is a potential risk factor for the onset and development of EXD. However, little is known about the neural substrates of EXD and the underlying neuropsychological mechanism by which stress affects EXD. Herein, we investigate these issues in 86 individuals who exercise regularly by estimating their cortical gray matter volume (GMV) utilizing a voxel‐based morphometry method based on structural magnetic resonance imaging. Whole‐brain correlation analyses and prediction analyses showed negative relationships between EXD and GMV of the right orbitofrontal cortex (OFC), left subgenual cingulate gyrus (sgCG), and left inferior parietal lobe (IPL). Furthermore, mediation analyses found that the GMV of the right OFC was an important mediator between stress and EXD. Importantly, these results remained significant even when adjusting for sex, age, body mass index, family socioeconomic status, general intelligence and total intracranial volume, as well as depression and anxiety. Collectively, the results of the present study provide crucial evidence of the neuroanatomical basis of EXD and reveal a potential neuropsychological pathway in predicting EXD in which GMV mediates the relationship between stress and EXD.

Prevalence and correlates of body dysmorphic disorder in health club users in the presence vs absence of eating disorder symptomology

PURPOSE

Body dysmorphic disorder (BDD) has been consistently linked with eating disorders, however studies that stratify associations between BDD in subjects with and without eating disorder symptomology are sparse. It was, therefore, the aim of this study to assess correlates of BDD (including social media use, motivations for exercise, exercise addiction, and sexuality) stratified by eating disorder symptomology.

METHODS

Cross-sectional study of 1665 health club users recruited online completed a battery of surveys. BDD prevalence rates were calculated and logistic regression models were created in two sub-samples: indicated or no-indicated eating disorder symptomology.

RESULTS

The key findings showed the prevalence of BDD in participants with indicated-eating disorder symptomology was significantly higher than in participants without indicated-eating disorder symptomology, yielding an odds ratio of 12.23. Furthermore, several correlates were associated with BDD only participants with an absence of eating disorder symptomology (gender, BMI, exercise addiction, exercising for mood improvement, attractiveness and tone), with others being significantly associated with BDD in participants in the presence of indicated eating disorders symptomology (exercising for health and enjoyment, relationship status, and ethnicity).

CONCLUSIONS

This study provides more evidence of the complex relationship that exists between BDD and eating disorders. Furthermore, it is recommended that practitioners working with BDD subjects should screen for eating disorders due to the high morbidity associated with eating disorders.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

Too Much of a Good Thing? Exercise Dependence in Endurance Athletes: Relationships with Personal and Social Resources

(1) Background: A large body of research has examined the positive effects of physical activity on physical and mental health. However, for some, excessive exercise can develop into an addiction that is detrimental to their health. In the present study, we examine potential personal (self-control, self-concordance) and social (social support) resources that we assume to be related to exercise dependence. (2) Methods: One hundred and forty athletes from different endurance sports participated in an online survey. Exercise dependence, self-control, self-concordance, and social support were assessed using questionnaires that are well-established in health and sport psychology. Additionally, further sport-relevant and demographic variables were assessed. (3) Results: Correlational analyses supported our hypotheses that exercise dependence is negatively correlated with the personal resources trait, state self-control, and self-concordance. Social support, however, was not significantly correlated with exercise dependence. Furthermore, the results of a mediation analysis revealed that the relationship between both personal traits (self-control, self-concordance) and exercise dependence was mediated by state self-control. (4) Conclusions: Our results indicate that trait self-control and self-concordance might be important personal resources that protect against exercise dependence by making state self-control available.

A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders

BACKGROUND

Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders.

METHODS

A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders.

RESULTS

Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95% CI 2.00-6.89; I² = 81; p  ≤ 0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used.

DISCUSSION

Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples.

Prevalence of Risk for Exercise Dependence: A Systematic Review

BACKGROUND

Exercise dependence (EXD) can be considered an addictive behaviour because it presents signs typical of other addictive behaviours. Despite possible health problems related to EXD, the prevalence of risk for EXD has never been systematically reviewed.

OBJECTIVE

This article aimed to systematically review the prevalence of risk for EXD.

METHODS

Studies were identified from searches in the ERIC, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science electronic databases up to June 2018. Empirical studies were selected if (1) they included the outcomes of the prevalence of EXD; (2) participants were regular exercisers; and (3) they were published in either the English, French, Portuguese, or Spanish languages. A total of 34 articles met the inclusion criteria.

RESULTS

The prevalence of risk for EXD was estimated to be between 3 and 7% of regular exercisers and the university student population, and between 6 and 9% of the athlete population.

CONCLUSION

The results of this review indicated that the prevalence of risk for EXD varies with the characteristics of the exerciser, but an overall prevalence of 3-9% is estimated. Risk for EXD is a cause for concern and, from a public health point of view, is a problem that has to be addressed.

The therapeutic potential of exercise for neuropsychiatric diseases: A review

Exercise is known to have a myriad of health benefits. There is much to be learned from the effects of exercise and its potential for prevention, attenuation and treatment of multiple neuropsychiatric diseases and behavioral disorders. Furthermore, recent data and research on exercise benefits with respect to major health crises, such as, that of opioid and general substance use disorders, make it very important to better understand and review the mechanisms of exercise and how it could be utilized for effective treatments or adjunct treatments for these diseases. In addition, mechanisms, epigenetics and sex differences are examined and discussed in terms of future research implications.

Problem Gambling in the Fitness World-A General Population Web Survey

The world of sports has a complex association to problem gambling, and the sparse research examining problem gambling in athletes has suggested an increased prevalence and particularly high male predominance. The present study aimed to study frequency and correlates of problem gambling in populations with moderate to high involvement in fitness or physical exercise. This is a self-selective online survey focusing on addictive behaviors in physical exercise distributed by ‘fitness influencers’ on social media and other online fitness forums to their followers. Respondents were included if they reported exercise at least thrice weekly, were above 15 years of age, and provided informed consent (N = 3088). Problem gambling, measured with the Lie/Bet, was studied in association with demographic data, substance use, and mental health variables. The occurrence of lifetime problem gambling was 8 percent (12 percent in men, one percent in women). In logistic regression, problem gambling was associated with male gender, younger age, risky alcohol drinking, obsessive-compulsive disorder, and less frequent exercise habits. In conclusion, in this self-recruited population with moderate to high fitness involvement, problem gambling was moderately elevated. As shown previously in elite athletes, the male predominance was larger than in the general population. The findings strengthen the link between problem gambling and the world of sports.

Mental Recovery and Running-Related Injuries in Recreational Runners: The Moderating Role of Passion for Running

This pilot study investigates the moderating role of passion for running in the relation between mental recovery from running and running-related injuries (RRIs). We predict that the relation between recovery and injuries is dependent on the level of passion. A cross-sectional survey study was conducted among 246 Dutch recreational runners. Multivariate logistic regression analyses revealed that the negative association between mental recovery after running and RRIs is moderated (i.e., strengthened) by harmonious passion. Put differently, runners who are able to mentally recover well after running were less likely to report RRIs in the case of harmonious passion. Additionally, findings demonstrated that obsessively passionate runners were more likely to report RRIs. Passionate runners may benefit from education programs to help them integrate running more harmoniously with other aspects of life, and to prevent injuries. In addition, they should be educated about the crucial role of appropriate mental recovery from running. Considering mental aspects in running such as mental recovery from running and passion for running seems to be worthwhile to gain a better understanding of the incidence and/or prevalence of RRIs. Future (quasi-experimental) studies should investigate the issues raised here more profoundly.

Do It, Don't Feel It, and Be Invincible: A Prolog of Exercise Addiction in Endurance Sports

The social relevance of endurance sports has increased people's motivation to engage in these particular physical activities, associating their practice with a particular lifestyle (e.g., feeling victorious and a feeling of self-improvement). Therefore, the dark personality traits (not because they are negative but because they are more hidden), understood as a personal and adaptive response to the psychosocial relationships that athletes establish while practicing these sports. Following these arguments, Grit has been used to trace the response of athletes in their quest to improve performance and endurance in the face of common setbacks suffered as a result of long hours of training. Empirical studies should help to discover how these personality traits can pose real challenges to their adaptation, and what the impact of their psychological response may be in a functional or dysfunctional way [e.g., exercise addiction (EA)], in order to classify them as risk or protective factors. Through transversal design, the present study sought to explore the relationship between Grit and Dark Traits of Personality regarding the appearance of EA in a sample (N = 241) of amateur endurance sport athletes (M age = 31.80; SD = 9.87). The results show that men not only score higher for addiction levels but also for narcissism (grandiosity feelings) and psychopathy (coldness) factors. If signs of narcissism and Machiavellianism increase, perseverance efforts grow too, and the likelihood of EA increases considerably. The conclusions drawn on the basis of the results allow us to place consistency of interest as a protective factor for the EA, whereas Dark Traits of personality - especially Machiavellianism - constitute a risk factor.

Learning to lose control: A process-based account of behavioral addiction

Learning psycho(bio)logy has developed a solid corpus of evidence and theory regarding behavior control modes. The present article briefly reviews that literature and its influence on recent models in which the transition from goal-directed to compulsive behavior is identified as the main process underlying substance use disorders. This literature is also relevant to non-substance addictive disorders, and serves as basis to propose a restricted definition of behavioral addiction relying on the presence of behavior-specific compulsivity. Complementarily, we consider whether some activities can become disordered while remaining mostly goal-driven. Based on reinforcement learning models, relative outcome utility computation is proposed as an alternative mechanism through which dysfunctional behaviors (even not qualifying as addictive) can override adaptive ones, causing functional impairment. Beyond issues of conceptual delimitation, recommendations are made regarding the importance of identifying individual etiological pathways to dysregulated behavior, the necessity of accurately profiling at-risk individuals, and the potential hazards of symptom-based diagnosis. In our view, the validity of these recommendations does not depend on the position one takes in the nosological debate.

The "Journal of Functional Morphology and Kinesiology" Journal Club Series: Highlights on Recent Papers in Overtraining and Exercise Addiction

We are glad to introduce the seventeenth Journal Club. This edition is focused on several relevant studies published in the last years in the field of Overtraining and Exercise Addiction, chosen by our Editorial Board members and their colleagues. We hope to stimulate your curiosity in this field and to share with you the passion for the sport seen also from the scientific point of view. The Editorial Board members wish you an inspiring lecture.

The Associations between Mental Well-Being and Adherence to Physical Activity Guidelines in Patients with Cardiovascular Disease: Results from the Scottish Health Survey

The association between physical activity (PA) and mental well-being in individuals with a cardiovascular disease (CVD) is poorly studied. The objective of this study was to assess the association between mental well-being and adherence to the recommended guidelines for PA in a Scottish adult population with CVD. The study used data from 3128 adults who had CVD conditions (1547 men and 1581 women; mean age 63.29 years) who participated in the Scottish Health Survey between 2014 and 2017. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was used as a surrogate measure of mental health. PA was classified as "met" or "unmet" on the basis of the recommended PA guidelines (150 min of moderate activity or 75 min of vigorous activity per week). The relationship between PA guidelines being met and the WEMWBS score was explored using hierarchical linear regression accounting for a set of health and sociodemographic characteristics. Of the participants, ~41.8% met the recommended PA levels. Among those with CVD, the mean (SD) WEMWBS scores of individuals who did not have a long-standing illness (51.14 ± 7.65 vs 47.07 ± 9.54; p < 0.05), diabetes (48.44 ± 9.05 vs 46.04 ± 10.25; p < 0.05), or high blood pressure (48.63 ± 9.08 vs 47.52 ± 9.47; p < 0.05) were significantly higher than those of individuals with such conditions. Meeting PA recommendations was significantly associated with a higher mean WEMWBS score (50.64 ± 7.97 vs 46.06 ± 9.75; p < 0.05). Multiple regression analysis of health-related behaviors improved the prediction of mental well-being over and above meeting the recommended PA levels. Mental well-being was strongly correlated with PA adherence in CVD patients. It seems that for patients with CVD, PA should be tailored to meet patients' health conditions in order to promote mental well-being and improve overall health.