Psychobiological mechanisms of exercise dependence

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.

Exercise behaviour and body esteem of gym-goers in india

Exercise dependence is described as exercise which is harmful if engaged compulsively and excessively. The present study aims to investigate differences in categories of exercise behaviours and areas of body esteem in gym-goers in India across genders. The study used a cross-sectional design, and the sample consisted of 291 gym-goers (females = 146; males = 145) The Exercise Dependence Scale- 21 (EDS-21) and Body Esteem Scale-Revised (BES-R) was administered to the gym-goers in India after seeking informed consent. The obtained data were statistically analysed using descriptive statistics and multivariate analysis of variance. The results of the study indicated that there was a significant difference in the three categories of exercise behaviours and three areas of body esteem in male gym-goers. However, such similar differences were not found in female gym-goers. The differences found in body esteem for the male gym-goers in certain areas suggest how exercise has an impact on body image. For female gym-goers, we can see that irrespective of the category they belong to, there is no difference in the areas of body esteem. We can understand such findings with the sociocultural model of excessive exercise given by White and Halliwell (DOI: 10.1016/j.bodyim.2010.02.002) where perceived sociocultural pressure predicts excessive exercise, which is mediated by body image. Strengths and limitations of the study are discussed. Future research in India based on qualitative and longitudinal designs are warranted.

Naltrexone alters cardiovascular function following acute forced swimming in mice

Purpose

Naltrexone (NTX) is an opioid antagonist that can reverse the physiological effects of opioid receptors when bound. Opioid receptors have been found to play a role in cardiovascular (CV) function, and thus, binding of NTX may alter CV activity at rest and in response to acute and chronic exercise (EX). We hypothesized that opioid receptor blockade will alter the typical CV responses following acute EX.

Methods

We assessed the effects of opioid receptor blockade on CV function via echocardiography in mice following an acute bout of forced swimming (FSw), a model of rodent EX. We administered opioid receptor antagonist, NTX, or saline in mice before FSw and in the absence of an FSw perturbation. Furthermore, we assessed how NTX can influence maximal EX capacity on a rodent treadmill.

Results

Our data shows that NTX administration does not decrease maximal EX capacity in mice (P > 0.05). However, NTX attenuated cardiac output following FSw (FSw = 52.5 ± 2.5 ml/min vs. FSw + NTX = 32.7 ± 5.2 ml/min; P < 0.05) when compared with saline control (33.5 ± 3.8 ml/min). Further, the administration of NTX in the non-EX condition significantly (P < 0.05) reduced ejection fraction.

Conclusion

These data suggest that normal opioid receptor activation is necessary for typical CV function following FSw.

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.

Different Effects of the COVID-19 Pandemic on Exercise Indexes and Mood States Based on Sport Types, Exercise Dependency and Individual Characteristics

Exercise indexes have been affected by the coronavirus disease 2019 (COVID-19) pandemic and its related restrictions among athletes. In the present study, we investigated the exercise frequency and intensity before and during the COVID-19 pandemic, and also current exercise dependency and mood state among non-contact individual, contact individual, and team sports athletes. A total of 1353 athletes from non-contact individual sports athletes (NCISA), contact individual sports athletes (CISA) and team sport athletes (TSA) participated; 45.4% of them were females that completed a series of self-rating questionnaires covering sociodemographic information, former and current exercise patterns, exercise dependency and mood states. NCISA had less exercise frequency than CISA, both before and during the COVID-19 pandemic, and NCISA had less exercise frequency than TSA during the COVID-19 pandemic. Regarding exercise intensity, CISA had higher scores than NCISA and TSA before the COVID-19 pandemic, and CISA had more exercise intensity than TSA during the COVID-19 pandemic. Frequency and intensity were reduced from before to during the COVID-19 pandemic in the three groups, except for TSA intensity. In addition, positive and negative mood states were correlated with exercise dependency. CISA were more discouraged and vigorous than NCISA and TSA, respectively. For NCISA, CISA, and TSA, ordinal regressions separately showed that adherence to quarantine and exercise dependency were better predictors of exercise indexes. Finally, exercise dependency subscales were different among sports, but it was not in exercise dependency itself. Although the decrease in exercise indexes was noticeable, there was no consistent pattern of change in exercise behavior in all sports. Additionally, during the COVID-19 pandemic, negative moods were predominant among all athletes. The results discussed are based on exercise nonparticipating, sport type, and affect regulation hypothesis.

The Relationship of Self-Presentation, Psychological Needs, and Exercise Dependence in College Students With Overweight

Objectives

The objectives of the study were to explore the effect of self-presentation and psychological needs on exercise dependence and to provide an essential reference for preventing and inhibiting the production of exercise dependence in overweight college students.

Methods

The freshmen in two comprehensive universities accepted physical fitness tests, filled out the scales of self-presentation, psychological needs, and exercise dependence after obtaining their consent. A sample of 747 overweight college students who have regular exercise was screened using the formula of Fox sports participation and the standard of overweight for Chinese adults. Multiple regression, exploratory factor, and confirmatory factor analyses were used to analyze the related data.

Results

(1) In overweight college students, compared with the lower peers, those with higher physical attractiveness were more likely to suffer from detoxification of emotion, physiology, and vitality, and compared with the lower peers, those with higher self-presentation were more likely to appear in physiological abstinence. (2) The self-presentation of overweight male and female students has a significant positive influence on psychological needs (beta = 0.31, p < 0.01, and 0.37, p < 0.01, respectively, for males and females) and exercise dependence (beta = −0.21, p < 0.01, and 0.26, p < 0.01, respectively, for males and females). In contrast, psychological needs have a significant negative influence on exercise dependence (beta = −0.21, p < 0.01, and −0.26, p < 0.01, respectively, for males and females). (3) The psychological needs of overweight male and female college students were established as the mediating effect of self-presentation and exercise dependence. The mediating effect of psychological needs of females was higher than that of males (18.5 vs. 15.5%). The “ability display” of male and female students can affect “emotional distress” by “autonomy” and “competence.” The sense of relationship partially mediated the “attractiveness” of male and female students. Also, females on the one hand, rely on “weight control” by “competence” to produce some mediating effects on “physiological distress.” At the same time, the “ability display” by “competence” has a full mediating effect on “physiological distress.”

Conclusion

In the self-presentation of the overweight college students, the higher scores in “attractiveness,” “weight control,” and “ability display,” the higher the psychological needs and exercise dependence; the higher the autonomy, competence, and relationship, the less the emotional, physiological, and dynamic distress.

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.

"The addition of naltrexone alters cerebral glucose uptake following acute forced swimming"

Endogenous opioid release has been linked to exercise. We investigated if opioid blockade following forced swimming, a common model of rodent exercise, influenced cerebral glucose metabolism in mice. PET scan was used to assess the uptake of Fludeoxyglucose (FDG-18), a marker of cerebral glucose metabolism in 19 regions of the interest in the brain following: forced swimming, an acute dose of the opioid receptor blocker naltrexone or a combination of both. Forced swimming increased glucose uptake in the cerebellum, while naltrexone + forced swimming increased glucose uptake in the hypothalamus, forebrain, septum and amygdala. This suggests that opioid blockade alters the typical pattern of cerebral glucose uptake following forced swimming in mice in certain areas of the brain.

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.

The Influence of Psychological Needs and Exercise Motivation on Exercise Dependence among Chinese College Students

To explore the influence of exercise motivation and basic psychological needs on exercise dependence among Chinese college students. 1689 college students engaged in long-term exercise were selected from three universities in Hunan province in China as the objects of the survey. 1601 valid copies of the questionnaire were collected. Exercise Addiction Inventory, Motivation for Physical Activity Measure-Revised, Psychological Need Satisfaction in Exercise Scale and other questionnaires were used in the correlation analysis and structural equation model to investigate the influence of psychological needs and exercise motivation on exercise dependence among Chinese college students. Appearance motivation and ability motivation directly affect exercise dependence positively (r = 0.303, r = 0.269), while competence need directly affects exercise dependence positively (r = 0.309), and indirectly affects exercise dependence through appearance motivation and ability motivation. Appearance motivation and ability motivation directly affect exercise dependence positively; competence need not only directly affects exercise dependence but also indirectly affects it through appearance and ability.

Male Weight Trainers' Body Dissatisfaction and Exercise Dependence: Mediating Role of Muscularity Drive

In considering that body image-related perceptions may be associated with weight trainers’ exercise dependence, the purpose of this study was to examine the (a) relationship between body dissatisfaction and drive for muscularity and (b) drive for muscularity as a mediator of the body dissatisfaction–exercise dependence relationship. In sum, 278 male weight trainers ( Mage =29.03 years, SD = 7.83) residing in a southern city of Taiwan completed scales of body dissatisfaction, drive for muscularity, and exercise dependence. Pearson correlation analysis found that body dissatisfaction, drive for muscularity, and exercise dependence were all correlated. Further, the indirect mediation model with bootstrapping found that drive for muscularity partially mediated the body dissatisfaction–exercise dependence relationship (c path: β = .51, SE = 0.07, p=.001: c′ path: β = .13, SE = 0.80, p = .03). We concluded that male weight trainers’ body image-related perceptions influence exercise behavior and suggested that body image-related perceptions might be considered in studying exercise dependence.

A study on the relationship between exercise addiction, abnormal eating attitudes, anxiety and depression among athletes in Israel

BACKGROUND AND AIMS

The aim of this study was to investigate the relationship between exercise addiction, abnormal eating attitudes, anxiety, and depression among competitive and amateur athletes.

METHODS

Participants were 100 athletes of mean age 28.3 years (18-62), of which there were 67 males and 35 females. The sample consisted of competitive and amateur athletes who participated in individual and group sports. They filled in the Exercise Addiction Inventory, Body Shape Questionnaire, a questionnaire assessing Eating Attitudes Test, Spielberger State-Trait Anxiety Inventory, and Beck Depression Inventory (BDI).

RESULTS

Ratings of exercise addiction were positively correlated with BDI scores across the study sample. Exercise addiction ratings were associated with abnormal eating attitudes, but not with trait or state anxiety. Athletes engaging in individual sports scored marginally higher on depression scores than group athletes but there was no difference in depression scores between competitive and amateur athletes. Multiple regression analysis revealed that abnormal eating attitudes contributed significantly to ratings of exercise addiction and explained 7.7% of the variance. According to the Sobel test, the difference in the association between exercise addiction and eating disorder was significant. Therefore, body shape was a mediating factor between eating disorder and exercise addiction.

DISCUSSION AND CONCLUSIONS

This study extends our preliminary findings of an association between exercise addiction and depression. Second, abnormal eating attitudes may explain most of the variance of exercise addiction. This is a further support for previous evidence of comorbidity between exercise addiction and eating disorders.

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.

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.

Exercise deprivation increases negative mood in exercise-addicted subjects and modifies their biochemical markers

The aim of this study was to identify the possible association between biochemical markers of exercise addiction and affective parameters in a sample of athletes during 2weeks of withdrawal exercise. Eighteen male runners were distributed into a control group (n=10) composed of runners without exercise addiction symptoms and an exercise addiction group (n=8) composed of runners with exercise addiction symptoms. The volunteers performed a baseline evaluation that included affective questionnaires, blood samples, body composition and an aerobic test performed at ventilatory threshold I. After the baseline evaluation, the groups started an exercise withdrawal period that was sustained for 2weeks. During exercise withdrawal, an actigraph accelerometer was used to monitor the movement index, and CK and LDH were measured in blood samples to validate the non-exercise practice. At the end of the exercise withdrawal period, a blood collection, aerobic test and mood scale was performed in the re-test. The results showed that at the end of the experimental protocol, when compared with the control group, the exercise addiction group showed an increase in depression, confusion, anger, fatigue and decreased vigor mood that improved post-exercise, along with low levels of anandamide at all time-points evaluated and a modest increase in β-endorphin post-exercise. Moreover, the exercise addiction group showed a decrease in oxygen consumption and respiratory exchange ratio after the exercise withdrawal period, which characterized a detraining phenomenon. Our data suggest that a 2-week withdrawal exercise period resulted in an increase of negative mood in exercise addiction; additionally, exercise addiction showed low levels of anandamide.

Motivational and psychological correlates of bodybuilding dependence

BACKGROUND AND AIMS

Exercise may become physically and psychologically maladaptive if taken to extremes. One example is the dependence reported by some individuals who engage in weight training. The current study explored potential psychological, motivational, emotional and behavioural concomitants of bodybuilding dependence, with a particular focus on motives for weight training. Using a path analysis paradigm, putative causal models sought to explain associations among key study variables.

METHODS

A convenience sample of 101 men aged between 18 and 67 years was assembled from gymnasia in Adelaide, South Australia. Active weight trainers voluntarily completed a questionnaire that included measures of bodybuilding dependence (social dependency, training dependency, and mastery), anger, hostility and aggression, stress and motivations for weight training.

RESULTS

Three motives for weight training were identified: mood control, physique anxiety and personal challenge. Of these, personal challenge and mood control were the most directly salient to dependence. Social dependency was particularly relevant to personal challenge, whereas training dependency was associated with both personal challenge and mood control. Mastery demonstrated a direct link with physique anxiety, thus reflecting a unique component of exercise dependence.

CONCLUSIONS

While it was not possible to determine causality with the available data, the joint roles of variables that influence, or are influenced by, bodybuilding dependence are identified. RESULTS highlight unique motivations for bodybuilding and suggest that dependence could be a result of, and way of coping with, stress manifesting as aggression. A potential framework for future research is provided through the demonstration of plausible causal linkages among these variables.

Crawling to the finish line: why do endurance runners collapse? Implications for understanding of mechanisms underlying pacing and fatigue

Effective regulation of pace enables the majority of runners to complete competitive endurance events without mishap. However, some runners do experience exercise-induced collapse associated with postural hypotension, which in rare cases results from life-threatening conditions such as cardiac disorders, cerebral events, heat stroke and hyponatraemia. Despite the experience of either catastrophic system failure or extreme peripheral muscle fatigue, some runners persist in attempting to reach the finish line, and this often results in a sequence of dynamic changes in posture and gait that we have termed the 'Foster collapse positions'. The initial stage involves an unstable gait and the runner assumes the 'Early Foster' collapse position with hips slightly flexed and their head lowered. This unstable gait further degrades into a shuffle referred to as the 'Half Foster' collapse position characterized by hip flexion of approximately 90° with the trunk and head parallel to the ground. At this point, the muscles of postural support and the co-ordination of propulsion begin to be compromised. If the condition worsens, the runner will fall to the ground and assume the 'Full Foster' collapse position, which involves crawling forwards on knees and elbows towards the finish line, with their trunk angled such that the head is at a lower angle than the hips. Upon reaching the finish line, or sometimes before that, the runner may collapse and remain prone until recovering either with or without assistance or medical treatment. The Foster collapse positions are indicative of a final, likely primordial, protective mechanism designed to attenuate postural hypotension, cardiac 'pump' insufficiency or cerebral blood flow deficiency. Continuing to attempt to reach the finish line in this impaired state is also perhaps indicative of a high psychological drive or a variety of neurological and psychological pathologies such as diminished sensitivity to interoceptive feedback, unrealistic situational appraisal or extreme motivational drives. A better understanding of the physiological, neurological and psychological antecedents of the Foster collapse sequence remains an important issue with practical implications for runner safety and theoretical understanding of collapses during exercise.

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.

The role of age, gender, mood states and exercise frequency on exercise dependence

OBJECTIVES

The purpose of our study was to explore the prevalence, and the role of mood, exercise frequency, age, and gender differences of exercise dependence.

METHODS

Regular exercisers (N = 409) completed a socio-demographic questionnaire, the Exercise Dependence Scale, and the Profile of Mood States. For data analyses, the participants were stratified for sex and age (age ranges = young adults: 18-24 years, adults: 25-44 years, and middle-aged adults: 45-64 years).

RESULTS

We found that: (a) 4.4% of the participants were classified as at-risk for exercise dependence; (b) the men and the two younger groups (i.e., young adults and adults) had higher exercise dependence scores; and (c) age, gender, exercise frequency, and mood state were related to exercise dependence.

CONCLUSIONS

Our results support previous research on the prevalence of exercise dependence and reveal that adulthood may be the critical age for developing exercise dependence. These findings have practical implication for identifying individuals at-risk for exercise dependence symptoms, and may aid in targeting and guiding the implementation of prevention program for adults.

The psychological benefits of recreational running: a field study

Running yields positive changes in affect, but the external validity of controlled studies has received little attention in the literature. In this inquiry, 50 recreational runners completed the Exercise-Induced Feeling Inventory (Gauvin & Rejeskí, 1993) before and after a bout of self-planned running on an urban running path. Positive changes were seen in all four measures of affect (p < .001). Multivariate regressions were performed to examine the contribution of four exercise characteristics (i.e., duration of the current run, weekly running time, weekly running distance, and running experience) to the observed changes in affect. The results have revealed that exercise characteristics accounted for only 14-30% of the variance in the recreational runners' affect, in both directions. It is concluded that psychological benefits of recreational running may be linked to placebo (conditioning and/or expectancy) effects.

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.

Does food addiction exist? A phenomenological discussion based on the psychiatric classification of substance-related disorders and addiction

The relationship between overeating, substance abuse and (behavioral) addiction is controversial. Medically established forms of addiction so far pertain to substance use disorders only. But the preliminary Diagnostic and Statistical Manual for Mental Disorders V (DSM V) suggests replacing the previous category 'Substance-Related Disorders' with 'Addiction and Related Disorders', thus for the first time allowing the diagnosis of behavioral addictions. In the past psychiatrists and psychologists have been reluctant to systematically delineate and classify the term behavioral addiction. However, there is a broad overlap between chemical and behavioral addiction including phenomenological, therapeutic, genetic, and neurobiological aspects. It is of interest to point out that the hormone leptin in itself has a pronounced effect on the reward system, thus suggesting an indirect link between overeating and 'chemical' addiction. Thus, leptin-deficient individuals could be classified as fulfilling criteria for food addiction. In our overview we first review psychological findings in chemical (substance-based) and subsequently in behavioral addiction to analyze the overlap. We discuss the diagnostic validity of food addiction, which in theory can be chemically and/or behaviorally based.

Development and validation of the appearance and performance enhancing drug use schedule

Appearance-and-performance enhancing drug (APED) use is a form of drug use that includes use of a wide range of substances such as anabolic-androgenic steroids (AASs) and associated behaviors including intense exercise and dietary control. To date, there are no reliable or valid measures of the core features of APED use. The present study describes the development and psychometric evaluation of the Appearance and Performance Enhancing Drug Use Schedule (APEDUS) which is a semi-structured interview designed to assess the spectrum of drug use and related features of APED use. Eighty-five current APED using men and women (having used an illicit APED in the past year and planning to use an illicit APED in the future) completed the APEDUS and measures of convergent and divergent validity. Inter-rater agreement, scale reliability, one-week test-retest reliability, convergent and divergent validity, and construct validity were evaluated for each of the APEDUS scales. The APEDUS is a modular interview with 10 sections designed to assess the core drug and non-drug phenomena associated with APED use. All scales and individual items demonstrated high inter-rater agreement and reliability. Individual scales significantly correlated with convergent measures (DSM-IV diagnoses, aggression, impulsivity, eating disorder pathology) and were uncorrelated with a measure of social desirability. APEDUS subscale scores were also accurate measures of AAS dependence. The APEDUS is a reliable and valid measure of APED phenomena and an accurate measure of the core pathology associated with APED use. Issues with assessing APED use are considered and future research is considered.

Exercise dependence score in patients with longstanding eating disorders and controls: the importance of affect regulation and physical activity intensity

OBJECTIVE

To examine associations among exercise dependence score, amount of physical activity and eating disorder (ED) symptoms in patients with longstanding ED and non-clinical controls.

METHODS

Adult female inpatients (n = 59) and 53 age-matched controls participated in this cross sectional study. Assessments included the eating disorders examination, eating disorders inventory, exercise dependence scale, reasons for exercise inventory, and MTI Actigraph accelerometer.

RESULTS

Positive associations were found among vigorous, not moderate, physical activity, exercise dependence score and ED symptoms in patients. In the controls, ED symptoms were negatively associated with vigorous physical activity and not correlated with exercise dependence score. Exercise for negative affect regulation, not weight/appearance, and amount of vigorous physical activity were explanatory variables for exercise dependence score in both groups.

CONCLUSIONS

The positive associations among exercise dependence score, vigorous physical activity and ED symptoms need proper attention in the treatment of longstanding ED.

Compulsive exercise and eating disorders

The aim of this review was to develop an empirically supported cognitive behavioural model of compulsive exercise within the context of the eating disorders. A systematic review of the correlates and predictors of compulsive exercise among eating disordered patients identified four key correlates. These were subsequently validated by a second review, incorporating both the clinical and non-clinical as well as the exercise science literatures. A proposed model is presented which is both evidence-based and testable.

The diagnostic dilemma of pathological appearance and performance enhancing drug use

Appearance and performance enhancing drug (APED) use includes the use of a range of pharmacologically distinct substances and concurrent investment in outward appearance or achievement, dietary control, and frequent exercise. A number of existing reviews and conceptual papers have defined pathological forms of APED use within the APED class of anabolic-androgenic steroids (AASs) and using the framework of AAS dependence. We review published data on APED use including human studies of AAS users and identified three defining phenomenological features associated with increased health risk and pathology. These features included (1) polypharmacy or the concurrent use of several pharmacologically distinct substances used to change outward appearance or increase likelihood of personal achievement; (2) significant body image disturbance; (3) rigid practices and preoccupations with diet and exercise. Investigations into the latent structure of APED use suggest these features cluster together in a homogenous group of APED users who have the highest health risk and most psychopathology. These features are discussed in the context of AAS dependence and problems with defining classic tolerance-withdrawal symptoms among APED users. Suggestions for a resolution and outline for future research needed to determine the best system for identifying and diagnosing pathological APED use are discussed.

Influence of physical exercise on neuroimmunological functioning and health: aging and stress

Chronic and acute stress, with associated pathophysiology, are implicated in a variety of disease states, with neuroimmunological dysregulation and inflammation as major hazards to health and functional sufficiency. Psychosocial stress and negative affect are linked to elevations in several inflammatory biomarkers. Immunosenescence, the deterioration of immune competence observed in the aged aspect of the life span, linked to a dramatic rise in morbidity and susceptibility to diseases with fatal outcomes, alters neuroimmunological function and is particularly marked in the neurodegenerative disorders, e.g., Parkinson's disease and diabetes. Physical exercise diminishes inflammation and elevates agents and factors involved in immunomodulatory function. Both the alleviatory effects of life-long physical activity upon multiple cancer forms and the palliative effects of physical activity for individuals afflicted by cancer offer advantages in health intervention. Chronic conditions of stress and affective dysregulation are associated with neuroimmunological insufficiency and inflammation, contributing to health risk and mortality. Physical exercise regimes have induced manifest anti-inflammatory benefits, mediated possibly by brain-derived neurotrophic factor. The epidemic proportions of metabolic disorders, obesity, and diabetes demand attention; several variants of exercise regimes have been found repeatedly to induce both prevention and improvement under both laboratory and clinical conditions. Physical exercise offers a unique non-pharmacologic intervention incorporating multiple activity regimes, e.g., endurance versus resistance exercise that may be adapted to conform to the particular demands of diagnosis, intervention and prognosis inherent to the staging of autoimmune disorders and related conditions.

Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder

Aerobic exercise can acutely influence anxious and depressive mood in both clinical and nonclinical populations. However, there are no existing studies that have examined the acute effect of exercise on mood, anxiety, obsessions, and compulsions in patients with OCD. The primary aim of this study was to examine acute changes in these symptoms after engaging in single exercise sessions during a 12-week exercise intervention for 15 (53% female; mean age=41.9 years) patients with OCD. Participants reported reductions in negative mood, anxiety, and OCD symptoms at the end of each exercise session relative to the beginning. Changes in the magnitude of the effect of exercise in reducing negative mood and anxiety remained fairly stable while levels of self-reported obsessions and compulsions decreased over the duration of the intervention. Results of this study point toward the promising effect of exercise for acute symptom reduction in patients with OCD.