The impact of the COVID-19 pandemic on the mood and family relationships of runners

Introduction

The aim of this study was to analyze the impact of the COVID-19 lockdown on the mood of amateur runners and on their relationships with their partners and families.

Methods

Adult runners 18 years or older (N = 260) completed an online survey that included demographic information, standardized psychological assessments of Exercise Dependence (EDS-R) and mood (POMS), and, to measure relationship functioning, either the Dyadic Adjustment Scale (DAS) if they did not have children, or the Basic Family Evaluation Questionnaire (CERFB), measuring conjugal and parental relationships. Participants also answered questions about their exercise habits and the coping strategies they adopted during lockdown.

Results

The results suggest that runners who saw the largest reductions in time spent exercising during lockdown tended to feel significantly less energetic (p < 0.05) and friendly (p < 0.01). In addition, they recorded significantly lower scores in marital satisfaction with their peers (p < 0.05). The runners with a higher degree of dependence on physical exercise registered significantly higher levels of depression, tension and anger than non-dependent runners (p < 0.001). Runners whose partners were physically active and did not have children had significantly higher scores marital satisfaction than runners whose partners were not physically active and had children (p < 0.05).

Discussion

These findings seem to indicate that the psychological approach to athletes in the context of crises such as the pandemic should consider not only individual aspects, but also include the family perspective.

Is Problematic Physical Activity (PPA) a Uni- or Multi-Dimensional Concept? A Bifactor Analysis of the Exercise Dependence Scale-Revised (EDS-R)

The study of exercise dependence, or as we prefer, problematic physical activity (PPA), faces both theoretical and methodological challenges. Different factorial solutions were obtained for the widely used Exercise Dependence Scale-Revised (EDS-R), leading us to question both its latent underlying construct and the interpretation of its factor solutions. Through confirmatory factor analysis (CFA) and the use of a bifactor model (BCFA), we assessed the dimensionality of a French version of the EDS-R. We recruited 745 students from Paris Nanterre University, but we removed 88 responses (16.8%) to retain only those who (a) engaged in a moderate to high levels of physical activity, according to the Global Physical Activity Questionnaire (GPAQ; N = 494; 9.5%), and (b) completed the EDS-R. We used a final sample of 435 students (58.4% of the total population) for a factorial analysis of the EDS-R. We conducted a three-step CFA in Mplus, producing three models: (a) unidimensional, (b) second-order, and (c) bi-factor (BCFA). The results of the BCFA indicated that most EDS-R items were better indicators of a general factor than their respective group factors, except for the second factor measuring a withdrawal construct. These results add to an ongoing debate in the field of behavioral addiction as to how to better conceptualize and measure exercise dependence or PPA. Withdrawal appears to have a special position in this debate, since our BCFA suggested that it is the only specific sub-dimension of the EDS-R scale.

Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report

OBJECTIVE

Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and cost-effective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin.

METHOD

We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n = 42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points.

RESULTS

We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain.

DISCUSSION

Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings.

PUBLIC SIGNIFICANCE

Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological markers of the inflexible thinking style thought to be characteristic of anorexia nervosa and exercise dependence.

Understanding the influence of irrational beliefs and body image inflexibility on exercise dependence and psychological well-being: A latent profile analysis approach

Irrational beliefs are a risk factor for mental ill-health and exercise dependence. In addition to this, researchers have also proposed that body image inflexibility can determine mental health and behavioural outcomes. However, research is yet to explore whether and to what extent irrational beliefs and body image inflexibility align to influence mental health and exercise dependence. We examined the latent profile structure of irrational beliefs and body image inflexibility, and how these latent profiles relate to mental health and exercise dependence in exercise active adults. Results indicate a two class profile, whereby class 1 is characterized by high irrational beliefs and body image inflexibility, and class 2 is characterized by low irrational beliefs and body image inflexibility. Those in class 1 reported significantly greater depression, anxiety, stress, and exercise dependence than those in class 2 (p ≤ .02). The findings are discussed in relation to the implications for practitioners in the mental health of exercise participants.

Is (Disordered) Social Networking Sites Usage a Risk Factor for Dysfunctional Eating and Exercise Behavior?

BACKGROUND

Research over the past years has shown that exposure to thin and beauty ideals in the media can be associated with disordered eating and related variables. Nowadays, interactive media, such as social networking sites, have gained growing popularity and represent a major part of people's lives. It is therefore crucial to investigate how far users might be negatively influenced by social networking sites regarding eating pathology or excessive exercise behavior and if there are particular links to social media use disorder.

METHODS

Data were collected by an online-survey encompassing questions on regular social networking site use, eating disorders, and excessive exercise behavior.

RESULTS

Analyses showed that disordered social networking sites use was significantly related to eating pathology and a poorer body image in men and women. The frequency of active or passive social networking sites usage however was not associated with exercise behavior.

CONCLUSIONS

Our results confirm that disordered social networking sites use represents a risk factor for body image dissatisfaction and associated eating disorders.

Exercise addiction: A narrative overview of research issues

This narrative overview summarises the work on exercise addiction (EA) over the past 12 years and exposes critical conceptual and methodological issues. More than 1000 articles exist on EA, conceptualised as uncontrolled training harming the individual. Still, EA has no clinical diagnosis criteria at this time. Research is increasing continuously, but it is stale in advancing knowledge. Scalar measurement and lack of differentiation between addictive and instrumental exercise could be reasons for insufficient progress. Exercise addiction fits in the framework of behavioural addictions, but excessive exercise patterns also co-occur with other morbidities, including eating or body-image disorders. In these cases, exercise is instrumental; it functions to achieve a non-exercise-related goal. Therefore, it is essential to separate primary from secondary EA. Based on the interactional model, significant stress and capacity-exceeding ambitions fuel primary EA, while chief motives behind secondary EA embed body image dissatisfaction and eating disorders. Few reports exist on EA's brain mechanisms, which could delay its classification as a distinct psychiatric dysfunction. Treatment of EA involves cognitive-behavioural approaches, but we know little about their effectiveness. Conceptually focussed psychophysiological research and in-depth interviews, complementing scalar data, could answer several open questions in this widely studied but relatively stagnant scholastic field.

Dispositional mindfulness and its relationship to exercise motivation and experience

Mindfulness is the psychological state of staying attuned to the present moment, without ruminating on past or future events, and allowing thoughts, feelings, or sensations to arise without judgment or attachment. Previous work has shown that heightened dispositional mindfulness is associated with the awareness of the importance of exercise, exercise self-efficacy, exercise motivation, and self-reported exercise level. However, more methodologically rigorous studies are needed to understand the relationship between mindfulness and the psychological mechanisms related to exercise motivation, including the identification of why individuals are motivated to engage in exercise, the subjective experience of exercise, and the propensity for exercise dependence and addiction. In this cross-sectional investigation, we utilized the framework of the Self-Determination Theory to examine the hypothesis that heightened dispositional mindfulness (as measured by the Mindful Attention Awareness Scale) would be associated with increased levels of exercise motivation that were derived by higher levels of autonomous self-regulation. Individuals were recruited from urban areas who self-reported either low (exercising 2 or fewer times per week for 20 min or less; n = 78) or moderate (exercising 1 or 2 times per week for 20 min or more; n = 127) levels of exercise engagement. As hypothesized, heightened dispositional mindfulness was significantly associated with heightened levels of exercise self-determination as measured by the Behavioral Regulations in Exercise Questionnaire, with this effect being driven by negative associations with amotivation, external regulation, and introjected regulation. Additionally, we found that heightened dispositional mindfulness was associated with lower levels of psychological distress upon exercise and decreased exercise dependence/addiction. Overall, increased dispositional mindfulness may support a healthy relationship with exercise. These findings have implications for the utility of mindfulness interventions to support the regulation of exercise behaviors in service of enhancing exercise motivation and engagement.

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.

Exercise Dependence and Anxiety in Cross-Trainers, Bodybuilders and Gym Exercisers During COVID19

The World Health Organization declared the COVID-19 pandemic an international public health emergency in January 2020, and, soon thereafter, a worldwide adoption of quarantine and physical isolation measures restricted regular practitioners of indoor group physical exercise from many of their usual practices. Some, with exercise dependence (ED), may have experienced exercise withdrawal symptoms that triggered unhealthy anxiety levels. In February 2021, during Portugal’s second COVID-19 lockdown, we characterized and compared ED and anxiety levels among different groups of indoor exercise practitioners (cross trainers [CG], bodybuilders [BG] and gym practitioners [GG]). In this cross-sectional study, we recruited 234 adult participants through the internet. To assess participants’ ED and anxiety levels, we used Portuguese versions of the ED Scale-21 (EDS-21) and the State-Trait Anxiety Inventory (STAI-State; STAI-Trait). ED symptoms were evident in all participant subgroups, and we found no gender differences in ED. Anxiety was higher among women than men in CG and GG groups, and there were significant differences in ED between groups such that BG practitioners showed higher ED than GG and CG practitioners (small effect size). Bodybuilders reported most ED behavior, followed by CG and regular gym exercisers, but on some criteria BG and CG groups had similar ED levels. Our results are in line with prior ED prevalence reports conducted before COVID-19 restrictions among regular GG, but these are the first data to report a higher ED prevalence among BG and CG, relative to GG.

Examining the reliability of the scores of self-report instruments assessing problematic exercise: A systematic review and meta-analysis

Background and aims

Problematic exercise (PE) has mainly been assessed with self-report instruments. However, summarized evidence on the reliability of the scores derived from such instruments has yet to be provided. The present study reports a reliability generalization meta-analysis of six well-known self-report measures of PE (Commitment to Exercise Scale, Compulsive Exercise Test, Exercise Addiction Inventory, Exercise Dependence Questionnaire, Exercise Dependence Scale, and Obligatory Exercise Questionnaire).

Methods

Pooled effect sizes were computed using a random-effect model employing a restricted maximum likelihood estimation method. Univariable and multivariable meta-regressions analyses were employed for testing moderator variables.

Results

Data retrieved from 255 studies (741 independent samples, N = 254,174) identified three main groups of findings: (i) pooled alpha values that, ranging from 0.768 to 0.930 for global scores and from 0.615 to 0.907 for subscale scores, were found to be sensitive to sociodemographic and methodological characteristics; (ii) reliability induction rates of 47.58%; and (iii) the virtually non-existent testing of the assumptions required for the proper applicability of alpha. Data unavailability prevented the provision of summarized reliability estimates in terms of temporal stability.

Discussion

These findings highlight the need to improve reliability reporting of the scores of self-reported instruments of PE in primary studies. This implies providing both prior justification for the appropriateness of the index employed and reliability data for all the subpopulation of interest. The values presented could be used as a reference both for comparisons with those obtained in future primary studies and for correcting measurement-related artefacts in quantitative meta-analytic research concerning PE.

Benefits, Risks and Gender Differences in Sport, and Exercise Dependence: Key Role of Alexithymia

The literature has long highlighted the benefits of sport, but too much sport could indicate a dependence without a substance, namely exercise dependence. The literature has only recently investigated this issue and therefore several questions are open, particularly with regard to psychopathological significance and gender differences. The aim of this paper is to investigate whether young subjects (M = 20 years) with a risk of exercise dependency and non-dependent symptomatic display other behavioural and psychological suffering and discomforts, or whether such an investment in physical activity is compatible with a framework of relative well-being; and if there are differences related to gender. A total of 396 subjects were involved in this study. Exercise Dependence Scale, Toronto Alexithymia Scale, Subjective Happiness Scale, Satisfaction with Life Scale and an ad hoc questionnaire with information relating to the consumption of alcohol, soft and hard drugs, quality of sleep and nutrition, affective and friendship relationships, hobbies, presence of psychological or physical disorders, motivations for sporting activity, and any traumatic experiences were used. With regard to the Exercise Dependence Scale (EDS), the prevalence of subjects at risk of exercise dependence was 1.5% and that of non-dependents symptomatic was 31.3%. Considering only men, the percentage of subjects at risk of exercise dependence rose to 3% and that of non-dependents symptomatic to 47.9%. Our data support the hypothesis that the risk of exercise dependence and the symptomatic condition without dependence can occur in situations of relative well-being (happiness, satisfaction, relationships) without significant associations with other problematic behaviours. Modest consumption of soft drugs is reported in non-dependent symptomatic subjects. The hypothesis of increased levels of alexithymia is confirmed but limited to the male gender. Gender differences are confirmed in the frequency and motivation to practice sport and in the risk of dependence. It is important that the assessment of addiction risk is integrated with the assessment of alexithymia and personal and social resources over time.

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.

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.

Associations between Self-Esteem, Psychological Stress, and the Risk of Exercise Dependence

Body concerns and stress-related disorders are increasing in the younger population in a wide range of nations. Studies find links between both self-worth, exercise dependence, and self-esteem in relation to stress, but few have considered all three variables in relation to one another. The present study explored whether the co-appearance of high levels of psychological distress, and low levels of self-esteem may be a vulnerability factor for developing exercise dependence by studying the links between self-esteem, psychological stress, and exercise dependence. A standardized cross-sectional questionnaire was completed by 203 regular exercisers attending two gyms (mean age: 35.9 years). The variables self-esteem, psychological distress, and exercise dependence were all significantly correlated with each other, even after weekly exercise amount, age, and gender had been accounted for. Those who exercised for more than 9 h per week had a significantly higher score on stress and exercise dependence symptoms, and a lower score on self-esteem compared with the remaining groups. One could hypothesize that low self-esteem is a vulnerability factor and high psychological stress a maintenance factor for an exercise-dependent person. It is argued that more focus should be directed toward the negative consequences of excessive exercise.

Theoretical conceptualisations of problematic exercise in psychometric assessment instruments: A systematic review

BACKGROUND AND AIMS

The aim of the present systematic review was to identify psychometric tools developed to assess problematic exercise in order to identify and compare their theoretical conceptualisations on which they are based.

METHODS

A systematic literature search was conducted in the electronic databases Web of Science, Scielo, PsychINFO, PsycTEST and SCOPUS from their inception to January 2020.

RESULTS

Seventeen assessment instruments met the eligibility criteria to be included in the present review. The instruments were classified according to their conceptualisation into five groups: (i) problematic exercise as an end of an exercise continuum, (ii) problematic exercise as a means of regulating body size and weight, (iii) problematic exercise as dependence, (iv) problematic exercise as a behavioural addiction and (v) no clear conceptualisation.

DISCUSSION

The results suggest that the conceptualisations of the assessment instruments have resulted in a strong dichotomy in relation to the primary or secondary character of the problematic exercise that might be limiting the capacity of the instruments to adequately capture the multidimensionality of this construct.

CONCLUSIONS

Given the interest in understanding the complexity surrounding the problematic exercise, future research should develop more comprehensive definitions of this construct. This would allow a greater conceptual consensus to be reached that would allow progress to be made in the study of the problematic exercise.

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.

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.

Body and appearance-related self-conscious emotions and exercise addiction in Brazilian adolescents: A person-centred study

The present study aimed to identify profiles of adolescents based upon body and appearance-related self-conscious emotions, and to examine whether these profiles differed from each other in terms of their exercise addiction (EA) symptoms. A sample of 703 Brazilian adolescents (41% girls) completed a self-report questionnaire. The results from a two-step cluster analysis identified four profiles: prideful (19.5%), low self-consciousness (31.7%), moderately high self-consciousness (29.2%), and shameful-guilty (19.6%). The prideful profile was characterized by a greater presence of boys, as well as by higher frequency/intensity levels of exercise than the remaining groups. The shameful-guilty profile was characterized by a greater presence of girls and by higher levels of BMI compared to the remaining groups. Regarding EA symptoms, the results from the ANCOVA/MANCOVA analyses revealed that the prideful profile showed (i) higher salience and tolerance levels than the low-level balanced self-consciousness profile, and (ii) higher salience and lower conflict compared to the shameful-guilty profile. Additionally, the moderately high self-consciousness profile showed (i) higher salience and tolerance levels than the low self-consciousness profile, and (ii) higher salience levels than the shameful-guilty profile. Identifying subgroups on the basis of body appearance-related self-conscious emotions contributes to explaining different EA symptoms in adolescents.

A Systematic Review and Meta-Analysis on the Relationship between Body Dissatisfaction and Morbid Exercise Behaviour

Background: The present study aimed to quantify the relationship between body dissatisfaction and morbid exercise behaviour (MEB). Methods: The electronic databases MEDLINE, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global were searched from inception to September 2020. Pooled effect sizes corrected for sampling errors (r⁺) were computed using a bare-bones meta-analysis. The robustness of the results was examined by influence analyses. The presence of moderators was examined by inspection of the variance in r⁺ attributable to sampling errors and 80% credibility intervals, followed by subgroup analysis and univariable/multivariable meta-regressions. Publication bias was examined by visual inspection of funnel plot symmetry, cumulative meta-analysis, and Egger’s test. Results: A total of 41 effect sizes from 33 studies (n = 8747) were retrieved. Results showed a significant and near to moderate effect size (r⁺ = 0.267, 95% CI = 0.226 to 0.307), and this did not differ by gender, BMI, age, percentage of Whites, study quality, or MEB measure. Conversely, effect sizes were found to be stronger in published and more recently conducted studies. Conclusion: The findings indicate that body dissatisfaction is one of the likely causes underlying MEB. This suggests the need for further longitudinal research aimed at confirming the potential causal nature of this relationship.

Mental Disorders in Individuals With Exercise Addiction-A Cross-Sectional Study

Background and Aims: Exercise addiction has not yet been designated as an addictive disorder in the DSM-5 due to a lack of detailed research. In particular, associations with other psychiatric diagnoses have received little attention. In this study, individuals with a possible exercise addiction are clinically assessed, in order to establish a profile of co-occurring psychiatric disorders in individuals with exercise addiction. Methods: One hundred and fifty-six individuals who reported exercising more than 10 h a week, and continued to do so despite illness or injury, were recruited for the study. Those who met the cut-off of the Exercise Dependence Scale (n = 32) were invited to participate in a screening with the Structured Clinical Interview for DSM-5 (SCID-5-CV) and personality disorders (SCID-5-PD). Additionally, an interview based on the DSM-5 criteria of non-substance-related addictive disorders was conducted to explore the severity of exercise addiction symptoms. Results: 75% of participants fulfilled the criteria for at least one psychiatric disorder. Depressive disorders (56.3%), personality disorders (46.9%) and obsessive-compulsive disorders (31.3%) were the most common disorders. Moreover, there was a significant positive correlation between the number of psychiatric disorders and the severity of exercise addiction (r = 0.549, p = 0.002). Discussion: The results showed a variety of mental disorders in individuals with exercise addiction and a correlation between the co-occurrence of mental disorders and the severity of exercise addiction. Exercise addiction differs from other addictive und substance use disorders, as obsessive-compulsive (Cluster C), rather than impulsive (Cluster B) personality traits were most commonly identified. Conclusions: Our results underscore the importance of clinical diagnostics, and indicate that treatment options for individuals with exercise addiction are required. However, the natural history and specific challenges of exercise addiction must be studied in more detail.

Binge Eating and Addictive-Like Behaviours in Males and Females

INTRODUCTION

Binge eating is a common behaviour that is strongly linked to both obesity and eating disorder. There is evidence that binge eating commonly co-occurs with other problematic and addictive-like behaviours; however, this has not been explored systematically. The present study aimed to examine the relationship between binge eating, body weight, disordered eating behaviours and associated addictive-like behaviours, with particular attention paid to gender differences.

METHOD

A community sample (N = 500; 75% female, M_age = 32.5 years) reported disordered eating behaviours (i.e. binge eating, purging, restriction of eating, compulsive exercise), body mass index (BMI), food addiction, starvation addiction, exercise dependence, tobacco use and alcohol consumption.

RESULTS

42% of females and 21% of males reported binge eating during the past four weeks. Binge eating was significantly associated with all investigated behaviours in females, and with purging, compulsive exercise and overweight/obesity in males. Controlling for BMI, self-starvation predicted binge eating in males (OR = 1.07), while food addiction (OR = 1.73) and alcohol dependence (OR = 1.11) predicted binge eating in females.

CONCLUSIONS

The multiple associations between binge eating and addictive-like behaviors supports broad screening and generalized prevention efforts. Prevention efforts should reflect gender differences.

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.

Morbid exercise behaviour and eating disorders: A meta-analysis

BACKGROUND AND AIMS

This study examined the relationship between self-reported symptoms of morbid exercise behaviour (MEB) and eating disorders (ED) using meta-analytic techniques.

METHODS

We systematically searched MEDLINE, PsycINFO, Web of Science, SciELO and Scopus. Random effects models were used to compute pooled effect sizes estimates (r). The robustness of the summarized estimates was examined through sensitivity analyses by removing studies one at a time.

RESULTS

Sixty-six studies comprising 135 effect-sizes (N = 21,816) were included. The results revealed: (a) small-sized relationship in the case of bulimic symptoms (r = 0.19), (b) small- (r = 0.28) to medium-sized relationships (r = 0.41) in the case of body/eating concerns, and (c) medium-sized relationships in the case of overall ED symptoms (r = 0.35) and dietary restraint (r = 0.42). Larger effect sizes were observed in the case of overall ED symptoms in clinical, younger, and thinner populations, as well as when employing a continuously-scored instrument for assessing ED or the Compulsive Exercise Test for assessing MEB. Larger effect sizes were also found in female samples when the ED outcome was dietary restraint.

CONCLUSIONS

The identified gaps in the literature suggest that future research on the topic may benefit from: (a) considering a range of clinical (in terms of diagnosed ED) and non-clinical populations from diverse exercise modalities, (b) addressing a wide range of ED symptomatology, and (c) employing longitudinal designs that clarify the temporal direction of the relationship under consideration.

Fitness-Related Self-Conscious Emotions and Risk for Exercise Addiction: Examining the Mediating Role of Passion

Fitness-related self-conscious emotions (SCEs) have been proposed as antecedents of exercise addiction (EA). However, the potential mechanisms underlying such a relationship remain unexplored. The present study examined the relationship between fitness-related SCEs and risk of EA, as well as the mediating role of passion for exercise. A total of 296 male runners (M = 40.35 years, SD = 10.69) completed a survey assessing weekly exercise frequency/hours, fitness-related SCEs, passion for exercise, and the risk of EA. The relationships between the study variables were examined using structural equation modeling. After controlling for age and weekly exercise frequency/hours, fitness-related SCEs of shame, guilt, and hubristic pride were positively associated with risk of EA. However, while guilt had direct effects on risk of EA, shame and hubristic pride showed indirect effects via obsessive passion. The results of the study are discussed, and some practical implications and future research directions are presented.

Exploring the contribution of exercise dependence to eating disorder symptoms

OBJECTIVE

Exercise dependence is a set of cognitive and behavioral symptoms that constitute a reliance on exercise and is related to eating disorder (ED) symptoms. There are seven components of exercise dependence: tolerance, withdrawal, continuance, lack of control, reduction in other activities, time, and intention effects. Exercising in response to negative affect (NA) is a key feature of dysfunctional exercise in the EDs. However, it is unknown which specific components of exercise dependence relate to ED symptoms, above and beyond NA.

METHOD

The current study (N = 168 individuals with EDs) investigated which components of exercise dependence relate to ED symptoms both cross-sectionally and prospectively.

RESULTS

In cross-sectional data, we found that withdrawal, tolerance, and time were associated with ED symptoms, above and beyond NA. Prospectively over 1 month, when adjusting for baseline ED symptoms and NA, we found that lack of control, withdrawal, and time positively predicted ED symptoms.

DISCUSSION

These findings inform future research on how exercise dependence relates to ED symptoms, showing that withdrawal and time are uniquely associated with ED symptoms both cross-sectionally and over time.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

DISCUSSION

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

The psychometric evaluation of the Revised Exercise Addiction Inventory: Improved psychometric properties by changing item response rating

BACKGROUND

The Exercise Addiction Inventory (EAI) is a short, valid, and reliable instrument used to assess the risk for exercise addiction, and has already been used in numerous published studies. The EAI contains six items, rated on a 5-point scale (strongly agree to strongly disagree), which are based on the components model of addiction. The middle of the original scale (scoring 3 out of 5) reflects neither agreement nor disagreement, which conveys neutrality. However, the present authors believe that individual who provides a neutral opinion on each item (i.e., scoring 3) is a conceptual dilemma because it artificially increases the total score obtainable on the scale without yielding agreement or disagreement with a particular item. Indeed, the six items of the EAI are phrased in such way that respondents can either agree or disagree in the slightly to strongly range.

METHODS

This study modified the EAI from a 5-point rating scale to a 6-point one, so that it eliminated a middle neutral response. A total of 277 exercising participants completed the Revised Exercise Addiction Inventory (EAI-R) and Exercise Dependence Scale.

RESULTS

All psychometric properties of the EAI-R were superior to the originally published scale.

CONCLUSION

Considering these findings, it is recommended that scholars now use the EAI-R in the future research if they need to assess the risk of exercise addiction.

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

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

Exercise dependence: Associations with capability for suicide and past suicidal behavior

OBJECTIVE

Exercise dependence has been linked to capability for suicide and suicidal behavior; however, less understood are which facets of exercise dependence confer risk for suicidal behavior and the potential mechanisms of this association. This study examined relationships between exercise dependence, capability for suicide, and past suicidal behavior.

METHODS

A sample of 540 individuals recruited via MTurk completed online measures of their exercise dependence, capability for suicide, and history of suicidal behavior.

RESULTS

Suicide attempters reported higher levels of continuance in exercise despite physical or psychological consequences, lack of control over exercise, and reductions in other activities due to exercise than nonattempters. Capability for suicide accounted for the relationship between continuance in exercise despite adverse consequences and lifetime number of suicide attempts.

CONCLUSIONS

When exercise becomes pathological in the form of exercise dependence, steps should be taken to reduce such engagement due to its observed association with suicidal behavior.

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.

Antecedents of Exercise Dependence in Ultra-Endurance Sports: Reduced Basic Need Satisfaction and Avoidance-Motivated Self-Control

Initiating and maintaining sports and exercise behavior are usually discussed in terms of strategies for promoting health. In the present study, we analyzed a sample of extreme endurance sport athletes and set out to predict exercise addiction, which is a facet of a sport-related health risk. We therefore draw on self-determination theory (Deci and Ryan, 1985, 2000), according to which low basic psychological need satisfaction can lead to excessive compensatory behavior. We aim to disentangle the effects of need satisfaction in the activity itself (exercising) and outside the activity (work/leisure) on exercise addiction. Furthermore, we propose anxious self-motivation as a mediator and tested whether it links low basic need satisfaction with exercise dependence. A correlational study with 323 multi-triathlon athletes confirmed our hypothesis that need satisfaction in work/leisure (but not in sports) is negatively related to exercise addiction. Furthermore, only need for competence in both domains (sport, work/leisure) is associated with anxious self-motivation. Mediation models showed that low competence satisfaction leads to anxious self-motivation that in turn predicts exercise addiction. The results are discussed critically in terms of their practical and theoretical implications for promoting health through sport and exercise.

Exercise motivational regulations and exercise addiction: The mediating role of passion

Background and aims The study explored the mediating role of forms of passion in the relationship between motivational regulations in exercise and exercise addiction (EA). Methods A total of 485 university students (368 males and 117 females; M_age = 20.43, SD = 3.21) completed a questionnaire measuring the frequency and intensity of exercise, motivational regulations in exercise, passion for exercise, and EA. Controlling the effects of age, frequency, and intensity of practice, the relationships between the study variables were examined though a path analysis. Results Both self-determined and non-self-determined forms of motivation showed positive association with EA. The forms of motivation with greatest predictive power for EA were introjected and integrated regulations. Both forms of motivation had positive direct and indirect effects through obsessive passion (OP) on EA; however, integrated regulation also showed negative indirect effects through harmonious passion on EA. Conclusions Both forms of passion and, especially, OP, seem to affect how motivational regulations are associated with EA. These findings clarify the association found in previous studies between self-determined forms of motivation and EA.

"If it's not Iron it's Iron f*cking biggest Ironman": personal trainers's views on health norms, orthorexia and deviant behaviours

Orthorexia nervosa (ON) describes a pathological obsession with healthy eating to avoid ill health. In the Swedish context, ON is also understood in terms of unhealthy exercise. Fitness gyms are popular health-promoting places, but exercise-related problems, disordered eating and ON-like behaviour are increasing. Personal trainers (PTs) play an important role in detecting unhealthy behaviours. The aim of the present study was to illuminate PTs' understandings of healthy and unhealthy exercise and eating behaviours in relation to orthorexia nervosa in a fitness gym context. Five focus groups with 14 PTs were conducted. These were analysed using interpretative qualitative content analysis and Becker's model "Kinds of Deviance." In contrast to PTs' health norms (practicing balanced behaviours and contributing to well-being), ON was expressed mainly in terms of exercise behaviour and as being excessive and in total control. The PTs maintain that extreme behaviours are legitimized by an aggressive exercise trend in society and that they fear to falsely accuse clients of being pathological. Certain sport contexts (bodybuilding, fitness competitions and elite sports) and specific groups (fitness professionals) contribute to complicating PTs' negotiations due to a competition, performance and/or profession norm, making it difficult to determine whether or not to intervene.

Exercise addiction in adolescents and emerging adults - Validation of a youth version of the Exercise Addiction Inventory

Background Behavioral addictions often onset in adolescence and increase the risk of psychological and social problems later in life. The core symptoms of addiction are tolerance, withdrawal symptoms, lack of control, and compulsive occupation with the behavior. Psychometrically validated tools are required for detection and early intervention. Adolescent screening instruments exist for several behavioral addictions including gambling and video gaming addiction but not for exercise addiction. Given recent empirical and clinical evidence that a minority of teenagers appear to be experiencing exercise addiction, a psychometrically robust screening instrument is required. Aims The aim of this study was to develop and test the psychometric properties of a youth version of the Exercise Addiction Inventory (EAI) - a robust screening instrument that has been used across different countries and cultures - and to assess the prevalence of exercise addiction and associated disturbed eating. Methods A cross-sectional survey was administered to three high-risk samples (n = 471) aged 11-20 years (mean age: 16.3 years): sport school students, fitness center attendees, and patients with eating disorder diagnoses. A youth version of the EAI (EAI-Y) was developed and distributed. Participants were also screened for disordered eating with the SCOFF Questionnaire. Results Overall, the EAI-Y demonstrated good reliability and construct validity. The prevalence rate of exercise addiction was 4.0% in school athletes, 8.7% in fitness attendees, and 21% in patients with eating disorders. Exercise addiction was associated with feelings of guilt when not exercising, ignoring pain and injury, and higher levels of body dissatisfaction.

Using Social Network Analysis to Better Understand Compulsive Exercise Behavior Among a Sample of Sorority Members

BACKGROUND

Compulsive exercise, a form of unhealthy exercise often associated with prioritizing exercise and feeling guilty when exercise is missed, is a common precursor to and symptom of eating disorders. College-aged women are at high risk of exercising compulsively compared with other groups. Social network analysis (SNA) is a theoretical perspective and methodology allowing researchers to observe the effects of relational dynamics on the behaviors of people.

METHODS

SNA was used to assess the relationship between compulsive exercise and body dissatisfaction, physical activity, and network variables. Descriptive statistics were conducted using SPSS, and quadratic assignment procedure (QAP) analyses were conducted using UCINET.

RESULTS

QAP regression analysis revealed a statistically significant model (R² = .375, P < .0001) predicting compulsive exercise behavior. Physical activity, body dissatisfaction, and network variables were statistically significant predictor variables in the QAP regression model.

DISCUSSION

In our sample, women who are connected to "important" or "powerful" people in their network are likely to have higher compulsive exercise scores. This result provides healthcare practitioners key target points for intervention within similar groups of women. For scholars researching eating disorders and associated behaviors, this study supports looking into group dynamics and network structure in conjunction with body dissatisfaction and exercise frequency.

Exercise Addiction in Athletes and Leisure Exercisers: The Moderating Role of Passion

Background and aims Recently, empirical research has linked obsessive passion to the etiology of exercise addiction, and the conceptual reason behind the fact that the latter is more prevalent in athletes than leisure exercisers has been challenged. The aim of this study was to determine the link between exercise addiction and harmonious passion, obsessive passion, and dedication to sports, in the context of athletic levels. Method A sample comprised of low- and high-level competitive athletes and non-competitive leisure exercisers (n = 313) was examined, in a cross-sectional design, in which participants completed the Spanish validated versions of the Exercise Addiction Inventory (Sicilia, Alías-García, Ferriz, & Moreno-Murcia, 2013) and Passion Scale (Chamarro et al., 2015). Results Obsessive passion and dedication to sports emerged as strong predictors of exercise addiction. Competitive athletes scored higher than leisure exercisers on all measures. Athletes competing at low and high levels only differed in dedication to their sports from each other. Team-sports athletes reported greater harmonious and obsessive passions, and dedication to sports, but not different exercise addictions, than people taking part in individual sports. Conclusions The concept of exercise addiction is not a plain and independent construct and may not reflect a psychological dysfunction in the athletic population. Athletes could interpret exercise addiction screening-items differently from non-athletes. Athletes in team sports report greater passion and dedication than those practicing individual sports.

Maladaptive perfectionism as mediator among psychological control, eating disorders, and exercise dependence symptoms in habitual exerciser

Background and aims The current study examined the mediating role of maladaptive perfectionism among parental psychological control, eating disorder symptoms, and exercise dependence symptoms by gender in habitual exercisers. Methods Participants were 348 Italian exercisers (n = 178 men and n = 170 women; M age = 20.57, SD = 1.13) who completed self-report questionnaires assessing their parental psychological control, maladaptive perfectionism, eating disorder symptoms, and exercise dependence symptoms. Results Results of the present study confirmed the mediating role of maladaptive perfectionism for eating disorder and exercise dependence symptoms for the male and female exercisers in the maternal data. In the paternal data, maladaptive perfectionism mediated the relationships between paternal psychological control and eating disorder and exercise dependence symptoms as full mediator for female participants and as partial mediator for male participants. Discussion Findings of the present study suggest that it may be beneficial to consider dimensions of maladaptive perfectionism and parental psychological control when studying eating disorder and exercise dependence symptoms in habitual exerciser.

Using implicit attitudes of exercise importance to predict explicit exercise dependence symptoms and exercise behaviors

OBJECTIVES

"Fast" (i.e., implicit) processing is relatively automatic; "slow" (i.e., explicit) processing is relatively controlled and can override automatic processing. These different processing types often produce different responses that uniquely predict behaviors. In the present study, we tested if explicit, self-reported symptoms of exercise dependence and an implicit association of exercise as important predicted exercise behaviors and change in problematic exercise attitudes.

DESIGN

We assessed implicit attitudes of exercise importance and self-reported symptoms of exercise dependence at Time 1. Participants reported daily exercise behaviors for approximately one month, and then completed a Time 2 assessment of self-reported exercise dependence symptoms.

METHOD

Undergraduate males and females (Time 1, N = 93; Time 2, N = 74) tracked daily exercise behaviors for one month and completed an Implicit Association Test assessing implicit exercise importance and subscales of the Exercise Dependence Questionnaire (EDQ) assessing exercise dependence symptoms.

RESULTS

Implicit attitudes of exercise importance and Time 1 EDQ scores predicted Time 2 EDQ scores. Further, implicit exercise importance and Time 1 EDQ scores predicted daily exercise intensity while Time 1 EDQ scores predicted the amount of days exercised.

CONCLUSION

Implicit and explicit processing appear to uniquely predict exercise behaviors and attitudes. Given that different implicit and explicit processes may drive certain exercise factors (e.g., intensity and frequency, respectively), these behaviors may contribute to different aspects of exercise dependence.

Risk for exercise dependence, eating disorder pathology, alcohol use disorder and addictive behaviors among clients of fitness centers

BACKGROUND AND AIMS

Exercise dependence (EXD) is considered a behavioral addiction that is often associated with eating disorders. To date, only few studies examined the potential overlap between EXD and other addictive behaviors. Therefore, the present study aimed at investigating the relationship of EXD with pathological buying, pathological video gaming (offline and online), hypersexual behavior, and alcohol use disorder in a sample of clients of fitness centers.

METHODS

The following questionnaires were answered by 128 individuals (age M = 26.5, SD = 6.7 years; 71.7% men, 74.2% university students): Exercise Dependence Scale, Eating Disorder Examination-Questionnaire, Compulsive Buying Scale, Pathological Computer-Gaming Scale, Hypersexual Behavior Inventory, and Alcohol Use Disorders Identification Test (AUDIT).

RESULTS

7.8% of the sample were at-risk for EXD, 10.9% reported eating disorder pathology, 2.3% pathological buying, 3.1% hypersexual behavior, and none of the participants suffered from pathological video gaming. The criteria for severe alcohol disorder pathology (AUDIT ≥ 16) were fulfilled by 10.2%. With regard to continuous symptom scores, EXD symptoms were positively correlated with both eating disorder pathology and pathological buying but not with pathological video gaming, hypersexuality or alcohol use disorder. It is noteworthy that more symptoms of pathological buying corresponded with more symptoms of hypersexual behavior. The correlation pattern did not differ by gender.

DISCUSSION

The co-occurrence of EXD, pathological buying and hypersexual behavior on a subclinical level or in the early stage of the disorders should be taken into account when assessing and treating patients. More research is warranted in order to investigate possible interactions between these conditions.

The influence of exercise identity and social physique anxiety on exercise dependence

BACKGROUND

Previous research has identified exercise identity and social physique anxiety as two independent factors that are associated with exercise dependence.

AIMS

The purpose of our study was to investigate the unique and interactive effect of these two known correlates of exercise dependence in a sample of 1,766 female runners.

METHODS

Regression analyses tested the main effects of exercise identity and social physique anxiety on exercise dependence. An interaction term was calculated to examine the potential moderating effect of social physique anxiety on the exercise identity and exercise dependence relationship.

RESULTS

Results indicate a main effect for exercise identity and social physique anxiety on exercise dependence; and the interaction of these factors explained exercise dependence scores beyond the independent effects. Thus, social physique anxiety acted as a moderator in the exercise identity and exercise dependence relationship.

DISCUSSION

Our results indicate that individuals who strongly identify themselves as an exerciser and also endorse a high degree of social physique anxiety may be at risk for developing exercise dependence.

CONCLUSIONS

Our study supports previous research which has examined factors that may contribute to the development of exercise dependence and also suggests a previously unknown moderating relationship for social physique anxiety on exercise dependence.

Pathological motivations for exercise and eating disorder specific health-related quality of life

OBJECTIVE

To examine associations among pathological motivations for exercise with eating disorder (ED) specific health-related quality of life (HRQOL).

METHOD

Survey data assessing ED severity (i.e., Eating Disorder Diagnostic Survey), ED specific HRQOL (i.e., Eating Disorders Quality of Life Instrument), and pathological motivations for exercise (i.e., Exercise Dependence Scale) were collected from female students (N = 387) at seven universities throughout the United States. Regression analyses were conducted to examine the associations among exercise dependence, ED-specific HRQOL and ED severity, and the interaction of exercise dependence and ED severity on HRQOL scores.

RESULTS

The overall model examining the impact of ED severity and exercise dependence (independent variables) on HRQOL (dependent variable) was significant and explained 16.1% of the variance in HRQOL scores. Additionally, the main effects for ED severity and exercise dependence and the interaction among ED severity and exercise dependence were significant, suggesting that the combined effects of ED severity and exercise dependence significantly impacts HRQOL.

DISCUSSION

Our results suggest that pathological motivations for exercise may exacerbate ED's detrimental impact on HRQOL. Our results offer one possible insight into why exercise may be associated with deleterious effects on ED HRQOL. Future research is needed to elucidate the relationship among psychological aspects of exercise, ED, and HRQOL.

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

DISCUSSION

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

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.

Exercise dependence and muscle dysmorphia in novice and experienced female bodybuilders

BACKGROUND AND AIMS

Extensive research has shown that male bodybuilders are at high risk for exercise dependence, but few studies have measured these variables in female bodybuilders. Prior research has postulated that muscular dysmorphia was more prevalent in men than women, but several qualitative studies of female bodybuilders have indicated that female bodybuilders show the same body image concerns. Only one study has compared female bodybuilders with control recreational female lifters on eating behaviors, body image, shape pre-occupation, body dissatisfaction, and steroid use. The purpose of this study was to compare exercise dependence and muscle dysmorphia measures between groups of female weight lifters.

METHODS

Seventy-four female lifters were classified into three lifting types (26 expert bodybuilders, 10 or more competitions; 29 novice bodybuilders, 3 or less competitions; and 19 fitness lifters, at least 6 months prior lifting) who each completed a demographic questionnaire, the Exercise Dependence Scale (EDS), the Drive for Thinness scale (DFT) of the Eating Disorder Inventory-2, the Bodybuilding Dependence Scale (BDS), and the Muscle Dysmorphia Inventory (MDI).

RESULTS

Female bodybuilders scored higher than fitness lifters for EDS Total, BDS Training and Social Dependence, and on Supplement Use, Dietary Behavior, Exercise Dependence, and Size Symmetry scales of the MDI.

DISCUSSION AND CONCLUSIONS

Female bodybuilders seem to be more at risk for exercise dependence and muscle dysmorphia symptoms than female recreational weight lifters.

The moderating effect of gender on ideal-weight goals and exercise dependence symptoms

Background and aims Exercise dependence is implicated in the development of eating disorders and muscle dysmorphic disorder. Although conceptually these disorders represent similar pathologies they largely affect different genders and result in opposite body composition, appearance, and ideal-weight goals (i.e., to gain or lose/maintain weight). Therefore, understanding individuals' ideal-weight goals related to engaging in exercise while simultaneously examining gender differences in exercise dependence symptoms may help to identify those whom may be most at-risk for eating disorders and muscle dysmorphic disorder. The purpose of our study was to examine the moderating effect of gender for exercise dependence symptoms in relation to weight gain, loss, or maintenance goals. Methods Self-reported exercise behavior and exercise dependence symptoms (i.e., Exercise Dependence Scale) were assessed in 513 undergraduate students. Results Our analysis revealed a moderating effect for gender on ideal-weight goals and a gender difference in exercise dependence symptoms. Specifically, men who were dissatisfied with their current weight reported more exercise dependence symptoms than women. Conclusions These results support a growing body of research and extend our understanding of the relationships among exercise dependence and gender specific body-focused psychiatric disorders.

Psychometric examination and factorial validity of the Exercise Dependence Scale-Revised in Italian exercisers

Background and aims The purpose of this study was to verify the factorial structure, internal validity, reliability, and criterion validity of the 21-item Exercise Dependence Scale-Revised (EDS-R) in an Italian sample. Methods Italian voluntary (N = 519) users of gyms who had a history of regular exercise for over a year completed the EDS-R and measures of exercise frequency. Results and conclusions Confirmatory factor analyses demonstrated a good fit to the hypothesized 7-factor model, and adequate internal consistency for the scale was evidenced. Criterion validity was evidenced by significant correlations among all the subscale of the EDS and exercise frequency. Finally, individuals at risk for exercise dependence reported more exercise behavior compared to the nondependent-symptomatic and nondependent-asymptomatic groups. These results suggest that the seven subscales of the Italian version of the EDS are measuring the construct of exercise dependence as defined by the DSM-IV criteria for substance dependence and also confirm previous research using the EDS-R in other languages. More research is needed to examine the psychometric properties of the EDS-R in diverse populations with various research designs.

Exercise dependence among customers from a Parisian sport shop

AIM OF THE STUDY

We assessed exercise dependence (ED), alcohol and nicotine use disorders, eating disorders, hypochondria and compulsive buying and in a population of customers of a Parisian sport shop.

METHODS

Five hundred consecutive customers of a sport shop were invited to participate. Diagnostic of exercise dependence was made with the Exercise Addiction Inventory and a specific questionnaire checking all diagnostic criteria. The DSM-IV-TR criteria for bulimia, alcohol and nicotine use disorders were checked and all subjects answered the CAGE and Fagerström questionnaires. Hypochondria was assessed with the DSM-IV-TR criteria and the Whiteley Index of Health Anxiety. For all parameters, customers with (ED+) and without (ED-) exercise dependence were compared.

RESULTS

The prevalence of exercise dependence was 29.6%. Subjects from the ED+ group were younger than in the ED-group (27.1 vs 29.8 years) and there were more women. They were more dependent on alcohol, had higher scores at the CAGE questionnaire. ED+ subjects more often presented hypochondria (23 vs 15%), bulimia and binge eating and they more often made gifts to themselves and to others.

CONCLUSIONS

Exercise dependence appears as a frequent and almost always unrecognized form of behavioral dependence in non clinical population frequenting sport shops. It is frequently associated to chemical dependence and eating disorders.

"Exercise dependence"--a problem or natural result of high activity?

OBJECTIVES

To compare physical activity (PA) and exercise dependence (ED) in 267 weight-loss maintainers (WLM) and 213 normal-weight (NW) controls.

METHODS

PA and ED assessed via accelerometery and the Exercise Dependence Questionnaire.

RESULTS

WLM had higher PA levels and ED scores than those of NW (P< 0.0001). WLM status (P=.006) and higher PA (P=.0001) were independently related to higher ED, although effect sizes were larger for PA. Exercising for weight control was the ED domain that most discriminated WLM from NW.

CONCLUSIONS

WLM have higher ED scores than do NW, but this is mostly due to exercising for weight control.

Negative addiction to exercise: are there differences between genders?

INTRODUCTION

Regular physical exercise has numerous benefits. However, there is a subset of the exercising population who may develop a compulsion to exercise excessively and who may, as a consequence, display physiological and psychological changes that have a direct influence on their quality of life.

OBJECTIVE

Our objective was to determine if there are differences between male and female athletes' scores on measures of negative addiction symptoms, quality of life, mood and sleep.

METHODS

144 female and 156 male athletes participated in this study by answering the following questionnaires: Negative Addiction Scale, Beck Depression Inventory, Trait Anxiety Inventory, Profile of Mood States, SF-36 Quality of Life, Pittsburgh Sleep Quality and Epworth Sleepiness Scale.

RESULTS

Higher dedication to training sessions in the male group, and members of the female group with symptoms of negative addiction to exercise showed a lower score on vigor observed by the Profile of Mood States compared to the males in both situations. We also observed depression symptoms in both members of groups who had negative addiction symptoms when compared with their peers without symptoms, and these figures were even higher in females compared with the male group in the same situation.

CONCLUSION

No differences were seen in the development of negative addiction exercise symptoms in males and females and there were no changes in the quality of life and mood of these athletes. Further studies of eating disorders associated with changes in body image perception could contribute to a better understanding of negative addiction to exercise.