Exercise dependence

The physical benefits of regular exercise are well-known, including reduced risk for cardiovascular disease, certain cancers, and diabetes (U.S. Department of Health and Human Services, 1996). Regular and moderate level physical activity plays an important role not only in the physical but also in the mental well-being, as it increases general well-being, creates positive mood, and reduces the level of depression and anxiety (Reed & Ones, 2006).

Although, regular physical activity is considered to be healthy, some forms of exercise may have negative consequences. Growing body of literature reports that exercise can lead to a form of dependence or addiction in case of some individuals (Davis & Fox, 1993; de Coverley Veale, 1987; Hausenblas & Fallon, 2002; Krejci et al, 1992).

1.7.2.1 Definition and criteria of exercise dependence

Exercise dependence is defined as “a craving for leisure-time physical activity, resulting in uncontrollable excessive exercise behaviour that manifests in physiological (e.g.

tolerance/withdrawal) and/or psychological (e.g. anxiety, depression) symptoms”

(Hausenblas & Symons Downs, 2002). Others define exercise addiction as an unhealthy reliance or compulsive need for the workout, not necessarily to improve performance in competition, but to deal with daily stress and provide relief from bad feelings associated with not working out (Baratt, 1994).

Most of the studies examined the exercise dependence in runners (Hailey & Bailey, 1982; Furst & Germone, 1993), bodybuilders (Smith & Hale, 2005), aerobic participants (Kirkby & Adams, 1996), and triathletes (Blaydon & Lindner, 2002).

Terry, Szabo, and Griffiths (2004) proposed the criteria for exercise dependence (Hungarian review: Demetrovics & Kurimay, 2008):

1. Salience – The exercise becomes the most important activity in the person’s life and dominates their thinking, feelings, and behaviour.

2. Mood modification – The individual experiences mood modification as a consequence of excessive exercise which can be considered as a coping strategy (i.e., experiencing an arousal enhancing ‘‘high’’ effect, or tranquilizing feeling of ‘‘escape’’ or ‘‘numbing’’).

3. Tolerance – Increasing amounts of the exercise are required to achieve the former effects (e.g. euphoria).

4. Withdrawal symptoms – Unpleasant feelings and/or physical effects occur when the exercise is discontinued or suddenly reduced (e.g. sleeping disturbances, moodiness, and irritability).

5. Conflict – The individual still continues the excessive exercise even though he/she realizes the interpersonal conflicts between the addict and the environment, conflicts with other activities (e.g., job, social life, and hobbies).

6. Relapse – Rapid reinstatement of the previous pattern of exercise and withdrawal symptoms after a period of abstinence or control.

7. The preoccupation with the exercise is not better accounted for by another mental disorder. For instance in case of AN the excessive exercise is the consequence of the eating disorder and serves as a weight control strategy. Thus it has to be considered as the symptom of AN and defined as “secondary exercise dependence” (de Coverley Veale, 1987). Exercise dependence can develop without any accompanying eating disorder, which is identified as

“primary exercise dependence” (de Coverley Veale, 1987).

1.7.2.3 Bodybuilding dependence and muscle dysmorphia

After the first description of exercise dependence, it has been studied in several kinds of sports. However, bodybuilding seemed to be a neglected area of interest until the last few years, when studies pointed out the relationship between exercise dependence, bodybuilding, and MD. Compulsive bodybuilding is considered as a behavioural characteristic of MD as MD sufferers spend long hours with lifting weight in order to gain muscle mass and achieve muscular physique. They often sacrifice important social and occupational activities in order to keep the strict exercise schedule. This kind of exercise addiction is called bodybuilding dependence (Smith, Hale, & Collins, 1998;

Smith & Hale, 2004). Given this, most of the instruments that measure MD symptoms, also assess bodybuilding dependence.

Relating to the causal factors of bodybuilding dependence, research revealed that often low self-esteem and body image dissatisfaction serve as the basis for bodybuilding dependence (Smith et al., 1998; Hurst, Hale, Smith, & Collins, 2000). Smith et al.

(1998) highlighted that some individuals may have started bodybuilding training because they suffered from low self-esteem and poor body image, and they may have become dependent on it to feel good about themselves. Bodybuilding training improves self concept and body attitudes, and those who are involved in this sport may experience

self-efficacy, thus they can become dependent upon it to feel positive about themselves (Tucker, 1987).

Hurst et al. (2000) examined exercise dependence in experienced and inexperienced bodybuilders and weightlifters. They found that social support and positive comments of others also played an important role in the development of bodybuilding dependence.

Moreover, experienced bodybuilders displayed more exercise dependence than inexperienced bodybuilders and weightlifters. These results indicate that bodybuilders can become dependent on the actual activity of lifting weights rather than weightlifters.

Smith and Hale (2004) examined bodybuilding dependence in competitive and non-competitive bodybuilders in both genders. Results showed that non-competitive bodybuilders exhibited more bodybuilding dependence than non-competitive ones, but there were no gender differences. Moreover, the study also found positive relationship between bodybuilding dependence and MD, confirming previous findings that exercise dependence is an important behavioural pattern of MD.

A recent study investigated exercise dependence and drive for muscularity in male bodybuilders, power lifters, and fitness lifters (Hale, Roth, DeLong, & Briggs, 2010).

Results indicated that bodybuilders and power lifters may tend to become overcommitted in their weight lifting trainings compared to fitness lifters and may be at higher risk for developing exercise dependence. Authors suggested that drive for muscularity is clearly related to exercise dependence behaviours. Therefore, those individuals who display higher levels of drive for muscularity may be at higher risk for developing more addictive exercise behaviour patterns and even more susceptible to the negative psychological and social consequences of the addiction than those with less drive for muscularity.