1. EPHE 348

2. Addiction to Something Good? Benefits are well-established about physical activity Adherence is a problem for most Some – too much of a good thing?

3. Exercise Dependence Craving for leisure-time physical activity, resulting in uncontrollable excessive exercise behaviour, that manifests in physiological (withdrawl) and/or psychological (anxiety, depression) symptoms

4. History First considered in 1970 by Baekeland via a study designed to examine sleep and a month of exercise deprivation – couldn’t find any subjects in the 6+ frequency category even with pay! Had to use 3-4 per week participants During the month, participants experienced anxiety, sexual tension, nocturnal awakening

5. Properties Downs & Hausenblas (2002) suggest three of : -Tolerance (need for increases with diminished effect) -Withdrawal (symptoms of mood/anxiety) -Intention discrepancy (exercise is more than intended) -Loss of Control (failure to cut down) -Time (consumes/controls a great deal time) -Conflict (other activities are give-up or reduced) -Continuance (continued despite adverse events) Mimics substance dependence

6. DSM-IV-TR Eating Disorders DeCoverley Veale (1995) has suggested that exercise dependence not be assessed until eating disorders have been ruled out: Refusal to maintain body weight Intense fear of gaining weight Disturbance in how one’s body is viewed in self- evaluation; denial of seriousness of body weight

7. Obsessive Compulsive Disorder Recurrent, persistent thoughts, impulses ….that cause anxiety or distress The behaviours are performed to reduce distress but are clearly not aligned with the intended outcome (i.e., clearly excessive) Person recognizes that the impulses are a product of his or her own mind Behaviour is repetitive and must be applied rigidly Behaviours are time consuming and interfere with other activities Disturbance is not the direct effect of substance or medical condition

8. Current Research Three main areas: Comparing to eating disorder patients Comparing to less excessive regular exercisers Comparing exercisers and nonexercisers

9. Hausenblas & Symons Downs 2002 Review 77 studies Exercise deprivation Research (11 studies) Adverse effects on well-being The effect is partially independent of dependence Feelings of guilt, depression, irritability, stress/anxiety, sluggishness Limits to research because most research is with involuntary deprivation (dependents do not enter research of this kind)

10. Continued Measurement Mixed measures across studies from questionnaires to case studies Exercise itself is not a good measure Lack of cohesive measures makes it difficult to estimate prevalence Not a formal clinical condition

11. Hausenblas & Symons Downs (2003) 2300 exercisers surveyed Prevalence of 9% found (perhaps 3-4% of populace) 40% had some symptoms

12. Why Dependence? Psychological Personality (perfectionism, OC, neuroticism) Anorexia-analogue hypothesis (personality-based, attempts to establish an identity) Affect regulation – reverse of benefits; used to keep affect positive Physiological Beta-endorphin – dependency on this process Sympathetic arousal – efficiency of exercise widens the gap between systems

13. Treatment Single study of physiotherapy clinicians (Adams & Kirby, 1997) Education of overuse outcomes Prescribing reduced or alternative activities Referral to other health professionals Behaviour modification Results suggested that the clinicians were not very effective