Compulsive Exercise VS Overtraining: The clashing of worlds!
I would like to begin this post with a story from the first patient I worked with when I started as an Exercise Physiologist in a residential eating disorder clinic. After two weeks of sitting in on both group and individual therapy one of my coworkers who is therapists asked if I would meet with one of her patients who over exercises. I was excited to begin working with patients. During my first meeting with this patient I conducted an activity/exercise history looking at previous and current interactions with any form of activity. I asked some pertinent medical questions specific to symptoms that the world of exercise science would define as overtraining and overreaching. Commonly used terms within exercise science related to what many would call 'overexercising' would be:
Functional overreaching: Increased training leading to a temporary performance decrement and with improved performance after rest.
Nonfunctional overreaching: Intense training leading to a longer decrease in performance but with full recovery after rest; accompanied by increased psychologic and/or neuroendocrine symptoms.
Overtraining syndrome: similiar to nonfunctional overreaching but more extreme with longer performance decrement typically greater than 2 months with more severe symptoms and negative physiological response amongst multiple body systems (psychologic, neurologic, endocrinologic, immunologic systems, etc.) (1, 2).
These are the terms I was familiar with having studied in the field of exercise science. I went into the meeting with this patient expecting to hear of symptoms that included, but not limited to:
possible bradycardia or tachycardia (very low or high heart rate at rest), decreased motivation, increased depression (higher amounts of depression than baseline if patient has baseline/underlying depression), insomnia, irritability, agitation, hypertension (high blood pressure), restlessness, loss of appetite, increased anxiety (higher than baseline levels if underlying anxiety), stiff/sore muscles, lack of mental concentration (1, 2).
The basic definition to take away from overtraining is you see a decrease in performance and negative physical/medical consequences occurring due to the exercise/activity that is being engaged. Basically the activity performance is decreased while still continuing to train.
When I met with the patient and discussed current and previous activity they had engaged with they claimed to have not been actively exercising regularly in 10 years! This I found a bit confusing and started to research a bit more. I decided to take a small step outside the comfort of my known world of exercise science. My first thought was the defintions discussed above relate to research done on athletes specific to their performance. This begs the question about the majority of individuals who are not athletes? Can they over train per the definitions stated above? Are the symptoms I mentioned needed for a negative interaction to occur with exercise? Why is my colleague, who comes from a therapy background, calling this patient an 'over exerciser'? I was very motivated to get to the bottom of discrepancy between the two world views.
I decided to take a deep dive into the therapy/psychology journals to investigate a bit. I discovered a term that seemed to fit into what I was observing from the patient. Compulsive exercise is defined by The American National Eating Disorder Association as:
Compulsive Exercise: “Physical exercise that significantly interferes with important activities, occurs at inappropriate times or inappropriate settings, or when the individual continues to exercise despite injury or other medical complications; Intense anxiety, depression and/or distress if unable to exercise; Discomfort with rest or inactivity; Exercise is used to manage emotions; Exercise is used as a means of purging; Exercise is used as permission to eat; Exercise that is secretive or hidden; and Feeling as though you are not good enough, fast enough or not pushing hard enough during a period of exercise.”(3)
I found this term compulsive exercise very helpful and also found how it interrelates with the common term in exercise science of overtraining. A very simplified definition of compulsive exercise means that there is some negative consequence in your life due to the exercise/acivity in which you engage. Explaining to patients that just because you can physically engage in all the exercise/acivity does not mean they may not be viewing exercise in a compulsive manner. For example, a past patient would tell me should could physically engage in all the exercise in which she engaged without decreased performance or any negative physical symptoms, but she would miss her sons hockey games because she felt compelled/needed to go to the local spin class to feel good about herself. In this specific example a negative consequence was occuring in this patients life from a social/family perspective.
Viewing exercise in a compulsive manner can increase the likelihood that they will over train and have physical consequences to the exercise they engage with, but viewing exercise in a compulsive manner does not in and of itself mean someone is overtraining. If someone is questioning if they view exercise in a compulsive manner there is wonderfully validated tool known as the Compulsive Exercise Test (CET), which is used regularly with patients to better understand, and more importantly, for patients to better investigate some underlying roots of why they may be viewing exercise in a compulsive manner (4). I will be doing future blog posts that are more specific and detailed on compulsive exercise and overtraining.
References
Kreher J. B. (2016). Diagnosis and prevention of overtraining syndrome: an opinion on education strategies. Open access journal of sports medicine, 7, 115–122. https://doi.org/10.2147/OAJSM.S91657
Meeusen, R., Duclos, M., Foster, C., Fry, A., Gleeson, M., Nieman, D., ... & Urhausen, A. (2013). Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine. Medicine and science in sports and exercise, 45(1), 186-205.
Rubin, J. (2016). Compulsive Exercise. National Eating Disorder Association NEDA: Plano, TX, USA, 1-2.
Meyer, C., Plateau, C. R., Taranis, L., Brewin, N., Wales, J., & Arcelus, J. (2016). The Compulsive Exercise Test: confirmatory factor analysis and links with eating psychopathology among women with clinical eating disorders. Journal of eating disorders, 4, 22. https://doi.org/10.1186/s40337-016-0113-3