Compulsive Exercise

Melissa has been a track fanatic since she was 12 years old. She has run the mile in meets in junior high and high school, constantly improving her times and winning several medals. Best of all, Melissa truly loves her sport.

Recently, however, Melissa's parents have noticed a change in their daughter. She used to return tired but happy from practice and relax with her family, but now she's only home for 15 minutes before she heads out for another run on her own. On many days, she gets up to run before school. When she's unable to squeeze in extra runs, she becomes irritable and anxious. And she no longer talks about how much fun track is, just how many miles she has to run today and how many more she should run tomorrow.

Melissa is living proof that even though exercise has many positive benefits, too much can be harmful. Teens who exercise compulsively are at risk for both physical and psychological problems.

About Compulsive Exercise

Compulsive exercise (also called obligatory exercise and anorexia athletica) is best defined by an exercise addict's frame of mind: He or she no longer chooses to exercise but feels compelled to do so and struggles with guilt and anxiety if he or she doesn't work out. Injury, illness, an outing with friends, bad weather — none of these will deter those who compulsively exercise. In a sense, exercising takes over a compulsive exerciser's life because he or she plans life around it.

Of course, it's nearly impossible to draw a clear line dividing a healthy amount of exercise from too much. The government's 2005 dietary guidelines, published by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS), recommend at least 60 minutes of physical activity for kids and teens on most — if not all — days of the week.

Experts say that repeatedly exercising beyond the requirements for good health is an indicator of compulsive behavior, but because different amounts of exercise are appropriate for different people, this definition covers a range of activity levels. However, several workouts a day, every day, is overdoing it for almost anyone.

Much like with eating disorders, many people who engage in compulsive exercise do so to feel more in control of their lives, and the majority of them are female. They often define their self-worth through their athletic performance and try to deal with emotions like anger or depression by pushing their bodies to the limit. In sticking to a rigorous workout schedule, they seek a sense of power to help them cope with low self-esteem.

Although compulsive exercising doesn't have to accompany an eating disorder, the two often go hand in hand. In anorexia nervosa, the excessive workouts usually begin as a means to control weight and become more and more extreme. As the rate of activity increases, the amount the person eats might decrease. Someone with bulimia also may use exercise as a way to compensate for binge eating.

Compulsive exercise behavior can grow out of student athletes' demanding practice schedules and their quest to excel. Pressure, both external (from coaches, peers, or parents) and internal, can drive an athlete to go too far to be the best. He or she ends up believing that just one more workout will make the difference between first and second place . . . then keeps adding more workouts.

Eventually, compulsive exercising can breed other compulsive behavior, from strict dieting to obsessive thoughts about perceived flaws. Exercise addicts may keep detailed journals about their exercise schedules and obsess about improving themselves. Unfortunately, these behaviors often compound each other, trapping the person in a downward spiral of negative thinking and low self-esteem.

Why Is Exercising Too Much a Bad Thing?

We all know that regular exercise is an important part of a healthy lifestyle. But few people realize that too much can cause physical and psychological harm:

• Excessive exercise can damage tendons, ligaments, bones, cartilage, and joints, and when minor injuries aren't allowed to heal, they often result in long-term damage. Instead of building muscle, too much exercise actually destroys muscle mass, especially if the body isn't getting enough nutrition, forcing it to break down muscle for energy.
• Girls who exercise compulsively may disrupt the balance of hormones in their bodies. This can change their menstrual cycles (some girls lose their periods altogether, a condition known as amenorrhea) and increase the risk of premature bone loss (osteoporosis). And of course, working their bodies so hard leads to exhaustion and constant fatigue.
• An even more serious risk is the stress that excessive exercise can place on the heart, particularly when someone is also engaging in unhealthy weight loss behaviors such as restricting intake, vomiting, and using diet pills or supplements. In extreme cases, the combination of anorexia and compulsive exercise can be fatal.
• Psychologically, exercise addicts are often plagued by anxiety and depression. They may have a negative image of themselves and feel worthless. Their social and academic lives may suffer as they withdraw from friends and family to fixate on exercise. Even if they want to succeed in school or in relationships, working out always comes first, so they end up skipping homework or missing out on time spent with friends.

Warning Signs

Someone may be exercising compulsively if he or she:

• won't skip a workout, even if tired, sick, or injured
• doesn't enjoy exercise sessions, but feels obligated to do them
• seems anxious or guilty when missing even one workout
• does miss one workout and exercises twice as long the next time
• is constantly preoccupied with his or her weight and exercise routine
• doesn't like to sit still or relax because of worry that not enough calories are being burnt
• has lost a significant amount of weight
• exercises more after eating more
• skips seeing friends, gives up activities, and abandons responsibilities to make more time for exercise
• seems to base self-worth on the number of workouts completed and the effort put into training
• is never satisfied with his or her own physical achievements

It's important, too, to recognize the types of athletes who are more prone to compulsive exercise because their sports place a particular emphasis on being thin. Ice skaters, gymnasts, wrestlers, and dancers can feel even more pressure than most athletes to keep their weight down and their body toned. Runners also frequently fall into a cycle of obsessive workouts.

Getting Professional Help

If you recognize some of the warning signs of compulsive exercise in your child, call your doctor to discuss your concerns. After evaluating your child, the doctor may recommend medical treatment and/or other therapy.

Because compulsive exercise is so often linked to an eating disorder, a community agency that focuses on treating these disorders might be able to offer advice or referrals. Extreme cases may require hospitalization to get a child's weight back up to a safe range.

Treating a compulsion to exercise is never a quick-fix process — it may take several months or even years. But with time and effort, kids can get back on the road to good health. Therapy can help improve self-esteem and body image, as well as teach them how to deal with emotions. Sessions with a nutritionist can help develop healthy eating habits. Once they know what to watch out for, kids will be better equipped to steer clear of unsafe exercise and eating patterns.

Ways to Help at Home

Parents can do a lot to help a child overcome a compulsion to exercise:

• Involve kids in preparing nutritious meals.
• Combine activity and fun by going for a hike or a bike ride together as a family.
• Be a good body-image role model. In other words, don't fixate on your own physical flaws, as that just teaches kids that it's normal to dislike what they see in the mirror.
• Never criticize another family member's weight or body shape, even if you're just kidding around. Such remarks might seem harmless, but they can leave a lasting impression on kids or teens struggling to define and accept themselves.
• Examine whether you're putting too much pressure on your kids to excel, particularly in a sport (because some teens turn to exercise to cope with pressure). Take a look at where kids might be feeling too much pressure. Help them put it in perspective and find other ways to cope.

Most important, just be there with constant support. Point out all of your child's great qualities that have nothing to do with working out — small daily doses of encouragement and praise can help improve self-esteem.

If you teach kids to be proud of the challenges they've faced and not just the first-place ribbons they've won, they will likely be much happier and healthier kids now and in the long run.