Too Much of a Good Thing
In This Chapter
▶ Identifying the symptoms and possible causes of excessive exercise
▶ Providing support and assistance to people who exercise too much
▶ Recognizing how exercising can be harmful to those with certain health conditions
▶ Avoiding the dangers associated with exercising in extreme weather conditions
Although we all know that regular exercise can have many physical and psychological benefits, when taken to extremes or when practiced in combination with certain environmental conditions or personal risk factors, even this typically healthy, positive behavior can be bad for you. While the admonition to exercise regularly is usually very solid advice, a few rare, but important, exceptions to this general rule exist.
In this chapter, we explore how something that is usually one of the best things you can ever do for yourself may, in some extraordinary cases, degen- erate into one of the worst things you can do to yourself.
Good Exercise Gone Bad: Understanding the Problem of Excessive Exercise
For a variety of reasons that are not fully understood, some people (usu- ally estimated to be about 3 percent of the general population) develop the unhealthy craving to take their exercise to such extremes that it begins to do them more harm than good. This intense urge to exercise can have seri- ous physical, psychological, and social implications. Increased likelihood of physical injury, psychological burnout, and the neglect of family, friends, and work are just a few of the negative consequences that are often associated with excessive amounts of exercise.
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This extreme need to exercise goes by many names. Although often informally referred to as exercise addiction, most researchers and health professionals prefer less emotionally charged terms such as exercise dependence, exercise compulsion, dysfunctional exercise, excessive exercise, or (heaven forbid) hypergymnasia. Regardless of what it’s called, pinpointing exactly where good and healthy physical activity becomes harmful is almost impossible.
Very few things are better for the human body than physical activity and exer- cise. Most people simply don’t get enough of either. Because of the emphasis that is frequently placed on exercising, people sometimes forget that, like pretty much everything in life, there is a point at which things that are generally good for you can sometimes do you great harm. So that you can take full advantage of all the good things a physically active lifestyle can offer without having to deal with the problems that sometimes come when you take this good thing too far, carefully think about where, when, why, and how much you exercise.
Crossing the line: How much is too much?
The thing that makes any discussion of excessive exercise so tricky is that researchers and health professionals don’t really know — or at least can’t seem to agree on — what they’re even talking about. If pressed, most people distinguish between beneficial and excessive exercise with something
When is an addiction not an addiction?
For years, mental health professionals have engaged in an ongoing debate as to whether or not excessive behaviors, such as the ten- dency to over-exercise, should be referred to as addictions, obsessions, compulsions, or some- thing less medical-based entirely. The latest skirmish in this ongoing battle erupted during the recent revision of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used to diagnose and classify mental disorders.
In the final edition, the section “Addictions and Related Disorders” is generally limited to compulsions toward drug-seeking behaviors.
The new DSM-5, however, includes a broad category of disorders called “behavioral addic- tions,” which, oddly enough, lists only one behavioral disorder — gambling addiction.
The good news is that the addition of this new category will, in itself, probably increase atten- tion and research on other potential behavioral disorders — including the need to exercise too much. The bad news is that not being specifi- cally mentioned in the DSM-5 will make insur- ance reimbursements virtually impossible for health professionals wishing to work with clients who exhibit symptoms associated with excessive exercise.
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like, “If I schedule my exercise so it fits into my life, that’s a positive and healthy thing, but as soon as I start scheduling my life so it fits into my exercise, I may be on the verge of taking this whole thing a bit too far.”
Exercise specialists have agreed that the best way to identify and assist people who may be exercising too much for their own good is to consider the reasons people exercise and the positive or negative impact it has on their lives rather than on how much exercising they actually do.
Identifying symptoms of excessive exercise
Researchers still, for better or worse, tend to think about behavioral excesses in much the same way they think about addictions. In fact, the most common ways to measure whether someone has gone overboard with exercising is to see responses to a series of questions that ask the person to describe what he does and why he does it — the same kind of survey used to figure out whether someone is addicted to cocaine, heroin, alcohol, or some other chemical substance.
Table 15-1 lists the seven symptoms that are usually examined when deter- mining whether a person is engaging in healthy or unhealthy exercise and the kind of questions asked to determine whether someone has a problem or not.
It’s pretty easy to see that they were intentionally developed to mimic the way addictions are assessed.
Table 15-1 Symptoms of Excessive Exercise
Symptom This Question Is an Indication of This
Tolerance Do you need to keep doing more and more exercise just to get the same good feelings?
Whether you are building up an exercise tolerance.
Withdrawal Do you feel anxious, irritable, or have trouble sleeping when you aren’t able to get your regular amount of exercise?
Whether you’re experiencing withdrawal symptoms when you can’t get your daily exercise “fix.”
Intension Do your workouts last longer or involve a great deal more effort than you had originally intended?
Whether you are unable to limit yourself to your inten- sions regarding exercise.
(continued)
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Symptom This Question Is an Indication of This
Control Do you wish you could — but don’t seem to be able to — cut down on the amount of exercising you do?
Whether you lack the ability to control your exercise.
Time commit-
ment Do you spend a lot of time exercising or planning what you’ll do when you exercise?
Whether you make large time commitments to exercise.
Interference Have you had to reduce or eliminate other activi- ties — social, recreational, personal, or job-related — to accommodate your workout schedule?
Whether you are reducing involvement in other activities in order to exercise.
Continuance Do you continue exercising even when you know it’s probably not good for you — like when you have a physical injury or illness?
Whether you continue to exercise even when you know it may result in negative consequences.
Answering yes to one or even a couple of these questions doesn’t necessarily mean you have a serious exercise problem. However, the more these experi- ences describe you and the way you exercise, the more you may want to begin thinking about whether you’re placing just a bit too much emphasis on your training at the expense of other important things in your life.
Examining why people exercise too much
Most people do or don’t do things as in order to either increase pleasure or to decrease pain. Deciding whether to exercise or not is no exception. Let’s face it: Most people probably wouldn’t exercise at all if they didn’t really think that all that hard work would either pay off in some positive way or help them avoid or delay something negative. This desire to maximize plea- sure and minimize pain may drive how often people exercise and whether they end up developing an over-attachment to exercise.
Getting hooked on the feeling
Ask people why they engage in intense, regular exercise, and many tell you, in almost spiritual terms, about the fantastic feelings of well-being they get when they physically push themselves to their limits.
Table 15-1 (continued)
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As we explain in Chapter 14, intense exercise can produce chemical changes in the body that are often associated with feelings of euphoria. In fact, a couple of the chemicals that the body releases during strenuous exercise (serotonin and norepinephrine) are so closely linked to “feeling groovy” that they serve as the basis of most commercial antidepressant medications. Two other chemical byproducts of exercise — dopamine and endorphins — are essentially the body’s own way of treating itself to a reward.
With all those pleasure-producing drugs being pumped into the brain during long and hard workouts, it’s no surprise that some people continually seek out the amazing sensations they can get (legally) only through intense exer- cise. Anyone who develops a craving for extreme exercise just for the sheer pleasure it brings is said to have a primary, or an immediate, attraction or dependence to exercise. But there are other, secondary, reasons some people can’t seem to get enough of this good thing called exercise, which we explain in the next section.
No pain, no gain: Believing that the ends justify the means
Some exercise extremists don’t find exercise for its own sake enjoyable in the least. Instead, they are far more interested in what they think their strenu- ous workouts will do for them in the long run. To them, exercise is little more than a means to an end, the price that must be paid to get something they want in the future.
Athletes, for example, may routinely drive themselves to the point of exhaus- tion in the hopes of seeing just the slightest improvement in their perfor- mance. Those who are particularly vulnerable to this type of motivation are
✓ Those who participate in events that are judged, in part, on the way the performer looks: gymnasts, figure skaters, dancers, competitive cheer- ers, and so on.
✓ Those who participate in sports with severe weight restrictions or clas- sifications: wrestlers, boxers, mixed martial artists, and equestrians, for example.
These people use excessive exercise as a way to control their weight, alter their appearance, and thus improve their performance.
Even non-athletes often push themselves through countless hours of demand- ing physical workouts just to drop a few pounds, develop those “iron abs” or
“buns of steel” that they can then show off during their next trip to the beach.
Their motivation is to work hard in the gym now in order to reap the benefits sometime in the future.
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Combining excessive exercise with disordered eating
Many who have distorted body images that lead to eating disorders, such as anorexia nervosas (severe reduction in eating), bulimia (binge eating and then vomiting or using laxatives to purge food), or some other pattern of dis- ordered eating, begin to see exercise as a convenient — and even healthy — way to obtain their unrealistic body ideals or otherwise gain some personal control over an important aspect of their lives.
The logic here is pretty straightforward. People in general, but especially those with distorted body images, tend to think that their weight is deter- mined by simple arithmetic: If you burn more calories than you eat, you lose weight. This calories in/calories out mindset leads them to falsely (and dangerously) conclude that losing weight (their main goal) is just a matter of eating less and/or exercising more. Although this may be true in theory, body metabolism is far more complicated than adding and subtracting calories (refer to Chapter 4 for more on metabolism).
Mistakenly believing that more is always better
The numbers don’t add up: Twice as much ain’t always twice as good. Many people stumble into the trap of believing that, if something is good for them, then more should be even better. But that’s not the way it works, especially when you’re talking about the potential benefits of exercise.
Unfortunately, the official recommendations for exercise aren’t very help- ful. Although most are very good at specifying how much exercise is enough, they don’t seem particularly interested in addressing the question of how much exercise is too much. In fact, some organizations may even
Meaningless and misleading words: “Anorexia athletica” and “sports anorexia”
Some people use invented and highfalu- tin’ terms like anorexia athletica and sports anorexia to make a connection between excessive exercise and a specific disordered eating pattern (anorexia). The problem with this combined term is that it doesn’t make sense:
Anorexia is a combination of an (a lack of)
orexia (appetite), and so it literally means a lack of appetite. Although the exercise and the lack of appetite may be happening at the same time and be designed to accomplish the same goal (weight loss), having a lack of appetite really has nothing to do with exercise and even less with athletics or sports.
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inadvertently contribute to the problem. Both the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), for exam- ple, indicate that healthy adults should engage in at least 150 minutes of moderate exercise or 75 minutes of intensive exercise per week. They imme- diately follow this minimum recommendation by unconditionally stating that doubling these times produces “even greater health benefits.”
Although that particular assertion may be true, some people are inclined to erroneously extrapolate that they would get the greatest health benefits of all by simply doubling these numbers once again — 600 minutes of moderate or 300 minutes of intense exercise each week. At some point this “more exercise is better exercise” reasoning breaks down, as do most of the exercisers themselves.
Getting a Grip on Reality — and Exercise: Addressing the Problem
Making sure that you and the folks you work with get just the right amount of exercise isn’t nearly as easy as it sounds. If you (or they) don’t exercise enough, you run a huge risk of developing some pretty serious health prob- lems, such as cardiovascular disease (heart attack and stroke), diabetes, depression, arthritis, bone degeneration, and even certain types of cancer.
On the other hand, engaging in too much exercise can result in extremely painful overuse injuries (sometimes called repetitive micro-traumas), such as tendonitis and stress fractures; physical and psychological burnout; and det- rimental impacts on relationships at home and at work.
Making things all the more difficult is the fact that everyone is different.
Depending on age, physical condition, personality, and existing illnesses or injuries, what may be a perfect amount of exercise for one person would be way too much or far too little for someone else.
In Chapter 13, we discuss how to inspire yourself to begin and stick with an exercise program. Here, we tell you how to control your exercise so that your exercise doesn’t control you.
Throughout this section, we talk a lot about ways to keep yourself from exer- cising too much. But we are not telling you to quit exercising! Exercise is one of the best things you can ever do for yourself. The key is to make sure you’re maximizing the good things exercise and physical activity can do for you while minimizing the bad that can come from overdoing it.
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Taking stock: Knowing what you hope to get from exercise
To figure out exactly how to set up healthy parameters around how much you exercise, you have to figure out what’s tempting you to exercise too much in the first place. Basically, you need to ask yourself the question,
“What’s in it for me?”
Are you exercising just to get some of those fantastic direct (primary) posi- tive feelings that seem to come naturally when you work up a serious sweat?
Or maybe you’re seeking indirect (secondary) rewards like weight loss, a better self-image, or the satisfying sense of control or accomplishment that can come from exercise.
Although there’s nothing wrong with exercising for either (or a combination) of these reasons, if you ever want to limit yourself, you need to know what rewards you’re asking yourself to give up and what you’ll have to replace in some other way.
Thinking about what you do before you do it: Being mindful
Life can get so hectic sometimes that you may just switch on automatic pilot and go through your daily routine with as little thought as possible. Routines can help you get important things done without devoting a great deal of time and energy to thinking about them, but you need to be careful. If your exercise program has become just another thing that you do without a lot of thought, you’re denying yourself the opportunity to make some interesting observations about how you can improve the way you exercise — without increasing the amount of time you spend doing it. Ask these questions:
✓ Are you using exercise as a distraction? Are you increasing your work- out schedule (exercising longer or more frequently) just to avoid inter- acting with your family and friends?
✓ When will enough ever be enough? Can you imagine ever getting to a point where you will be completely satisfied that you’re doing enough exercise and you don’t have to continue trying to get a little stronger, a little thinner, a little faster, or into a little better condition?
✓ What else can you do to get the same benefit? Is there any way you can accomplish your goals without exercising quite as much? If you’re exer- cising to relieve stress, can you take a stress management or relaxation class? If you’re exercising to look better, can you improve your diet?
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Committing to change
Making changes to your daily or weekly exercise schedule isn’t often easy.
After all, you’ve established this routine because you like it this way, right?
In fact, having a routine you can count on every day often feels comfort- ing and reassuring. But you can make a few minor — even pleasurable — modifications to minimize your chances of suffering from the negative effects excessive exercise can produce.
Acknowledging that over-exercising isn’t good for you
One of the first things people who are prone to over-exercising need to do is to truly acknowledge the harm excessive exercise can cause. Simply put, you actually have to believe a real need exists to limit your physical activity, or you’ll never be able to set healthy parameters around exercise. Rethinking the role exercise plays in your life may be the most difficult — but important — change you’ll ever need to make.
Accepting the fact that too much exercise can be a problem is the necessary first step in any behavioral change. Acceptance and Commitment Therapy (ACT) is a popular form of psychotherapy used to treat various behavioral compulsions and dependencies. This approach maintains that participants must acknowledge that a potential problem exists before anything can be accomplished. Interestingly, the acronym ACT has also come to stand for the three steps in behavioral change:
✓ A = Acknowledgement (that a problem exists)
✓ C = Choose (to do something about the problem)
✓ T = Take action (follow through on the voluntary choice to do something or, to use the common catchphrase “git-r-done”).
Adding variety
Variety is the spice of life — and physical activity, too. To vary your exercise routine, try changing the location, time, or preferred exercise activity. Doing so can make modifying your overall level of exercise a lot easier. An added benefit to changing your exercise routine is that you’re less likely to suffer overuse injuries or psychological boredom. You may even find you like your new way of exercising even more than the rut you were in!
Habits are hard to break partly because they have become engrained parts of our lives. Changing even small things about the way you exercise can break your habit and weaken the hold these patterns of behavior have on you: Go to a different gym (some even honor the membership you hold elsewhere in the hopes of getting you to switch), work out before rather than after work at least one day a week, or take a spin on an exercise bike instead of using the elliptical runner once in a while.