Compulsive Exercise

person stretching before a run

There is good reason exercise is called the “miracle drug:” its positive health effects, physiological and psychological, are seemingly boundless. However, many become addicted to this drug, feeling compelled to exercise and struggle with guilt or anxiety when they cannot work out. And when, over time, they burn off more calories through exercising than they consume, their bodies become malnourished, causing a host of physiological and psychological problems. Exercise is wonderful when used properly; however, when overdone, it backfires making exercisers less healthy, not more – and it is very often difficult to know when this line has been crossed. But at The Kahm Clinic, we can see with great precision when and to what extent someone is over exercising, and we also know how to help them recover.

Compulsive exercise takes many different forms. It is often used to manage uncomfortable feelings. It is often used as a way to purge or as a way to compensate binging, or simply to give themselves permission to eat. They are often deeply uncomfortable with inactivity and will miss social functions to exercise; they will exercise when normal people wouldn’t, often in secret, and they often don’t feel like they are pushing themselves hard enough. Some may exercise 3-4 hours a day, but many seem to exercise moderately, some are on sports teams, but many are not; in fact, this patient population is often very hard to detect because they seem so healthy.

Here are some warning signs to consider if you suspect you or someone you know may be struggling with compulsive exercising;

  • Feeling anxious, guilty, and/or getting angry when unable to exercise.

  • Avoiding social functions interfering with exercise routine.

  • Restricting food intake when unable to exercise.

  • Exercising to compensate for food consumed.

  • Exercising in addition to the training required for their sport.

  • Counting only strenuous exercise, i.e. walking doesn't count.

  • Exercising when sick or injured.

  • No menstrual period for 3 or more months.

  • Having one or more stress fractures without a significant injury.

Exercise powerfully affects the brain, which make exercisers feel good, but these good feelings often mask their malnourishment, making the compulsive exercisers blind to how unhealthy they have become. The combination of the “runner’s high” (increased dopamine and endorphin levels), feeling more pleasure and reward (elevated dopamine levels), and in a better mood (increased serotonin), makes compulsive exercising a difficult behavior to break. While exercise is initially done to become healthier and perhaps lose some weight, like any addiction, they need more and more exercise to increase these neurotransmitter levels (endorphin, dopamine, and serotonin). But over exercising also leads to elevated cortisol levels, which causes a decrease in the blood flow, oxygen, and glucose to the brain, leading to a loss of neurons, shrinkage of the brain, and difficulty concentrating.

Physiologically, the body’s metabolism plummets and the body uses its lean tissue to fuel itself, including heart, bones, brain, and muscles in order to survive. Over exercising often leads to amenorrhea (loss of menses), osteoporosis/osteopenia, cardiac complications, fatigue, fractures, and insomnia.  

How Metabolic Testing And Body Composition Analysis Can Help

Metabolic Testing and Body Composition Analysis are extremely useful in treating and diagnosing compulsive exercisers, measuring how the body has been affected by high levels of exercise and inadequate intake. We can see if an individual's fat-free mass, including organs and muscle, is below minimum level and being consumed for fuel. It is difficult to convince them that their excessive exercise is damaging their bodies, but when faced with empirical data showing that they are hypometabolic and catabolic, they cannot deny it and are motivated to begin recovery. Ongoing improvements and test results help convince them that cutting back on exercise and eating more leads to increased energy and improved health. Without the data, most compulsive exercises would not entertain making these changes.