Abstract
Background
Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders.
Methods
A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders.
Results
Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95% CI 2.00–6.89; I2 = 81; p ≤ 0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used.
Discussion
Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples.
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References
Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V (2017) Exercise and mental health. Maturitas. Elsevier 106:48–56. https://doi.org/10.1016/j.maturitas.2017.09.003
Wilson MG, Ellison GM, Cable NT (2016) Basic science behind the cardiovascular benefits of exercise. Br J Sport Med. BMJ 50:93–99. https://doi.org/10.1136/bjsports-2014-306596rep
Mandolesi L, Polverino A, Montuori S, Foti F, Ferraioli G, Sorrentino P et al (2018) Effects of physical exercise on cognitive functioning and wellbeing: biological and psychological benefits. Front Psychol Front 9:509. https://doi.org/10.3389/fpsyg.2018.00509
Landolfi E (2013) Exercise addiction. Sport Med 43:111–119. https://doi.org/10.1007/s40279-012-0013-x
Leuenberger A (2006) Endorphins, exercise, and addictions: a review of exercise dependence. Prem J Undergrad Publ Neurosci 3:1–9. Available from https://impulse.appstate.edu/sites/impulse.appstate.edu/files/2006_06_05_Leuenberger.pdf
Adams J (2009) Understanding exercise dependence. J Contemp Psychother 39:231–240. https://doi.org/10.1007/s10879-009-9117-5
Szabo A, Griffiths MD, de La Vega Marcos R, Mervó B, Demetrovics Z (2015) Methodological and conceptual limitations in exercise addiction research. Yale J Biol Med 88:303–308. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=26339214&site=ehost-live
Goodman A (1990) Addiction: definition and implications. Br J Addict 85:1403–1408. https://doi.org/10.1111/j.1360-0443.1990.tb01620.x
Berczik K, Szab A, Griffiths MD, Kurimay T, Kun B, Urbán R et al (2012) Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Subst Use Misuse 47:403–417. https://doi.org/10.3109/10826084.2011.639120
de Coverley Veale DM (1987) Exercise dependence. Br J Addict 82:735–740. https://doi.org/10.1111/j.1360-0443.1987.tb01539.x
Sachs ML (1981) Running Addiction. In: Sachs M, Sachs M (eds) Psychol run. Human Kinetics, Champaign, pp 116–126
Thompson JK, Blanton P (1987) Energy conservation and exercise dependence: a sympathetic arousal hypothesis. Med Sci Sports Exerc. https://doi.org/10.1249/00005768-198704000-00005
Szabo A (1995) The impact of exercise deprivation on well-being of habitual exercisers. Aust J Sci Med Sport 27:68–75. Available from: http://articles.sirc.ca/search.cfm?id=390518
Hamer M, Karageorghis CI (2007) Psychobiological mechanisms of exercise dependence. Sports Med 37:477–484. https://doi.org/10.2165/00007256-200737060-00002
Freimuth M, Moniz S, Kim SR (2011) Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. Int J Environ Res Public Health 8:4069–4081. https://doi.org/10.3390/ijerph8104069
McNamara J, McCabe MP (2012) Striving for success or addiction? Exercise dependence among elite Australian athletes. J Sports Sci 30:755–766. https://doi.org/10.1080/02640414.2012.667879
Egorov AY, Szabo A (2013) The exercise paradox: an interactional model for a clearer conceptualization of exercise addiction. J Behav Addict 2:199–208. https://doi.org/10.1556/jba.2.2013.4.2
American Psychiatric Association. DSM-V. Am. J. Psychiatry. 2013
WHO (2019) WHO| international classification of diseases, 11th revision (ICD-11). WHO
Pasman L, Thompson JK (1988) Body image and eating disturbance in obligatory runners, obligatory weightlifters, and sedentary individuals. Int J Eat Disord 7:759–769. https://doi.org/10.1002/1098-108x(198811)7:6%3C759:aid-eat2260070605%3E3.0.co;2-g
Ogden J, Veale D, Summers Z (1997) The development and validation of the exercise dependence questionnaire. Addict Res 5:343–355. https://doi.org/10.3109/16066359709004348
Hausenblas HA, Downs DS (2002) How much is too much? The development and validation of the exercise dependence scale. Psychol Health 17:387–404. https://doi.org/10.1080/0887044022000004894
Diagnostic and Statistical Manual of Mental Disorders (2000) Fourth Edition, Text Revision (DSM-IV-TR)
Terry A, Szabo A, Griffiths M (2004) The exercise addiction inventory: a new brief screening tool. Addict Res Theory 12:489–499. https://doi.org/10.1080/16066350310001637363
Brown RIF (1993) Some contributions of the study of gambling to the study of other addictions. Gambl Behav Probl Gambl 1:241–272
Brown RIF (1997) A theoretical model of the behavioural addictions–applied to offending. Addict Crime 13–65
Dalle Grave R, Calugi S, Marchesini G (2008) Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome. Compr Psychiatry 49:346–352. https://doi.org/10.1016/j.comppsych.2007.12.007
Bratland-Sanda S, Martinsen EW, Rosenvinge JH, Rø O, Hoffart A, Sundgot-Borgen J (2011) Exercise dependence score in patients with longstanding eating disorders and controls: the importance of affect regulation and physical activity intensity. Eur Eat Disord Rev J Eat Disord Assoc 19:249–255. https://doi.org/10.1002/erv.971
Hollander E, Kwon JH, Stein DJ, Broatch J, Rowland CT, Himelein CA (1996) Obsessive-compulsive and spectrum disorders: overview and quality of life issues. J Clin Psychiatry 57(SUPPL. 8):3–6
Dalle Grave R (2009) Features and management of compulsive exercising in eating disorders. Phys Sportsmed 37:20–28. https://doi.org/10.3810/psm.2009.10.1725
Smink FRE, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414. https://doi.org/10.1007/s11920-012-0282-y
Sauchelli S, Arcelus J, Granero R, Jiménez-Murcia S, Agüera Z, Del Pino-Gutiérrez A et al (2017) Dimensions of compulsive exercise across eating disorder diagnostic subtypes and the validation of the Spanish version of the compulsive exercise test. Front Psychol 7:1852. https://doi.org/10.3389/fpsyg.2016.01852
Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. JAMA Psychiatry 68:724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74
Solmi M, Veronese N, Correll CU, Favaro A, Santonastaso P, Caregaro L et al (2016) Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 133:341–351. https://doi.org/10.1111/acps.12556
Klein DA, Bennett AS, Schebendach J, Foltin RW, Devlin MJ, Walsh BT (2004) Exercise “addiction” in anorexia nervosa: model development and pilot data. CNS Spectr 9:531–537. https://doi.org/10.1017/s1092852900009627
Laban MM, Wilkins JC, Sackeyfio AH, Taylor RS (1995) Osteoporotic stress fractures in anorexia nervosa: etiology, diagnosis, and review of four cases. Arch Phys Med Rehabil Elsevier 76:884–887. https://doi.org/10.1016/s0003-9993(95)80558-3
Misra M, Klibanski A (2011) Bone health in anorexia nervosa. Curr Opin Endocrinol Diabetes Obes. https://doi.org/10.1097/MED.0b013e32834b4bdc
Kaye WH, Gwirtsman HE, Obarzanek E, George DT (1988) Relative importance of calorie intake needed to gain weight and level of physical activity in anorexia nervosa. Am J Clin Nutr. https://doi.org/10.1093/ajcn/47.6.989
Trott M, Jackson S, Firth J, Stubbs B, Smith L (2019) Exercise addiction prevalence and correlates in the absence of eating disorder symptomology. J Sports Sci 37:1–93. https://doi.org/10.1080/02640414.2019.1671688
Di Lodovico L, Poulnais S, Gorwood P (2019) Which sports are more at risk of physical exercise addiction: a systematic review. Addict Behav 93:257–262. https://doi.org/10.1016/j.addbeh.2018.12.030
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100. https://doi.org/10.7326/0003-4819-151-4-200908180-00136
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296. https://doi.org/10.7554/elife.08500.009
Borenstein M, Hedges L, Higgins J, Rothstein H (2013) Comprehensive meta analysis. Biostat, Englewood
Cochran WG (1954) The combination of estimates from different experiments. Biometr JSTOR 10:101–129. https://doi.org/10.2307/3001666
Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med Wiley 21:1539–1558. https://doi.org/10.1002/sim.1186
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics. https://doi.org/10.2307/2533446
Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta—analysis detected by a simple, graphical test. BMJ Br Med J. https://doi.org/10.1136/bmj.315.7109.629
Fu R, Gartlehner G, Grant M, Shamliyan T, Sedrakyan A, Wilt TJ et al (2011) Conducting quantitative synthesis when comparing medical interventions: aHRQ and the Effective Health Care Program. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2010.08.010
Sterne JA, Egger M, Moher D (2008) Addressing reporting biases. Cochrane Handb Syst Rev Interv Cochrane B Ser. https://doi.org/10.1002/9780470712184.ch10
Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. https://doi.org/10.1111/j.0006-341x.2000.00455.x
Garner DM, Garfinkel PE (1979) The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med Camb Univ Press 9:273–279. https://doi.org/10.1017/s0033291700030762
Garner DM, Olmsted MP, Bohr Y, Garfinkel PE (1982) The eating attitudes test: psychometric features and clinical correlates. Psychol Med 12:871–878. https://doi.org/10.1017/s0033291700049163
Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16:363–370. https://doi.org/10.1002/1098-108X(199412)16:4%3C363:AID-EAT2260160405%3E3.0.CO;2-%23
Garner DM (1991) Eating disorder inventory-2: professional manual. Psychological Assessment Resources. Inc, Florida
Morgan JF, Reid F, Lacey JH (1999) The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 319:1467–1468. https://doi.org/10.1136/bmj.319.7223.1467
Grandi S, Clementi C, Guidi J, Benassi M, Tossani E (2011) Personality characteristics and psychological distress associated with primary exercise dependence: an exploratory study. Psychiatry Res 189:270–275. https://doi.org/10.1016/j.psychres.2011.02.025
Dalle Grave R (2008) Excessive and compulsive exercises in eating disorders: prevalence, associated features, and management. Dir Psychiatry 28:273–282. https://doi.org/10.1016/j.comppsych.2007.12.007
Davis C, Katzman DK, Kaptein S, Kirsh C, Brewer H, Kalmbach K et al (1997) The prevalence of high-level exercise in the eating disorders: etiological implications. Compr Psychiatry 38:321–326. https://doi.org/10.1016/s0010-440x(97)90927-5
Davis C, Claridge G (1998) The eating disorders as addiction: a psychobiological perspective. Addict Behav 23:463–475. https://doi.org/10.1016/S0306-4603(98)00009-4
Symons Downs D, MacIntyre RI, Heron KE (2019) Exercise addiction and dependence. In: Anshel MH, Petruzzello SJ, Labbé EE (eds), APA Handb Sport Exerc Psychol Vol 2 Exerc Psychol vol 2, p 589–604. https://doi.org/10.1037/0000124-030
Weinman A, Weinman Y (2014) Exercise addiction- diagnosis, bio-psychological mechanisms and treatment issues. Curr Pharm Des 20:4062–4069. https://doi.org/10.2174/13816128113199990614
Adams JM, Miller TW, Kraus RF (2003) Exercise dependence: diagnostic and therapeutic issues for patients in psychotherapy. J Contemp 33:93–107. https://doi.org/10.1023/A:1022883104269
Lichtenstein MB, Hinze CJ, Emborg B, Thomsen F, Hemmingsen SD (2017) Compulsive exercise: links, risks and challenges faced. Psychol Res Behav 10:85–95. https://doi.org/10.2147/prbm.s113093
Di Nicola M, Martinotti G, Mazza M, Tedeschi D, Pozzi G, Janiri L (2010) Quetiapine as add-on treatment for bipolar I disorder with comorbid compulsive buying and physical exercise addiction. Prog Neuropsychopharmacol Biol Psychiatry 34:713–714. https://doi.org/10.1016/j.pnpbp.2010.03.013
Sundgot-Borgen J, Torstveit MK (2004) Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. https://doi.org/10.1097/00042752-200401000-00005
Bamber D, Cockerill IM, Carroll D (2000) The pathological status of exercise dependence. Br J Sports Med 34:125–132. https://doi.org/10.1136/bjsm.34.2.125
Blaydon MJ, Lindner KJ (2002) Eating disorders and exercise dependence in triathletes. Eat Disord. 10:49–60. https://doi.org/10.1080/106402602753573559
Blaydon MJ, Linder KJ, Kerr JH (2004) Metamotivational characteristics of exercise dependence and eating disorders in highly active amateur sport participants. Pers Individ Differ 36:1419–1432. https://doi.org/10.1016/s0191-8869(03)00238-1
De Young KP, Anderson DA (2010) The importance of the function of exercise in the relationship between obligatory exercise and eating and body image concerns. Eat Behav 11:62–64. https://doi.org/10.1016/j.eatbeh.2009.09.001
Di Lodovico L, Dubertret C, Ameller A (2018) Vulnerability to exercise addiction, socio-demographic, behavioral and psychological characteristics of runners at risk for eating disorders. Compr Psychiatry 81:48–52. https://doi.org/10.1016/j.comppsych.2017.11.006
Lease HJ, Bond MJ (2013) Correspondence between alternate measures of maladaptive exercise, and their associations with disordered eating symptomatology. J Behav Addict 2:153–159. https://doi.org/10.1556/jba.2.2013.012
Meulemans S, Pribis P, Grajales T, Krivak G (2014) Gender differences in exercise dependence and eating disorders in young adults: a path analysis of a conceptual model. Nutrients 6:4895–4905. https://doi.org/10.3390/nu6114895
Serier KN, Smith JE, Lash DN, Gianini LM, Harriger JA, Sarafin RE et al (2018) Obligatory exercise and coping in treatment-seeking women with poor body image. Eat Weight Disord 23:331–338. https://doi.org/10.1007/s40519-018-0504-3
Acknowledgements
The authors wish to express their gratitude to Malcolm Bond, Kyle De Young, Kelsey Serier and Laura Di Lodovico for their help and support in the collection of raw data for analysis.
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Trott, M., Jackson, S.E., Firth, J. et al. A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders. Eat Weight Disord 26, 37–46 (2021). https://doi.org/10.1007/s40519-019-00842-1
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DOI: https://doi.org/10.1007/s40519-019-00842-1