This warning comes from a prominent Australian psychiatrist who has co-authored 15 published peer-reviewed papers on the topic and has been part of an international team leading new approaches in the treatment of compulsive exercise.

Dr Phillipa Hay, a renowned eating disorders academic and psychiatrist, and Director of Wesley Eating Disorders Centre, at Wesley Hospital in Ashfield (NSW) claims a compulsive drive to exercise excessively may often stem from underlying weight- or food-related issues. Together, they can be detrimental to physical and psychological health.

According to Dr Hay, studies have shown that compulsive exercise occurs in half of all patients with an eating disorder[1], up to 80 per cent of anorexia nervosa patients^[2] and up to 57 per cent of patients with bulimia.^[3]

“The combination of the two disorders is associated with poorer outcomes and longer hospitalisations^[4], and is a predictor of relapse^[5],” Dr Hay said. “Obsessive-compulsive exercise also causes higher levels of psychological distress, including depression and anxiety, in people with an eating disorder^[6], and in some studies it has also been related to increased rates of suicide and self-harm^[7].”

“For this reason, it’s important to get help if you or a loved one is showing symptoms, which often include increased anxiety and mood changes if unable to exercise, rigid and unrealistic exercise rules or goals and the drive to exercise even when ill or injured.”

To treat obsessive-compulsive exercise symptoms and establish a healthy relationship with physical activity, body image and diet, Dr Hay recommends cognitive behavioural therapy (CBT)[8].

“CBT can help change a person’s attitude, beliefs and behaviours towards a difficult-to-manage behaviour such as physical activity, to promote exercise that is ‘healthy’,” Dr Hay said. “This therapy also equips people with more effective coping strategies and the skills to prevent relapse. While exercise therapy is not often included in the treatment of eating disorders, studies have found that ‘healthy’ exercise for patients with anorexia can reduce eating disorder symptoms, facilitate weight gain and improve body perception, mood and quality of life^[9]. ‘Healthy’ exercise is exactly that – exercise for health and well-being – like joining a local sports team – versus solitary weight lifting at midnight driven from fear.”

“Exercise has many benefits for health, both physically and psychologically. Just 20 minutes of exercise a day is known to be anti-depressive and reduce anxiety. However, over-exercising can become an addiction that has negative consequences on health. Specialised clinics such as Wesley Eating Disorders Centre can help in the recovery, management and prevention of obsessive-compulsive exercise in people with eating disorders.”

Dr Phillipa Hay’s six signs and symptoms of obsessive-compulsive exercise:

1. Mood changes. Exercise becomes ‘unhealthy’ when the inability to exercise causes mood changes. Feelings of guilt, anger or irritability may arise when a person is unable to engage in physical activity.
2. Fear of stopping or reducing exercise. People may have an overwhelming fear of the negative consequences that may result if they stop or reduce exercise; such has becoming fat, or a feeling as of an inability to cope. Not being able to exercise may cause heightened levels of anxiety.
3. Strict exercise rules. A common sign of obsessive-compulsive exercise is following rigid exercise rules to avoid negative consequences. These are often linked with food consumption. For instance, a person might decide they should spend extra time exercising if they ate something unhealthy, or miss a meal if they do not exercise.
4. Setting difficult exercise goals. A fitness goal such as losing excess weight, training for a race or gaining muscle is healthy. Exercise goals become unhealthy when they are unrealistic and inflexible. Failure to meet high standards often leads to self-criticism, heightened anxiety and negative feelings.
5. Skipping other engagements. Exercise becomes compulsive when physical activity becomes the central focus of a person’s thoughts to such an extent that it takes precedence over other responsibilities. People may spend too much time thinking about, planning and engaging in exercise that they miss social engagements, or it gets in the way of work or study.
6. Exercising in poor health or circumstances. While an injury or illness may cause a healthy exercising person to rest and recover, an obsessive-compulsive exerciser will continue to workout even when it is detrimental to their physical health. The compulsion will motivate them to exercise even in bad weather despite the increased risk of other infections or ailments.

To fitness professionals who suspect a client may be at risk, Dr Hay says:

“It is important that fitness professionals confidently share with clients any concerns that they have about their health and wellbeing, if they are showing signs of obsessive exercise or an underlying eating disorder. Rather than being confrontational or rejecting clients, fitness professionals should encourage them to talk to their GP. Ongoing participation in ‘healthy exercise’ is acceptable when appropriate to the client’s physical state, such as setting BMI limits for intense cardiovascular exercise, or in consultation with a doctor. Fitness professionals can also complete eating disorder mental health first aid courses, to equip themselves with the skills on how to best deal with clients that are suffering from a condition.”

References

[1] Monell et al. 2018, ‘Running on empty – a nationwide large-scale examination of compulsive exercise in eating disorders’, Journal of Eating Disorders

[2] Davis et al in L.W.C Ng et al, 2013, ‘Is supervised exercise training safe in patients with anorexia nervosa?

A meta-analysis’, Physiotherapy, Volume 99, Issue 1, 1 – 11

[3] Schelgel et al, 2018, ‘Self-reported quantity, compulsiveness and motives of exercise in patients with eating disorders and healthy controls: differences and similarities’, Journal of Eating Disorders

[4] Solenberger, S. E. (2001). Exercise and eating disorders: A 3-year inpatient hospital record

analysis. Eating Behaviors, 2, 151-168.

[5] Young et al, 2018, ‘Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa’, Journal of Eating Disorders

[6] Young et al, 2018, ‘Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa’, Journal of Eating Disorders

[7] Monell et al. 2018, ‘Running on empty – a nationwide large-scale examination of compulsive exercise in eating disorders’, Journal of Eating Disorders

[8] Hay Pet al, 2018, ‘A randomized controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): A new approach to compulsive exercise in anorexia nervosa’, International Journal of Eating Disorders, Jul 26.

[9] Hausenblas et al. in L.W.C Ng et al, 2013, ‘Is supervised exercise training safe in patients with anorexia nervosa?

A meta-analysis’, Physiotherapy, Volume 99, Issue 1, 1 – 11

About Wesley Hospital

Wesley Hospital (wesleymission.org.au/hospital) has provided world-class treatment for mental health conditions for more than 60 years to patients from all over Australia. Its two private Sydney centres – Wesley Hospital Ashfield and Wesley Hospital Kogarah – offer evidence-based psychiatric, nursing and psychological support to help in the recovery, management and prevention of eating disorders, depression, anxiety, addiction and other mental health conditions. The highly experienced team of medical professionals includes renowned leaders in mental health research and treatment. Wesley Hospital is run by Wesley Mission. For more information, visit wesleymission.org.au/hospital