MY friend Alice’s older brother is a general practitioner. He’s also an ultra-distance runner, which requires hours and hours of training. He’s up while it is still pitch dark each morning to pound the pavements and he trains again for hours after work each evening. He runs hundreds of kilometres every month.

There’s nothing wrong with that except that running has become an obsession for him. It’s a priority in his life, so much so that that he misses important family events – like his son’s graduation and his daughter’s award-winning ballet recital – to get his fix of kilometres. He puts running ahead of all social engagements and, increasingly, his career is suffering. Not only does he rank running above his patients and their requirements, but he is also so exhausted from the excessive exercise and lack of rest that he’s forgetful, detached and even irritable at work.

And, as if that’s not worrying enough, Alice’s brother also ignores illness and injury to keep up with his rigorous programme. While, especially since he is a doctor, one would expect him to appreciate the potential danger of exercising when ill, he runs when he has the flu and regularly ignores an injury to a muscle in his calf.

“Sometimes he limps so badly when he’s training, it’s hard to imagine he can continue to run. And yet he does,” says Alice, who is deeply worried about her sibling’s mental and physical well-being. “And when, on the rare occasion he’s forced to miss a run, he complains about not being able to sleep and is moody and depressed.”

Alice’s brother is addicted to running. He’s well below a healthy weight for a man of his height and age, and looks years older than he is. His addiction is known as exercise dependence, exercise addiction, obligatory exercise, compulsive athleticism, compulsive exercising and exercise abuse. And it’s something that is receiving increasing attention from health practitioners as more and more people abandon important activities and neglect everyday responsibilities because of their exercise dependence.

According to director of the Oasis Counselling Centre in Plettenberg Bay, psychotherapist, Anstice Wright, people who are addicted to exercise have various motivations for their behaviour. These include a strong desire to control their body weight or shape, a feeling of incomprehensible dread if exercise is not performed and strong drive to achieve an exercise-induced “high”.

“As with all compulsive behaviours, the problem is not the exercise itself,” she explains. “But, when dependence on exercise becomes a destructive force in people’s lives and on the lives of people around them, that’s when the problems arise.”

Signs of exercise addiction and dependence include exercising when sick, overtraining to the point of causing physical harm and exercising for extended periods of time.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, defines excessive exercise as exercise that “significantly interferes with important activities, occurs at inappropriate times or in inappropriate settings, or when the individual continues to exercise despite injury or other medical complications”.

Like Alice’s brother, individuals who suffer from an addiction to exercise continue to workout even through the pain of an injury or against the advice of medical practitioners. For them, the psychological anguish of not exercising is greater than the negative consequences that influence their physical and social well-being. When they’re prevented from exercising, individuals experience irritability and depression; symptoms that are only are relieved by exercising. And the cycle continues.

Although there are numerous studies underway, there are no absolute reasons why a person becomes an exercise addict. Researchers believe it may be due to dissatisfaction with one’s body, low self-esteem, eating disorders and personality disorders like obsession-compulsion. Another theory is that people become addicted to elevated levels of endorphins, which are hormones that are chemically similar to opiates like morphine and heroin.

“At Oasis, we find that it is common for people with exercise addiction to obsess about weight loss or muscle gain, or other physical attributes,” says Wright. “The problem may occur in conjunction with eating disorders such as bulimia nervosa. As in the case of many eating disorders, people suffering from exercise addiction frequently have self-image issues and low self-confidence and may exhibit anxiety and depression.”

In these instances, individuals with bulimia exercise excessively so that they can control their body weight and/or compensate for a binge eating episode, as opposed to or in addition to purging.

“People suffering from anorexia nervosa may also engage in excessive exercise as a way to achieve weight loss,” she adds.

But, as Alice’s brother demonstrates, it’s not only those struggling with eating disorders who become obsessed with exercise. Researchers have concluded that exercise addiction also occurs among people do not and have never suffered from poor body image or eating disorders. Their studies conclude that exercise addiction it is a primary disorder that results in exercising for the sake of exercising in itself.

There are also theories that some addicts use exercise as a means of escape. Their extreme, constant focus on physical activity enables them to avoid thinking about other real-life problems they may be facing.

Addiction to exercise isn’t always easy to diagnose. Addicts seldom admit they have a problem. More often it’s the friends and family of the addict who step forward with their concerns.

Oasis, which offers counselling and various programmes to manage compulsive behaviour, has seen an increase in people suffering from exercise addiction. Wright attributes many of these cases to the ongoing obsession that modern society has with achieving the perfect body.

“And it’s not only women who suffer,” she says. “We’ve seen more and more young men, fixated on building bigger and better bodies, becoming addicted to exercise and terrified of what might happen to their bodies if they stop following extreme weightlifting and fitness programmes.”

Wright believes that exercise addiction, like all compulsive behaviours, is a manifestation of an underlying problem that requires professional treatment.

“In most cases, treatment for exercise addiction and dependence involves counselling to address the emotional problems that cause people to become dependent on exercise. The idea is to guide addicts towards making healthy lifestyle choices to attain balance and well-being, and to help people to cope with the stresses of modern life without resorting to compulsive behaviours. The objective is to get over the addiction altogether and eventually be able to include exercise as part of a balanced healthy lifestyle,” she says.

Warning signs that you may be addicted to exercise

• Always working out alone and in isolation from others.
• Following the same strict exercise pattern day after day.
• Exercising in spite of weather conditions.
• Experiencing extreme anxiety and depression when a workout is missed.
• Becoming aware that exercise provides the primary source of gratification in your life.
• Exercising for more than two hours daily, repeatedly.
• Fixating on weight loss or calories burned.
• Exercising when sick or injured.
• Exercising to the point of pain and beyond.
• Skipping work, appointments or social plans for workouts.
• Constantly talking about your sport, training schedule and diet.
• Justifying excessive exercise as necessary to your sport.
• Having friends and family notice a loss of perspective.
• Using exercise as the primary means of escape or avoidance of problems.
• Needing to exercise more and more than to achieve the desired effect.

(First published in Business Day’s Health News supplement.)