Prevalence of Risk for Exercise Dependence: A Systematic Review

Abstract

Background

Exercise dependence (EXD) can be considered an addictive behaviour because it presents signs typical of other addictive behaviours. Despite possible health problems related to EXD, the prevalence of risk for EXD has never been systematically reviewed.

Objective

This article aimed to systematically review the prevalence of risk for EXD.

Methods

Studies were identified from searches in the ERIC, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science electronic databases up to June 2018. Empirical studies were selected if (1) they included the outcomes of the prevalence of EXD; (2) participants were regular exercisers; and (3) they were published in either the English, French, Portuguese, or Spanish languages. A total of 34 articles met the inclusion criteria.

Results

The prevalence of risk for EXD was estimated to be between 3 and 7% of regular exercisers and the university student population, and between 6 and 9% of the athlete population.

Conclusion

The results of this review indicated that the prevalence of risk for EXD varies with the characteristics of the exerciser, but an overall prevalence of 3–9% is estimated. Risk for EXD is a cause for concern and, from a public health point of view, is a problem that has to be addressed.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

References

  1. 1.

    Caspersen C, Powell K, Christenson G. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100:126–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Hardman A, Stensel D. Physical activity and health. The evidence explained. 2nd ed. Oxon: Routledge; 2009.

    Google Scholar 

  3. 3.

    Egorov AY, Szabo A. The exercise paradox: an interactional model for a clearer conceptualization of exercise addiction. J Behav Addict. 2013;2(4):199–208.

    Article  Google Scholar 

  4. 4.

    Hausenblas HA, Downs DS. Exercise dependence: a systematic review. Psychol Sport Exerc. 2002;3(2):89–123.

    Article  Google Scholar 

  5. 5.

    Hausenblas HA, Giacobbi PR. Relationship between exercise dependence symptoms and personality. Pers Indiv Differ. 2004;36(6):1265–73.

    Article  Google Scholar 

  6. 6.

    Landolfi E. Exercise addiction. Sports Med. 2013;43(2):111–9.

    Article  Google Scholar 

  7. 7.

    Freimuth M, Moniz S, Kim SR. Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. Int J Environ Res Public Health. 2011;8(10):4069–81.

    Article  Google Scholar 

  8. 8.

    Szabo A, Griffiths MD, de La Vega Marcos R, Mervo B, Demetrovics Z. Methodological and conceptual limitations in exercise addiction research. Yale J Biol Med. 2015;88(3):303–8.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Baekeland F. Exercise deprivation. Sleep and psychological reactions. Arch Gen Psychiatry. 1970;22(4):365–9.

    CAS  Article  Google Scholar 

  10. 10.

    Weinstein A, Weinstein Y. Exercise addiction- diagnosis, bio-psychological mechanisms and treatment issues. Curr Pharm Des. 2014;20(25):4062–9.

    CAS  Article  Google Scholar 

  11. 11.

    Szabo A. Addiction to exercise: a symptom or a disorder?. New York: Nova Science Publishers; 2010.

    Google Scholar 

  12. 12.

    Cook B, Luke R. Primary and secondary exercise dependence in a sample of cyclists. Int J Ment Health Addict. 2017;15(2):444–51.

    Article  Google Scholar 

  13. 13.

    Bruno A, Quattrone D, Scimeca G, Cicciarelli C, Romeo VM, Pandolfo G, et al. Unraveling exercise addiction: the role of narcissism and self-esteem. J Addict. 2014;2014:987841.

    Article  Google Scholar 

  14. 14.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). Arlington: American Psychiatric Association; 2013.

    Google Scholar 

  15. 15.

    Muller A, Loeber S, Sochtig J, Te Wildt B, De Zwaan M. Risk for exercise dependence, eating disorder pathology, alcohol use disorder and addictive behaviors among clients of fitness centers. J Behav Addict. 2015;4(4):273–80.

    Article  Google Scholar 

  16. 16.

    Lejoyeux M, Avril M, Richoux C, Embouazza H, Nivoli F. Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room. Compr Psychiatry. 2008;49(4):353–8.

    Article  Google Scholar 

  17. 17.

    Carnes PJ, Murray RE, Charpentier L. Bargains with chaos: sex addicts and addiction interaction disorder. Sex Addict Compulsivity. 2005;12(2–3):79–120.

    Article  Google Scholar 

  18. 18.

    Lichtenstein MB, Christiansen E, Bilenberg N, Stoving RK. Validation of the exercise addiction inventory in a Danish sport context. Scand J Med Sci Sports. 2014;24(2):447–53.

    CAS  Article  Google Scholar 

  19. 19.

    Mayolas-Pi C, Simon-Grima J, Penarrubia-Lozano C, Munguia-Izquierdo D, Moliner-Urdiales D, Legaz-Arrese A. Exercise addiction risk and health in male and female amateur endurance cyclists. J Behav Addict. 2017;6(1):74–83.

    Article  Google Scholar 

  20. 20.

    Bamber D, Cockerill IM, Carroll D. The pathological status of exercise dependence. Br J Sports Med. 2000;34(2):125–32.

    CAS  Article  Google Scholar 

  21. 21.

    Lichtenstein MB, Emborg B, Hemmingsen SD, Hansen NB. Is exercise addiction in fitness centers a socially accepted behavior? Addict Behav Rep. 2017;6:102–5.

    Article  Google Scholar 

  22. 22.

    Hausenblas HA, Schreiber K, Smoliga JM. Addiction to exercise. BMJ. 2017;357:j1745. https://doi.org/10.1136/bmj.j1745.

    Article  PubMed  Google Scholar 

  23. 23.

    Monok K, Berczik K, Urban R, Szabo A, Griffiths MD, Farkas J, et al. Psychometric properties and concurrent validity of two exercise addiction measures: a population wide study. Psychol Sport Exerc. 2012;13(6):739–46.

    Article  Google Scholar 

  24. 24.

    Griffiths MD, Szabo A, Terry A. The exercise addiction inventory: a quick and easy screening tool for health practitioners. Br J Sports Med. 2005;39(6):e30.

    CAS  Article  Google Scholar 

  25. 25.

    Griffiths M. Exercise addiction: a case study. Addict Res. 1997;5(2):161–8.

    Article  Google Scholar 

  26. 26.

    Allegre B, Souville M, Therme P, Griffiths M. Definitions and measures of exercise dependence. Addict Res Theory. 2006;14(6):631–46.

    Article  Google Scholar 

  27. 27.

    Szabo A, Griffiths MD. Exercise addiction in British sport science students. Int J Ment Health Addict. 2007;5(1):25–8.

    Article  Google Scholar 

  28. 28.

    Terry A, Szabo A, Griffiths M. The exercise addiction inventory: a new brief screening tool. Addict Res Theory. 2004;12(5):489–99.

    Article  Google Scholar 

  29. 29.

    Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    Article  Google Scholar 

  30. 30.

    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

    Article  Google Scholar 

  31. 31.

    National Collaborating Centre for Methods and Tools. Quality assessment tool for quantitative studies method. Hamilton: McMaster University; 2008. http://www.nccmt.ca/resources/search/14. Accessed 1 July 2016.

  32. 32.

    Lejoyeux M, Guillot C, Chalvin F, Petit A, Lequen V. Exercise dependence among customers from a Parisian sport shop. J Behav Addict. 2012;1(1):28–34.

    Article  Google Scholar 

  33. 33.

    Guidi J, Pender M, Hollon SD, Zisook S, Schwartz FH, Pedrelli P, et al. The prevalence of compulsive eating and exercise among college students: an exploratory study. Psychiatry Res. 2009;165(1–2):154–62.

    Article  Google Scholar 

  34. 34.

    Cunningham HE, Pearman S, Brewerton TD. Conceptualizing primary and secondary pathological exercise using available measures of excessive exercise. Int J Eat Disord. 2016;49(8):778–92.

    Article  Google Scholar 

  35. 35.

    Cook B, Karr TM, Zunker C, Mitchell JE, Thompson R, Sherman R, et al. Primary and secondary exercise dependence in a community-based sample of road race runners. J Sport Exerc Psychol. 2013;35(5):464–9.

    Article  Google Scholar 

  36. 36.

    Magee CA, Buchanan I, Barrie L. Profiles of exercise dependence symptoms in Ironman participants. Psychol Sport Exerc. 2016;24:48–55.

    Article  Google Scholar 

  37. 37.

    Latorre Román PÁ, Obra AJ, Montilla JP, Pinillos FG. Dependency on physical exercise and body dissatisfaction in various endurance sports and their relation with the motivation to do sports. Rev Psicol Deporte. 2016;25(1):113–20.

    Google Scholar 

  38. 38.

    García CR, Martínez-Rodríguez A, Ortín Montero FJ. Exercise dependence and mood states indicators in university athletes. C Psicol Deport. 2015;15(2):21–6.

    Article  Google Scholar 

  39. 39.

    Meulemans S, Pribis P, Grajales T, Krivak G. Gender differences in exercise dependence and eating disorders in young adults: a path analysis of a conceptual model. Nutrients. 2014;6(11):4895–905.

    Article  Google Scholar 

  40. 40.

    Downs DS, Hausenblas DH, Nigg C. Factorial validity and psychometric examination of the exercise dependence scale-revised. Meas Phys Educ Exerc Sci. 2004;8(4):183–201.

    Article  Google Scholar 

  41. 41.

    Menczel Z, Kovács E, Eisinger A, Magi A, Vingender I, Demetrovics Z, et al. Exercise dependence among hungariane fitness center users: preliminary results. New Med. 2014;2014(3):103–8.

    Google Scholar 

  42. 42.

    Soler PT, Fernandes HM, Damasceno VO, Novaes JS. Vigorexy and levels of exercise dependence in gym goers and bodybuilders. Rev Bras Med Esporte. 2013;19(5):343–8.

    Article  Google Scholar 

  43. 43.

    Costa S, Hausenblas HA, Oliva P, Cuzzocrea F, Larcan R. The role of age, gender, mood states and exercise frequency on exercise dependence. J Behav Addict. 2013;2(4):216–23.

    Article  Google Scholar 

  44. 44.

    Lindwall M, Palmeira A. Factorial validity and invariance testing of the exercise dependence scale-revised in Swedish and Portuguese exercisers. Meas Phys Educ Exerc Sci. 2009;13(3):166–79.

    Article  Google Scholar 

  45. 45.

    Maselli M, Gobbi E, Probst M, Carraro A. Prevalence of primary and secondary exercise dependence and its correlation with drive for thinness in practitioners of different sports and physical activities. Int J Ment Health Addict. 2018. https://doi.org/10.1007/s11469-017-9867-3.

    Article  Google Scholar 

  46. 46.

    Villella C, Martinotti G, Di Nicola M, Cassano M, La Torre G, Gliubizzi MD, et al. Behavioural addictions in adolescents and young adults: results from a prevalence study. J Gambl Stud. 2011;27(2):203–14.

    Article  Google Scholar 

  47. 47.

    Lichtenstein MB, Jensen TT. Exercise addiction in CrossFit: prevalence and psychometric properties of the Exercise Addiction Inventory. Addict Behav Rep. 2016;3:33–7.

    Article  Google Scholar 

  48. 48.

    Lichtenstein MB, Larsen KS, Christiansen E, Stoving RK, Bredahl TVG. Exercise addiction in team sport and individual sport: prevalences and validation of the exercise addiction inventory. Addict Res Theory. 2014;22(5):431–7.

    Article  Google Scholar 

  49. 49.

    Szabo A, De La Vega R, Ruiz-Barquin R, Rivera O. Exercise addiction in Spanish athletes: investigation of the roles of gender, social context and level of involvement. J Behav Addict. 2013;2(4):249–52.

    Article  Google Scholar 

  50. 50.

    Sicilia A, Alias-Garcia A, Ferriz R, Moreno-Murcia JA. Spanish adaptation and validation of the Exercise Addiction Inventory (EAI). Psicothema. 2013;25(3):377–83.

    PubMed  Google Scholar 

  51. 51.

    Pallanti S, Bernardi S, Quercioli L. The Shorter PROMIS Questionnaire and the Internet Addiction Scale in the assessment of multiple addictions in a high-school population: prevalence and related disability. CNS Spectr. 2006;11(12):966–74.

    Article  Google Scholar 

  52. 52.

    Alcaraz-Ibanez M, Aguilar-Parra J, Alvarez-Hernandez JF. Exercise addiction: preliminary evidence on the role of psychological inflexibility. Int J Ment Health Addict. 2018;16(1):199–206.

    Article  Google Scholar 

  53. 53.

    Valenzuela PL, Arriba-Palomero F. Risk of exercise addiction among male amateur triathletes and its relationship with training variables. Rev Int Cienc Deporte. 2017;13(48):162–71.

    Article  Google Scholar 

  54. 54.

    Rocks T, Pelly F, Slater G, Martin LA. Prevalence of exercise addiction symptomology and disordered eating in Australian students studying nutrition and dietetics. J Acad Nutr Diet. 2017;117(10):1628–36.

    Article  Google Scholar 

  55. 55.

    Sicilia A, Bracht V, Penha V, Almeida UR, Ferriz R, Alcaraz-Ibanez M. Psychometric properties of the Exercise Addiction Inventory (EAI) in a sample of Brazilian university students. Univ Psychol. 2017;16(2).

  56. 56.

    Lichtenstein MB, Griffiths MD, Hemmingsen SD, Stoving RK. Exercise addiction in adolescents and emerging adults: validation of a youth version of the Exercise Addiction Inventory. J Behav Addict. 2018;7(1):117–25.

    Article  Google Scholar 

  57. 57.

    Rudolph S. The connection between exercise addiction and orthorexia nervosa in German fitness sports. Eating Weight Disord. 2018;23(5):581–6.

    Article  Google Scholar 

  58. 58.

    Hammond CJ, Mayes LC, Potenza MN. Neurobiology of adolescent substance use and addictive behaviors: treatment implications. Adolesc Med State Art Rev. 2014;25(1):15–32.

    PubMed  PubMed Central  Google Scholar 

  59. 59.

    Potenza MN. Biological contributions to addictions in adolescents and adults: prevention, treatment, and policy implications. J Adolesc Health. 2013;52(2 Suppl 2):S22–32.

    Article  Google Scholar 

  60. 60.

    McElhaney KB, Antonishak J, Allen JP. “They like me, they like me not”: popularity and adolescents’ perceptions of acceptance predicting social functioning over time. Child Dev. 2008;79(3):720–31.

    Article  Google Scholar 

  61. 61.

    Hausenblas HA, Fallon EA. Relationship among body image, exercise behavior, and exercise dependence symptoms. Int J Eat Disord. 2002;32(2):179–85.

    Article  Google Scholar 

  62. 62.

    Babic MJ, Morgan PJ, Plotnikoff RC, Lonsdale C, White RL, Lubans DR. Physical activity and physical self-concept in youth: systematic review and meta-analysis. Sports Med. 2014;44(11):1589–601.

    Article  Google Scholar 

  63. 63.

    Hausenblas HA, Fallon EA. Exercise and body image: a meta-analysis. Psychol Health. 2006;21(1):33–47.

    Article  Google Scholar 

  64. 64.

    Szabo A, Griffiths DM, Demetrovics Z. Neuropathology of drug addictions and substance misuse. In: Preedy VR, editor. Neuropathology of drug addictions and substance misuse. General processes and mechanisms, prescription medications, caffeine and areca, polydrug misuse, emerging addictions and non-drug addictions. London: Academic Press; 2016. p. 984–92.

    Google Scholar 

  65. 65.

    Fisher J, Sales A, Carlson L, Steele J. A comparison of the motivational factors between CrossFit participants and other resistance exercise modalities: a pilot study. J Sports Med Phys Fitness. 2017;59(9):1227–34.

    Google Scholar 

  66. 66.

    Pierce EF, Daleng ML, McGowan RW. Scores on exercise dependence among dancers. Percept Mot Skills. 1993;76(2):531–5.

    CAS  Article  Google Scholar 

  67. 67.

    Hale BD, Roth AD, DeLong RE, Briggs MS. Exercise dependence and the drive for muscularity in male bodybuilders, power lifters, and fitness lifters. Body Image. 2010;7(3):234–9.

    Article  Google Scholar 

  68. 68.

    Kovacsik R, Soós I, de la Vega R, Ruíz-Barquín R, Szabo A. Passion and exercise addiction: healthier profiles in team than in individual sports. Int J Sport Exerc Psychol. 2018. https://doi.org/10.1080/1612197x.2018.1486873.

    Article  Google Scholar 

  69. 69.

    Kovacsik R, Griffiths MD, Pontes HM, Soós I, de la Vega R, Ruíz-Barquín R, et al. The role of passion in exercise addiction, exercise volume, and exercise intensity in long-term exercisers. Int J Ment Health Addict. 2018;1:1. https://doi.org/10.1007/s11469-018-9880-1.

    Article  Google Scholar 

  70. 70.

    Szabo A. Addiction, passion, or confusion? New theoretical insights on exercise addiction research from the case study of a female body builder. Eur J Psychol. 2018;14(2):296–316.

    Article  Google Scholar 

  71. 71.

    Mageau GA, Vallerand RJ, Charest J, Salvy SJ, Lacaille N, Bouffard T, et al. On the development of harmonious and obsessive passion: the role of autonomy support, activity specialization, and identification with the activity. J Pers. 2009;77(3):601–46.

    Article  Google Scholar 

  72. 72.

    Vallerand RJ, Blanchard C, Mageau GA, Koestner R, Ratelle C, Leonard M, et al. Les passions de l’ame: on obsessive and harmonious passion. J Pers Soc Psychol. 2003;85(4):756–67.

    Article  Google Scholar 

  73. 73.

    Pontes HM, Macur M, Griffiths MD. Internet gaming disorder among Slovenian primary schoolchildren: findings from a nationally representative sample of adolescents. J Behav Addict. 2016;5(2):304–10.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Professor Bruce Jones for revising the document.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Adilson Marques.

Ethics declarations

Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Adilson Marques, Miguel Peralta, Hugo Sarmento, Vânia Loureiro, Élvio Rúbio Gouveia and Margarida Gaspar de Matos declare they have no conflicts of interest relevant to the content of this review.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Marques, A., Peralta, M., Sarmento, H. et al. Prevalence of Risk for Exercise Dependence: A Systematic Review. Sports Med 49, 319–330 (2019). https://doi.org/10.1007/s40279-018-1011-4

Download citation