Exercise addiction: Researchers warn against pathologizing healthy dedication to sports and fitness

A recent scientific review provides evidence that physical activity can sometimes transition into a harmful behavioral addiction, though the researchers warn against pathologizing a healthy dedication to sports and fitness. The analysis suggests that truly addicted individuals engage in compulsive training that leads to severe physical and emotional consequences, even though the condition remains absent from official psychiatric diagnostic manuals. The findings were recently published in the Journal of Behavioral Addictions.

Regular physical activity provides well-documented benefits for both the body and the mind. It lowers the risk of chronic diseases, improves mental health, and boosts overall quality of life. However, exercise can sometimes shift from a healthy habit to an uncontrollable and destructive behavior.

A team of scientists reviewed existing literature to untangle the varying definitions, symptoms, and treatment options surrounding this condition. The research team included Bhavya Chhabra, a researcher at Eötvös Loránd University; Zsolt Demetrovics, a professor in mental health and wellbeing at Flinders University; Attila Szabo, a professor of psychology at Széchenyi István University and Eötvös Loránd University; and Mark D. Griffiths, a researcher at Nottingham Trent University. The authors initiated this review because the scientific community currently struggles to agree on exactly how to define and measure problematic fitness habits.

Exercise addiction is classified as a behavioral addiction. Unlike a substance addiction to drugs or alcohol, a behavioral addiction involves a person becoming dependent on a specific action. In this case, an individual feels intense urges to work out and experiences withdrawal symptoms like emotional distress if they are unable to train.

The scientists explain that true addiction always involves two main ingredients, which are dependence and compulsion. Dependence means the body or mind relies on the activity to function normally. Compulsion refers to an overwhelming, irresistible urge to perform the behavior.

“The key difference is whether exercise is a choice, or something a person feels compelled to do,” Demetrovics said. He notes that passion, discipline, and high training loads are generally positive traits, especially among athletes, but these healthy habits can sometimes tip into harmful territory.

Addiction to physical activity can be categorized as either primary or secondary. In primary exercise addiction, the workout itself is the main source of the addictive reward. In secondary exercise addiction, the excessive activity is driven by another underlying condition, such as an eating disorder or body image disturbance.

“Underlying drivers are often more complex than the workouts themselves, with social pressures around body image and performance, alongside mental health challenges like anxiety and depression, playing a significant role,” Demetrovics said. “In many cases, excessive exercise is linked to deeper issues such as eating disorders or other compulsive behaviors.”

Despite over fifty years of research, this condition is not formally recognized in major medical texts like the Diagnostic and Statistical Manual of Mental Disorders. The researchers note that this exclusion stems from inconsistent screening methods and a lack of clinical studies. The academic literature uses more than thirty different assessment tools to describe the problem, with no general agreement on which is best.

“It has led to inflated estimates and a tendency to pathologize normal, healthy exercise,” Demetrovics said. He explains that studies on how many people actually suffer from this condition yield highly inconsistent numbers, largely depending on the screening tool used.

“Widely quoted figures suggest up to 42% of some exercising populations are at risk of being labeled addicted to exercise,” Demetrovics said. The authors point out that these inflated numbers likely result from relying on basic self-report surveys, which often struggle to tell the difference between a healthy passion for sports and a true pathology.

“While screening tools can indicate possible risk, they cannot diagnose exercise addiction which means the line is often blurred between genuine harm and healthy commitment,” Szabo said. Questionnaires can measure a person’s dedication, but they cannot replace a formal clinical diagnosis.

“As a result, highly motivated athletes and regular exercisers can be misclassified but it’s important to differentiate that being dedicated to fitness is not the same as addiction,” Szabo said. These high scores often reflect deep passion rather than an underlying mental health issue.

The scientists also mapped out how this addiction tends to develop. They found that it often begins as a recreational activity aimed at improving health. Over time, individuals might start using the activity as a psychological escape to cope with stress or emotional hardship. Eventually, the behavior becomes an inflexible obligation that dominates a person’s life.

These behaviors signal a shift from healthy habits to damaging routines. “Exercising through pain or injury, feeling anxious or guilty when missing sessions, or consistently prioritizing training over rest, relationships or responsibilities are the signals that exercise may be shifting from something enjoyable to something compulsive,” Szabo said.

Psychologically, certain models suggest that addiction arises abruptly from a sudden, overwhelming life stressor. A traumatic event, such as a relationship breakup or job loss, can cause a person to retreat into physical training as their only coping mechanism. This means that for some people, the addiction triggers rapidly in response to psychological pain.

Physiological models provide evidence that natural brain chemicals play a role in this addictive cycle. Engaging in physical activity releases endocannabinoids, which are natural compounds in the body that reduce pain and create a sense of euphoria. People who exercise excessively may become dependent on this chemical response, experiencing drug-like withdrawal symptoms when they rest.

Another biological explanation focuses on resting energy levels. This idea suggests that regular physical activity lowers a person’s baseline nervous system activity. To counteract feeling lethargic during the day, the individual might feel forced to increase their workout volume just to feel normal and alert.

The resulting negative consequences span multiple areas of an individual’s life. Addicted exercisers often push through severe physical injuries, knowing their actions will cause further bodily harm. They also tend to neglect family, friends, and work responsibilities, leading to social isolation and a decreased quality of life.

Regarding treatment, the authors found that interventions used for other behavioral addictions show promise. Cognitive behavioral therapy is widely recommended to help patients identify maladaptive thought patterns and establish balanced fitness routines. This form of therapy helps individuals change unhelpful thoughts and behaviors into healthier ones.

Acceptance and commitment therapy is another suggested approach. This therapy encourages patients to mindfully accept the uncomfortable cravings they feel when they miss a workout, rather than acting on them. By developing psychological flexibility, individuals can slowly break the addictive cycle and find alternative ways to cope with stress.

Cue exposure therapy is another method discussed by the scientists. In this approach, a psychologist repeatedly exposes a patient to triggers that normally cause the urge to work out. The patient is then guided to resist the behavior, which slowly weakens the mental link between the trigger and the compulsion.

Substitution therapy also offers a practical path forward. This strategy encourages patients to find pleasure in alternative, low-impact activities. Hobbies like meditation, yoga, or volunteer work can replace the problematic behavior and provide a different source of personal reward.

Psychological therapies are the first line of defense, but the researchers note that pharmacological treatments could be considered in certain cases. Medications that help balance brain chemicals have proven effective for other behavioral addictions, like compulsive gambling or shopping. Because exercise addiction lacks an official medical diagnosis, doctors rarely prescribe medication specifically for this condition.

A major limitation in current research is the heavy reliance on screening questionnaires rather than clinical interviews. High scores on these tests simply indicate a risk of addiction, which is often misinterpreted as a confirmed diagnosis. A person might score high simply because they are highly dedicated to a sport, rather than actually suffering from a mental health disorder.

Future studies need to shift their focus from calculating risk scores to studying actual, diagnosed cases of addiction. The authors recommend increased collaboration between academic researchers and clinical psychologists. When researchers identify someone at risk, they should refer that person to a clinician who can determine if a true addiction exists.

There is also a pressing need for larger, long-term studies that track individuals over extended periods. Experimental research will help scientists better understand the underlying causes of this disorder. Establishing solid clinical evidence is a necessary step before exercise addiction can be officially recognized in diagnostic manuals.

Even without an official diagnosis, public health initiatives can take steps to minimize harm. Promoting balanced fitness routines and educating sports organizations about the warning signs of overtraining can help prevent healthy habits from turning into destructive compulsions. Educational campaigns should emphasize overall well-being over extreme performance or appearance goals.

The researchers hope their findings encourage a more balanced approach to physical fitness. “Our message isn’t to exercise less, it’s to exercise smarter by building in rest and recovery days, focusing on overall wellbeing rather than appearance or performance, and seeking support early if exercise starts to feel like an obligation rather than a choice,” Szabo said.

Recognizing personal limits remains an essential part of any training program. “In a culture that celebrates pushing harder, more isn’t always better and staying healthy means knowing when to pull back as well as when to push forward,” Demetrovics said.

The paper, “Exercise addiction: A review and evaluation of current research and theory,” was authored by Bhavya Chhabra, Zsolt Demetrovics, Mark D. Griffiths, and Attila Szabo.