Compulsive Exercise
June 3, 2004, KidsHealth.org

Melissa has been a track fanatic since she was 12 years old. She has run the mile in meets in junior high and high school, constantly improving her times and winning several medals. Best of all, Melissa truly loves her sport.

Recently, however, Melissa's parents have noticed a change in her. She used to return tired but happy from practice and relax with her family, but now she's hardly home for 15 minutes before she heads out for another run on her own. On many days, she gets up to run before school as well. When she's unable to squeeze in her extra runs, she becomes irritable and anxious. And she no longer talks about how much fun track is, just how many miles she has to run today and how many more she should run tomorrow. . . .

Melissa is living proof that even though exercise has many positive benefits, too much can be harmful. Teens who exercise compulsively are at risk for both physical and psychological problems. Read on to learn more about compulsive exercise, its warning signs, and its effects.

What Is Compulsive Exercise?
It's impossible to draw a clear line dividing a healthy amount of exercise from too much. Experts say that repeatedly exercising beyond the requirements for good health is an indicator of compulsive behavior, but because different amounts of exercise are appropriate for different people, this definition covers a range of activity levels.

However, several workouts a day, every day, is overdoing it for almost anyone.

Compulsive exercise (also called obligatory exercise and anorexia athletica) is best defined by the exercise addict's frame of mind: she no longer chooses to exercise but feels compelled to do so and struggles with guilt and anxiety if she doesn't work out. Injury, illness, an outing with friends, bad weather - none of these will deter her. In a sense, exercising takes over her life because she plans her life around it.

Much like with eating disorders, many people who engage in compulsive exercise do so to feel more in control of their lives, and the majority of them are female. They often define their self-worth through their athletic performance and try to deal with emotions like anger or depression by pushing their bodies to the limit. In sticking to a rigorous workout schedule, they seek a sense of power to help them cope with low self-esteem.

Although compulsive exercising does not have to accompany an eating disorder, the two often go hand in hand, particularly with anorexia nervosa. In these cases, the excessive workouts usually begin as a means to control weight and become more and more extreme. As the person's rate of activity increases, the amount she eats decreases.

This behavior can also grow out of student athletes' demanding practice schedules and their quest to excel. Pressure, both external (from coaches, peers, or parents) and internal, can drive the athlete to go too far to be the best. She ends up believing that just one more workout will make the difference between first and second place . . . then keeps adding more workouts.

Eventually, compulsive exercising can breed other compulsive behavior, from strict dieting to obsessive thoughts about perceived flaws. The exercise addict may keep meticulous journals about her exercise schedule and obsess about improving herself. Unfortunately, these behaviors often compound each other, trapping the girl in a downward spiral of negative thinking and low self- esteem.

Why Is Exercising Too Much a Bad Thing?
We all know that moderate exercise is an important part of physical health. But few people realize that too much can cause physical and psychological harm. Excessive exercise can damage tendons, ligaments, bones, cartilage, and joints, and when minor injuries are not allowed to heal, they often result in long-term damage. Instead of building muscle, too much exercise actually destroys muscle mass, especially if the body is not getting enough nutrition, forcing it to break down muscle for energy.

Girls who exercise compulsively may disrupt the balance of hormones in their bodies, changing their menstrual cycles (some girls lose their periods altogether, a condition known as amenorrhea) and risking premature bone loss (a condition known as osteoporosis). And of course, working their bodies so hard leads to exhaustion and constant fatigue.

An even more serious risk is the stress that excessive exercise can place on the heart, particularly when a girl is also curtailing how much she eats. In extreme cases, the combination of anorexia and compulsive exercise can be fatal.

Psychologically, exercise addicts are often plagued by anxiety and depression. They may have a negative image of themselves and feel worthless. Their social and academic lives may suffer as they withdraw from friends and family to fixate on exercise. Even if they want to succeed in school or in relationships, working out always comes first, so they end up skipping homework or missing out on time spent with friends.

Is Your Child Exercising Too Much?
If you're concerned that your child may be exercising compulsively, look for these warning signs:
o She won't skip a workout, even if she's tired, sick, or injured.
o She doesn't enjoy the exercise sessions but feels obligated to do them.
o She seems anxious or guilty when she misses even one workout.
o If she does miss one, she exercises twice as long the next time.
o She is constantly preoccupied with her weight and exercise routine.
o She doesn't like to sit still or relax because she worries that she isn't burning enough calories.
o She has lost a significant amount of weight.
o She exercises more when she eats more.
o She skips seeing friends, gives up activities she loves, and forsakes her responsibilities to make more time for exercise.
o She seems to base how she feels about herself on how much she works out or how hard she trains.
o She is never satisfied with her physical achievements.

It's important, too, to recognize the types of athletes who are more prone to compulsive exercise because their sports place a particular emphasis on being thin. Ice skaters, gymnasts, and dancers can feel even more pressure than most athletes to keep their weight down and their body toned. Runners also frequently fall into a cycle of obsessive workouts.

Getting Help for Your Child
If you recognize two or more warning signs in your child, call your child's doctor to discuss your concerns about compulsive exercise. After evaluating your child, the doctor may recommend medical treatment and/or other therapy. (Extreme cases may require hospitalization to get the child's weight back up to a safe range.) Because compulsive exercise is so often linked to an eating disorder, a community agency that focuses on treating these disorders might be able to offer advice or referrals.

Treating a compulsion to exercise is never a quick-fix process - it may take several months, even years. But with time and effort, your child can get back on the road to good health. Therapy can help her improve her self-esteem and body image, as well as teach her how to deal with emotions instead of sweating them out. Sessions with a nutritionist can help develop healthy eating habits. Once she knows what to watch out for in herself, your child will be better equipped to steer clear of unsafe exercise and eating patterns

Tips for Helping Your Child
You can do a lot at home to help your child overcome a compulsion to exercise. To encourage a healthy approach to food and fitness, involve her in preparing nutritious meals, and combine activity and fun by going for a hike or a bike ride together as a family. You may also need to work on accepting your own body. Don't fixate on physical flaws, as that just teaches your child that it's normal to dislike what she sees in the mirror.

And never criticize another family member's weight or body shape, even in jest. Such remarks may seem harmless, but they can leave a lasting impression on a child or teen struggling to define and accept herself.

Because some teens turn to exercise to cope with pressure, examine whether you are putting too much pressure on your child to excel, particularly in a sport. If you are, start complimenting her other achievements and make sure she knows that you don't expect her to win all the time.

Most importantly, just be there to support your child. Small daily doses of encouragement and praise can improve her self-esteem and point out all her great qualities that have nothing to do with how much she works out. If you teach her to be proud of the challenges she has faced, and not just the first-place ribbons she wins, she will be happier and healthier.