Am I exercising too much?

You run in the morning, train for your next marathon at night despite a nagging injury, and head to the gym to weight train in your free time. Missing a workout is not an option.

Are you exercised obsessed, or just an avid exercise enthusiast?

That depends on your attitude, say mental health experts. If you exercise frequently because you enjoy it and you like the health benefits it provides, you have the right reasons in mind. If you exercise because you feel compelled to do so, and in spite of having injuries, you may be at risk for developing an exercise disorder.

“There is no set formula or standard that reveals how much exercising is too much,” says Theresa Fassihi, Ph.D., a psychologist with the Eating Disorders Program at The Menninger Clinic. “But if exercising is interfering in a person's life, and it is compulsory, then it may be a problem.”

Dr. Fassihi treats patients in the Eating Disorders Program who over exercise in an attempt to burn off calories, build muscle or attain physical perfection. It is common for patients with exercise disorders to also have an eating disorder, Fassihi says. Problems occur when body perception doesn't match reality.

As with eating disorders, persons involved in activities or professions that require physical beauty or high levels of physical performance—such as athletes and dancers—are particularly vulnerable to developing exercise disorders. High achievers with perfectionist personalities are also vulnerable. Both men and women can have an exercising disorder, but they often have different goals for their exercise regimens. Women seek the “lean look” and typically exercise aerobically to become thin. Men want to bulk up and lift weights to increase muscle mass.

“If you have an exercising disorder, you also may be very preoccupied about your body's appearance, weight and muscle mass.” Dr. Fassihi says. “You spend a lot of time looking at yourself, scrutinizing yourself, measuring yourself and constantly working out to create the muscle mass or lean body that you want.”

Distorted body image, also called body dysmorphia, is a common component of an exercising disorder. Persons with body dysmorphia have a distorted view and exaggerated vision of their appearance—thin women may think they are too big, and muscular men may think they are too puny or scrawny. The obsession with being too small or frail is a subtype of body dysmorphia called muscle dysmorphia, nicknamed bigorexia, which is most common in men. Men with muscle dysmorphia constantly weight train and exercise to achieve a more muscular or perceived “manly” body.

To achieve their ideal body or fitness goals, many persons with exercise disorders also restrict their calories, based on the mistaken belief that they will build a higher proportion of muscle if they restrict their food intake while exercising, Dr. Fassihi says. Instead, they lose both muscle and fat, putting their health at risk.

“Over exercising can cause significant damage to the body,” Dr. Fassihi adds. “It can increase the risk of injuries for both men and women. Women may be more at risk for osteoporosis if they are over exercising and restricting their food intake, and they may stop menstruating completely. Men may use steroids and protein powders to help them achieve their goals, leading to other health problems.”

Over exercising can also cause stress fractures, which can impede walking. Constant repetitive exercise can cause wear and tear on the body's muscle, bones and joints--in severe cases making joint replacement surgery necessary at a young age.

Despite their health problems, many persons who over exercise are reluctant to admit their behavior is problematic, Dr. Fasshi says. Exercise provides them with a sense of control, power, and in some cases, superiority. Exercise also relieves anxiety and releases endorphins, which provide a sense of euphoria. Because of the positive aspects of exercise, and its value in our achievement and appearance oriented-society, treatment for exercise disorders can be difficult.

“If you give up an addiction that is bad for you, you give it up cold turkey. However, you can't give up exercise completely, because it is healthy,” Dr. Fassihi says. “You want to learn how to exercise moderately in a healthy way. That's very tough without help from a professional.”

Staff members with the Eating Disorders Program at Menninger work with patients who over exercise to help them recognize normal levels of exercise. At the beginning of treatment, patients are limited to the mildest physical activity, such as walking, in an attempt to increase their body weight to normal levels. As treatment progresses, patients may increase their amount of exercise. By the time they leave Menninger, patients are exercising moderately every other day, for about four hours a week.

Men and women also learn to confront their anxiety about not exercising, and learn other methods to help them relieve their anxiety—such as relaxation and breathing exercises. They may also participate in a body image group to identify negative beliefs they have about their bodies and how to dispute those beliefs.

With treatment, patients realize the toll that over exercising has taken on their lives.

“Over exercising interferes with their quality of life because they devote so much of their time to exercise to the exclusion of anything else,” Dr. Fassihi says. “Their time is not available for socializing, relationships or work. It is all consuming.”

Am I exercising too much?

Dr. Fassihi says your attitude toward exercising provides important clues about whether you have a problem with over exercising. You may be exercising too much if you:

• Feel you absolutely cannot miss your workout. If you do miss a workout, you feel extremely guilty and uneasy.
• Feel you have to exercise even if you notice that instead of helping your body; you are damaging your body.
• Are getting more injuries.
• Hear family and friends expressing concern about your exercise regimen or appearance, yet don't stop exercising.
• Feel like you can't stop exercising. “It can feel like an addiction for some people,” Dr. Fassihi says. “They feel like they are powerless to stop.”

If you believe you have an over exercising disorder or at risk for developing an over exercising disorder, seek help from a trusted advisor, such as a coach or teacher, or a doctor or mental health professional.

The Menninger Clinic is an international specialty psychiatric center, providing treatment, research and education. Founded in 1925 in Kansas, Menninger relocated to Houston in 2003 and is affiliated with Baylor College of Medicine and The Methodist Hospital. For 16 consecutive years, Menninger has been named among the leading psychiatric hospitals in U.S. News & World Report's annual ranking of America's Best Hospitals.