Exercise, Pleasure, and Punishment: A Historical, Social, and Medical Perspective on Exercise Addiction

Exercise, Pleasure, and Punishment: A Historical, Social, and Medical Perspective on Exercise Addiction

By Sandro Angulo Rincón

My knees are shot (worn out), and so is my hip, because I’ve pushed myself too hard (excessive training) in the gym. All of that needs surgery.

“Isn’t it necessary to be obsessed with exercise?” asks the journalist.
You don’t have to go ‘crazy’ (train without control) at the gym—it’s not worth it, replies the celebrity being interviewed. You need to know how to eat well, but also enjoy your food, indulge now and then.

“And what does it mean to go ‘crazy’ at the gym?” the reporter follows up.
For example, I’ve trained for five hours in a single day. At 1 or 2 in the morning, after coming back from a party. That’s delirium, that’s pathology…

This is part of the conversation held by the talented Colombian artist Margarita Rosa de Francisco on Desnúdate con Eva, a YouTube show hosted and directed by Spanish journalist Eva Rey Botana. What was Margarita trying to tell the audience? That she’s addicted to exercise?

Even the medical community has not reached a consensus on whether physical activity should be considered an addiction. One reason is that exercise is typically associated with therapeutic benefits for physical and mental well-being—hardly something scientists would classify as a vice. In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, does not include this type of addiction. It only addresses addictions related to substance use, gambling, and internet dependency.

That perception stems from the meaning attributed to bodily movement from antiquity to the present. Historically, the concept of health in 19th-century America was rooted in the ancient non-natural tradition of Greek physicians Hippocrates (c. 460 BCE – c. 370 BCE) and Galen (c. 129 – c. 216 CE), who linked vigorous physical activity with disease prevention. As a result, during the 19th century, moderate exercise held a prominent place in medical literature.

Later, in the 1960s, medical interest in exercise was revived for two key reasons: First, pioneering epidemiological studies from mid-century linked sedentary lifestyles to chronic illnesses; and second, physical routines became prescriptive in response to the economic and productivity-related consequences of unhealthy lifestyles.

So, why consider sport as a pathology?

Because evidence shows that some individuals lack control—the hallmark of any addiction—over moderating the time spent on physical activity, and continue to exercise despite experiencing pain, the body’s primary warning signal of excess. According to researchers Heather Hausenblas and Danielle Symons in How Much Is Too Much? The Development and Validation of the Exercise Dependence Scale, there are psychological manifestations such as:
(1) experiencing anxiety, irritability, or insomnia when not engaging in exercise;
(2) dedicating excessive time to preparation, performance, or recovery after strenuous workouts; and
(3) continuing to exercise despite injury.

These symptoms had already drawn the attention of physicians in the 1970s—the decade in which the term “exercise addiction” appeared in scientific literature, initially framed as a “positive addiction,” referring to the potentially beneficial dose-response relationship between exercise and health.

Under these conditions, a sports addict is defined as an individual who, through habitual exercise, loses control over their routines and acts compulsively, exhibits dependency, and experiences negative consequences on their health and social life. For instance, such individuals may become withdrawn and neglect personal and professional responsibilities. If told to rest, they are likely to become irritated and vehemently defend the benefits of exercise—even as those around them notice obsessive behavior.

However, a challenge in diagnosing this condition lies in the fact that it is often a consequence of other underlying disorders, such as Obsessive-Compulsive Disorder, depression, and anxiety, and even bulimia or anorexia nervosa—since excessive exercise is frequently linked to rigorous monitoring of energy balance and weight loss. In other words, sports addiction is more often a result than a root cause of these mental health disorders.

Scientific studies also suggest that overexercising may serve as a coping mechanism for individuals experiencing frequent anxiety attacks, offering them an anxiolytic effect. Lejoyeux and colleagues, in Prevalence of Exercise Dependence and Other Behavioral Addictions Among Clients of a Parisian Fitness Room, propose an even more provocative hypothesis: they argue that individuals who engage in compulsive exercise may be more vulnerable to other forms of behavioral addiction, such as compulsive shopping or excessive screen time.

The Origin of the Condition

In addition to psychological factors, experts propose two primary mechanisms behind this addiction. One is physiological, referring to the runner’s high hypothesis—the euphoric feeling many runners experience after an intense race. This sensation has been attributed to endorphins, chemical substances produced by the body that are associated with feelings of relaxation, pleasure, and happiness. It appears that in some individuals, exercise reduces endorphin sensitivity, requiring an increased training dose to maintain the same effects.

The other mechanism is sociocultural. Scholars in the social sciences argue that the “exercise addict” is continually exposed to neoliberal demands for self-optimization, where certain individuals push positive physical practices to the extreme, treating them as indispensable habits for health. According to Helen Keane in her essay A Normalised Future of Addiction, health in neoliberal ideology is no longer defined as the absence of disease, but rather as a utopian state of complete well-being. Consequently, individuals feel compelled to achieve goals through inhuman effort, dietary restrictions, and stoic discipline—often without any medical justification. Compounding the issue, the symptoms of this pathology are frequently tolerated or even applauded by society, as overexercising is often viewed as a shield against substance addictions. Media and technology play a role in reinforcing this context.

Photo: Logan Weaver/Unsplash

Media, driven by the marketing strategies of the sports industry, promote a model of beauty and well-being that glorifies thinness, idealizes the superhuman physique, and stigmatizes body fat percentages. Meanwhile, the use of technology—particularly fitness applications and wearable devices such as Strava, Garmin, and FitBit—may be linked to fluctuations in users’ self-esteem based on the metrics they generate. When the results fall short or are not as impressive compared to those of other “users/competitors,” it is likely to negatively affect self-worth and may lead individuals to increase their exercise to unhealthy levels.

Prevalence

The scientific community has developed several questionnaires to assess exercise addiction. Among the most prominent are the Obligatory Exercise Questionnaire (OEQ), the Exercise Dependence Questionnaire (EDQ), the Exercise Dependence Scale (EDS), and the Exercise Addiction Inventory (EAI). The existence of multiple assessment tools has led to significant variability in the estimation of the prevalence of this behavioral dependency.

In a cross-sectional study conducted by Lichtenstein and other researchers titled Is exercise addiction in fitness centers a socially accepted behavior?, the Danish version of the Exercise Addiction Inventory (EAI) was used to identify participants at risk of exercise addiction. A total of 577 individuals who engage in regular exercise completed the survey. The gender distribution was 71% women, with an average age of 26.7 years (ranging from 15 to 73). The findings suggest that a high risk of exercise addiction was associated with a greater amount of weekly exercise, as 80.6% of those at high risk reported training for 8 hours or more per week, compared to 35.3% of those at low risk. A higher proportion of those at high risk also reported exercising despite injuries or illness, and 61% acknowledged having an eating disorder.

Emmanuelle Larocque and her colleagues, in When sport is taken to extremes: A sociohistorical analysis of sport addiction, reviewed data from the literature on physical activity dependence as part of a broader research project on this disorder in Canada and Australia. They concluded that the sports most likely to lead individuals to develop an addiction include running, weightlifting, bodybuilding, marathon/triathlon, extreme sports, and cycling.

Similarity and Difference with Bigorexia

Bigorexia and exercise addiction are two pathological processes that share the characteristic of excessive physical training, often used as an emotional escape and a way to experience fleeting pleasure from physical results, even when such behaviors lead to social impairments and body image distortions. However, bigorexia is classified as an eating disorder (ED), in which individuals typically follow a restrictive diet, use drugs to accelerate muscle growth, engage in extreme workout routines, and feel deeply dissatisfied with their bodies.

A person with bigorexia experiences obsessive and recurring thoughts about their appearance and often plans rigid improvements to their muscle mass. As a result, they train compulsively to compensate for a “flaw” that only they perceive.

In somatoform disorders, individuals report physical symptoms of a medical illness that do not objectively exist. These symptoms are not faked; they are genuinely felt. There is a noticeable and pathological preoccupation with an imagined physical defect, or if a minor defect does exist, their response is highly disproportionate. Bigorexia is considered a variant of Body Dysmorphic Disorder (BDD), as individuals perceive their body as small and weak—one of the most commonly reported symptoms.

Research Findings on Exercise Addiction and Bigorexia

Research by Alonso Andrade and colleagues, titled Niveles de adicción al ejercicio corporal en personas fisicoculturistas (“Levels of Physical Exercise Addiction in Bodybuilding Individuals”), reveals that 73.3% of participants showed moderate levels of exercise addiction, while 26.7% demonstrated high levels, with no significant differences between men and women. The age ranges with the highest prevalence were 20–32 years and 33–45 years. The purposive sample consisted of 30 regular gym-goers in Ibagué, Colombia, who completed the General Addiction Scale.

Individuals suffering from both bigorexia and exercise addiction often use anabolic steroids—performance-enhancing substances that increase muscle mass and improve physical appearance and athletic output. They are also frequent consumers of dietary supplements. Anabolic steroids are linked to severe and irreversible health consequences, including strokes, early heart attacks, liver tumors, kidney failure, and psychiatric issues. When discontinued abruptly, these substances commonly trigger depression, which often leads users to resume consumption.

Other Dangerous Substances and the Case of Synthol

Other equally hazardous substances have claimed the lives of bodybuilders. One such substance is Synthol—a mixture of oil, xylocaine, and alcohol—used to promote the artificial enlargement of muscles through localized injections. A recent fatal case reported by AS Deportes involved Nikita Tkachuk, known as the “Russian Hulk,” who died at the age of 35 due to multiple organ failure. The news, published on May 23, noted that Synthol had been applied indiscriminately, leading to liver damage, pulmonary edema, and cardiac arrest. In a video prior to his death, Tkachuk remarked, “If your arm measures 45 or 50 centimeters, what is going to change in your life? You’re only going to lose your health. It’s not worth it.”

Although body image disorders were traditionally considered more typical among women, studies such as Vigorexia, adicción, obsesión o dismorfia; un intento de aproximación by José Miguel Rodríguez have found a high prevalence among men. This trend is rooted in cultural consumption patterns and the aesthetic demands imposed by modern social environments. As a result, men experience constant pressure regarding their bodies, and individuals with bigorexia often report distorted perceptions of their appearance.

Treatment

The treatment for exercise addiction typically relies on cognitive-behavioral interventions designed to help patients change their attitudes toward physical activity. The process involves educating individuals about the adverse effects of excessive exercise. This approach includes:

  1. Identifying and interrupting compulsive behavior through individualized psychotherapeutic support.

  2. Helping the patient understand the health benefits of physical activity and the importance of practicing it in moderation.

  3. Supporting the development of strategies to address the problem.

  4. Understanding the patient’s defensive structure and how they confront the issue of addiction.

  5. Increasing the patient’s tolerance to adapt to compulsive behavior by modifying psychological defenses and encouraging acceptance of their response to regaining control.

  6. Separating the compulsion from the specific triggers associated with exercise addiction.

  7. Rebuilding coping strategies and stimulating support systems, such as family, teachers, partners, and friends (Márquez & de la Vega, 2015). Medication is not ruled out.

A study by Sara Knapp, Psychological well-being and exercise addiction: The treatment effects of an REBT intervention for females, examined the effects of Rational Emotive Behavior Therapy (REBT) on irrational beliefs (e.g., “if I don’t go to the gym, I’m worthless”) and exercise addiction symptoms in women who regularly work out. The study concluded that REBT is effective in reducing irrational beliefs, exercise addiction, and psychological distress (a negative stress state associated with emotional discomfort, anxiety, overload, or suffering), as well as in improving mood.

Stopping to reflect on the models and representations of beauty and well-being that the family promotes is essential to prevent addictive behaviors among its members. Parents who are excessively and repeatedly concerned with physical appearance and attractiveness may instill in their children a psychological and emotional mindset of rejection and dissatisfaction with their body image—conditions that can lead to psychopathological disorders related to eating behavior and mood. Education and scientifically validated messaging about moderate physical activity should prioritize individuals’ overall well-being rather than their mental and physical deterioration.

Likewise, it is crucial that gyms and sports clubs provide information on the disadvantages and harmful consequences of excessive exercise and highlight the benefits of rest after training—both for health and for achieving better athletic performance.

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References

Cover photo by Tima Miroshnichenko/pexels.

Alonso Andrade, J., García, S., Remicio, C., & Villamil Buitrago, S. (2012). Niveles de adicción al ejercicio corporal en personas fisicoculturistas (Levels of addiction to physical exercise in bodybuilders). Revista Iberoamericana de Psicología del Ejercicio y el Deporte, 7(2), 209–226.

Hausenblas, H. A., & Downs, D. S. (2002). How much is too much? The development and validation of the exercise dependence scale (¿Cuánto es demasiado? Desarrollo y validación de la escala de dependencia del ejercicio). Psychology and Health, 17(4), 387–404. https://doi.org/10.1080/0887044022000004894

Keane, H. (2021). A normalised future of addiction (Un futuro normalizado de la adicción). International Journal of Drug Policy, 94, 102972. https://doi.org/10.1016/J.DRUGPO.2020.102972

Knapp, S., Miller, A., Outar, L., & Turner, M. (2023). Psychological well-being and exercise addiction: The treatment effects of an REBT intervention for females (Bienestar psicológico y adicción al ejercicio: los efectos terapéuticos de una intervención TREC en mujeres). Psychology of Sport and Exercise, 64. https://doi.org/10.1016/j.psychsport.2022.102298

Larocque, E., & Moreau, N. (2023). When sport is taken to extremes: A sociohistorical analysis of sport addiction (Cuando el deporte se lleva al extremo: un análisis sociohistórico de la adicción al deporte). International Review for the Sociology of Sport, 58(2), 368–391. https://doi.org/10.1177/10126902221104956

Lejoyeux, M., Avril, M., Richoux, C., Embouazza, H., & Nivoli, F. (2008). Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room (Prevalencia de dependencia al ejercicio y otras adicciones conductuales en usuarios de un gimnasio parisino). Comprehensive Psychiatry, 49(4), 353–358. https://doi.org/10.1016/J.COMPPSYCH.2007.12.005

Lichtenstein, M. B., Emborg, B., Hemmingsen, S. D., & Hansen, N. B. (2017). Is exercise addiction in fitness centers a socially accepted behavior? (¿Es la adicción al ejercicio en los gimnasios una conducta socialmente aceptada?). Addictive Behaviors Reports, 6, 102–105. https://doi.org/10.1016/j.abrep.2017.09.002

Rodríguez, J. M. (2007). Vigorexia, adicción, obsesión o dismorfia; un intento de aproximación (Vigorexia, adicción, obsesión o dismorfia; un intento de aproximación). Salud y Drogas, 7(2), 289–308. http://www.redalyc.org/articulo.oa?id=83970205

Tipton, C. M. (2014). Historical Perspectives: The history of “Exercise Is Medicine” in ancient civilizations (Perspectivas históricas: la historia del “ejercicio como medicina” en las civilizaciones antiguas). Advances in Physiology Education, 38, 109–117. https://doi.org/10.1152/advan.00136.2013.-In

Veale, D. (1995). Does primary exercise dependence really exist? (¿Existe realmente la dependencia primaria al ejercicio?). In C. B. Annet J & Steinberg H. (Eds.), Exercise addiction: motivation for participation in sport and exercise (Adicción al ejercicio: motivaciones para la participación en el deporte y el ejercicio). The British Psychological Society.

Weinstein, A., & Weinstein, Y. (2014). Exercise Addiction – Diagnosis, Bio-Psychological Mechanisms and Treatment Issues (Adicción al ejercicio: diagnóstico, mecanismos biopsicológicos y cuestiones terapéuticas). Current Pharmaceutical Design, 20(25), 4062–4069.

Agon y Areté
I am Sandro Angulo Rincón, a Colombian journalist and university professor. I engage in amateur sports research, practice, and consumption. I aspire to produce high-quality journalistic pieces and receive feedback from readers so that Agon & Areté can grow among diverse audiences who speak Spanish, English, Portuguese, and Arabic.

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