Michael Mantell by Michael Mantell

Anorexia AthleticaYou’ve been an elite personal trainer for years and have heard nearly every reason why people seek out training.  When you hear, “to run faster,” “build endurance,” “to lose body fat,” or to “get thinner,” besides thinking about structuring an integrated fitness training program, do you ever wonder if these performance goals are thinly disguised indicators of anorexia athletica?  Probably not, given that compulsive exercisers are often erroneously honestly mistaken for people with an enviable, deep commitment to exercise.  They are far from that, pushing the threshold of distance, intensity or duration beyond which exercise will have health and social consequences.

As a personal trainer, you are among the first to notice the exercise addict. Armed with knowledge and understanding of obligatory exercisers, trainers can be first responders, often able to make health-promoting interventions.  This is where mind-body interaction really hits the road, not for the good.

First labeled in 1976 by Dr. William Glasser who was then working with runners, the exact prevalence of exercise addicts, those who no longer enjoy exercise but feel obligated to do so, has been estimated as ranging from 1%-7% of committed exercisers. Some believe that 50% of those with clinical eating disorders are also dependent on exercise.

How can you recognize this addiction which often sprouts right in your own gym or health club?  First and foremost, poor self-image, low self-esteem and body dysmorphia are key indicators.  Stress, anxiety, depression and/or anger are underlying issues.  Anorexia athletic and anorexia nervosa (or bulimia) co-exist frequently, thus it is all too common that you will notice your clients are preoccupied with food, caloric intake and body image.  You may begin to wonder if those you train with this disorder are forcing themselves to exercise for all the wrong reasons, the outstanding one being to control their body image that is highly inaccurate.  The endorphin/endocannabinoid “high” that many healthy people dedicated to exercise enjoy, may be taken to the extreme in those tripped up by compulsive exercise patterns.

Constant preoccupation with exercise throughout the day, never taking a day off even when inured or ill, feeling anxious and guilty if one misses an exercise session that “must” be made up, food choices based only on exercise, taking time off from work or school to exercise, lying about exercise, conflicts with friends and family arise due to the amount of exercise one does, using the amount of exercise one does as the basis for self-esteem that day, finding no pleasure in exercise but driven to do so anyway, a sense of isolation du to exercising, weight loss greater than 5% of normal body weight, and never being satisfied with the exercise one did—these are all behavioral indicators of compulsive exercise. 

Obligatory exercise addicts and athletes may workout for similar numbers of hours per day, but that’s where the similarities end.  For example, if you are training an athlete who is focused on an upcoming competition, an injury will cause them to rethink the amount of exercise they are doing. Not so with the exercise addict.

The athlete typically takes a break when their goals are accomplished.  Not so for the exercise addict.  For them, every day is a new goal with the finish line always being moved further down the road. 

The athlete focuses on the finish line, the trophy, the accomplishment, or the title.  The compulsive exerciser finds her/his result is all too often illness or injury. 

The psychology here is based on am understanding of general addictive behavior.  The components included preoccupation, using the behavior as coping skill for mood swings, requiring increasing amounts of exercise to satisfy deeper psychological needs, unpleasant feelings when unable to exercise (withdrawal), conflict with others around the intrusiveness of exercise in the addict’s life, and even relapse when the exercise addiction comes under control.

The “stages of change” or “transtheoretical” model (described in the ACE Personal Trainer Manual) is an excellent way of understanding the natural process by which your clients move through steps to overcome exercise addiction. Let’s review:

  1. The precontemplation stage occurs prior to the exercise addict (or any other addict) being ready to change behavior.
  2. The contemplation stage occurs when the exercise addict is considering changing the exercise addiction.
  3. The preparation stage occurs when the compulsive exerciser is ready to alter their exercise behavior
  4. The action stage occurs when the individual actually takes control of their addictive behavior.
  5. The maintenance stage occurs when your client is free of compulsive exercise behavior and is in a period of healthier exercise behavior.
  6. The relapse stage occurs when your client returns to addictive exercise behaviors. 

Here’s where “motivational interviewing” will be helpful for you in assisting your client.  Non-confrontational, non-pathology oriented and more “person-centered,” this approach involves the following:

  1. Collaborate, don’t confront.  Think of yourself as in a partnership with your client working through the lens of your client.  This will build rapport and trust, necessary to begin talking about the addictive exercise you see.  It’s not about you trying to convince your client—that won’t work.  It is about creating a mutual understanding.
  2. Draw out, don’t impose.  That is, draw out your client’s thinking about the unhealthy body image and exercise behaviors you notice.  Unless your client agrees to the need for change, you will not be able to impose it. 
  3. Emphasize autonomy, not your authority.  Since your client is the only one who can make necessary change, underscoring their autonomy, responsibility and self-direction is not only smart, it’s effective.

Through creating an empathic, supportive, accepting, non-judgmental, non-humorous atmosphere about this unhealthy set of behaviors and mind-set, by helping your clients make up their own mind to change, by helping your client achieve a new understanding of what she/he is doing in terms of harm, you can go a long way to helping your client face the need for specific mental health professional intervention.