Conceptualizing primary and secondary pathological exercise using available measures of excessive exercise

Area of Science:

• Exercise Science
• Clinical Psychology
• Psychiatry

Background:

• Pathological exercise (PE) lacks consistent conceptualization and measurement, leading to debate on its addictive or compulsive nature.
• Understanding the distinction between primary (without eating disorders) and secondary (with eating disorders) PE is crucial for accurate diagnosis and treatment.
• Existing research presents varied findings on the prevalence and characteristics of PE, necessitating further investigation into its subtypes.

Purpose of the Study:

• To investigate the addictive versus compulsive nature of primary and secondary pathological exercise.
• To examine the relationship between pathological exercise and eating disorders.
• To determine the prevalence of primary and secondary PE in a diverse adult sample.

Main Methods:

• A sample of 1,497 adults completed validated questionnaires assessing exercise dependence, addiction, compulsivity, and eating disorder symptomatology.
• Diagnostic criteria for DSM-5 eating disorders were applied.
• Statistical analyses included correlation coefficients, t-tests, chi-squared tests, ANOVA, and ANCOVA to compare groups and assess relationships.

Main Results:

• All measures of pathological exercise (PE) demonstrated high intercorrelations.
• Individuals with eating disorders (EDs) exhibited significantly higher scores on all PE measures compared to those without EDs, with bulimia nervosa showing the highest scores.
• Secondary PE was associated with higher compulsive exercise scores (CET, ESDOCS) than primary PE. PE prevalence was 6.4% (1.4% primary, 5.0% secondary).

Conclusions:

• Primary pathological exercise (PE) appears to be predominantly addictive, whereas secondary PE, often co-occurring with eating disorders (EDs), presents as more compulsive.
• While men and women are equally susceptible to PE, men tend to experience primary, addictive forms, and women more often present with secondary, compulsive forms.
• The findings underscore the importance of differentiating between primary and secondary PE, particularly in relation to EDs, for targeted interventions.