"Aching for the Burn –
Exercise addiction similar to drug abuse"
First came the bruises all over her legs, and the chronic "tired to the bone" feeling. Then her periods stopped coming. And she kept losing weight.
For two years, Katherine Kross's doctors puzzled over what could be wrong with this athletic, 39-year-old go-getter from Estes Park. Perhaps she had a tumor on her adrenal gland, they thought -- until tests proved otherwise.
It was only when she was referred to a psychotherapist that Kross was forced to recognize what had been wrong all along.
"I'm totally addicted to exercise," says Kross, who, for several years, has worked out up to three hours a day, seven days a week.
"I make plans based on whether or not I am going to be able to exercise. I base everything that I eat on how much exercise I am going to get. My whole life revolves around it. I can't take a day off and feel good about it."
In a region known nationwide as a Mecca for fitness buffs, at a time when obesity is at the top of the minds of health practitioners, the suggestion that exercise could be addictive and hazardous is often met with skepticism, experts say. There is no mention of exercise addiction in the Diagnostic and Statistical Manual of Mental Disorders, a practitioners' guide to mental illnesses. Treatment for it is seldom covered by insurance. And many hard-core athletes joke that, as addictions go, it's a good one to have.
But a growing body of scientific evidence suggests that the same neurological underpinnings that lead some people to grow addicted to drugs and alcohol may lead others to crave and abuse exercise. Whether they do it to lose weight, or to fend off depression and keep a sense of control, the results can be equally devastating, say some therapists. And once hooked, it can be tough to kick the habit.
"People don't take it seriously enough and people don't know how widespread it is," says Taylor White, a Boulder social worker who specializes in eating disorders and compulsive exercise. "In a place like Boulder, it is probably a huge problem for a lot of people."
Born to run
A recent study published in the journal "Behavioral Neuroscience," may explain why.
For the experiment, 48 mice were let loose on individual running wheels to sprint for as long as they wanted to. Half had been selectively bred to love running. The other half could take it or leave it.
For six days, the rodent ultrarunners sprinted furiously around the clock, logging roughly three times the distance as their counterparts. On the seventh day, a wooden slat was placed in front of the wheel, forcing all the mice to take a reprieve from training. When University of Wisconsin researchers measured their brain activity, they found the brains of the ultrarunning mice went wild on the seventh day, with the regions that control desire and reward showing much higher activity levels than those in the control group.
"If you give a rat morphine or alcohol or something addictive for several days and then take it away, you see the exact same response," says study author Stephen Gammie, an assistant professor of zoology at University of Wisconsin in Madison. "We felt it was pretty good evidence that there is an addictive component to exercise."
Justin Rhodes, a behavioral neuroscientist and lead researcher for the study, says previous animal research had already shown that mice with a tendency to love running seemed to also respond differently "at the receptor level" to drugs that promote feel-good brain chemicals like dopamine. While it is hard to say how that translates to humans, researchers say, it suggests that some people may be genetically hard-wired to get a stronger buzz from exercise.
"There may be a genetically predisposed group of people out there that may be more prone to addiction, and in extreme cases it can have negative consequences," Rhodes says.
A compulsion to move
Carolyn Costin knows those consequences well.
As someone from who jumped from anorexia to compulsive exercise, and eventually recovered, she founded the MonteNido Residential Treatment Center in Malibu, Calif., eight years ago, creating one of the first and only places in the country with a program devoted specifically to exercise addiction.
"People years ago used to say 'is there really such a thing as an eating disorder, or is it just dieting gone bad?'" Costin says. Today, she notes, eating disorders are widely accepted as a legitimate mental health problem. And she believes the same will happen with compulsive exercise. "It can be just as bad and debilitating of an illness."
Over the years, her center has treated runners, snowboarders, tennis players, lacrosse and soccer players, and a few ex-soldiers who got accustomed to the rigorous workouts of the military and felt lost when back in the civilian world. Some patients haven't socialized in years, instead packing their schedule with exercise. Others have been getting up in the middle of the night to work out, because they don't want friends and family to see them. Many arrive at the center with serious health problems.
While weight and body image are the driving factor for some, she says, many are driven more by an internal compulsion to "keep moving."
"We actually had to have someone watch one of our patients 24 hours a day to stop her from doing sit-ups on her bathroom floor or doing jumping jacks," Costin says. "If you weren't watching her, she would be sneaking push-ups, or sitting there tightening and relaxing her muscles during group."
Neal Henderson, a sports physiologist with the Boulder Center for Sports Medicine, says he has no doubt that athletes can become addicted to the biochemical byproducts of exercise.
He's seen the damage.
He often sees athletes who come in with torn tendons, stress fractures in bones, and other overuse injuries that re-occur as patients train "through the pain." Those who have been over-exercising for a long time may have more serious systemic problems, such as an inability to get their heart rate up, a depressed immune system, a build-up of lactate and other metabolic byproducts in their blood, and hormonal changes, such as a cessation of menstruation in women.
"I've seen cases where people had to take four to six months off to recover," Henderson says, noting that he often refers them to a sports psychologist for help. "A lot of them are resistant."
Rich Benyo, editor of Marathon and Beyond magazine and author of "The Exercise Fix; How the aerobic athlete's compulsive need for the next workout is self-destructive," (Leisure Press; 1990) says he knows from experience what it's like to be a competitive athlete in the grips of an exercise addiction.
When he first began running in 1978, he dived in head first, running eight marathons and a few ultramarathons (50-plus races) in one year alone. He logged no less than 97 miles per week, often pounding the pavement in the wee hours of the night, despite a nagging injury in his Achilles tendon.
It had nothing to do with weight, he says.
"I was just trying to get better and better and I got more into it and more into it and became more compulsive," he says. "I needed to run."
When he found his race times were getting slower the more miles he put in, he took a hard look at himself and cut his training back radically.
"At first, it felt really bizarre," he says. But soon he discovered the less he trained, the faster he got. Many of his friends weren't so lucky.
"There were some friends of mine that got so hooked, they ran themselves into the ground."
Too much exercise; too little food
Dr. Ken Weiner, medical director of the Eating Disorders Center of Denver, says roughly half of the center's patients compulsively exercise, and that, combined with anorexia or bulimia can be particularly tragic.
Restricting food and over-exercising often halts menstruation in women, and without adequate circulation of estrogen in the body, their bones become more fragile, leaving them prone to injury.
"We have had patients fracture their femur exercising," says Weiner.
Kross says she's been lucky.
So far, she has had few physical injuries as a result of her three-hour-per-day regimen of running, cycling, swimming and hiking. But she admits her weight has dipped to unhealthy levels. She's often tired. And her marriage and social life have suffered.
"It is the point now where no one will exercise with me because they know it is an addiction and I am not supposed to be doing as much as I am," she says.
Still, it's hard to stop: She once was very overweight, and she fears what would happen if she limits her exercise.
"When everything else seems out of control, it is the one area of my life that I feel I still have control over," she says. She sees White regularly, and plans to check into a treatment center this summer.
That's what Malinda Parrish did, and she says it saved her life.
At one point, Parrish's daily exercise topped five hours a day, with a morning aerobics class, lunch time lifting, evening aerobics, and a two-hour wrestling practice in the evening. If she didn't exercise, she didn't eat, period.
Constant compliments from friends on her "fit" looks, and a love of the "endorphin rush" she felt when she was exercising kept her at it for nearly 13 years. But in December, she had a wake-up call.
"I started throwing up blood," says Parrish, 30, who works for an audio-visual company in Denver. "I realized I could die."
Today, she no longer exercises to ward off guilt or purge calories, she says. She only does it if it's for fun.
"There are times that I still wake up and think that I need to go on a run because I need to lose weight. Those are the days that I just don't allow myself to go."
And she's finding that with so much free time on her hands, there's a big world out there:
"If you are constantly focused on one thing, everything else passes you by. That's not what I want anymore."
Contact Lisa Marshall at (303) 473-1357 or firstname.lastname@example.org.
Are you addicted?
Local therapists stress that a moderate amount of exercise is key to a person's health. But there is such a thing as overdoing it.
Here are some things to consider to determine if your exercise is becoming compulsive:
Are you exercising seven days a week?
Are you exercising more than once a day?
Do you tend to exercise through injury and illness?
Do you let your body rest between workouts?
Does your exercise interfere with your social life, job or family?
Do you base your food choices on how much you have exercised?
Do you feel guilty when you don't exercise?
What would happen if you couldn't exercise?
Why do you do it?
Sources: Taylor White, Alisa Shanks, eating disorders specialist with Wardenburg Student Health Center.
Symptoms of overtraining
Consistent decrease in training and/or race performance
Change in resting heart rate (increase or decrease 10 percent from normal values)
Loss of coordination and decreased motor skills
Significant changes in training heart rate Lack of motivation
Loss of appetite
Muscle soreness or feeling of "heaviness"
Significant decrease in body weight
Increased susceptibility to colds/flu/allergies
Menstrual dysfunction in females
Loss of sense of humor
Source: Boulder Center for Sports Medicine