Demographics and physical and mental health of clients at a sports center with and without exercise addiction

Introduction

The rapid development of the economy and society has made physical exercise for physical and mental health a part of daily life for many individuals (Scully et al., 1998). Exercise is widely recognized as a cornerstone of physical and mental well-being, promoting cardiovascular health, muscular strength, and emotional resilience and reducing the risk of chronic diseases and psychological disorders such as depression and anxiety. Regular physical activity is strongly associated with improved mood, cognitive functioning, and overall life satisfaction (Warburton & Bredin, 2017). While exercise offers numerous advantages, excessive or compulsive patterns of physical activity can result in significant disadvantages (O’Connor, 2000; Freimuth, Moniz & Kim, 2011). Exercise addiction (EA) is an obsessive and maladaptive pattern of exercise that negatively impacts physical and psychological health (Freimuth, Moniz & Kim, 2011; Allegre et al., 2007; VanLandeghem, Jakobson & Keough, 2019). Key features of EA include loss of control, symptoms of overtraining, exhaustion, sleep disturbances, and withdrawal symptoms such as restlessness, sadness, and irritability (Hausenblas, Schreiber & Smoliga, 2017). Psychological symptoms may include anxiety, feelings of guilt when not exercising, and social withdrawal, while physical symptoms may involve exhaustion, sleeplessness, headache, and poor appetite. Criteria of EA are tolerance, effects of interrupting exercise, the intended effect, loss of time control, reduction of other activities, and continuity (Hausenblas & Downs, 2002b; Bamber, Cockerill & Carroll, 2000).

The prevalence of EA varies across populations and settings. Studies suggest that EA affects 0.3% to 0.5% of the general population and up to 3%–7% of regular exercisers (Mónok et al., 2012; Griffiths, Szabo & Terry, 2005; Griffiths et al., 2015; Szabo & Griffiths, 2007). Among specific groups, such as elite athletes and fitness enthusiasts, prevalence rates can reach as high as 20% (Griffiths et al., 2015; Hausenblas & Downs, 2002a). Individuals with eating disorders are particularly vulnerable, with EA co-occurring in 39% to 48% of these populations (Freimuth, Moniz & Kim, 2011; Klein et al., 2004). Variations in prevalence underscore the importance of examining contextual and demographic factors influencing exercise behaviors. However, the precise effects remain unclear due to differences in definitions of EA, inconsistent assessment methods, and small sample sizes. Additionally, demographics such as gender and age, and cultural norms may influence susceptibility to EA (Griffiths et al., 2015), though findings remain inconsistent. Understanding these association is crucial for identifying individuals at risk and designing comprehensive treatment approaches. Well-being, a central concept in positive psychology, is defined as a state where individuals achieve success during one’s life through the coordinated work of the body (physical well-being), mind, and intellect, which positively affects society in one way or another. Well-being of the mind is formed by the working together of (1) subjective well-being, the hedonic or happiness that arises from the external environment, which relates to physical health, positive and negative emotions, and life satisfaction, and (2) psychological well-being (Bamber, Cockerill & Carroll, 2000) or Eudaimonic well-being (EWB), where happiness arises within a person’s mentality, who acts in accordance with feelings of being, without expecting the results of the following outcome and can be perceived within oneself in the values and needs of each person (Mónok et al., 2012).

Effect of exercise on well-being has been explored previously. On one hand, moderate, regular physical activity is a potent tool for enhancing quality of life and well-being, contributing to better mental health, improved sleep, and higher energy levels (Penedo & Dahn, 2005). On the other hand, excessive or compulsive exercise can lead to physical injuries, social withdrawal, and psychological distress, including feelings of guilt, anxiety, or frustration when unable to exercise (Lichtenstein et al., 2014). This paradox underscores the need to understand the intricate relationship between exercise, well-being, and EA.

Given the widespread promotion of exercise as a health-enhancing behavior, distinguishing between healthy and pathological exercise patterns is critical. In light of the varying prevalence of EA and its potential to influence well-being and quality of life, identifying the factors related to EA can better inform public health strategies, guide diagnostic criteria development, and improve therapeutic outcomes for affected individuals. This study aims to (1) assess the relationship between demographics and behavioral patterns such as diet and exercise habits with EA among clients at a university sports center, and (2) assess the association between EA and physical and psychological well-being. By doing so, it seeks to contribute to a more comprehensive understanding of exercise behaviors and their implications for health and well-being.

Materials and Methods

Results

All data from 386 participants were included as no substantial missing data was observed. The percentage of subjects who had full symptoms of EA (EAI score ≥ 24) was 9.1% (n = 35) and the percentage of those who had partial symptoms of EA was 83.4% (n = 322). Table 1 summarizes the univariate findings, including demographics, exercise and dietary habits, and EA among the participants at the sports center.

The mean age of participants was 27.5 years (SD = 10.9), with 213 males (55.2%) and 173 females (44.8%). Nearly half (46.6%) had a normal Body Mass Index (BMI), while 23.3% were categorized as obese (BMI > 30.00). Most of the subjects attending the sports center were students (63.2%), with 80.8% reporting no physical illness and 95.9% never using substances.

In terms of dietary habits, most participants did not control their diet (62.7%), did not avoid high-calorie foods (64.8%), and consumed all food groups for health (78.8%). However, most subjects considered metabolism during exercise (52.1%), drank water instead of soft drinks (68.1%), but did not avoid sugary foods (55.7%).

Regarding exercise patterns, most subjects (67.9%) spent 1–3 h a day with exercise, and 4.4% spent more than 3 h per day. Moreover, the most common types of exercise were running (55.2%), walking (35.0%), and weight training (29.8%), respectively.

Table 2 highlights the associations between EA and demographic, exercise patterns, and dietary habits. EA was associated with gender, frequency of exercise, current smoking, hours of walking, hours of other sports, and metabolism awareness during exercise (P <  0.05).

Table 3 shows an association between EA and psychological (Eudaimonic) and physical (knee outcome) well-being. The results show that EA was associated with poor knee outcome regarding the poor symptoms aspect of the knee outcome (P < 0.05). Psychological well-being and other aspects of knee outcomes including pain, daily activities, movement, and quality of life were not associated with EA (P > 0.05). Logistic regression analysis showed that being male was the only predictor of EA (OR = 2.65, P < 0.024), as shown in Table 4.

Discussion

This study explored the prevalence and determinants of EA among regular exercisers at a sports center. The prevalence of EA (9.1%) was notably higher than the 3% reported in prior research conducted among gym clients (Mónok et al., 2012), indicating potential contextual or methodological differences. EA was associated with higher frequency and longer exercise durations, and specific activities such as walking and other sports. The results were consistent with the study of Garman et al. (2004), who found that students who worked out more than 360 min per week had a high level of EA . However, it is crucial to distinguish between frequent exercisers with healthy habits and those meeting clinical criteria for EA.

The study revealed a potential relationship between dietary habits and EA. Participants with EA were more likely to consume all food groups for health, possibly reflecting a heightened focus on health. The subjects who thought about calories burning during exercise had EA symptoms higher than those who never think of calories burning. The result may be associated with weight control that was facilitating EA. This aligns with literature suggesting that disordered eating and EA often coexist, with excessive exercise serving as a compensatory behavior for calorie intake. A previous study suggests that the eating behavior should go to the extreme, such as Rocks et al. (2017) found that the hour of physical activities and disordered eating were associated with a high level of EA in students. EA had symptoms in common and high comorbidity with eating disorders (Weinstein & Weinstein, 2014). De Coverley Veale (1987) said that the difference between primary and secondary EA is that primary EA occurs in the absence of an eating disorder. Any weight loss is secondary to calories burned or if there is dieting, it occurs solely for the purpose of improving performance. Sociocultural norms emphasizing fitness and body aesthetics may further exacerbate this association. Individuals may view exercise as a coping mechanism to achieve idealized body standards of the sociocultural norms. Sociocultural factors, including societal pressures to maintain a fit body type, and the extreme fitness regimens and types may also play a role in fostering EA. The interplay between EA and eating patterns may create a reinforcing cycle, where exercise is used to compensate for disordered eating patterns.

Interestingly, participants who were current smokers had a higher prevalence of EA compared to non-smokers or former smokers, contradicting some studies that report lower EA rates among smokers. For example, Szabo et al. (2018) found that subjects with a higher risk of EA had a lower level of prevalence of smokers than those without. This discrepancy warrants further investigation into the interplay between smoking and EA in different populations.

EA was associated with poor knee outcomes, specifically in terms of symptoms, though other aspects of physical well-being were not significantly affected. The absence of a broader impact on physical or psychological well-being suggests that the implications of EA might vary based on the specific context of exercise. Our results were inconsistent with Ersöz (2017), that showed higher psychological well-being levels when the students worked out in advanced levels of exercise. However, the result partially aligns with studies reporting physical injuries and overuse conditions among individuals with EA. A recent study found association between frequent physical injuries and EA among runners in Croatia (Zivcic Tomic et al., 2023).

Gender differences emerged as a key finding, with males more likely to exhibit EA symptoms. The logistic regression results showed that being male was the only predictor for EA in our study. This could reflect differing motivations for exercise across genders, such as performance-driven goals in men versus body image concerns in women. In addition, the interpretation of the EA scale was different across genders (Griffiths et al., 2015). There are potential psychosocial determinants of exercising that could have confounded the associations observed across genders. Gender may moderate the relationship between well-being and exercise addiction by influencing how psychological and physical well-being affect the behaviors. The sociocultural and psychological determinants of these differences warrant further exploration.

Despite its contributions, this study has limitations. The high prevalence of partial EA symptoms (83.4%) suggests potential over-sensitivity of the EA assessment tool. Additionally, the study’s cross-sectional design and reliance on self-reported data may introduce biases and limit causal inferences. Finally, the absence of measures for other psychiatric conditions, such as eating disorders, restricts a comprehensive understanding of EA’s comorbidities. Future investigators should use more objective measurements to verify the physical and mental well-being, to measure these complex issues, and to include other psychiatric disorders in the future studies.

In Thailand nowadays, government organizations promote activities of regular exercises for health and well-being. Thai Health Promotion Foundation (2015), which supports exercise and sports events, plans to increase the physical activity of Thai people aged 11 years and older to at least 80 percent by 2021. However, the understanding of EA among Thai people should be more educated and explored generally.

Conclusions

The study found that gender, considering metabolism during workouts, the frequency of workouts and the number of hours of walking was associated with EA among clients at a sports center. Being male was the only predictor for EA. EA was associated with physical well-being such as poor knee outcome, but not associated with psychological well-being. The limitation of this study was a cross-sectional descriptive in a specific area in which the result may not be represented to all populations. However, future studies should clarify the relationship between EA and other mental health problems, also understanding EA or overtraining conditions in general.

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