Exercise dependence (Week 6)

Question 1

what did (Hausenblas et al., 2017) say to whether we can get addicted to exercise

Answer 1

(Hausenblas et al., 2017) stated that, according to the DSM-V criteria, you cannot become addicted to exercise

Question 2

state 2 general facts about exercise dependancy

Answer 2

1) has a high comorbidity with eating disorders, anxiety, and depressive disorders
2) has a high comorbidity with disorders, such as anxiety, that do meet DSM-V criteria

Question 3

how was exercise dependancy first stumbled upon (3 points) ?

Answer 3

• (Baekeland., 1970) sought to do a study looking at the effect of exercise deprivation on habitual runners
• he found that habitual runners were refusing to participate, despite financial incentives
• ended up having to do his study on moderately active runners, so the study probably didn’t get as much of an insight into exercise dependence as it would if ED individuals had taken part

Question 4

what did (Baekeland., 1970) discover about the effects of exercise deprivation ?

Answer 4

anxiety, sleep loss, appetite loss, and reduced libido

Question 5

state what it is meant by the key term - ‘exercise dependance’

Answer 5

‘exercise dependance is a multi-directional and maladaptive pattern of physical activity that leads to significant impairment or distress’

(Hausenblas & Symons-Downs., 2002)

Question 6

state 3 additional facts identified by (Hausenblas & Symons-Downs., 2002) of exercise dependancy ?

Answer 6

• other terms include: compulsive exerciser, exercise addiction, obligatory exercisers
• ED has both psychological and behavioural elements
• a maladaptive attribute –> too much exercise can lead to the break down of body tissue and other health issues such as chronic fatigue

Question 7

state 3 diagnostic criteria of exercise dependance identified by (Hausenblas & Symons-Downs., 2002)

Answer 7

1) increased tolerance to physical activity
2) intention effects (over exercising)
3) time effects (over investment)
4) inability to control thoughts about exercise
5) a reduction in social and vocational activities
6) exercise withdrawal effects
7) continuing to exercise despite injury/illness

Question 8

state 3 warning signs of exercise dependance identified by (Hausenblas & Symons-Downs., 2002)

Answer 8

1) significant weight loss
2) marked increase in exercise behaviours
3) withdrawal from other activities
4) preoccupation with exercise and diet
5) calorie counting
6) exercising more having eaten more
7) struggling to sit still and relax

Question 9

state 3 health risks of exercise dependance as identified by (Hausenblas & Symons-Downs., 2002)

Answer 9

1) muscle and joint damage
2) muscle retardation
3) pressure sores and stress fractures
4) amenorrhea (absence of menstruation)
5) dehydration and/or exhaustion
6) strokes (in older adults)
7) immunodeficiency

Question 10

state 3 facts referring to the prevalence of exercise dependancy as identified by (Hausenblas & Symons-Downs., 2002)

Answer 10

3 - 13% of college population (n = 2400) were at risk of exercise dependance

40% of this college population were considered symptomatic for exercise dependance

the rate of exercise dependance in the general population is thought to be much lower (approx. 3%)

Question 11

what was the purpose of the systematic review done by (Hausenblas & Symons-Downs., 2002) ?

Answer 11

the purpose was to review all the literature examining exercise dependance and exercise deprivation

Question 12

what were the methods to the systematic review done by (Hausenblas & Symons-Downs., 2002) ?

Answer 12

• comprehensive literature search selected 77 exercise dependance and 11 exercise deprivation studies spanning 29 years (1970 - 1999)
• the exercise deprivation studies reviewed were only experimental studies

Question 13

state, and possibly explain, 4 considerations identified by (Hausenblas & Symons-Downs., 2002) about exercise dependance literature

Answer 13

1) majority of studies failed to have control groups (N = 42)

2) many studies were correlational in design
- limiting in nature, cannot be used to establish a relationship between more than 2 variables

3) discrepant criteria for exercise dependence

4) few experimental designs in the field
- important to ensure the study is precise, generates power, and an appropriate sample size is present to answer the research question

Question 14

state 2 findings identified by (Hausenblas & Symons-Downs., 2002) about the effects of exercise cessation

Answer 14

the cessation of regular exercise results in negative psychological states (Hausenblas & Symons-Downs., 2002)

exercise deprivation sensations (symptoms) can be experienced by both dependent and non-dependent exercisers (Szabo., 1999)

Question 15

state 5 considerations of exercise deprivation research identified by (Hausenblas & Symons-Downs., 2002)

Answer 15

1) studies showing different lengths of deprivation cause these effects
2) different studies examine different exercise regiments
3) self-reported PA measures used frequently without the use of hard-outcome measures
4) use of diverse methodologies
5) probably only examined non-dependent exercisers due to the lack of likelihood that dependent exercisers would sign up and withdraw themselves from exercise

Question 16

what was the first self-reported measure used to analyse exercise dependence ?

Answer 16

the ‘unidimensional commitment to running scale’ (Carmack & Martens., 1979)

Question 17

why was the ‘unidimensional commitment to running scale’ heavily criticised ? (3 points)

Answer 17

1) commitment and dependence represent different entities (Szabo et al., 1997)
2) although designed to assess positive addiction, several items can be constructed as negative components of addiction (e.g. - inc^ sense of discomfort when a run is missed) (Hausenblas & Symons-Downs., 2002)
3) runners self-perception of addiction were predictive of the scores. However, the term addiction was operationalised, rendering the significance of this relationship questionable ((Pierce., 1994)

Question 18

what was a more recent measure of exercise dependance throughout the literature reviewed by (Hausenblas & Symons-Downs., 2002)

Answer 18

the ‘obligatory exercise questionnaire’ (Pasman & Thompson., 1998)

Question 19

state 2 advantages of using the ‘obligatory exercise questionnaire’ to assess exercise dependance (Pasman & Thompson., 1998)

Answer 19

1) assesses psychological aspects of obligatory exercisers

2) has well established psychometric properties (Coen & Dyles., 1993)

Question 20

what is a drawback of the use of the ‘obligatory exercise questionnaire’ ?

Answer 20

scale items developed from a highly criticised study done by (Yates et al., 1983) which had no pertinent data, poor methodology, and no relevance to the majority of runners (paper focus)

Question 21

what was one of the better scales used to measure exercise dependance identified by (Hausenblas & Symons-Downs., 2002) in their review paper

Answer 21

‘commitment to exercise scale’ (Davis et al)

Question 22

what was the ‘commitment to exercise scale’ (Davis et al) ?

Answer 22

• a multi-dimensional assessment of exercise dependance which had 2 scales measuring:

1) ‘obligatory’ (e.g. - guilt from missed exercise sessions)
2) ‘pathological’ (e.g. - continuing to exercise through injury/illness)

Question 23

(Hausenblas & Symons-Downs., 2002) gave 5 reasons to why the diversity of methodology used to assess exercise dependance was difficult. what are those 5 reasons ?

Answer 23

1) insufficient evidence that ‘dependent exercisers’ has been selected in studies
2) questionnaires fail to distinguish between dependant, symptomatic, and asymptomatic individuals so is possible people of different commitments were analysed by accident
3) many researchers used non-operationalised, single item questions of self-perceived dependance as evidence of concurrent or discrepant validity
4) a conceptual basis for the questionnaires was failed to be established
5) the data driven development approach of the scales resulted in the danger of borrowing the problems of previous studies due to relying on past instruments as a major item scorer

Question 24

(Hausenblas & Symons-Downs., 2002) stated that future research on exercise dependance should be based on what 5 measures ?

Answer 24

• based on theoretical models
• homogeneity of definitions
• use objective measures of behaviour accompanied with self-reported measures
• require longitudinal, ecological, and experimental studies to enhance understanding of the construct
• sufficient control groups are required to infer causal effects

Question 25

what was the purpose of the following study:

‘striving for success or addiction? exercise dependance amongst elite Australian athletes (McNamara & McCabe., 2012)

Answer 25

to understand our theoretical understanding of exercise dependancy and to determine the use of the ‘biopsychosocial model’ to explain the development and maintenance of exercise dependancy amongst elite Australian athletes

Question 26

what is the ‘Biopsychosocial Model of exercise dependance’ ?

Answer 26

• provides a framework to examine the predisposing, precipitating, and perpetuating factors of exercise dependance among elite athletes
• suggests that biological factors have development and maintenance over the condition
• has a direct relationship with social and behavioural factors
• both interact to influence the development and maintenance of exercise dependance

Question 27

what were the participants from the following study:

‘striving for success or addiction? exercise dependancy amongst elite Australian athletes (McNamara & McCabe., 2012)

Answer 27

(n = 234) elite male and female athletes, aged 18-50, ranging across 25 sports

Question 28

what was the procedure of the following study:

‘striving for success of addiction? exercise dependance amongst elite Australian athletes (McNamara & McCabe., 2012)

Answer 28

1) ‘exercise dependance and elite athlete scale’ (EDEAS)
2) ‘eating disorder examination questionnaire’ (EDE-Q)
3) BMI
4) ‘social support survey’ (SSS)
5) ‘exercise beliefs questionnaire’ (EBQ)
6) ‘coach and teammate pressure 8-point scale’

• all emailed to the participants and asked to return
• 42.5% respondence rate

Question 29

what were the results from the following study:

‘striving for success of addiction? exercise dependance amongst elite Australian athletes (McNamara & McCabe., 2012)

Answer 29

1) 34% of AIS male and female athletes were considered at risk of exercise dependancy
2) athletes at risk had: higher BMI’s, low self-esteem, maladaptive beliefs, high pressure, low social support
3) 10% of high performance runners are thought to be as risk

Question 30

state 3 limitations to the following study:

‘striving for success of addiction? exercise dependance amongst elite Australian athletes (McNamara & McCabe., 2012)

Answer 30

1) only Australian athletes examined –> results could differ across cultures
2) only athletes aged > 18 examined –> could look at longitudinal effects/predictors of exercise dependance
3) athletes from sports most ‘at risk’ were not fully represented in the study

Question 31

state 2 future research recommendations suggested by (McNamara & McCabe., 2012) from their following study:

‘striving for success of addiction? exercise dependance amongst elite Australian athletes (McNamara & McCabe., 2012)

Answer 31

1) longitudinal research to determine conclusive relationships between biological, psychological, and social factors on exercise dependance
2) qualitative interviews with exercise dependent athletes can also be used for an in depth analysis of the condition

Question 32

describe what ‘primary exercise dependance’ (ED-1) is as identified by (Bamber et al., 2000)

Answer 32

• exercise for intrinsic reasons (e.g. - enjoyment, physical sensations)
• preoccupation with exercise is not accounted for by a mental disorder (i.e. - not paired with a mental disorder)
• preoccupation can cause physiological, social, and vocational impairment
  e. g. - ‘i am always late for work, terrible… it’s just something that takes priority over other things’

Question 33

describe what ‘secondary exercise dependance’ (ED-2) is as identified by (Bamber et al., 2000)

Answer 33

• exercise secondary to pathological preoccupation with body, eating disorder, and/or athletic performance
• exercise used to control weight, punish self, and/or increase performance
• exercise behaviour/effects are extremely salient
• low physical self-concept and esteem
  e. g. - ‘weight makes me feel awful; really bad about myself’

Question 34

what was the purpose of the following study:

‘it’s exercise or nothing - a qualitative analysis of exercise dependance’ (Bamber et al., 2000)

Answer 34

to use qualitative methods to explore the concept of exercise dependance

Question 35

what was the study design to the following study:

‘it’s exercise or nothing - a qualitative analysis of exercise dependance’ (Bamber et al., 2000)

Answer 35

• female exercisers (n = 194) allocated to 1 of 4 groups via the use of questionnaires on personality, body image, anxiety:

1) primary exercise dependance
2) secondary exercise dependance
3) eating disorder
4) control (neither condition)

• then interviews were completed with each individual for a more in depth analysis

Question 36

what were the results to the following study:

‘it’s exercise or nothing - a qualitative analysis of exercise dependance’ (Bamber et al., 2000)

Answer 36

1) ED-1 classified participants showed mix of no ED behaviour and/or attitudes, or showed mix of ED and eating disorder symptoms (more ED-2)
- the latter reported history of high psychological distress

2) interviews confirmed the placements of individuals in the other 3 groups

3) primary ED may not truly exist
- individuals probably should have been classified as either ED-2 or eating disorder groups after the interview data was obtained

Question 37

state, and explain, 2 considerations to the following study:

‘it’s exercise or nothing - a qualitative analysis of exercise dependance’ (Bamber et al., 2000)

Answer 37

1) the ‘exercise dependancy questionnaire’ (EDQ) cut off criterion could have misplaced individuals in the ED-1 group
- interviews of some women gave completely different results compared to the questionnaire

2) research must be done in male participants as well, although the prevalence of eating disorders is far greater in females (Gulmiche et al., 2019)

Question 38

state what it is meant by the key term - ‘bigorexia’

Answer 38

bigorexia is the preoccupation with gaining more muscle mass (Olivardia et al., 2000)

• body dysmorphia (too small)

Question 39

what was the method of the following study:

‘muscle dysmorphia in male weightlifters - a case study example’ (Olivardia et al., 2000)

Answer 39

1) 24 men who suffer from muscle dysmorphia and 30 control weightlifters obtained
2) selected using demographic, psychometric, and physical measures (e.g. - can bench BW for 10 reps displays solid training age)
3) both groups interviewed by authors

Question 40

what were the results of the following study:

‘muscle dysmorphia in male weightlifters - a case study example’ (Olivardia et al., 2000)

Answer 40

sufferers have:

• low self-esteem and body dissatisfaction
• anxiety and mood disturbances
• eating disorders
• experienced domestic violence

Question 41

state 2 further findings from the following study:

‘muscle dysmorphia in male weightlifters - a case study example’ (Olivardia et al., 2000)

Answer 41

1) in a posteriori analysis, individuals who suffer from ED closely resemble a group of college individuals who also suffer from ED
- control group also resembled group of college individuals who don’t suffer from ED

2) few differences emerged based on family background measures or childhood physical and sexual abuse

Question 42

state, and explain, 3 limitations to the following study:

‘muscle dysmorphia in male weightlifters - a case study example’ (Olivardia et al., 2000)

Answer 42

1) selection bias
- possible that men who suffer didn’t take part due to embarrassment
- 7 enrolled athletes admitted embarrassment nearly stopped them volunteering
- severity of condition probs higher than what was investigated here

2) information bias
- participants probs withheld information on abuse or sexual orientation

3) small sample size
- larger may reveal more symptoms and provide us with a clearer picture of the condition

Question 43

state what the 5 ‘Psychobiological’ mechanisms of exercise dependance are as identified by (Hamer et al., 2007)

Answer 43

1) affect regulation hypothesis
2) anorexia analogue hypothesis
3) sympathetic arousal hypothesis
4) B endorphin hypothesis
5) cytokine hypothesis

Question 44

who first presented the ‘affect regulation model’ of exercise dependance, and what was it ?

Answer 44

• (Tomkins., 1968) presented the affect regulation model
• people either exercise to reduce distress or to increase positive effect
• this leads to exercise becoming an ‘autotelic behaviour’
• exercise abstinence results in marked inc^ in depression, guilt and irritability (Hausenblas & Symons-Downs., 2002)
• theory supported by other researchers (Johnsguard., 1985; Anshel., 1991) who also reported an inc^ restlessness prior to exercise

Question 45

who first came up with, and what is the ‘anorexia analogue hypothesis’ of exercise dependance ? (5 points)

Answer 45

• (Yates et al., 1983) stated personality profiles similar between compulsive runners and diagnosed anorexia nervosa individuals
• evidence received little support as Yates provided no objective data to support their findings
• (Blumenthal et al., 1984) also found no evidence of psychopathology in a sample of obligatory runners with anorexia patients using the ‘Minnesota Personality Inventory’

Question 46

what is the ‘sympathetic arousal hypothesis’ of exercise dependance ? (5 points)

Answer 46

• (Thompson., 1987) suggested repeated exercise is maintained by hormonal changes as a result of exercise training
• evidence shows there’s a dec^ in sympathetic NS activity as a result of exercise training (Koivisto et al., 1982)
• this adaptation results in better energy utilisation, but the reduced output results in lethargy and lower arousal
• therefore, habitual exercisers perform more exercise to hit those arousal levels again
• However, little work has been done to support this hypothesis, but (Glass et al., 2004) study on exercise deprivation leaned towards this construct

Question 47

what is the ‘beta endorphin hypothesis’ of exercise dependance ? (3 points)

Answer 47

• beta endorphin networks form part of the neuroconnectivity reward system in the brain part responsible for a host of addictive behaviours (Koob et al., 2001)
• aerobic exercise stimulates release of endorphins which appear to produce addictive behaviours (Janal et al., 1984)
• However, (Markoff et al., 1982) did a study where he controlled the physiological pathway of endorphins with naloxone (competitive inhibitor) and saw no reduction in POMS scores post naloxone injection

Question 48

what is the ‘cytokine hypothesis’ of exercise dependance ?

Answer 48

• (Hamer et al., 2007) stated cytokine signals modulate complex CNS functions which influence behaviour
• IL-6 has been shown to impact changes in mood and behaviour in a negative way (Reichenberg et al., 2001)
• low muscle glycogen and eating disorders associated with an increase in IL-6 release (Keller et al., 2001; Veale et al., 1995)

Question 49

having completed his review on the psychobiological theories of exercise dependance, what did (Hamer et al., 2007) say future research should do ?

Answer 49

1) greater focus on the biological causes of exercise dependance due to the over-dependance on psychological theories
2) homogeneity of ED and symptom definitions
3) selection of appropriate control groups

Question 50

what are the 3 main theories of exercise dependance ?

Answer 50

1) personality and behavioural trait models
2) affect/mood regulation models
3) psychobiological mechanisms

Question 51

what are some of the predisposing traits (personality theory of ED) of individuals who suffer from exercise dependance ?

Answer 51

1) neuroticism (Costa & Oliva., 2012)
2) extraverted (Costa & Oliva., 2012)
3) agreeableness - people pleaser (Costa & Oliva., 2012)
4) maladaptive perfectionism (Costa et al., 2016)
5) preference for intense activities
6) low self-esteem

Question 52

explain a case study example of a misdiagnosis of ED-1 in the studies done by (Bamber et al., 2000)

Answer 52

• Annie, 28 years old, BMI = 16.8
• originally identified as ED-1 via the questionnaire
• admitted using exercise to control weight and found to have symptoms of anorexia and bulimia in the interviews
• binged on chocolate and whiskey

Question 53

what is the relevance of the misclassification of individuals, such as Annie (Bamber et al., 2000) ?

Answer 53

we need to fully define the construct of exercise dependance, come up with a sufficient model, and come up with appropriate assessment material so individuals can identify the problem and seek help

Question 54

what was the purpose of the study done by (Magee et al., 2016) looking at exercise dependance in Australian ironman athletes

Answer 54

a cross-sectional study of 345 ironman competitors in Australia

Question 55

what were the 3 measures used in the study done by (Magee et al., 2016) looking at exercise dependance in Australian ironman athletes

Answer 55

1) ED measured using ‘Exercise Dependance Scale’
2) eating disorder assessed using the ‘Three Factor Eating Questionnaire’
3) psychological distress using the ‘Kessler 6 scale’

Question 56

what was the main finding from the study done by (Magee et al., 2016) looking at exercise dependance in Australian ironman athletes

Answer 56

30% of 345 examined were found to be either ‘at risk’ or ‘symptomatic’ for exercise dependance

Question 57

what characteristics did (Magee et al., 2016) find ironman athletes ‘at risk’ of exercise dependance have ?

Answer 57

• higher psychological distress
• lack of self-control
• lack of tolerance
• withdrawal effects
• intention and time effects

Question 58

what was the study design looking at ‘Thinspiration’ (Quensel et al., 2017)

Answer 58

898 women completed measures of exercise dependance, eating disorders, and problematic internet use (PIU)

Question 59

what were the findings to ‘Thinspiration’ (Quensel et al., 2017) ?

Answer 59

• 14% of the women reported PIU, and 35% of the women reported exercise dependancy
• found that PIU was a predictor of exercise dependancy, low body satisfaction, appearance comparison, and a drive for thinness

Question 60

state 3 pieces of advise presented by (Mary Gavin., 2007) for parents to help prevent exercise dependance in the youth

Answer 60

1) involve children in food preparation
2) make exercise fun and family oriented
3) be a good role model by exercising
4) never criticise a child’s body characteristics
5) avoid social comparison
6) don’t pressure children to compete

Question 61

what was the study design by (Adams & Kirkby., 1997) looking at physiotherapists intervention strategies for those who suffer from exercise dependance ?

Answer 61

24 postgraduate physiotherapists who have worked with athletes for at least 2 years were surveyed about their experiences with exercise dependant individuals via a telephone interview

Question 62

what was a crazy statistic about the study done by (Adams & Kirkby., 1997)

Answer 62

71% of the physiotherapists interviewed reported problems with communicating with the exercise dependant individuals

Question 63

state 3 treatments listed from trained physiotherapists found by (Adams & Kirkby., 1997) for treating exercise dependant individuals

Answer 63

1) athlete/coach education on exercise dependance
2) rest, recover, and reduce training load
3) monitor compliance and symptoms
4) substitute high with low intensity activities (i.e. - yoga, stretching)
5) counselling; psychiatric referral

Question 64

what was the aim of the following study by (Smith et al., 2001) looking at the effect CBT can have on obligatory exercisers ?

Answer 64

to use CBT to treat body dissatisfaction in obligatory and non-obligatory female exercisers of normal weight

Question 65

what was the study design employed by (Smith et al., 2001) to look at the effect of CBT on exercise dependance ?

Answer 65

1) women randomly assigned to either the CBT intervention group, or the control (wait list) group
2) 1 x 1.5 hour sessions a week for 8 weeks
3) 2 month follow up to assess body image and behaviour

Question 66

what were the findings to the study looking at CBT treatment for exercise dependant individuals completed by (Smith et al., 2001) ?

Answer 66

1) both obligatory and non-obligatory improved body image and reported less anxiety post-intervention
- can infer causality as did far better than control group

2) gains were attenuated at the 2-month follow up period
- obligatory exercisers did not reduce their PA nor did their BMI’s change

3) results infer that you can change an individuals beliefs a lot easier than you can change their behaviour
4) social support was seen to be key for change as the drop off occurred after the social aspect was removed (i.e. - end of 8 week intervention)

Question 67

what was the study design done by (Bratland Sandle et al., 2010) looking at ED-2 in Norway ?

Answer 67

• individuals living in hospital who were diagnosed with ED or an eating disorder
• 13 week intervention
• individual and group therapy given to all individuals
• went out aiming to switch behaviours to healthier ones (e.g. - running to art)

Question 68

what did (Bratland Sandle et al., 2010) discover when comparing the ED individuals to the eating disorder individuals ?

Answer 68

• use exercise to regulate negative affect
• performed higher on the exercise dependance symptomatology scale
• scored higher on the exercise dependancy psychopathology scale

Question 69

what were the findings to the study done by (Bratland Sandle et al., 2010) looking at the effect of ED-2 in Norway

Answer 69

• exercise dependant individuals did lower their PA during the programme, but were back to pre-intervention levels 2-months after discharge
• this relationship is seen in a lot of other addictive behaviours (e.g. - smoking)
• therefore, further acknowledges the concept that exercise can become addictive and can become very difficult to change