When Habitual Exercise Becomes a Problem: The Link Between Exercise Addiction and Low Energy Availability

A new study from the Department of Human Health and Nutritional Sciences has shed light on how exercise addiction can contribute to low energy availability, a condition where the body doesn’t have enough energy available to support optimal physiological function. 

Low energy availability can occur due to an eating disorder or unintentionally when an athlete doesn’t eat enough calories to cover the energy cost of training. If not addressed and corrected, low energy availability can develop into a more severe syndrome known as “relative energy deficiency in sports” (or RED-S, for short). Individuals with RED-S suffer from gastrointestinal symptoms, reproductive dysfunction, frequent injuries, and decreased athletic performance.

Until now, no one has studied how exercise addiction, either alone or in tandem with an eating disorder, can impact low energy availability and other health markers.

Masters student and registered dietitian Megan Kuikman set out to address this gap with Dr. Jamie Burr, who leads the Human Performance and Health Research Laboratory.

There are two main forms of exercise addiction: secondary exercise dependence stems from an eating disorder, while primary exercise dependence, albeit less common, is more driven by pure psychological gratification, independent of disordered eating habits.

Using a series of questionnaires, Kuikman and colleagues surveyed athletes from all levels, ranging from recreational to elite international competitors. They assessed individuals for symptoms of low energy availability, as well as their risk for 1) primary exercise dependence, 2) eating disorders only, or 3) a combination of the two (secondary exercise dependence).

“We found that those with primary exercise dependence were not at an increased risk of low energy availability or symptoms of low energy availability at any athletic level,” says Kuikman. “It is only when exercise dependence is secondary to an eating disorder that individuals are at a higher risk.”

Interestingly, elite-caliber athletes appear to be at a lower risk for an eating disorder, while recreational athletes are more likely to experience disordered eating.

“Disordered eating isn’t compatible with high level athletes,” explains Kuikman. “If they’re not fueling themselves properly, their performance and rankings will drop, and their likelihood of injuries will increase.”

But in recreational athletes, disordered eating can be easily overlooked. That’s because they are less likely to have support from coaches and dietitians.

Unlike most areas of health research, males are the vastly understudied sex when it comes to low energy availability and RED-S. And while there is a clear demand for future research to include a focus on male populations, Kuikman stresses the importance of recognizing that everyone is susceptible to low energy availability – it can happen to males, females, and athletes of all levels.

“It can be very difficult to identify athletes with RED-S because only once they’ve been chronically under fueling will symptoms start to become more noticeable,” she explains. “This highlights the need for screening tools that encompass both exercise and eating habits to catch it at an earlier stage.”

Effective long-term treatment for low energy availability, RED-S, and eating disorders requires a holistic approach.

“Athletes demonstrating problematic exercise behaviours should also be screened for disordered eating,” says Kuikman. “An individual’s relationship with exercise needs to be equally considered alongside their eating habits.”

So where exactly is the fine line between healthy habitual exercise and a compulsive behaviour? According to Kuikman, intention is everything.

“When exercising, try to assess your motivation behind it. Ask yourself, ‘Why am I exercising right now? Is it because I enjoy it and it’s adding value to my life? Or do I experience anxiety and obsession if I don’t?’”

Without a doubt, exercise is a great way to de-stress, bring joy and add value to your life. Being aware of the signs and symptoms of excessive exercise and disordered eating habits can help reduce the risk of developing low energy availability and the negative health impacts it can lead to.

Read the full study in the journal Nutrients.

Read about other CBS Research Highlights.