CHAPTER 74 • PSYCHOLOGIC CONSIDERATIONS IN EXERCISE AND SPORT 447or jogging three times a week) and antidepressant
medication (sertraline), or the combination of exer-
cise and medication. Across all three groups, par-
ticipants had clinically significant improvements in
their depression scores at the 16-week follow up.
At the 10-month follow-up, those in the only exer-
cise group and the exercise plus antidepressant
medication group had a lower rate of relapse and a
higher likelihood of being partially or fully recov-
ered than those in the medication alone group
(Babyak et al, 2000). An association was also
found between exercising on one’s own during
follow-up and reduced risk of relapse.- Studies have also supported a positive impact on
affect following exercise (Gauvin, Rejeski, and
Norris, 1996; Gauvin, Rejeski, and Reboussin,
2000), and even improvements on some aspects of
cognitive function (e.g., scheduling, planning,
working memory) (Kramer et al, 1999). For ado-
lescents, an inverse relationship between physical
activity and depression has been supported (Sallis,
Prochaska, and Taylor, 2000). The aforementioned
psychologic health benefits are not exhaustive, but
are among those with the most strong and consis-
tent findings (U.S Department of Health and
Human Services, 1996).
- More than 360,000 collegiate athletes and almost
6.5 million high school athletes participated in sports
during the 1998–1999 school year (Weaver, Marshall,
and Miller, 2002). Participating in athletics encour-
ages the development of leadership skills, self-esteem,
muscle development, and overall physical health. For
children and adolescents, play and sport can enhance
physical, psychologic, and social development
(Eppright et al, 1997).
•A number of psychologic considerations are relevant
in understanding exercise and sport behavior. While
not exhaustive, among the most common issues are
exercise addiction and overtraining, alcohol use,
abuse, and dependence, disordered eating behavior,
performance anxiety, recovery from sports injuries,
and specialty consultation decision making.
EXERCISE ADDICTION
AND OVERTRAINING
•Exercise addiction is the unhealthy reliance on exer-
cise for daily functioning (Barrett, 2003; p 182). More
specifically, it comprises dependence, tolerance, and
withdrawal factors.
- An individual who is dependent on exercise has a
need to exercise in order to feel good. Exercise is
often a primary coping skill in this respect.
2. With tolerance, the individual must continually
elevate the level of exercise in order to achieve the
same feeling good state.
3. Believed to be a critical component of exercise
addiction is the presence of withdrawal symptoms.
These symptoms can encompass mood symptoms,
such as anxiousness, irritability, depression, and
restlessness or even physical symptoms of fatigue
24–36 h after missing a scheduled session of exercise.
- Prevalence rates for exercise addiction are unknown,
but it is hypothesized to be a small subset of those
who exercise regularly (Barrett, 2003). Additionally,
there is no data to suggest that exercise addiction is
consistently associated with other addictive behaviors
(e.g., alcohol abuse) or psychologic disorders; how-
ever, for some individuals, anorexia nervosa and exer-
cise addiction may be comorbid conditions. This has
been termed secondary exercise addiction (Barrett,
2003). - Assessment and treatment for exercise addiction can
be difficult as individuals with an exercise addiction
do not usually access the healthcare system unless it
is for an overuse injury, such as sprains, strains, bursi-
tis, and/or stress fractures secondary to their addictive
behavior (Barrett, 2003).
- To determine the presence of an exercise addiction,
the health care provider should explore the
patient’s motivators for exercise and consequences
they experience when they cannot exercise. Any
functional impairment associated with maintaining
their exercise (e.g., missed work, missed social
activities with friends) should also be assessed. - Determining the frequency, intensity, and duration
of exercise is important. Running is the most com-
monly associated activity; however, other aerobic
activities (e.g., swimming) and team sports (e.g.,
basketball) also have the potential for exercise
addiction (Barrett, 2003). - There is no empirically supported treatment for
exercise addiction, and treatment can be difficult.
The best strategy is to identify and treat the intrap-
ersonal and interpersonal factors for which they are
using excessive exercise to cope (Barrett, 2003).
•Overtraining and exercise addiction can be comorbid
conditions. Overtraining involves increased training
intensity and/or duration without adequate recovery
(Sachtleben, 2003). An example would be a runner
who trains at increased distances every day without
allowing a day of rest or recovery in between sessions.
The ultimate result of this behavior is the opposite of
what is pursued. That is, a state of staleness or a lack
of performance improvement, and possibly even a
deterioration in performance may result (Barrett,
2003).