© Borgis - New Medicine 3/2014, s. 103-108
*Zsuzsa Menczel1, Eszter Kovács2, Andrea Eisinger3, Anna Magi3, István Vingender1, Zsolt Demetrovics3
Exercise dependence among Hungarian Fitness Center users – preliminary results
1Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
Head of Faculty: prof. Zoltán Zsolt Nagy, PhD
2Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
Director of Centre: Pèter Gaál, PhD
3Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
Head of Institute: Zsolt Demetrovics MD, PhD
Regular physical activity plays an important role in the healthy life. However, excessive exercising might lead to addictive behavior. Exercise dependence (ED) is an extreme commitment to sports that was identified as a behavioral addiction.
The objective of the present study is to explore the prevalence of ED in a sample of fitness center users (n = 1743) recruited from 17 fitness and wellness centers in Budapest. A questionnaire-based survey was carried out to measure ED. Two standardized scales, the Exercise Dependence Scale (EDS) and the Exercise Addiction Inventory were used. Results revealed that 2.2% (on EDS) and 7 % (on EAI) of subjects belonged to the dependent group and 69.3% (on EDS) and 76.5 % (on EAI) showed ED-related symptoms. It is surmised that due to their sport activities, these groups are at elevated risk for ED. Moreover, younger people with decreased self-esteem tend to have higher likelihood and to have problems with excessive sport behaviour. Therefore it is important to raise the awareness of the harmful and risky patterns of exercise behaviour. The here adopted two instruments, EDS and EAI, might be utilized for to early detection of ED and prevention of the disorder.
The amount of physical activity in our daily lives has been reduced to an unhealthy minimum over the last decades due to the amendment of labour characteristics, e.g., sedentary work.. Several studies have shown that mental and physiological benefits of physical activity are almost undisputed. Scholars concluded previously several times that integrating physical activity in one’s regular lifestyle is crucial in protecting health (1). The importance of body shape gets wider attention in European cultures. The consumer society has a crucial influence on people’s values shaped by the media. People’s attention to regular exercise is strongly linked to physical appearance and the pressure of being slim. The message of „solely thin, young and good looking people can be successful” (2) may be addressed with sports, which can help in reaching this goal. The society needs to pay attention to adolescents, who are vulnerable to such a social pressure during the identity and personality formation life phase. Therefore, the changes of cultural ideals of body images may have a stronger influence on youth than adults. The risk of development of unhealthy sporting habits may be higher among them (3).
The phenomenon of Exercise Dependence
Although regular exercise has been shown to have beneficial effects on one’s well-being, researchers found that exercise may lead to a form of dependence or abuse in some individuals (4).
In general, this category describes a condition in which the practice of a moderate or intense exercise becomes a compulsive behavior. Specifically, exercise dependence (ED) manifests as a strong desire to perform physical activity in one’s leisure time, becoming uncontrollable and expressed in the forms of physiological symptoms (e.g., tolerance, abstinence) and/or psychological symptoms (e.g., anxiety, depression; 4). Nevertheless, research on exercise dependence has been ambiguous, as yet, the terminology of the constructs that surround this phenomenon, its definition is rather vague, and the measures to assess it were not well operationalized yet. This ambiguity about of ED highlights a challenge for basic and applied research, because the factors that predominate, concur, and perpetuate it are still unclear or indefinite, thus making its prevention and treatment more problematic (5).
Prevalence of Exercise Dependence
Based on the various samples and investigations on the prevalence of exercise addiction varies in a wide range.
Hausenblas and Symons Downs (6) found that 2.5% of their university student sample, – by using EDS – could be classified as exercise dependent. Also, Terry, Szabo and Griffiths (7), reported that 3.0% of the sample – university students – could be identified as at risk of exercise addiction. The two questionnaires, the EDS and the EAI, have a strong relationship, as they highly correlate (r = 0.81; p < 0.001) with each other (7). In Hungary solely one research shed light on this population; Menczel, Kovacs and Vingender (8) referred about 2% of students belonging to „at risk group” of exercise dependence and 45.3% were detected as non-dependent, symptomatic group. Other study has examined the prevalence ED between athletes (elite category) and also between recreational sportsman, for instance people using fitness and wellness facilities. One of the first of these studies was conducted by Blaydon and Lindner, in 2002 (9). They found that 52% of triathletes are in risk of ED. Additionally, Youngman (10) said that 20% of people doing Ironman (long distance triathlon) are in high risk, and 79% of the sample showing symptoms of ED. Other studies and research monitoring people from fitness centers showed that 7% to 42% of people are linking to risk group (11, 12). From Hungary one study (13), – besides Menczel, Kovacs and Vingender (8) – investigated the phenomenon among fitness users. Their results showed, – that 6,7% of people are in the at risk category, and further 64% showed ED-related symptoms, which means the significant part of the sample are likely to become addict to exercise.
The link between age and exercise dependence and the perception of quality of life
Some studies demonstrated the link between age and ED. This relation means that the younger the person is the higher the chance is to become exercise dependent (3). Parallely with the findings of Edmunds (3), Urban and Hann (14) stated that the prevalence of doing sport reduces in elderly (14). The reduction of exercise might be resulted by to several factors, for instance older people have more duties to deal with, e.g. work, family, etc. Also older people have better and more widespread coping strategies and stress managing ability. Younger people may lack these, so they probably can build stronger upon their body, which can also provide them support in their self-esteem.
Based on the previous studies, the objective of the present paper is to investigate the phenomenon of ED and to explore how age, self-esteem and the quality of life might determine the presence of ED. We also consider important to investigate a special sample, namely the fitness users in Hungary that might show higher risk for ED.
The present study was conducted in 2010 among fitness center users. We chose our sample from 17 fitness and wellness centers in Budapest. The participation was voluntary, selection criteria were people under 18 years of age and exercising more than once in two weeks. Our participants yield consent to take part in filling in our questionnaire with providing their contact details. In 24 hours they received an e-mail with a password to enter the online survey. It took approximately 20 minutes to complete the survey. Our final sample consisted of 1743 people, 58.6% of them were female, the mean age was 31.7 (SD = 8.491). For data analyzes SPSS 18.0 was used.
Our questionnaire consisted of different parts, namely, demographic questions, e.g. age, gender, residency, weight and height. In the second part we assessed the sporting habits, such as the frequency, the kind of sport they practise. We also measured the existence of eating disorders. The existence of eating disorders could indicate the so called primary or secondary exercise dependence (8). If no eating disorders could be detected, the subject was included in the analysis.
As the final part of the survey, fitness users were asked to fill in two standardized questionnaires, the Exercise Dependence Scale-21 (EDS) (6) and the Exercise Addiction Inventory (EAI) (7) in the Hungarian context, translated by Demetrovics & Kurimay (15). Besides these scales self-esteem and well-being were also measured.
Exercise Dependence Scale (EDS)
EDS 21-items questionnaire contain seven subscales, which are rated on a 6-point Likert scale (6). The scales are the following 1) tolerance (e.g., „continually increase my exercise intensity to achieve the desired effects/benefits”), 2) withdrawal (e.g., „I exercise to avoid feeling tense”), 3) intention effect (e.g., „I exercise longer than I plan”), 4) lack of control (e.g., „I am unable to reduce how often I exercise”) , 5) time (e.g., „I spend most of my free time exercising.”), 6) reduction in other activities (e.g., „I think about exercise when I should be concentrating on school/work”), and 7) continuance (e.g., „I exercise when injured.”). Following the instructions the test can divide between dependent, symptomatic and asymptomatic group. The scale has excellent psychometric properties, it’s internal reliability was Cronbach α = 0.90.
The Exercise Addiction Inventory (EAI)
EAI consists of six statements, evaluated on the model of addiction (7). The statements are rated on a five-point Likert scale. The six statements of the EAI are the following: 1) salience („Exercise is the most important thing in my life”), 2) conflict („Conflicts have arisen between me and my family and/or my partner about the amount of exercise I do”), 3) mood modification („I use exercise as a way of changing in my mood”), 4) tolerance („Over time I have increased the amount of exercise I do in a day”), 5) withdrawal symptoms („If I have to miss an exercise session I feel moody and irritable”, 6) relapse („If I cut down the amount of exercise I do, and then start again, I always end up exercising as often as I did before”). (7) The higher scores on the scale indicate higher likelihood of exercise addiction. The EAI’s reliability index – in our research resulted Cronbach value α = 0.62.
Rosenberg Self-esteem Scale (RSES)
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