Content area
Full Text
Correspondence to Dr Dusty Marie Narducci, USF Health Morsani College of Medicine, Tampa, FL 33612, USA; [email protected]
Is it possible for exercise to become excessive and unhealthy, and if so, when? Is this threshold different in athletes versus non-athletes? Is it customary for an athlete to track caloric intake and workouts in a manner as habitual as brushing one’s teeth yet fail to have sufficient energy availability for healthy function? Indeed, the adverse psychological and physiological effects endured by athletes who far exceed exercise guidelines in an unhealthy fashion may go undetected if these behaviours are considered normal or permissible. The aim of this editorial is to illustrate how even the well-trained sports and exercise medicine (SEM) clinician can overlook an athlete engaging in unhealthy exercise and eating behaviours, and how the field of SEM can better support this unrecognised population of athletes.
A missed opportunity
Eating disorder specialists care for a patient population including athletes where excessive exercise can become harmful and sometimes even fatal. Behaviours such as self-induced vomiting and caloric restriction causing emaciation are notoriously concerning, yet a confirmed case of unhealthy exercise or malnourishment without obvious health consequences is unlikely to be recognised as problematic.
Given that SEM clinicians routinely use exercise and nutrition to prevent and treat chronic illnesses, the threshold for defining unsafe activity and inadequate nourishment may be unclear. Athletes may have complicated incentives steering them towards pathological exercise, often feeling obligated to undergo high levels of training to meet scholarship, income, personal goals and athletic commitments. Therefore, individuals who engage in unhealthy exercise can be overlooked and even celebrated if also achieving athletic success.
The challenges of defining unhealthy exercise
Unhealthy exercise is ill defined as is the associated nomenclature which includes terms such as dysfunctional exercise, pathological physical activity, compulsive exercise, exercise addiction, and can lead to relative energy deficiency in sport (RED-S).1–3 Complicating matters further is the numerous internal and external forces involved and vague criteria concerning disordered eating and exercise as psychological pathologies in the Diagnostic and Statistical Manual of Mental Disorders-V and International Classification of Diseases (figure 1A).4...