Spotlight on Exercise, Part 2: The potential risks of over-exercising

If you are suffering from any condition that may affect your ability to safely exercise, do seek the advice of your GP before attempting any of the advice discussed. As always, what is written here is no substitute for individual medical, fitness or lifestyle advice.

Please do take a look at Part 1, The health benefits of exercise.

It is common for practitioners to skirt around the tricky topic of over-exercising. But in clinic, this is something I often see.

We do need to move, of course, for all the health-giving reasons I highlighted in Part 1 (The health benefits of exercise), and I completely understand that everyone’s abilities and hobbies differ. But pushing ourselves excessively (and that is definitely the key word here) with endless hours of classes, training sessions, long runs, gym time and so on may not necessarily be the best idea for overall health. I sometimes see clients who are so exhausted and stressed and just need to focus on getting some good quality sleep and rest in order to establish a better overall life balance. It can be hard to encourage them to consider meditation or yoga instead of their daily HITT class.

Whilst no single definition of ‘over-exercising’ exists, I tend to think of it as the point at which your body is starting to struggle with the amount of training stress you are asking it to handle, i.e., where the downsides are starting to outweigh the positives.

This tipping point will vary widely between people and their life circumstances. Someone who is happy, stress-free, fit and healthy can potentially handle a higher training load than someone who is under enormous personal pressure, less fit than they used to be and suffering from a chronic disease. Therefore, there cannot be an absolute level at which you can definitively say “this is over-exercise” and “this is not”. It will all depend on the individual.

Having said that, there are a couple of questions that I might ask my clients, to help them to identify for themselves if they might be over-doing it. Whilst this is not a validated test, it may help to prompt a discussion about ways that we could potentially modify (not necessarily stop) an exercise programme if desired:

1. How do you feel emotionally during and after your workout?

– Do you feel excitement and joy during and immediately after your session, followed by a sense of contentment and ease a little while later?
– Or do you feel more panic, anger or anxiety during and immediately after your session, followed by a sense of overwhelm, exhaustion and despair?

2. Do you look forwards to training or dread it?

3. Do you find yourself getting lots of infections or back-to-back injuries?

4. Are you always tired, particularly upon waking?

If you find that your answers to these questions are weighted more towards the negative, then this may be an indication your balance is tipping in the wrong direction and perhaps it’s time to ease off a little.

Effective training can be thought of as a tripod made up of exercise, diet and rest. If all three are not equally addressed, the tripod will tumble and so will your training goals’ – Richard Hannam

When it comes to exercise, I therefore think of it as a bit of a goldilocks phenomenon; not too little, not too much, but just the right amount for you at each point in time is the best bet for optimising health.

The reasons why people over-exercise are, of course, varied. For some, it is simply what is necessary to enable them to compete at a high level. But, perhaps more commonly in my clinic, it is as a result of trying to manage either weight or body image, or a belief that it is somehow necessary to really go hard with the training to be healthy – a conviction that seems to be increasingly fueled by social media and fitness gurus.

Although it is certainly true that a combination of exercise and diet together is the best way to maintain a healthy weight in the long run, we may be more likely to maintain good habits if we are exercising for enjoyment and pleasure, rather than simply as compensation for calories. Remember – exercise should never be considered penance for eating. We need to eat, and we need to move. Neither needs be contingent on the other!

Here are a few potential consequences of over-exercise on health and/or sports performance

  • Dampened immune function, and potentially increased risk of common infections (such as coughs and colds) (Smith, 2003).
  • Gut inflammation and potential increase in intestinal permeability after prolonged periods of intensive exercise (Costa et al., 2017).
  • Irregular menstrual cycles
  • Female infertility (Olive, 2010), particularly if underweight (Rich-Edwards et al., 2002).*
  • Excessive weight loss
  • Excessive fatigue (Meussen et al., 2013)
  • Increased stress, reduced sleep
  • Increased risk of injury, especially if you are more of a ‘weekend warrior’ (Psoinos et al., 2012)
  • Over-training syndrome; where you are continuing to train vigorously, but your performance starts to deteriorate over the long term (Meussen et al., 2013).

*However, in women with a BMI > 25 who undertake vigorous exercise of for <60 minutes per day, there is actually a reduced risk of infertility (Hakimi and Cameron, 2016). So, as with so much of health and nutrition, individual context clearly matters.

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For more information:

The UK register of Exercise Professionals is a good place to start your search for a new fitness instructor to help and support you: exerciseregister.org/members/members-directory-listing

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Next: Part 3, Creating an exercise habit

References & Bibliography:

Barrack, M., Ackerman, K. and Gibbs, J. (2013). Update on the female athlete triad. Current Reviews in Musculoskeletal Medicine, 6(2), pp.195-204.

Costa, R., Snipe, R., Kitic, C. and Gibson, P. (2017). Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease. Alimentary Pharmacology & Therapeutics.

Griffiths, M., Szabo, A. and Terry, A. (2005). The exercise addiction inventory: a quick and easy screening tool for health practitioners. British Journal of Sports Medicine, 39(6), pp.e30-e30.

Hakimi, O. and Cameron, L. (2016). Effect of Exercise on Ovulation: A Systematic Review. Sports Medicine.

Lakier Smith, L. (2003). Overtraining, Excessive Exercise, and Altered Immunity. Sports Medicine, 33(5), pp.347-364.

Lee, I., Sesso, H., Oguma, Y. and Paffenbarger, R. (2004). The “Weekend Warrior” and Risk of Mortality. American Journal of Epidemiology, 160(7), pp.636-641.

NICE (2013). Physical activity: brief advice for adults in primary care | Guidance and guidelines | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/ph44/chapter/1-Recommendations [Accessed 9 Jun. 2017].

O’Donovan, G., Lee, I., Hamer, M. and Stamatakis, E. (2017). Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality. JAMA Internal Medicine, 177(3), p.335.

O’Keefe, J., Lavie, C. and Guazzi, M. (2015). Part 1: Potential Dangers of Extreme Endurance Exercise: How Much Is Too Much? Part 2: Screening of School-Age Athletes. Progress in Cardiovascular Diseases, 57(4), pp.396-405.

O’Keefe, J., Patil, H., Lavie, C., Magalski, A., Vogel, R. and McCullough, P. (2012). Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise. Mayo Clinic Proceedings, 87(6), pp.587-595.

Olive, D. (2010). Exercise and fertility: an update. Current Opinion in Obstetrics and Gynecology, 22(4), pp.259-263.

Psoinos, C., Emhoff, T., Sweeney, W., Tseng, J. and Santry, H. (2012). The dangers of being a “weekend warrior”. Journal of Trauma and Acute Care Surgery, 73(2), pp.469-473.

Rich-Edwards, J., Spiegelman, D., Garland, M., Hertzmark, E., Hunter, D., Colditz, G. and et al. (2002). Physical Activity, Body Mass Index, and Ovulatory Disorder Infertility. Epidemiology, 13(2), pp.184-190.

Roberts, D., Ouellet, J., McBeth, P., Kirkpatrick, A., Dixon, E. and Ball, C. (2014). The “weekend warrior”: Fact or fiction for major trauma?. Canadian Journal of Surgery, 57(3), pp.E62-E68.

Stranahan, A., Lee, K. and Mattson, M. (2008). Central Mechanisms of HPA Axis Regulation by Voluntary Exercise. NeuroMolecular Medicine, 10(2), pp.118-127.

Walsh, N. and Oliver, S. (2015). Exercise, immune function and respiratory infection: An update on the influence of training and environmental stress. Immunology and Cell Biology, 94(2), pp.132-139