1 - (IOP 34) Prevalence and Correlates of Primary and Secondary Exercise Dependence: A Theory-driven Evaluation and Comparison

Exercise can promote health and well-being, and yet a proportion of individuals who exercise develop a maladaptive relationship with physical activity, which can be associated with significant impairment, psychological distress, and somatic health concerns. Despite the prevalence and concerning sequela mentioned, a consensus has not been reached regarding how maladaptive exercise should be conceptualized in the scientific literature. This incongruity precludes the development of accurate assessment, intervention, and prevention methods for this harmful behavior. The literature attempts to distinguish primary exercise dependence (ExD) or excessive exercise for its intrinsic reinforcement (akin to other behavioral addictions), from secondary ExD or excessive exercise related to weight/shape concerns corresponding to eating pathology. Whether maladaptive exercise is prevalent in the absence of eating pathology is contested, and an examination of the different theories underlying primary and secondary ExD warrants further attention. To address these gaps, the current study aimed to 1) evaluate exercise behaviors in highly physically active individuals in order to characterize the prevalence of primary versus secondary ExD and 2) evaluate mechanisms theorized to differentially maintain primary and secondary ExD. Participants (n = 464) were young adult women who self-reported engaging in frequent exercise. Participants scoring above the clinical cutoff on the Exercise Dependence Scale (EDS-21) and below the clinical cutoff on the Eating Disorder Examination Questionnaire (EDEQ) were categorized as primary ExD and participants scoring above the clinical cutoff on both measures were classified as secondary ExD. They completed a series of questionnaires and a neuropsychological task measuring cognitive inflexibility, an executive function and hypothesized transdiagnostic mechanism underlying comorbid exercise and eating pathology. In support of our first aim hypothesis, 4.1% of participants met criteria for primary ExD and 5.4% met criteria for secondary ExD. Contrary to aim 2 hypotheses, measures of emotion regulation, reward processing, impulsivity, and perfectionism as well as exercise motives, did not significantly differentiate primary and secondary ExD. A consistent main effect of eating pathology emerged, such that elevated scores on the EDEQ were associated with deficits in reward processing and emotion regulation, increased perfectionism, exercise for extrinsic and appearance related motives, and facets of impulsivity. Consistent with prior work and our hypotheses, cognitive inflexibility related to food and exercise was significantly associated with secondary ExD Future work evaluating ExD needs to account for eating disorders, in order to identify unique factors associated with maladaptive exercise, rather than impairment driven by highly comorbid eating pathology.