LAUSR

CONTEXT Exercise dependence (EXD) is a compulsive and addictive behavior that can negatively impact physical and mental health, leading to significant impairment or distress. EXD has been associated with symptoms of eating disorders (ED). Student-athletes are an at-risk population for EDs and EXD given the physical and psychological demands of competitive sports. OBJECTIVE To examine EXD and ED risk in student-athletes across sex and sport category; and determine the association between EXD and ED. DESIGN Cross-sectional study. SETTING Collegiate Athletics. PARTICIPANTS NCAA Division I and II student-athletes (n=1885; age: 19.8±1.4 females: 69.6%, n=1312; males: 30.4%, n=573). MAIN OUTCOME MEASURES A web-based survey including demographics, the Exercise Dependence Scale-21, the Eating Attitudes Test-26 and questions about pathogenic behaviors. RESULTS Overall 4.9% (n=92) student-athletes were categorized as "at-risk" for EXD (females: 4.8%, n=63/1312; male: 5.1%, n=29/573), with significant differences across sex and sport category [All: χ2(8,1885) =99.1, p<0.001]. Overall, student-athletes' ED risk (EAT-26 and/or pathogenic behavior use) resulted in 22.7%, n=428 (females: 25.5%, n=334/1312; males: 16.4%, n=94/573) with significant differences across sex (χ2(4,1885) = 10.1, p=0.039). Multiple logistic regressions indicated a significant association between ED risk and EXD for all student-athletes, with more EXD at-risk athletes at-risk for EDs (OR=5.104, 95% CI: 3.237-8.046 vs nondependent-asymptomatic; at-risk vs nondependent-symptomatic: OR=2.4068, 95% CI: 1.5618-3.7089). CONCLUSIONS While physical activity has become a Public Health intervention to improve overall health in populations, exercise EXD can be considered a problem related to physical activity. EXD may negatively impact physical and mental health; whereas EDs may be a psychiatric disorder affected by EXD, as exercise can be a compensatory behavior for weight loss. Special attention should be given to student-athletes, specifically females, who display signs of EXD as well as additional education and awareness to minimize the overall risk of EDs in student-athletes.