Table 1 Definition of compulsive exercise applied to high-performance athletes

A1: Excessive exercise that the patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly

High-performance athletes are generally highly motivated and driven to exercise to improve their sporting performance, which some may conceptualise as an “obsession”. High-performance athletes also frequently adhere to strict training programs, which could be interpreted as “rules that must be applied rigidly”

A2: The exercise is aimed at preventing some dreaded consequence or at preventing or reducing distress, often based on distorted beliefs about exercise

Many high-performance athletes exercise to increase performance and fitness, but also due to a fear of failure (“some dreaded consequence”) in sports competition [65]. Exercise may also be used by some competitive athletes to regulate affect, particularly the avoidance of negative affect [23]

The compulsive exercise is time-consuming (takes more than 1 h a day)

The training program of a high-performance athlete is often very time-consuming and requires on average multiple hours of training per day during the week

[The compulsive exercise] significantly interferes with the person’s daily routine, occupational functioning or social relationships

Being a high-performance athlete requires life activities to be structured around training and competition, rather than training and competition to be structured around life activities

[The compulsive exercise] is continued despite medical injury, illness, or lack of enjoyment

High-performance athletes often train through illness and injury. Lack of exercise enjoyment may occur during extremely intense sessions, extended competition periods, or episodes of burnout [66]

At some point during the course of the disorder the patient has recognized that the compulsive exercising is excessive or unreasonable

Although some high-performance athletes show insight that their training is unsustainable (which may coincide with retirement), there is little empirical research on this topic [36]