Pathological forms of exercising are a topic of debate in terms of classification, etiology, and treatment. Validated instruments are a precondition for research in this field. The aim of this study was to validate the German version of the Commitment to Exercise Scale (CES-de). A confirmatory factor analysis was conducted using data from a large community sample (n = 571). In a second study, 100 eating disordered patients, 107 elite athletes and 100 individuals engaged in leisure time sporting activities were compared to assess discriminant validity and psychological correlates. A 1-factor solution showed the best fit to the data. The CES-de differentiated between the eating disordered group and individuals engaged in leisure time sporting activities, but not between those with an eating disorder and competitive athletes. The total score was significantly correlated with drive for thinness, perfectionism, and overall psychopathology. The CES-de can be considered a valid instrument for measuring problematic behavioral and attitudinal aspects of the commitment to exercise. The use of the CES-de total score is recommended. However, a more specific instrument should be used for athletes. A limitation of the study is that the samples were not stratified by age and gender.

Keywords:
Physical activity, Exercise, Eating disorders, Assessment
1.
Heath GW, Parra DC, Sarmiento OL, Andersen LB, Owen N, Goenka, S, Montes F, Brownson RC; Lancet Physical Activity Series Working Group: Evidence-based intervention in physical activity: lessons from around the world. Lancet 2012;380:272-281.
2.
Morgan AJ, Parker AG, Alvarez-Jimenez M, Jorm AF: Exercise and mental health: an excercise and sports science Australia commissioned review. J Exerc Phys Online 2013;16:64-73.
3.
Glasser W: Positive Addiction. New York, Harper & Row, 1976.
4.
Morgan WP: Negative addiction in runners. Physician Sports Med 1979;7:57-70.
5.
Allegre B, Souville M, Therme P, Griffiths M: Definitions and measures of exercise dependence runners. Physician Sports Med 1979;7:57-70.
6.
De Coverley Veale DMW: Exercise dependence. Br J Addiction 1987;82:735-740.
7.
Emini NN, Bond MJ: Motivational and psychological correlates of bodybuilding dependence. J Behav Add 2014;3:182-188.
8.
Hausenblas HA, Symons Downs D: Exercise dependence: a systematic review. Psychol Sport Exerc 2002;3:89-123.
9.
Meyer C, Taranis L, Goodwin H, Haycraft E: Compulsive exercise and eating disorders. Eur Eat Disord Rev 2011;19:174-189.
10.
Schack T: Laufsucht und Aspekte von Ausdauersport aus einer gesundheitspsychologischen Perspektive; in Ziemainz H, Schmidt U, Stoll O (eds): Psychologie in Ausdauersportarten. Butzbach-Griedel, Afra, 2000, pp 123-145.
11.
Breuer S, Kleinert J: Primäre Sportsucht und bewegungsbezogene Abhängigkeit - Beschreibung, Erklärung, Diagnostik; in Batthyany D, Pritz A (eds): Rausch ohne Drogen. Substanzungebundene Süchte. Wien, Springer, 2009, pp 191-218.
12.
Elbourne KE, Chen J: The continuum model of obligatory exercise: a preliminary investigation. J Psychosom Res 2007;62:73-80.
13.
Davis C, Kennedy SH, Ralevski E, Dionne M: The role of physical activity in the development and maintenance of eating disorders. Psychol Med 1994;24:957-967.
14.
Davis C, Katzman D, Kirsh C: Compulsive physical activity in adolescents with anorexia nervosa: a psychobehavioral spiral of pathology. J Nerv Ment Dis 1999;187:336-342.
15.
Adkins EC, Keel PK: Does “excessive” or “compulsive” best describe exercise as a symptom of bulimia nervosa? Int J Eat Disord 2005;10:31-47.
16.
Symons Downs D, Hausenblas H, Nigg CR: Factorial validity and psychometric examination of the Exercise Dependence Scale-Revised. Meas Phys Educ Exerc Sci 2004;8:183-201.
17.
Adams J: Understanding exercise dependence. J Contemp Psychother 2009;39:231-240.
18.
Davis C, Kaptein S: Anorexia nervosa with excessive exercise: a phenotype with close links to obsessive-compulsive disorder. Psychiatr Res 2006;142:209-217.
19.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 5. Washington, American Psychiatric Association, 2013.
20.
Davis C, Brewer H, Ratusny D: Behavioral frequency and psychological commitment: necessary concepts in the study of excessive exercising. J Behav Med 1993;16:611-628.
21.
Mond JM, Hay PJ, Rodgers B, Owen C: An update on the definition of “excessive exercise” in eating disorder research. Int J Eat Disord 2006;39:47-153.
22.
Goodwin H, Haycraft E, Meyer C: Sociocultural risk factors for compulsive exercise: a prospective study of adolescents. Eur Eat Disord Rev 2014;22:360-365.
23.
Ziemainz H, Stoll O, Drescher A, Erath R, Schipfer M, Zeulner B: Die Gefährdung zur Sportsucht in Ausdauersportarten. Dtsch Z Sportmed 2013;62:57-64.
24.
Müller A, Claes L, Smits D, Gefeller O, Hilbert A, Herberg A, Müller V, Hofmeister D, de Zwaan M: Validation of the German version of the Exercise Dependence Scale. Eur J Psychol Assess 2013;29:213-219.
25.
Zeeck A, Leonhardt R, Mosebach N, Schlegel S, Linster HW, Hartmann A: Psychopathologische Aspekte von Sport: Eine deutsche Adaptation der „Exercise Dependence Scale (EDS-R). Z Sportpsychol 2013;20:94-106.
26.
Szabo A, Griffiths MD, de La Vega Marcos R, Mervó B, Demetrovics Z: Methodological and conceptual limitations in exercise addiction research. Yale J Biol Med 2015;88:303-308.
27.
Müller A, Cook B, Zander H, Herberg A, Müller V, de Zwaan M: Does the German version of the Exercise Dependence Scale measure exercise dependence? Psychol Sport Exerc 2014;15:288-292.
28.
Shroff H, Reba L, Thornton LM, Tozzi F, Klump KL, Berrettini WH, Brandt H, Crawford S, Crow S, Fichter MM, Goldman D, Halmi KA, Johnson C, Kaplan AS, Keel P, LaVia M, Mitchell J, Rotondo A, Strober M, Treasure J, Woodside DB, Kaye WH, Bulik CM: Features associated with exercise dependence in women with eating disorders. Int J Eat Disord 2006;39:454-461.
29.
Davis C, Katzman D, Kaptein S, Kirsh C, Brewer H, Olmsted M, Woodside D, Kaplan A: The prevalence of high-level exercise in the eating disorders: etiological implications. Comp Psychiatry 1997;38:321-326.
30.
Schipfer M: Sportbindung und Sportsucht im Ausdauersport: Theorie-Diagnostik-Empirie. Hamburg, Schriften zur Sportpsychologie, 2015, vol 15.
31.
Wilson PM, Rodgerns WM, Carpenter PJ, Hall J, Fraser SN: The relationship between commitment and exercise behavior. Psychol Sport Exerc 2004;5:405-421.
32.
Davis C, Claridge G: The eating disorders as addiction: a psychobiological perspective. Add Behav 1998;23:463-475.
33.
Lu F. Hsu M-Y, Wang J-M, Huang M-Y, Chang J-N, Wang C-H: Exercisers identities and exercise dependence: the mediating effect of exercise commitment. Percept Motor Skills Exerc Sport 2012;115:618-631.
34.
Hausenblas HA, Symons Downs D: How much is too much? The development and validation of the Exercise Dependence Scale. Psychol Health 2002;17:387-404.
35.
Pasman L, Thompson J: Body image and eating disturbance in obligatory runners, obligatory weight lifters and sedentary individuals. Int J Eat Disord 1988;7:759-769.
36.
Terry A, Szabo A, Griffiths M: The exercise addiction inventory: a new brief screening tool. Addict Res Theory 2004;12:489-499.
37.
Taranis L, Touyz S, Meyer C: Disordered eating and exercise: development and preliminary validation of the Compulsive Exercise Test (CET). Eur Eat Disord Rev 2011;19:256-268.
38.
McNamara J, McCabe M: Development and validation of the Exercise Dependence and Elite Athletes Scale. Perform Enhanc Health 2013;2:30-36.
39.
Lipsey Z, Barton SB, Hulley A, Hill A: After a workout. Beliefs about exercise, eating and appearance in female exercisers with and without eating disorder features. Psychol Sport Exerc 2009;7:425-436.
40.
Mond JM, Hay PJ, Rodgers B, Owen C, Beumont P: Relationship between exercise behavior, eating disordered behavior and quality of life in a community sample of women: when is exercise excessive? Eur Eat Disord Rev 2004;12:265-272.
41.
Mond J, Myers TC, Crosby R, Hay P, Mitchell J: Excessive exercise and eating-disordered behavior in young adult women: further evidence from a primary care sample. Eur Eat Disord Rev 2008;16:215-221.
42.
Fuchs R: Fragebogen zur Erfassung der sportlichen Aktivität (unpubl project report). Freiburg i. Breisgau, Institute for Sport and Sport Sciences, 2006.
43.
Bauer S, Winn S, Schmidt U, Kordy H: Construction, scoring and validation of the Short Evaluation of Eating Disorders (SEED). Eur Eat Disord Rev 2005;13:191-200.
44.
Hardt J, Egle U, Brähler E: Die Symptom-Checkliste-27 in Deutschland. Psychother Psych Med 2006;56:276-284.
45.
Garner DM: Eating Disorder Inventory. 2. Professional Manual. Odessa, Psychological Assessment Research, 1991.
46.
Hambleton R, de Jong J: Advances in translating and adapting educational and psychological tests. Lang Test Adv Transl Adapt Educ Psychol Tests 2003;20:127-134.
47.
Schmitt M, Eid M: Richtlinien für die Übersetzung fremdsprachlicher Messinstrumente. Diagnostica 2007;53:1-2.
48.
Thiel A, Jacobi C, Horstmann S, Paul T, Nutzinger DO, Schüssler G: Eine deutschsprachige Version des Eating Disorder Inventory EDI-2. Psychother Med Psychol 1997;47:365-376.
49.
Hu L, Bentler PM: Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling 1999;6:1-55.
50.
McLaren L, Gauvin L, White D: The role of perfectionism and excessive commitment to exercise in explaining dietary restraint: replication and extension. Int J Eat Disord 2001;29:307-313.
51.
Sundgot-Borgen J, Larsen S: Nutrient intake and eating behaviors of female elite athletes suffering from anorexia nervosa, anorexia athletica or bulimia nervosa. Int J Sport Nutr 1993;3:431-442.
52.
Giel KE, Kullmann S, Preissl H, Bischoff SC, Thiel A, Schmidt U, Zipfel S, Teufel M: Understanding the reward system functioning in anorexia nervosa: crucial role of physical activity. Biol Psychol 2013;94:575-581.
53.
Müller A, Claes L, Wos K, Kerling A, Wünsch-Leiteritz W, Cook B, de Zwaan M: Temperament and risk for exercise dependence: results of a pilot study in female patients with eating disorders compared to elite athletes. Psychopathology 2015;48:264-269.
54.
Thome JL, Espelage DL: Obligatory exercise and eating pathology in college females: replication and development of a structural model. Eat Behav 2007;8:334-349.
55.
Hall HK, Hill AP, Appleton PR, Kozub SA: Psychol Sport Exerc 2009;10:35-44.
56.
Stoeber J, Becker C: Perfectionism, achievement motives, and attribution of success and failure in female soccer players. Int J Psychol 2008;43:980-987.
57.
Long CG, Smith J, Midgley M, Cassidy T: Overexercising in anorexic and normal samples: behavior and attitudes. J Ment Health 1993;2:321-327.
58.
Schlegel S, Hartmann A, Fuchs R, Zeeck A: The Freiburg sport-therapy program for eating disordered outpatients: a pilot study. Eat Weight Disord 2015;20:319-327.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.