Cannabidiol extending beyond neuroprotection toward neuronal repair: A potential regenerative modulator.

Among individuals with eating disorders (EDs), exercise plays a complex and significant role in mental health. This is especially true for athletes, where the interplay between exercise and EDs may be uniquely influenced by performance demands and sport-related pressures. Defined as planned, structured physical activity, exercise is widely recognized for its mental health benefits, including improved mood, reduced symptoms of anxiety and depression, and overall enhanced well-being. Increasingly, exercise is prescribed as a component of mental health treatment. Among athletes, these psychological benefits may intersect with physical performance gains, further reinforcing exercise as an integral part of daily life. While exercise is widely recognized for its benefits, these dynamics change profoundly within the context of EDs. As an ED develops, exercise often shifts from being an adaptive behavior to a maladaptive ED behavior, characterized by compulsive qualities that interfere with quality of life, athletic performance, and ED recovery. The terminology and conceptualization of maladaptive exercise remain topics of ongoing debate, with terms such as compulsive exercise, obligatory exercise, compensatory exercise, exercise addiction, excessive exercise, and driven exercise frequently appearing in the literature. While these terms often overlap, distinctions may become clinically significant in certain contexts. In the current article, we use the term to denote exercise that is a rigid or “driven” urge to exercise or move, motivated by a desire to avoid or reduce psychological distress or prevent a disorder-related feared outcome (e.g., weight gain), and persists despite the risk of injury, illness, or other negative consequences. For some individuals with EDs, exercise can develop early in the course of the disorder, particularly for those with anorexia nervosa. Exercise may also represent a ‘non-purging’ clinical subtype for some individuals with bulimia nervosa, a compensatory behavior that may be more long-term and/or socially acceptable than other purging behaviors (e.g., self-induced vomiting). In athlete populations, the distinction between adaptive and compulsive exercise can be especially nuanced. Many athletes engage in high-frequency, high-intensity training without adverse effects, highlighting the role of psychological and contextual factors in differentiating healthy training from disordered patterns. Conversely, compulsive exercise can occur even at moderate levels of exercise frequency and intensity when accompanied by psychological distress, such as excessive urges to exercise, guilt associated with missed workouts, or reliance on exercise to regulate affect or weight concerns. Functional outcomes, including persistence despite injury, inability to scale back training, and interference with athletic, social, or academic roles, may indicate concern for compulsive exercise. For athletes, compulsive exercise may be further reinforced by pressures to perform, team expectations, and normalization of intense physical activity. We detail risk factors and considerations specific to athletes in the second section of this review, below.