Response to Can Older Adults Become Exercise Junkies? Commentary on ‘Exercise Addiction in Older Adults: Health Preservation or Fear of Death?’ by Surenkok and Colleagues

We appreciate the thoughtful commentary by Professor Szabo regarding our recent article, ‘Exercise Addiction in Older Adults: Health Preservation or Fear of Death?’ [1]. As Szabo is a key figure in the conceptual development of the Exercise Addiction Inventory (EAI), his perspective on the evolution of this field is invaluable [2]. We would like to address the points raised to clarify our study's intent and findings. Szabo emphasises that the EAI lacks diagnostic value and carries the risk of overpathologizing healthy ‘passion’ [3]. We share this perspective; self-report scales cannot replace clinical interviews. In our study [1], however, the EAI was employed solely as a standardised screening tool to detect individuals at risk of exercise addiction, using the validated cut-off scores proposed by Griffiths et al. [2]. Our objective was not to diagnose exercise addiction clinically, but to examine associations between psychosocial factors—particularly death anxiety—and high-risk exercise patterns in an aging population. Participants categorised in the higher score range in our study were interpreted as being at risk of exercise addiction, rather than as clinically ‘addicted’ individuals. We concur that the boundary between pathological behaviour and high commitment/passion is critical and requires careful consideration in interpretation. Our study employed a cross-sectional design relying on validated and reliable self-report instruments that are commonly used in investigations of behavioural risk patterns. Although structured clinical interviews or behavioural assessments could provide additional diagnostic insight, such approaches were beyond the scope of the present study. This limitation is acknowledged; future research with multidimensional assessments should better distinguish adaptive from maladaptive exercise in older adults. Regarding ‘passion,’ we concur that the boundary between high levels of commitment and addiction is remarkably thin. Nevertheless, our findings demonstrated a significant positive correlation between these ‘addiction’ scores and death anxiety. This suggests that, for some older adults, excessive exercise serves as a coping mechanism against existential fear rather than mere harmonious passion [1]. Szabo suggests that lower health anxiety in the high-score group is simply a result of being fit. In our discussion, we noted that older adults with high health anxiety may avoid intense exercise due to fear of harm [4]. Thus, lower health anxiety among ‘at-risk’ individuals suggests that reduced health-related fear may enable excessive or addictive exercise. In conclusion, owing to the cross-sectional design of the study, no conclusions regarding directionality or causality can be drawn. Regular exercisers may perceive themselves as healthier, potentially reducing health anxiety. This relationship merits further, more detailed investigation through longitudinal study designs. We agree that the field would benefit from greater methodological diversity, such as mixed-methods and clinical assessments. Our study contributes to the literature by examining an underrepresented age group and underscoring the need for cautious interpretation of exercise-related risks in older adults. We thank the author once again for their thoughtful commentary and for contributing to an ongoing scientific dialogue on this important topic. The authors have nothing to report. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.