To encourage the practice of physical activity new training modalities have been developed, such as CrossFit. CrossFit emerged in 2000/2001 and already has more than 14 thousand affiliated academies around the world and are located in 142 countries across all 7 continents^[1].

The modality stands out as a training modality that includes Olympic lifting exercises, workout and gymnastic movements that are usually performed quickly, with successive repetitions, with short or no rest intervals, organizing in circuit form, and with an established time for execution^[2]. Due to these characteristics, CrossFit can be classified as an extreme conditioning program^[3] by intensity and volume, ranging from moderate to high^[4].

The benefits of the practice of CrossFit are related to improving physical conditioning and body composition^{[5, 6]} leading to a positive change in the body shape of the practitioners^{[7, 8]}. Furthermore, the sense of community proportioned during the training in group mode can reinforce the adherence in maintaining the practice of the modality and encourages the adoption of a healthier life, taking care of food, and time of practice^{[9, 10]}. Recently a literature review about psychological variables of CrossFit participants demonstrated a high perception of motivation, enjoyment, challenge, and affiliation that can justify the major adherence in practice on the modality^[9]. However, the authors highlight that this topic remains at an initial stage and the findings should be generalized with caution.

Although the aforementioned benefits of CrossFit practice, these profiles can be considered dangerous if the practitioners overtaking too much care about it. In Dominski et al., 2021 review, the authors point out a possible problem related to the excessive practice of the modality, describing the Lichtenstein & Jensen, 2016 study in which the 5% of CrossFit practitioners presented a prevalence of exercise addiction. The excessive practice of exercise and excessive care about healthy food can be consequences or can trigger some disorders such as vigorexia and/or orthorexia.

Excessive practice of exercise can be a signal of vigorexia or also called muscular dystrophy, which can be described as a body image distortion leading to an obsessive concern with the body shape^[12]. It is considered a specific type of body image distortion disorder, which mainly affects males, however; the prevalence is uncertain and complex^[12]. The vigorexia also can be related to a severe modification in the food pattern.

Orthorexia is characterized as a pathological obsession with healthy eating, which can lead to significant dietary restrictions^[13]. This behavior induces a long dedication in the search, selection, preparation, and adequacy of food^{[14, 15]}, and can end up becoming an extreme, excessive, psychologically and sometimes physically dangerous disorder, which can also be related to anorexia, even though they are different turning to be a qualitative disorder. In certain cases, the individual who is recovering from anorexia migrates to orthorexia, changing the focus from weight to the aspect of quality and purity of food^[16].

Taken together, knowledge about the prevalence of vigorexia and orthorexia on practitioners involved in the CrossFit programs seems to be important to ensure a healthy practice and identify individuals sensitive to these disorders. Therefore, the main aim of this study was to describe the prevalence of vigorexia and orthorexia on Brazilian CrossFit practitioners. A secondary aim was to evaluate possible association with time practicing CrossFit, exercise frequency, engagement in other exercises and, food planning.

From the 54 participants selected in this study, women were prevalent (n=36). The orthorexic behavior was found in 14.8% (n=8) of participants, of which 87.5% (n=7) were female. For vigorexic behavior, 40.7 % (n=22) of participants were found with severe behavior and 3.7 % (n=2) with vigorexic behavior. Analyzing by sex, in the male group (n=18), 55.5% (n=10) were classified as a severe behavior for vigorexia. On the other way, in the female group (n=36), 41.7 % (n=15) were classified as a low behavior for vigorexia (Figure 1).

Considering that the questionnaire of vigorexy presents items with important information isolated, the results from the practitioners were presented independently (Figure 2). Frequency only severe or behavior vigorexy it was possible to observe that most of the sample do not use anabolic steroids (95.8%), and do not follow any specific diet for their training (54.2%). Moreover, 87.5% felt guilty when can not go to the gym and 87.5% already exercised injured.

Table 1 presents the association of participants with orthorexia behavior and severe vigorexia and vigorexia behavior with characteristics such as time practicing CrossFit, hours spent per week practicing exercise, engagement in other sport modalities, or exercise program and, food planning time practicing exercise, hours per week. It was found that most of the practitioners with orthorexia behavior and severe vigorexia and vigorexia behavior were practicing CrossFit for more than one year and do not have food planning by a nutritionist. Practitioners classified as an orthorexic behavior exercise 3 to 6 hours per week (75%) and only practice CrossFit (87.5%). There was also found that only 2 practitioners have both orthorexia behavior and severe vigorexy (p<0,001).

The present study aimed to describe the prevalence of vigorexia and orthorexia on Brazilian CrossFit practitioners and associated with time practicing CrossFit, exercise frequency, engagement in other exercises and, food planning. The main findings of this research were: i) small part of the practitioners presented orthorexia behavior, in which most were female; ii) severe scores of vigorexia and vigorexic behavior were found in almost half of the practitioners, with major prevalence in males; iii) practitioners with orthorexia and severe vigorexia behavior were engaged in CrossFit for more than one year and do not have food planning by a nutritionist; iv) only 2 practitioners had both orthorexia and severe vigorexia behavior.

The orthorexia behavior was found in 14.8% (n=8) of the practitioners, with a higher prevalence in females (87.5%; n=7); however, it is important to point out that most of the sample were also female (36 of 54 practitioners). Unlike, Donini et al., 2004 study, the authors evaluated 404 adults of both sexes, 6.9% showed orthorexia behavior and the prevalence of orthorexia is higher in males (11.3% vs 3.9%). Also, in a sample of Brazilian university athletes, 22% presented orthorexia behavior, with major prevalence in males (7 males vs 4 females)^[19]. On the opposite, recently, a sample of Brazilian exercise practitioners from the city of Petrolina presented 80% of orthorexia behavior, with no difference between the sexes^[20].

Regarding the vigorexia behavior, we considered the severe scores and vigorexia behavior together and, this prevalence was higher compared to orthorexia behavior (40.7% vs 14.8%). The vigorexia behavior was found in two males practitioners. Recently, Alencar et al., 2021, published a letter to the Editor of the International Journal of Social Psychiatry, highlighting the danger of vigorexy behavior. The authors described that vigorexy is the belief that the body is insufficiently muscular and thin when, in fact, patients have the normal body or are even more muscular than average. They also support that this behavior mainly affects males, “leading the individual to adopt intense and repetitive physical exercise combined with extreme diets and the use of anabolic steroids, to achieve ‘muscularity’.”

The finds of the present study agree in part with the statement of Alencar et al., 2021. Besides the major prevalence in males, also we found that the practitioners with severe vigorexy were engaged more than one year in the CrossFit modality, and 40.9% reported practice of exercise more than 7 hours (40.9%) per week. On the other hand, when the items from the vigorexy questionnaire were analyzed individually, most of the practitioners behavior vigorexy or severe reported not using anabolic steroids (95.8%) and not use any specific diet for the training (54.2%).

According to the findings of this study, the timing of physical activity practice may be related to the risk of orthorexia. According to Tocchetto et al., 2018, there may be a link between sports, physical activity, and low ORTO-15 scores. Brytek-Matera et al., 2015 examined different responses for people with eating disorders (orthorexia, bulimia, and anorexia) and discovered that 44.23 percent of them associated exercise with the intention of losing weight, which may be related to orthorexia. The relationship between the risk of orthorexia and the time of physical activity is still unknown, and more research is needed to determine the possible relationship.

The majority of participants reported feeling guilty for not going to the gym; obsessive characteristics of sports activities, such as guilt for missing training when combined with other factors, represent a factor that plays an important role in the development of vigorexia. Kiss-Leizer et al., 2019, have demonstrated that people exercise regularly to stay healthy and fit, and the amount of time spent exercising is often related to the end goal. However, some attitudes are red flags and may indicate the presence of a dysmorphic self-perception, which is accompanied by dissatisfaction with one’s physical shape, a trait shared by the participants in this study.

Despite being aware of the illnesses that can result from overtraining, more than half of the participants were willing to take the risk. In their study Schlegel, 2020, noted that previous injuries increase the risk of future injuries. This behavior could be a reflection of the frustrations caused by dysmorphic self-perception, which is often associated with excessive concern with achieving the idealized body, which is supplied by the demanding commitment to physical exercise.

Freire et al., 2020, seems that body dissatisfaction to be a determinant factor for risk behavior for eating disorders and addiction to exercise among fitness and crossfit particpants. On the other hand, in the present study only two people were classified as having associated vigorexia and orthorexia. This condition is understandable in light of the findings of Dominski et al., 2021, who aimed to review the existing literature on the psychological variables of CrossFit participants. This audience had a positive attitude toward effort, intrinsic motivation, and reasons for practicing such as enjoyment, challenge, and affiliation. It is worth noting, however, that the classification of orthorexia ignores nutritional goals, and Pearson & Jenkins, 2022 stated that nutritional goals are underlying factors that affect eating behaviors in non-competitive CrossFit® participants.

There are some limitations to this study. For starters, this study only included five CrossFit affiliates. The questionnaires were administered virtually. Because of the small number of Crossfit practitioners included, the sample size may reduce the statistical power of some analyses. Another limitation was the high proportion of females in the study group. This condition may have an impact on orthorexia and vigorexy interpretation behavior. Males, on the other hand, had a higher risk classification for vigorexy behavior. The study’s strength was its prospective design, which evaluated behavioral changes in an activity modality that has grown globally and for which there has been little characterization of these individuals in relation to behavioral changes thus far.

CrossFit participants demonstrated changes in eating behavior and body self-perception. Individuals with a predisposition to orthorexia engaged in regular physical activity for more than a year. Only CrossFit practitioners had more characteristics related to the risk of orthorexia when it came to the modality. Body image distortion predominated in the sample, owing to practitioners with a high risk of vigorexia having a longer period of regular physical activity practice. Individuals who were identified as having a high risk of vigorexia did not have a high risk of orthorexia. In practice, the findings suggest that health professionals, particularly physical education professionals and nutritionists, examine the motivation for physical activity and distorted perceptions of eating habits, and intervene as soon as possible in cases where an association with suggestive behaviors is observed.