A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders



Exercise addiction is associated with multiple adverse outcomes and can be classified as co-occurring with an eating disorder, or a primary condition with no indication of eating disorders. We conducted a meta-analysis exploring the prevalence of exercise addiction in adults with and without indicated eating disorders.


A systematic review of major databases and grey literature was undertaken from inception to 30/04/2019. Studies reporting prevalence of exercise addiction with and without indicated eating disorders in adults were identified. A random effect meta-analysis was undertaken, calculating odds ratios for exercise addiction with versus without indicated eating disorders.


Nine studies with a total sample of 2140 participants (mean age = 25.06; 70.6% female) were included. Within these, 1732 participants did not show indicated eating disorders (mean age = 26.4; 63.0% female) and 408 had indicated eating disorders (mean age = 23.46; 79.2% female). The odds ratio for exercise addiction in populations with versus without indicated eating disorders was 3.71 (95% CI 2.00–6.89; I2 = 81; p  ≤ 0.001). Exercise addiction prevalence in both populations differed according to the measurement instrument used.


Exercise addiction occurs more than three and a half times as often as a comorbidity to an eating disorder than in people without an indicated eating disorder. The creation of a measurement tool able to identify exercise addiction risk in both populations would benefit researchers and practitioners by easily classifying samples.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V (2017) Exercise and mental health. Maturitas. Elsevier 106:48–56. https://doi.org/10.1016/j.maturitas.2017.09.003

    Article  Google Scholar 

  2. 2.

    Wilson MG, Ellison GM, Cable NT (2016) Basic science behind the cardiovascular benefits of exercise. Br J Sport Med. BMJ 50:93–99. https://doi.org/10.1136/bjsports-2014-306596rep

    Article  Google Scholar 

  3. 3.

    Mandolesi L, Polverino A, Montuori S, Foti F, Ferraioli G, Sorrentino P et al (2018) Effects of physical exercise on cognitive functioning and wellbeing: biological and psychological benefits. Front Psychol Front 9:509. https://doi.org/10.3389/fpsyg.2018.00509

    Article  Google Scholar 

  4. 4.

    Landolfi E (2013) Exercise addiction. Sport Med 43:111–119. https://doi.org/10.1007/s40279-012-0013-x

    Article  Google Scholar 

  5. 5.

    Leuenberger A (2006) Endorphins, exercise, and addictions: a review of exercise dependence. Prem J Undergrad Publ Neurosci 3:1–9. Available from https://impulse.appstate.edu/sites/impulse.appstate.edu/files/2006_06_05_Leuenberger.pdf

  6. 6.

    Adams J (2009) Understanding exercise dependence. J Contemp Psychother 39:231–240. https://doi.org/10.1007/s10879-009-9117-5

    Article  Google Scholar 

  7. 7.

    Szabo A, Griffiths MD, de La Vega Marcos R, Mervó B, Demetrovics Z (2015) Methodological and conceptual limitations in exercise addiction research. Yale J Biol Med 88:303–308. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=cmedm&AN=26339214&site=ehost-live

  8. 8.

    Goodman A (1990) Addiction: definition and implications. Br J Addict 85:1403–1408. https://doi.org/10.1111/j.1360-0443.1990.tb01620.x

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Berczik K, Szab A, Griffiths MD, Kurimay T, Kun B, Urbán R et al (2012) Exercise addiction: symptoms, diagnosis, epidemiology, and etiology. Subst Use Misuse 47:403–417. https://doi.org/10.3109/10826084.2011.639120

    Article  PubMed  Google Scholar 

  10. 10.

    de Coverley Veale DM (1987) Exercise dependence. Br J Addict 82:735–740. https://doi.org/10.1111/j.1360-0443.1987.tb01539.x

    Article  PubMed  Google Scholar 

  11. 11.

    Sachs ML (1981) Running Addiction. In: Sachs M, Sachs M (eds) Psychol run. Human Kinetics, Champaign, pp 116–126

    Google Scholar 

  12. 12.

    Thompson JK, Blanton P (1987) Energy conservation and exercise dependence: a sympathetic arousal hypothesis. Med Sci Sports Exerc. https://doi.org/10.1249/00005768-198704000-00005

    Article  PubMed  Google Scholar 

  13. 13.

    Szabo A (1995) The impact of exercise deprivation on well-being of habitual exercisers. Aust J Sci Med Sport 27:68–75. Available from: http://articles.sirc.ca/search.cfm?id=390518

  14. 14.

    Hamer M, Karageorghis CI (2007) Psychobiological mechanisms of exercise dependence. Sports Med 37:477–484. https://doi.org/10.2165/00007256-200737060-00002

    Article  PubMed  Google Scholar 

  15. 15.

    Freimuth M, Moniz S, Kim SR (2011) Clarifying exercise addiction: differential diagnosis, co-occurring disorders, and phases of addiction. Int J Environ Res Public Health 8:4069–4081. https://doi.org/10.3390/ijerph8104069

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    McNamara J, McCabe MP (2012) Striving for success or addiction? Exercise dependence among elite Australian athletes. J Sports Sci 30:755–766. https://doi.org/10.1080/02640414.2012.667879

    Article  PubMed  Google Scholar 

  17. 17.

    Egorov AY, Szabo A (2013) The exercise paradox: an interactional model for a clearer conceptualization of exercise addiction. J Behav Addict 2:199–208. https://doi.org/10.1556/jba.2.2013.4.2

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    American Psychiatric Association. DSM-V. Am. J. Psychiatry. 2013

  19. 19.

    WHO (2019) WHO| international classification of diseases, 11th revision (ICD-11). WHO

  20. 20.

    Pasman L, Thompson JK (1988) Body image and eating disturbance in obligatory runners, obligatory weightlifters, and sedentary individuals. Int J Eat Disord 7:759–769. https://doi.org/10.1002/1098-108x(198811)7:6%3C759:aid-eat2260070605%3E3.0.co;2-g

    Article  Google Scholar 

  21. 21.

    Ogden J, Veale D, Summers Z (1997) The development and validation of the exercise dependence questionnaire. Addict Res 5:343–355. https://doi.org/10.3109/16066359709004348

    Article  Google Scholar 

  22. 22.

    Hausenblas HA, Downs DS (2002) How much is too much? The development and validation of the exercise dependence scale. Psychol Health 17:387–404. https://doi.org/10.1080/0887044022000004894

    Article  Google Scholar 

  23. 23.

    Diagnostic and Statistical Manual of Mental Disorders (2000) Fourth Edition, Text Revision (DSM-IV-TR)

  24. 24.

    Terry A, Szabo A, Griffiths M (2004) The exercise addiction inventory: a new brief screening tool. Addict Res Theory 12:489–499. https://doi.org/10.1080/16066350310001637363

    Article  Google Scholar 

  25. 25.

    Brown RIF (1993) Some contributions of the study of gambling to the study of other addictions. Gambl Behav Probl Gambl 1:241–272

    Google Scholar 

  26. 26.

    Brown RIF (1997) A theoretical model of the behavioural addictions–applied to offending. Addict Crime 13–65

  27. 27.

    Dalle Grave R, Calugi S, Marchesini G (2008) Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome. Compr Psychiatry 49:346–352. https://doi.org/10.1016/j.comppsych.2007.12.007

    Article  PubMed  Google Scholar 

  28. 28.

    Bratland-Sanda S, Martinsen EW, Rosenvinge JH, Rø O, Hoffart A, Sundgot-Borgen J (2011) Exercise dependence score in patients with longstanding eating disorders and controls: the importance of affect regulation and physical activity intensity. Eur Eat Disord Rev J Eat Disord Assoc 19:249–255. https://doi.org/10.1002/erv.971

    Article  Google Scholar 

  29. 29.

    Hollander E, Kwon JH, Stein DJ, Broatch J, Rowland CT, Himelein CA (1996) Obsessive-compulsive and spectrum disorders: overview and quality of life issues. J Clin Psychiatry 57(SUPPL. 8):3–6

    PubMed  Google Scholar 

  30. 30.

    Dalle Grave R (2009) Features and management of compulsive exercising in eating disorders. Phys Sportsmed 37:20–28. https://doi.org/10.3810/psm.2009.10.1725

    Article  PubMed  Google Scholar 

  31. 31.

    Smink FRE, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414. https://doi.org/10.1007/s11920-012-0282-y

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Sauchelli S, Arcelus J, Granero R, Jiménez-Murcia S, Agüera Z, Del Pino-Gutiérrez A et al (2017) Dimensions of compulsive exercise across eating disorder diagnostic subtypes and the validation of the Spanish version of the compulsive exercise test. Front Psychol 7:1852. https://doi.org/10.3389/fpsyg.2016.01852

    Article  Google Scholar 

  33. 33.

    Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies. JAMA Psychiatry 68:724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74

    Article  Google Scholar 

  34. 34.

    Solmi M, Veronese N, Correll CU, Favaro A, Santonastaso P, Caregaro L et al (2016) Bone mineral density, osteoporosis, and fractures among people with eating disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 133:341–351. https://doi.org/10.1111/acps.12556

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Klein DA, Bennett AS, Schebendach J, Foltin RW, Devlin MJ, Walsh BT (2004) Exercise “addiction” in anorexia nervosa: model development and pilot data. CNS Spectr 9:531–537. https://doi.org/10.1017/s1092852900009627

    Article  PubMed  Google Scholar 

  36. 36.

    Laban MM, Wilkins JC, Sackeyfio AH, Taylor RS (1995) Osteoporotic stress fractures in anorexia nervosa: etiology, diagnosis, and review of four cases. Arch Phys Med Rehabil Elsevier 76:884–887. https://doi.org/10.1016/s0003-9993(95)80558-3

    CAS  Article  Google Scholar 

  37. 37.

    Misra M, Klibanski A (2011) Bone health in anorexia nervosa. Curr Opin Endocrinol Diabetes Obes. https://doi.org/10.1097/MED.0b013e32834b4bdc

  38. 38.

    Kaye WH, Gwirtsman HE, Obarzanek E, George DT (1988) Relative importance of calorie intake needed to gain weight and level of physical activity in anorexia nervosa. Am J Clin Nutr. https://doi.org/10.1093/ajcn/47.6.989

    Article  PubMed  Google Scholar 

  39. 39.

    Trott M, Jackson S, Firth J, Stubbs B, Smith L (2019) Exercise addiction prevalence and correlates in the absence of eating disorder symptomology. J Sports Sci 37:1–93. https://doi.org/10.1080/02640414.2019.1671688

  40. 40.

    Di Lodovico L, Poulnais S, Gorwood P (2019) Which sports are more at risk of physical exercise addiction: a systematic review. Addict Behav 93:257–262. https://doi.org/10.1016/j.addbeh.2018.12.030

    Article  PubMed  Google Scholar 

  41. 41.

    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100. https://doi.org/10.7326/0003-4819-151-4-200908180-00136

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296. https://doi.org/10.7554/elife.08500.009

    Article  Google Scholar 

  43. 43.

    Borenstein M, Hedges L, Higgins J, Rothstein H (2013) Comprehensive meta analysis. Biostat, Englewood

    Google Scholar 

  44. 44.

    Cochran WG (1954) The combination of estimates from different experiments. Biometr JSTOR 10:101–129. https://doi.org/10.2307/3001666

    Article  Google Scholar 

  45. 45.

    Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med Wiley 21:1539–1558. https://doi.org/10.1002/sim.1186

    Article  Google Scholar 

  46. 46.

    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics. https://doi.org/10.2307/2533446

    Article  PubMed  Google Scholar 

  47. 47.

    Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta—analysis detected by a simple, graphical test. BMJ Br Med J. https://doi.org/10.1136/bmj.315.7109.629

    Article  Google Scholar 

  48. 48.

    Fu R, Gartlehner G, Grant M, Shamliyan T, Sedrakyan A, Wilt TJ et al (2011) Conducting quantitative synthesis when comparing medical interventions: aHRQ and the Effective Health Care Program. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2010.08.010

    Article  PubMed  Google Scholar 

  49. 49.

    Sterne JA, Egger M, Moher D (2008) Addressing reporting biases. Cochrane Handb Syst Rev Interv Cochrane B Ser. https://doi.org/10.1002/9780470712184.ch10

    Article  Google Scholar 

  50. 50.

    Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. https://doi.org/10.1111/j.0006-341x.2000.00455.x

    Article  PubMed  Google Scholar 

  51. 51.

    Garner DM, Garfinkel PE (1979) The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med Camb Univ Press 9:273–279. https://doi.org/10.1017/s0033291700030762

    CAS  Article  Google Scholar 

  52. 52.

    Garner DM, Olmsted MP, Bohr Y, Garfinkel PE (1982) The eating attitudes test: psychometric features and clinical correlates. Psychol Med 12:871–878. https://doi.org/10.1017/s0033291700049163

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16:363–370. https://doi.org/10.1002/1098-108X(199412)16:4%3C363:AID-EAT2260160405%3E3.0.CO;2-%23

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Garner DM (1991) Eating disorder inventory-2: professional manual. Psychological Assessment Resources. Inc, Florida

    Google Scholar 

  55. 55.

    Morgan JF, Reid F, Lacey JH (1999) The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 319:1467–1468. https://doi.org/10.1136/bmj.319.7223.1467

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  56. 56.

    Grandi S, Clementi C, Guidi J, Benassi M, Tossani E (2011) Personality characteristics and psychological distress associated with primary exercise dependence: an exploratory study. Psychiatry Res 189:270–275. https://doi.org/10.1016/j.psychres.2011.02.025

    Article  PubMed  Google Scholar 

  57. 57.

    Dalle Grave R (2008) Excessive and compulsive exercises in eating disorders: prevalence, associated features, and management. Dir Psychiatry 28:273–282. https://doi.org/10.1016/j.comppsych.2007.12.007

    Article  Google Scholar 

  58. 58.

    Davis C, Katzman DK, Kaptein S, Kirsh C, Brewer H, Kalmbach K et al (1997) The prevalence of high-level exercise in the eating disorders: etiological implications. Compr Psychiatry 38:321–326. https://doi.org/10.1016/s0010-440x(97)90927-5

    CAS  Article  PubMed  Google Scholar 

  59. 59.

    Davis C, Claridge G (1998) The eating disorders as addiction: a psychobiological perspective. Addict Behav 23:463–475. https://doi.org/10.1016/S0306-4603(98)00009-4

    CAS  Article  PubMed  Google Scholar 

  60. 60.

    Symons Downs D, MacIntyre RI, Heron KE (2019) Exercise addiction and dependence. In: Anshel MH, Petruzzello SJ, Labbé EE (eds), APA Handb Sport Exerc Psychol Vol 2 Exerc Psychol vol 2, p 589–604. https://doi.org/10.1037/0000124-030

  61. 61.

    Weinman A, Weinman Y (2014) Exercise addiction- diagnosis, bio-psychological mechanisms and treatment issues. Curr Pharm Des 20:4062–4069. https://doi.org/10.2174/13816128113199990614

    CAS  Article  Google Scholar 

  62. 62.

    Adams JM, Miller TW, Kraus RF (2003) Exercise dependence: diagnostic and therapeutic issues for patients in psychotherapy. J Contemp 33:93–107. https://doi.org/10.1023/A:1022883104269

    Article  Google Scholar 

  63. 63.

    Lichtenstein MB, Hinze CJ, Emborg B, Thomsen F, Hemmingsen SD (2017) Compulsive exercise: links, risks and challenges faced. Psychol Res Behav 10:85–95. https://doi.org/10.2147/prbm.s113093

    Article  Google Scholar 

  64. 64.

    Di Nicola M, Martinotti G, Mazza M, Tedeschi D, Pozzi G, Janiri L (2010) Quetiapine as add-on treatment for bipolar I disorder with comorbid compulsive buying and physical exercise addiction. Prog Neuropsychopharmacol Biol Psychiatry 34:713–714. https://doi.org/10.1016/j.pnpbp.2010.03.013

    Article  PubMed  Google Scholar 

  65. 65.

    Sundgot-Borgen J, Torstveit MK (2004) Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. https://doi.org/10.1097/00042752-200401000-00005

    Article  PubMed  Google Scholar 

  66. 66.

    Bamber D, Cockerill IM, Carroll D (2000) The pathological status of exercise dependence. Br J Sports Med 34:125–132. https://doi.org/10.1136/bjsm.34.2.125

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  67. 67.

    Blaydon MJ, Lindner KJ (2002) Eating disorders and exercise dependence in triathletes. Eat Disord. 10:49–60. https://doi.org/10.1080/106402602753573559

    Article  PubMed  Google Scholar 

  68. 68.

    Blaydon MJ, Linder KJ, Kerr JH (2004) Metamotivational characteristics of exercise dependence and eating disorders in highly active amateur sport participants. Pers Individ Differ 36:1419–1432. https://doi.org/10.1016/s0191-8869(03)00238-1

    Article  Google Scholar 

  69. 69.

    De Young KP, Anderson DA (2010) The importance of the function of exercise in the relationship between obligatory exercise and eating and body image concerns. Eat Behav 11:62–64. https://doi.org/10.1016/j.eatbeh.2009.09.001

    Article  PubMed  Google Scholar 

  70. 70.

    Di Lodovico L, Dubertret C, Ameller A (2018) Vulnerability to exercise addiction, socio-demographic, behavioral and psychological characteristics of runners at risk for eating disorders. Compr Psychiatry 81:48–52. https://doi.org/10.1016/j.comppsych.2017.11.006

    Article  PubMed  Google Scholar 

  71. 71.

    Lease HJ, Bond MJ (2013) Correspondence between alternate measures of maladaptive exercise, and their associations with disordered eating symptomatology. J Behav Addict 2:153–159. https://doi.org/10.1556/jba.2.2013.012

    Article  PubMed  PubMed Central  Google Scholar 

  72. 72.

    Meulemans S, Pribis P, Grajales T, Krivak G (2014) Gender differences in exercise dependence and eating disorders in young adults: a path analysis of a conceptual model. Nutrients 6:4895–4905. https://doi.org/10.3390/nu6114895

    Article  PubMed  PubMed Central  Google Scholar 

  73. 73.

    Serier KN, Smith JE, Lash DN, Gianini LM, Harriger JA, Sarafin RE et al (2018) Obligatory exercise and coping in treatment-seeking women with poor body image. Eat Weight Disord 23:331–338. https://doi.org/10.1007/s40519-018-0504-3

    Article  PubMed  Google Scholar 

Download references


The authors wish to express their gratitude to Malcolm Bond, Kyle De Young, Kelsey Serier and Laura Di Lodovico for their help and support in the collection of raw data for analysis.

Author information



Corresponding author

Correspondence to Mike Trott.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was granted ethical approval by Anglia Ruskin University.

Informed consent

Informed consent was not requried due to this being a systematic review.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Trott, M., Jackson, S.E., Firth, J. et al. A comparative meta-analysis of the prevalence of exercise addiction in adults with and without indicated eating disorders. Eat Weight Disord 26, 37–46 (2021). https://doi.org/10.1007/s40519-019-00842-1

Download citation


  • Exercise addiction
  • Exercise dependence
  • Addiction
  • Pathological exercise
  • Eating disorders
  • Disordered eating