Scoping review of therapeutic approaches among individuals with secondary exercise addiction

Secondary exercise addiction shows high comorbidity with eating and body image disorders. Despite its substantial impact on physical and mental health and daily functioning, evidence on effective therapeutic interventions remains limited. The aim of this scoping review was to identify and describe therapeutic interventions applied to adult individuals with secondary exercise addiction. This review followed the PRISMA Sc-R guidelines and covered the years 2002-2024. Ultimately, five studies were included (four randomized controlled trials and one quasi-experimental study). Three studies applied psychotherapeutic interventions based on cognitive-behavioral models (Cognitive Behavioral Therapy, Lifestyle, Exercise, Attitudes, and Relationships Program, Physical Exercise and Dietary Therapy), while two integrated physical or nutritional components. A secondary analysis published in 2024 based on the LEAP trial dataset was identified but not treated as an independent study to avoid duplication. EBSCOhost, Web of Science, PubMed, and Google Scholar were searched from January to May 2025 using terms related to exercise addiction, exercise abuse, psychotherapy, intervention, and treatment. English-language studies were eligible if they described an intervention with at least one treated group with pre- and post-test measures; the participants of the study were adult patients suffering from eating disorders and exercise addiction (the therapy programs involved one inpatient and four outpatient treatments) and therapeutic intervention was carried out with outcomes based on exercise addiction level data. Four out of five included studies reported improvements in variables related to compulsivity, although these did not always imply a reduction in the amount of exercise, indicating that qualitative changes may be more relevant. Longer interventions showed more consistent effects, but even brief treatments generated positive changes in non-clinical populations. The examination of the research revealed a gap in studies addressing interventions for those with secondary exercise addiction, especially highlighting the need for randomized controlled trials (RCTs) with proper randomization methods.