Treatment approaches for primary exercise addiction: a systematic review

Exercise addiction (EA) is a behavioural dysfunction characterised by compulsive and excessive engagement in physical activity. While EA remains unrecognised in current diagnostic systems, its clinical relevance has prompted targeted interventions. This systematic review synthesises the current empirical evidence on treatments for primary EA. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight databases were searched: Scopus, Web of Science, PubMed, MEDLINE, ResearchGate, ProQuest, EBSCO, and Google Scholar. Only six intervention studies met the inclusion criteria. Most were grounded in cognitive–behavioural therapy (CBT) frameworks, including rational emotive behaviour therapy (REBT) and multimodal CBT-informed approaches. Additional approaches included pharmacological interventions, artificial intelligence (AI)-assisted behavioural regulation, and structured breathing exercises. Findings indicate that REBT and multimodal CBT approaches may be promising in reducing primary EA symptoms, while pharmacological and AI-based interventions may offer alternative pathways. In contrast, the single breathing-exercise study produced an adverse effect, increasing EA scores; current evidence is therefore insufficient to determine whether breathing interventions reduce EA symptoms. The evidence base remains limited due to diagnostic ambiguity, lack of intervention studies, and small sample sizes. Future research should prioritise randomised controlled trials, establish clear diagnostic criteria, and explore multidisciplinary treatment models to support recovery and the associated psychiatric symptoms in individuals with primary EA.