Prevalence and correlates of exercise addiction in India, Malaysia, and Taiwan: cross-country comparison and pooled analysis

Exercise addiction (EA) involves compulsive excessive physical activity with potential adverse psychological effects. We examined its prevalence and psychobehavioral correlates using cross-sectional data from Taiwan, Malaysia, and India. We assessed EA using Exercise Addiction Inventory (EAI), with scores ≥24 indicating risk. General well-being was evaluated using WHO-5 Well-Being Index and perceived healthiness. Psychological distress was assessed via Hospital Anxiety and Depression Scale (HADS), while body image was assessed via Muscle Dysmorphic Disorder Inventory (MDDI) and Drive for Leanness Scale (DLS). Eating behaviours were evaluated via Eating Disorder Examination Questionnaire (EDEQ), Sick, Control, One, Fat, and Food (SCOFF), and Muscularity-Oriented Eating Test (MOET). Partial Pearson r correlation analyses and adjusted multivariate regression were performed to explore the relationship to EA. Pooled correlation and beta coefficients with 95% confidence intervals (CI) were reported. Among 2,680 participants, pooled prevalence of EA was 11%, highest in India (15%), followed by Taiwan (10%) and Malaysia (9%). Adjusted pooled bivariate analyses showed positive correlations between EAI and MDDI (estimate = 0.39; 95% CI = 0.22–0.54), MOET (estimate = 0.41; 95% CI = 0.20–0.58), and most other variables, except SCOFF. Pooled multivariates identified positive associations of EAI with WHO-5, perceived healthiness, MDDI-functional impairment, DLS, EDEQ (restraint and weight concern), and SCOFF, while MDDI-appearance intolerance and EDEQ shape concern were negatively associated. At-risk EA was linked to well-being, psychological distress, body image concerns, and eating disorders. Screening may aid early identification, especially in those with psychobehavioral issues.