Public Health Significance Statement The present study indicates that the most common treatment approach for compulsive exercise in people with eating disorders is a multi-component intervention including a combination of psychoeducation and/or psychotherapy and/or structured exercise. Randomized controlled trials (RCTs) suggest that existing multi-component treatments lead to small reductions in compulsive exercise compared with control groups. To date, no research has been conducted on the treatment of compulsive exercise in people with muscle dysmorphia and this represents an important area for future research. A lack of consensus exists among the scientific and medical communities on how to treat compulsive exercise, a core feature of eating disorders (EDs) and muscle dysmorphia (MD). We systematically searched five electronic databases for treatment studies of compulsive exercise that sampled adolescents and/or adults with an ED or MD, assessed longitudinal changes in compulsive exercise and used a validated instrument to measure compulsive exercise or related constructs. We identified 777 papers, of which 18 met eligibility criteria. None of the included studies sampled people with MD and 15 of 18 evaluated multi-component interventions combining psychoeducation and/or psychotherapy and/or structured exercise. Results from meta-analyses indicated moderate-to-large prepost treatment changes in compulsive exercise (Cohen's d = -.62), but small treatment effects between active and control treatments in randomized controlled trials (Cohen's d = -.23). Multi-component interventions appear best suited to reduce compulsive exercise in people with EDs, but the optimal combination of treatment components is unknown. Further treatment research on MD is needed.
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