Self-esteem mediates the relationship between psychological distress and exercise addiction in Italian adults: a cross-sectional study

Background Regular physical activity yields both physical and mental benefits. However, excessive and compulsive exercise can lead to maladaptive behaviours known as exercise addiction (EA). This condition has been studied in over 1,000 published empirical articles, yet it still lacks official clinical diagnostic criteria.Aims Exercise addiction is linked to psychological distress and has complex relationships with self-esteem, being both positively and negatively associated. Nevertheless, the role of self-esteem in the connection between psychological distress and EA remains unclear.Methods This cross-sectional study involved 350 Italian adults (62% female; M = 34.17, SD = ±11.06) and used validated measures of exercise addiction, psychological distress, and self-esteem. Data analysis consisted of mediation analysis with structural equation modelling.Results Results showed that psychological distress was strongly and negatively related to self-esteem, which in turn negatively predicted EA, unveiling a full mediation model. The direct influence of psychological distress on EA was not statistically significant, emphasizing the key role of self-esteem. Gender differences emerged, with men reporting higher EA scores than women, whereas age was not significantly associated.Conclusion These findings clarify mental processes underlying EA by demonstrating that self-esteem is a crucial factor to consider in prevention and treatment efforts.