The Expanded Exercise Addiction Inventory (EAI-3): Towards Reliable and International Screening of Exercise-Related Dysfunction

Umberto Granziol; Mark D Griffiths; Liye Zou; Peiying Yang; Hannah K Herschel; Annika Junker; Takayuki Akimoto; Oliver Stoll; Merve Alpay; Zeynep Aydın; Thomas Zandonai; Laura Di Lodovico; Mia Beck Lichtenstein; Mike Trott; Robert M Portman; Melanie Schipfer; Brian Cook; Silvia Cerea; Aleksei Y Egorov; Abril Cantù-Berrueto; Ricardo de la Vega Marcos; Paula Texeira Fernandes; Emilio Landolfi; Zsolt Demetrovics; Eliza E Tóth; Marco Solmi; Attila Szabo

doi:10.1007/s11469-023-01066-2

The Expanded Exercise Addiction Inventory (EAI-3): Towards Reliable and International Screening of Exercise-Related Dysfunction

Int J Ment Health Addict. 2023 May 10:1-27. doi: 10.1007/s11469-023-01066-2. Online ahead of print.

Authors

Umberto Granziol¹, Mark D Griffiths², Liye Zou³, Peiying Yang³, Hannah K Herschel¹, Annika Junker¹, Takayuki Akimoto⁴, Oliver Stoll⁵, Merve Alpay⁶, Zeynep Aydın⁷, Thomas Zandonai^{8

9}, Laura Di Lodovico¹⁰, Mia Beck Lichtenstein^{11

12}, Mike Trott¹³, Robert M Portman¹⁴, Melanie Schipfer⁵, Brian Cook¹⁵, Silvia Cerea^{1

16}, Aleksei Y Egorov¹⁷, Abril Cantù-Berrueto¹⁸, Ricardo de la Vega Marcos¹⁹, Paula Texeira Fernandes²⁰, Emilio Landolfi²¹, Zsolt Demetrovics^{22

23}, Eliza E Tóth²⁴, Marco Solmi^{25

26

27

28}, Attila Szabo²⁹

Affiliations

¹ Department of General Psychology, University of Padova, Via Venezia 8, 35131 Padua, Italy.
² School of Social Sciences, Nottingham Trent University, Nottingham, UK.
³ Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, China.
⁴ Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.
⁵ Martin-Luther University Halle-Wittenbergn, Halle (Saale), Germany.
⁶ Physical Education and Sports, Institute of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey.
⁷ International School of Advanced Studies, University of Camerino, Camerino, Italy.
⁸ Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University of Elche, Alicante, Spain.
⁹ Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy.
¹⁰ Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, Paris, France.
¹¹ Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
¹² Research Unit for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.
¹³ Centre for Public Health, Queen's University Belfast, Belfast, UK.
¹⁴ Centre for Applied Psychological Science and School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK.
¹⁵ St Augustine, USA.
¹⁶ Department of Biomedical Science, University of Padova, Padua, Italy.
¹⁷ Sechenov Institute of Evolutionary Physiology and Biochemistry of Russian Academy of Sciences, St. Petersburg, Russia.
¹⁸ University Autonomous of Nuevo León (UANL), San Nicolas de los Garza, Mexico.
¹⁹ Department of Physical Education, Sport & Human Movement, Autonomous University of Madrid, Madrid, Spain.
²⁰ Department of Sport Science and GEPEN - Physical Education Faculty, State University of Campinas/UNICAMP, Campinas, Brazil.
²¹ School of Kinesiology, University of the Fraser Valley, British Columbia, Canada.
²² Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
²³ Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.
²⁴ Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
²⁵ Department of Psychiatry, University of Ottawa, Ottawa, ON Canada.
²⁶ On track: The Champlain First Episode Psychosis Program, Department of Mental Health, The Ottawa Hospital, ON Ottawa, Canada.
²⁷ Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), University of Ottawa, Ottawa, ON Canada.
²⁸ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
²⁹ Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary.

Abstract

Exercise addiction (EA) refers to excessive exercise, lack of control, and health risks. The Exercise Addiction Inventory (EAI) is one of the most widely used tools in its assessment. However, the cross-cultural psychometric properties of the EAI could be improved because it misses three pathological patterns, including guilt, exercise despite injury, and experienced harm. Therefore, the present study tested the psychometric properties of the expanded EAI (EAI-3) in a large international sample. The EAI-3 was administered to 1931 physically active adult exercisers speaking five languages (Chinese, German, Italian, Japanese, and Turkish) and other measures for obsessive-compulsive behavior, eating disorders, and personality traits. The assessment structure and reliability of the EAI-3 were tested with factorial analyses and through measurement invariance across languages and sex. Finally, a cutoff point for dysfunction-proneness was calculated. The EAI-3 comprised two factors, reflecting the positive and pathological sides of exercise. The structure had excellent reliability and goodness-of-fit indices and configural and metric invariances of the scale were supported. However, three items caused violations in scalar invariance. The results of partial measurement invariance testing suggested an adequate fit for the data. Following sensitivity and specificity analysis, the EAI-3's cutoff score was 34 out of a maximum score of 48. This preliminary study suggests that the EAI-3 is a promising tool for screening EA in an international sample, with a robust and reliable structure comparable across languages and sex. In addition, the proposed cutoff could pave the way toward a consensus on a threshold to screen for EA.

Keywords: Cross-cultural validation; Exercise Addiction Inventory; Exercise addiction; Exercise dependence; Measurement invariance.