Despite evidence that exercise has been found to be effective in the treatment of depression, it is unclear whether these data can be extrapolated to bipolar disorder. Available evidence for bipolar disorder is scant, with no existing randomized controlled trials having tested the impact of exercise on depressive, manic or hypomanic symptomatology. Although exercise is often recommended in bipolar disorder, this is based on extrapolation from the unipolar literature, theory and clinical expertise and not empirical evidence. In addition, there are currently no available empirical data on program variables, with practical implications on frequency, intensity and type of exercise derived from unipolar depression studies. The aim of the current paper is to explore the relationship between exercise and bipolar disorder and potential mechanistic pathways. Given the high rate of medical co-morbidities experienced by people with bipolar disorder, it is possible that exercise is a potentially useful and important intervention with regard to general health benefits; however, further research is required to elucidate the impact of exercise on mood symptomology.

Tobacco use in mental health in general and bipolar disorder in particular remains disproportionally common, despite declining smoking rates in the community. Furthermore, interactions between tobacco use and mental health have been shown, indicating the outcomes for those with mental health disorders are impacted by tobacco use. Factors need to be explored and addressed to improve outcomes for those with these disorders and target specific interventions for people with psychiatric illness to cease tobacco smoking. In the context of bipolar disorder, this review explores; the effects of tobacco smoking on symptoms, quality of life, suicidal behaviour, the biological interactions between tobacco use and bipolar disorder, the interactions between tobacco smoking and psychiatric medications, rates and factors surrounding tobacco smoking cessation in bipolar disorder and suggests potential directions for research and clinical translation. The importance of this review is to bring together the current understanding of tobacco use in bipolar disorder to highlight the need for specific intervention.

BackgroundMassage is often applied with the intention of improving flexibility or reducing stiffness in musculotendinous tissue. There is, however, a lack of supporting evidence that such mechanical effects occur. The purpose of the study was to investigate the effect of massage on the passive mechanical properties of the calf muscle complex.MethodsTwenty nine healthy volunteers aged between 18 and 45 years of age had their calf muscle compliance and ankle joint dorsiflexion range of motion (ROM) measured using an instrumented footplate before, immediately and 30 minutes after a ten minute application of deep massage or superficial heating to the calf muscle complex. Repeated measures analysis of variance was used to determine differences between testing sessions and the types of intervention. Reliability testing for the measurement method was conducted using analysis of variance both within and between testing sessions.ResultsThere was no significant change in calf muscle stiffness or ankle dorsiflexion range of motion with or without the application of calf massage. Inter- and intra-session reliability were very high, ICC > 0.88 (p < 0.001).ConclusionsAlthough individuals’ perception of a change in tissue characteristics following massage has been reported, there was no evidence that soft tissue massage led to a change in the passive mechanical properties of the calf muscle complex. The findings of this study suggest that the use of massage to increase tissue flexibility prior to activity is not justified.

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