Exercising control over bipolar disorder

Abstract

Following extensive research exercise has emerged as an effective treatment for major depressive disorder, and it is now a recognised therapy alongside other interventions. In contrast, there is a paucity of research examining the therapeutic effects of exercise for those with bipolar disorder. Given that dysfunctional reward processing is central to bipolar disorder, research suggests that exercise can perhaps be framed as a reward-related event that may have the potential to precipitate a manic episode. The behavioural activation system (BAS) is a neurobehavioural system that is associated with responding to reward and provides an appropriate framework to theoretically examine and better understand the effects of exercise treatment on bipolar disorder. This article discusses recent research findings and provides an overview of the extant literature related to the neurobiological underpinnings of BAS and exercise as they relate to bipolar disorder. This is important clinically because depending on mood state in bipolar disorder, we postulate that exercise could be either beneficial or deleterious with positive or negative effects on the illness. Clearly, this complicates the evaluation of exercise as a potential treatment in terms of identifying its optimal characteristics in this population. INTRODUCTIONBehavioural activation is a commonly used psychological treatment for major depressive disorder (MDD) that broadly refers to the development of activity scheduling and also targets cognitive processes that are linked to avoidance.1 Research findings suggest that for MDD behavioural activation is generally an effective therapeutic intervention, 2 with some studies suggesting that it is equally as effective as cognitive therapies or a combination of cognitive and behavioural activation therapies.3 Behavioural activation is particularly relevant to depressive episodes, where individuals experience difficulty engaging in physical activity because of psychomotor retardation; feeling slowed down physically and mentally. The converse is true in mania where individuals usually experience increased energy and activity levels. This may partly explain why behavioural activation has been extensively studied in relation to MDD, but there is little research as yet, investigating its effectiveness in treating bipolar disorder. Therefore, in this article, we consider the emerging research findings examining the therapeutic effectiveness of exercise as a behavioural activation strategy for those with bipolar disorder. Furthermore, we propose the use of a neurobehavioural model for understanding the effects of this treatment strategy on depressive and manic mood states. Pertinent literature was identified using Google Scholar and PubMed, with relevant search terms-such as 'bipolar disorder', 'exercise' and acceptable variations of these (update: June 2016). Given the paucity of the literature, the reference lists of all identified papers were then inspected for further potential resources with particular attention paid t...

Effects of a 12-week running programme in youth and adults with complex mood disorders

“… 22 However, most research in this area is based on first-episode patients and/or excludes participants with treatment-resistant depression and BD. 39 Critically, this work also rarely evaluates the impact of exercise in terms of clinical outcomes, nor is there research on exercise type, intensity, the role of social support and/or the impact of exercise on functional outcomes. 40 In the current study, we found engagement in a group running programme improved mood symptoms including depression, anxiety and stress in participants with complex mood disorders, over a period of 12 weeks.…”

A physically active lifestyle is associated with lower long-term incidence of bipolar disorder in a population-based, large-scale study

“…In fact, the cumulative incidence of bipolar disorder among women in the fastest skiing group reached the same level as those not participating in the ski race. Several studies have suggested that heavy exercise may provoke manic episodes in individuals prone to bipolar disorder (Malhi and Byrow 2016 ). Nevertheless, when excluding all individuals who developed bipolar disorder during the first 5 years this difference became nonsignificant.…”

Prognostic value of exercise capacity among patients with treated depression: The Henry Ford Exercise Testing (FIT) Project

“…Recent data suggested that exercise, either as monotherapy or in combination with antidepressant medication, was associated with decreased relapse rate, depending on the depression severity and associated symptoms . Though some studies focused on exercise monotherapy, others evaluated exercise as an adjuvant therapy to medical treatment . However, mortality and CHD outcomes had not been studied before in this specific population .…”

“…[26][27][28] Though some studies focused on exercise monotherapy, [29][30][31][32] others evaluated exercise as an adjuvant therapy to medical treatment. [33][34][35] However, mortality and CHD outcomes had not been studied before in this specific population. 8 Our current study adds to the literature related to CHD prevention in patients with depression by showing a strong, consistent, and inverse relationship of increased exercise capacity with lower risk of ACM and nonfatal MI.…”