Physical Activity and Bipolar Disorder: A double edged sword?
By Dr. Yanni Malliaris, PsychCentral Blogs
Little is known about the benefits that exercise can offer in patients who are suffering from Bipolar Disorder. Over the past years little research has been conducted and this has been limited. Generally, physical activity has been found to reduce the risk of several diseases and to improve well-being. As for the mental spectrum evidence shows that exercise has significant benefits in unipolar depression (mild to moderate) but the evidence is limited.
National Institute for Health and Clinical Excellence (NICE) suggest’s that ”whilst exercise may be a healthy way of using up the excess energy in a person with mania and a useful distraction, it might further arouse the body physiologically, increasing energy, social contact and self-efficacy, exacerbating manic symptoms and potentially increasing further cardiovascular strain”. Furthermore literature suggests that no published research has directly assessed whether or not physical activity can be harmful to patients with a diagnosis of Bipolar disorder, or how the bipolar symptoms might be moderated by varying exercise intensity.
Literature (Carless & Douglas, 2008; Crone, 2008) on the other hand suggests that exercise can have several potential benefits such as:
• Increased social contact
• Social inclusiveness or a shared social experience
• A sense of purposeful activity,striving accomplishment or achievement
• Enhanced self esteem or a means of reconstructing positive identity
• Increased mental alertness and energy
• Distraction
• Improvements on sleep or physical health
A recent study by Kim Wright et al. (2012) examined the issue of physical activity in bipolar patients by exploring their experience using interviews.
In this study the participants were recruited by advertisements in the local community, mental health organisations, and a database of individuals who had previously expressed an interest in partaking in research projects run by the host institution. The participants required to be aged 18 or above, and the mean age of the participants was 51 years old. A total of 26 participants took part in the study.
The diagnosis of the participants was established using the Structured Clinical Interview for DSM-IV. Participants who had been diagnosed with mood independent psychosis were not included in the study.
The investigators used a measure called Seven Day Physical Activity Recall in order to measure the levels of exercise each participant. This research tool also measures the level of intensity of each activity (mild to moderate to vigorous etc). Vigorous activities are those who can leave the person out of breath, while moderate activity include the activities that may increase the heart rate but they do not leave the person breathless.
The investigators also developed a special semi structured interview for this study. This interview contained eight questions asking about the exercise habits of the participants. Two more questions were included in order to enquire about the experience between Bipolar disorder and exercise, and other questions examined the perceived barriers in doing and maintaining an exercise programme. In addition, the interview inquired about recommendations that have been given to the participants from health care professionals. Finally, it examined the potential utility of a short physical exercise intervention on people who suffer from a Bipolar disorder.
Three different themes emerged from the results:
• ”Regulating Exercise for mood regulation”
• ”Exercise as the double edged sword”
• ”Bringing structure to chaos”
The first theme revealed that some participants viewed exercise as a way of managing the changes in their mood. Many even reported that exercise is a useful way to manage the different symptoms of their bipolar disorder. Also participants stated that exercise helped them to extend the euthymic periods of their bipolar disorder, and also reported a reduction in the intensity of the depressive symptoms as well as the hypomanic ones. Some of the participants also reported that their mood would decrease if they did not exercise regularly.
The participants were also asked about the positive and negative impact of exercise on their Bipolar disorder. The majority of the participants discussed the helpful or harmful effects of physical activity when they were manic or hypomanic. Half of the participants reported that any positive effects of physical activity might be diminished if the person experiences severe manic symptoms or depressive ones. For example they reported that even though exercise can bring an initial feeling of calmness, then it can also lead to increases of symptoms of mania. Nevertheless with mild levels of depression many felt that exercise can be helpful.
Finally the majority of the participants proposed that physical activity can provide some sort of structure their chaotic bipolar life. They suggested the following:
• ”Exercise can provide structure to one’s daily routine
• ”Exercise can have an internal structure or an inherent rhythm”
A number of participants found that rhythmic exercise can be of use to people who suffer from Bipolar disorder by :
• Calming moods
• Supporting structured thinking
• Facilitating mood regulation
To conclude, almost over a quarter of the participants did not use physical activity to regulate their symptoms. On the other hand, almost half of the participants reported using exercise regularly to regulate their symptoms. Furthermore, the participants believed the notion that physical activity can have a prophylactic effect against severe mood swings.
The participants also suggested that exercise can bring some structure in the chaotic thoughts and it can support a structured routine. They also reported that exercise can have a calming effect on hypomania. Nevertheless, a minority feared that physical activity can trigger a manic episode. Some of the participants stated that exercise can function both in ascentive and descentive ways, depending on the severity of the mood state.
Lastly, a key theme that emerged from the study was that the physical activity needs to suit the patients’ interests, fitness needs, and energy levels. Many participants stressed the importance of having support for engaging in physical activity especially during depressive episodes, and during periods of high mood that need to be regulated.
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