Review article
Exercise in bipolar patients: A systematic review

https://doi.org/10.1016/j.jad.2016.03.004Get rights and content

Highlights

  • Bipolar patients commonly have sedentary lifestyle.

  • Duration and intensity of physical activity are reduced in bipolar disorder.

  • Exercise is associated with less depressive symptoms and increased functioning.

  • The impact of physical activity on the metabolic syndrome is uncertain.

  • An association between frequent exercise and mania is suggested.

Abstract

Background

Sedentary lifestyle is frequent in psychiatric disorders, however the directions of this association and benefits of physical activity are unclear. This is a systematic review about exercise in patients with bipolar disorder.

Methods

We performed a systematic literature search of studies published in English (1995 Jan to 2016 Jan) in PubMed, and Cochrane Library combining the medical terms ‘physical activity’ or ‘sedentary’ or ‘physical exercise’ with ‘bipolar disorder’ or ‘mania’ or ‘bipolar depression’.

Results

Thirty-one studies were selected and included 15,587 patients with bipolar disorder. Sedentary lifestyle varied from 40% to 64.9%. Physical activity was associated with less depressive symptoms, better quality of life and increased functioning. Some evidence indicates a relationship between vigorous exercises and mania. Three prospective cohorts were reported; and no prospective randomized controlled trial was identified. Three studies focused on biomarkers in bipolar patients; and one reported the relationship between exercise and sleep in this group. Two assessed physical exercise in adolescents.

Limitations

(1) Differences between studies preventing a unified analysis; (2) most studies were cross-sectional; (3) motivation for exercising is a selection bias in most studies; (4) no intervention study assessing only physical exercise; (5) lack of studies comparing exercise across mood states.

Conclusion

Generally, exercise was associated with improved health measures including depressive symptoms, functioning and quality of life. Evidence was insufficient to establish a cause-effect relationship between mood and physical exercise. Future research including randomized trials is needed to clarify the role of physical activity in bipolar patients.

Section snippets

Background

Bipolar disorder is a chronic psychiatric condition associated with severe disability, high mortality rates and increased demand for health services (Anderson et al., 2012, Price and Marzani-Nissen, 2012) whose therapy generally is based on pharmacological and non-pharmacological interventions (Geddes and Miklowitz, 2013, Kendall et al., 2014, McCormick et al., 2015).

Physical activity is frequently indicated for the prevention and treatment of various mental disorders (Moylan et al., 2013, Ten

Search strategies

Two researchers performed an electronic search of PubMed and Cochrane Library. The following keywords were used: ‘physical activity’ or ‘sedentary’ or ‘physical exercise’ and ‘bipolar disorder’ or ‘mania’ or ‘bipolar depression’. Manual searches were also conducted, using reference lists from identified articles.

We included all articles published since 1995 Jan until 2016 Jan evaluating the relationship between bipolar disorder and physical exercise. Reviews, case reports, conference abstracts,

Study selection

The initial electronic database search yielded 1671 hits. Five records were found from the reference list of identified studies. Initially, 1676 articles were included. After careful examination, 1542 were excluded: 115 were duplicated; 673 focused on other conditions; 182 referred to animal experiments and 572 were case reports, conference abstracts, and expert's opinions. Thereafter, 94 articles were removed: 8 were unavailable in English language; 1 was not located; 11 were reviews; 47

Discussion

This review shows that evidence about the effects of physical activity on bipolar disorder is scarce. The majority of studies are cross-sectional evaluations of patients compared, or not, to controls. Only three prospective cohorts were reported in this review. However, neither of them evaluated the effects of physical activity on symptoms, quality of life and functioning. Two intervention studies evaluated the effects of a combined therapy including nutrition, physical activity and lifestyle.

Role of the funding source

The authors do not have a financial relation with a commercial entity that has an interest in the content of this paper.

Declaration of interest

The authors report no conflicts of interest. The authors are responsible for the content and writing of the paper.

Contributors

MCAM conceived and designed the study, collected data and analyzed data. EDFD, SGCA and VMSB contributed to the conception and design of the study. All authors contributed to the drafting, and revisions of the manuscript. All authors read and approved the final manuscript.

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