Exercise in bipolar patients : a systematic review

Abstract

Background: Sedentary lifestyle is frequent in psychiatric disorders, however the directions of this as- sociation and bene fi ts of physical activity are unclear. This is a systematic review about exercise in pa- tients 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 ex- ercises and mania. Three prospective cohorts were reported; and no prospective randomized controlled trial was identi fi ed. Three studies focused on biomarkers in bipolar patients; and one reported the re- lationship between exercise and sleep in this group. Two assessed physical exercise in adolescents. Limitations: (1) Differences between studies preventing a uni fi ed 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 insuf fi cient to establish a cause-effect re- lationship between mood and physical exercise. Future research including randomized trials is needed to clarify the role of physical activity in bipolar patients.