Can Exercise Really Help Bipolar Depression?

Wednesday, March 25 2015 Natasha Tracy

In multiple studies, exercise has been shown to improve unipolar depression, but can exercise really help bipolar depression? Some doctors think so but this is mostly because they are generalizing the data from that on unipolar depression. Evidence for the usefulness of exercise in bipolar depression is scant.

Bipolar Disorder and Exercise

Multiple studies have shown that people with bipolar disorder lead more sedentary lifestyles than others. In one study of 60 bipolar outpatients, 78% of their days was considered to be sedentary and no participant met the 150 minutes/week of moderate/vigorous exercise recommended by the United Kingdom national guidelines. The data is limited, but it appears that even people with bipolar who are euthymic (neither depressed nor manic/hypomanic) lead more sedentary lifestyles.

I, personally, am completely guilty of a sedentary lifestyle. I know it. I know it’s not good for me. But here the thing: I’m exhausted – all the time. I’m tired from the time I wake up in the morning until the time I go to bed. And if I exercise? That just makes me more tired. I know it’s not supposed to. I know you’re supposed to get energy from exercise but I have never found this to be the case.

Evidence for the Usefulness of Exercise in Bipolar Depression

While there isn’t much evidence, there is some that says that physical activity is useful in bipolar disorder treatment. One small study with a walking group for people with bipolar showed improvements in depression, anxiety and stress while another small study showed that overall wellbeing was improved after 20 minutes of aerobic activity on a treadmill.

Exercise has been shown to help unipolar depression but what is the evidence for exercise and bipolar depression? Can exercise really help bipolar depression?

Psychosocial interventions which attempt to alter both the physical activity level of the person with bipolar along with his or her diet also appear to be helpful for some with bipolar depression.

It’s worth noting that programs that try to change diet and/or increase exercise in people with bipolar disorder experience very high attrition rates (in other words, lots of people drop out and just won‘t do it).

Again, I have never found an improvement in mood from exercise, but that’s me. It was obviously different for some of the people in the above studies.

(In what comes as no surprise to me, people in mania or hypomania do tend to exercise more and report that some exercise can actually elevate the mania or hypomania further while other types of exercise (those with a rhythm) may actually be helpful in moderating mood.)

Recommendations for Exercise in Bipolar Depression

People with bipolar disorder are at higher risk for obesity, cardiovascular disease, diabetes and metabolic syndrome than the general population so encouraging exercise for those with bipolar disorder is natural and, undoubtedly, healthy. At the moment, there is no research that indicates what type of exercise, what duration or what intensity of exercise works best for people with bipolar depression but some feel it’s individual.

But, the problem is, people with bipolar depression have trouble getting out of bed so I think telling them to exercise is a bit like telling a person with only one arm to clap three times a day. I think exercise would help some people with bipolar depression but it’s extremely tricky getting anyone to do it, particularly aerobic activity, which likely has the best results (generalizing from unipolar depression studies).

However, I will leave you with this one, very helpful, note. The Harvard Bipolar Program leader, Dr. Sachs, says, “here’s your exercise program: go to the door, look at your watch. Walk 7.5 minutes in any direction, then turn around and walk home. Do that 5 days a week at least.”

I can’t promise you it will improve your mood but, apparently, the average sedentary American would actually lose five pounds by doing this over the course of a year rather than gaining five pounds; and if it’s good enough for Harvard, then it’s probably good enough for me.

References

Thomson et al, Frontiers of Psychology, A Brief Review of Exercise, Bipolar Disorder, and Mechanistic Pathways

Phelps, PsychEducation.org, Accessed March 25, 2015, Exercise and Mood: Not the Usual Rap

You can find Natasha Tracy on Facebook or Google+ or @Natasha_Tracy on Twitter or at Bipolar Burble, her blog.

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate and author of Lost Marbles: Insights into My Life with Depression & Bipolar.

Find Natasha Tracy on her blog, Bipolar BurbleTwitterGoogle+ and Facebook.

View all posts by Natasha Tracy.

Can Exercise Really Help Bipolar Depression?

Renita
says:
March, 26 2015 at 4:44 am

Anhedonia and a lot of the bipolar medications which have a sedating affect can interfere with the interest, energy, motivation and drive to exercise. I was given $250 worth of free passes for swimming at a community recreation centre by a mental health clinic I attend but I've barely used it. I like swimming because it easy on the joints and I don't like to feel sweaty when I exercise but I still don't go as often as I should. About the only exercise I do get is walking to do the basic necessities like going to the work, the bank, the grocery store, etc

Amanda Lynn
says:
March, 26 2015 at 5:08 am

If it weren't for my mood swings I'd never get any exercise! ;-)

Melody Grell
says:
March, 26 2015 at 5:14 am

One must be very careful with exercise when it comes to bi-polar. If one goes to fast or to long at any activity it can have a bad rebound effect. If I walk medium 20 minutes it is good. But if I do a speedy 40 minutes, amps ups the hypo-mania and cycles into depression. People are sometime to fast to push (I am not saying that this article does so) exercise.

Melissa
says:
March, 26 2015 at 5:24 am

I have a hard time getting out of bed. Going to work has become so much of a challenge some days I just don’t. Since 2001 I can count my good days on 1 hand. I kinda feel like somewhere I lost myself. I forget what I went into a room, the refrigerator or the car for. I have had some serious injuries and a few of the medications they have put me on swelled up my joints so bad I could barely move. It was one of those "rare" side effects. My medication seems to be keeping me ok but still swinging every single day...some days worse than others. I used to work out (walk at an incline at 4mph) for 30 minutes on a treadmill at work 5 days a week. Now I start panicking when I go into the building. On days where I can...I try to walk outside. I love taking pictures so I grab my camera. It is motivation to move. I turn on daily burn and try a workout. But the exhaustion (which for me has gotten a bit better at least now I am getting some restful sleep…except the days where I cannot sleep) is almost paralyzing. It is almost always accompanied with pain. When I attend conferences and you get to introduce yourself and they always ask what you do in your spare time…mine is always sleep and people think I am joking.

Dyane Harwood
says:
March, 26 2015 at 4:17 pm

I suggest reading the following article by Dr. Mohammad Alsuwaidan, an acclaimed psychiatrist who believes exercise to be the "missing link" in treating bipolar depression.

http://kuwaitmood.com/exercise-mood-part-iii-from-science-to-action/

I have bipolar one disorder and it has bee impossible for me to work out when I'm severely depressed, but I encourage anyone reading this comment who feels on the fence about exercising for bipolar depression to try the "dosing" suggestions in Dr. Alsuwaidan's article.

Apart from finding the right medications after an eight-year-long search, Dr. Alsuwaidan's suggested way of exercising has completely transformed my life for the better & best of all, it's simple.

I also strongly recommend listening to his webinar "Exercise Treatment for Mood Disorders: A Neurobiological Rationale" on the International Society for Bipolar Disorders website - his talk will change the way you look at exercise as far as what it can do to help improve mood and prevent relapse. Here's the link:

http://www.isbd.org/education/webinar-series

Good luck!

Andrea
says:
March, 30 2015 at 7:31 am

I am one of the rare people with bipolar disorder who exercises regularly. I have always been athletic and was a college athlete, so I naturally love movement. I have been taking bipolar medications for 25 years and since taking medication, exercise still makes me feel good, but it is not exhilarating like it was before I started medication. It does help me with depression. My favorite exercise is to wake up, roll out of bed, take a hilly three mile walk, get back home, and have a shower and breakfast. This is a great start to the day. I also love hiking. I lift weights because it is good for me and makes me look better. It can be meditative. I also swim occasionally. I am overweight, and almost 45. I haven't run in a while because I kept hurting myself whenever I did (foot pain, hip pain, etc.) When I get down to a lower weight, I'd love to run from time to time. It really is hard to be fit when you take medications that slow you down and make you gain weight. I am a big advocate for exercise, but I also think I might not realize its importance if I hadn't been an athlete early in my life, before I took medication.

Molly
says:
April, 24 2015 at 10:22 am

I was first diagnosed with Manic Depression (BP-1) at age 19 in San Francisco while attending college and knew how important exercise was to mood health on a personal level - always athletic and played Division 1 soccer in college - but it was also being studied and recommended for mood disorders even way back then (1987).

So have to say this 'exercise as treatment for bipolar' is not new at all... the research studies are probably buried in medical archives somewhere :)

I need to write a blog post about this too!

Renita
says:
May, 23 2015 at 8:04 am

It's been 2 months since my last post on this subject. Since then I've drastically changed my eating habits and activity/exercise levels. For far too long I've suffered from low energy always reaching for either heavily laden sugary foods or lots of caffiene dense drinks to combat that feeling and infuse myself with some quick energy. I wanted to feel better and I wanted to feel better NOW! Too much coffee in particular was making me irritable, jittery and began eerily resembling the symptoms of mania. Diet to me was always a dirty word. It represented deprivation and I felt deprived in so many other areas of my life already that I had a strong aversion to it. Despite that I decided to bite the bullet and just give it one more try because mobility issues had started to set in from becoming so morbidly obese. Being medicated/sedated since my bipolar 1 diagnosis 3 years ago and sleeping on the couch up to 16 hours (and sometimes more) a day was definately not helping. Knowing that mobility issues would eventually further increase my sense of isolation among things like possibly the risk of diabetes, heart attack or stroke I spoke to my pdoc about my concerns and was referred to a free 6 month activity coaching program run by a local university. The word free peaked my interest since I'm currently drowning in debt but just the thought of actually having to move seemed so overwhelming to me and having a coach conjured up menacing thoughts of a drill sergeant barking out orders. Overall it just didn't seem very appealing. But after scrutinizing the pros and cons I decided to give it a try anyway. What did I have to lose, LOTS. Lately I am happy to report that I'm slowly (slow is good) starting to feel a little better and more hopeful about my future. My only regret is that I didn't start this sooner. Maybe then I wouldn't have as far to go. Having a coach has helped me stay on track. It's given me structure and made me more accountable. Activities have been tailored to my individual interests and abilities. Despite my previous mis perceptions having a coach has actually helped to encourage and push me in the right direction building on my successes no matter how small, improving my self esteem and motivating me to stay with it

r
says:
July, 11 2015 at 8:35 pm

Recently I've joined the Active Choices program and it has helped me immensely in my quest to be come more physically active. Link www.selfmanagementbc.ca It's a free 6 month government program run through the University of Victoria. I live in BC but far from Victoria yet they were able to match me up with an activity coach in my area. You need a doctor's referral (the referral form is available on the website listed above). Normally I hate exercise in all it's forms except maybe walking and swimming but lately I've been trying out a few low impact classes at a local recreation centre 3 times a week (I started with only once a week and worked my way up to that) . At first I thought I would die of a heart attack or stroke or something. I'd come home afterwards and have to sleep for a couple of hours but when I got up I actually felt better despite the sore aching muscles. It has increased my flexibility, stamina and mood tremendously. I have a lot of weight to lose and it has even helped with that. My coach used to weight 190 pounds so I trust her and feel comfortable with her. She encourages me and keeps coming up with new things for me to try when I get discouraged or begin to lose interest. If you live in BC it's a wonderful program. Give it a try. What can it hurt. It sure beats lying around on the couch for the past 3 years feeling like I have nothing to live for

r
says:
July, 11 2015 at 8:44 pm

Even my girlfriend who is recovering from a burst aneurysm is giving it a try. Her issue is mostly stress related but the Active Choices program is good for that too. Everything is tailored to your specific needs...

r
says:
July, 19 2015 at 6:14 am

Yesterday I woke up veeeeerrrry tired and cranky. I'd been out the night before and had stayed up past my usual bedtime of 9 PM. I told my activity coach the next morning how I was feeling, that what I reeeeeeealy needed was some rest and relaxation. She told me in her subtle way that I could either stay in bed and only dream of the life I wanted or I could get up and make it happen. So begrudginly I decided to get up and walked to class. It took about and hour. I had a chance to rest an hour before my Sat 9:30 AM low impact class. After the class I went for a 3 hour walk. It was a beautiful sun shining day and I walked around a local lake briefly resting 4 x on the benches around the lake because my knee and ankle were hurting (I'm 150 pounds overweigh and the pressure of my weight affects my joints) then I walked to Subway and had a 6" tuna sub (normally I'd have a 12") then I walked home which took another hour and I literally fell into bed after taking 2 aspirin for the pain. Surprisingly the next day I felt GREAT!!! My mood had improved 110%!!! I can't believe only a short while ago I was sleeping over 12 hours a day and had basically given up on life!!!!!!

Guy
says:
September, 1 2015 at 4:45 pm

Exercise is essential for everyone, whether diagnosed with a mental illness or not. Just like psyche medication, you have to give it some time to work. Don't give up! Push yourself for weeks to exercise; you'll definitely start seeing an improvement in your mood. And being physically fit and toned is a nice side effect ;)

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