16 Mar Exercise & Bipolar Affective Disorder

What is Bipolar Affective Disorder?

Bipolar affective disorder (BPAD), is a mental health condition that is characterised by severe mood swings, between a state of depression and mania, that can last several months at a time. Not all BPAD symptoms are equal – some people experience very high manic and low depressive periods, others may present with severe depression and mild mania (hypomania).

When experiencing a depressive episode, patients may appear low and flat in their mood, low motivation, have guilt and sadness, lowered appetite and energy levels and poor sleep. A manic episode is the opposite of a depressive episode, where a patient will have excessive energy, be  more easily excitable, sleep less, talk with a more pressured voice and potentially engage in dicey activities i.e gambling.

‘Switching’ from depressive and manic periods can be unpredictable and occur in a short time frame.

How can exercise help bipolar affective disorder?

After exercising it is common for people to report they get a ‘feel-good buzz’, this feeling is attributed to that of increased circulating endorphins – our natural ‘happy chemicals.’ Additionally, it is not uncommon that post-exercise people may have an increase in cognition/focus whilst feeling more relaxed. These improvements in mental state can have a massive impact on someone’s day i.e. reducing their anxiety so that they can go shopping or attend a social event, reduce feelings of sadness and potentially replace those with joy, improve energy levels.

On top of the psychological benefits of exercise, there are also physical benefits of exercise. The physical benefits of exercise are of great importance for those who suffer from a mental health illness. Unfortunately, anti-depressants, anti-psychotics and mood stabilising medication is associated with weight gain, and therefore an elevated risk of cardiovascular disease mortality. Patients often report having massive increases in their appetite and cravings for sweet or energy dense foods, whilst sometimes stating they feel sedated.

Your medications should not be ceased or adjusted without consultation with your Psychiatrist and General Practitioner – but they can help by referring you to an Accredited Exercise Physiologist and Accredited Practicing Dietitian.

So how much exercise should I do and what type of exercise is best?

Any exercise is better than none, and more exercise is better than some – is a great way to think about it. The best thing that you can do today to start having an impact on your physical and mental health is to try and do some form of exercise. It can honestly be as simple as going for a 10minute walk, a short bike ride, standing up and down from your chair at home or doing a few push ups against a wall. The key is that you started exercising today, and tomorrow we will build on that.

The exercise guidelines for those with bipolar affective disorder and the general population are not dissimilar; be active on most (preferably all days of the week), accumulate 150-300minutes of moderate physical activity or 75-150minutes of vigorous intensity per week – or a combination of both! These guidelines should be adjusted to your needs based on your goals, time available and co-morbid conditions.

The best type of exercise, is one that you’re going to keep doing, one that you enjoy and feel physical and psychological benefit from. It can also help to exercise with other people – this often makes it more fun and you can use each other for motivation!

Some common types of exercise that I use in my clinical practice, is strength and aerobic training use machines or weights, yoga, pilates, hydrotherapy and swimming, tai-chi, circuit/interval training and the always fun – boxing!

The highs and lows of exercise

If a patient is presenting in an elevated state, we need to adjust our exercise prescription to suit their needs. We should not be trying to stack high intensity exercises and over-stimulation on top of a mental state that is potentially manic. So, we vary our exercises and put a focus on relaxation and mindful movements – tai chi, yoga and stretching are great here, just simply going for a short slowed down walk can be helpful if we are bringing awareness of the present moment to our patients.

If a patient is presenting in a way that may be of clinical risk you need to contact the appropriate members of their treating team; psychiatrist, general practitioner, nursing staff, emergency services, support network.

When a person with bipolar affective disorder is in a depressive state we are going to be combatting a lack of energy and motivation and potential disinterest in anything and everything. The real win here, can be just getting someone out of their bed and doing a general strengthening exercises – if we can, try some slightly higher intensity exercises that may further improve their mood, alertness and cognition (jumping jacks, jogging on the spot), and importantly show your client how these movements have helped improve their mood!

How do I actually get started?

Getting moving can be really hard! We often lack the motivation to actually start exercising, because we have grand expectations that we need to be exercising and eating well constantly to improve. Whilst getting as close as possible to the recommended dose of exercise is going to be great for all of us, it is an unrealistic expectation to assume that everything will change tomorrow morning and you will instantly become a fitness guru.

We are much more likely to make changes in our physical and mental fitness by slowly integrating exercise into our life:

• Start slow if you need to!
• Set realistic goals for the short-term; aim to get out of the house 3 times for 20 minutes throughout your week.
• Pick a time of the day that suits you best! Consider when your energy levels are at the highest during the day and aim to head out then.
• Pick a walking track or route that you feel safe on
• Try to get a friend or family member to come along with you – exercise is going to be great for them too, so why not have a partner to take on the journey?

Important things to consider

• Higher intensity and doses of exercise may be more effective at improving mental illness, but these are hard to maintain. Start slow and aim to build up your exercise tolerance each week with slight increases.
• Your mood, alertness and cognition can improve in the short-term with exercise. Try and work on some of your other psychological interventions in this time. Exercise is a great physical and mental warm-up.
• It can take quite some time before your notice physical changes in your body with exercise– this is completely normal!
• Pick a form of exercise that you find enjoyable, this is the one that you are likely to stick with!
• It might be handy to speak with an Accredited Exercise Physiologist who understands mental health conditions and challenges that often come with them. You can speak to your GP who can refer you to an AEP through Medicare pathways.

Patrick is an Accredited Exercise Physiologist.  He specialises in exercise prescription for mental health, chronic pain and cardio-respiratory conditions.  Patrick works with those suffering from exacerbation in their mental health conditions through inpatient and outpatient services.  He has particular interest in Bipolar Affective Disorder, Borderline Personality Disorder, Post-Traumatic Stress Disorder, Eating Disorders and Schizophrenia.