Mike: Hello, I'm Mike Clark, podcast editor for the Cochrane Library. There are several Cochrane Reviews of the effects of physical activity and these were added to in June 2024 with a qualitative evidence synthesis of factors that influence it for people with bipolar disorder. We asked one of the authors, Gavin Breslin, from Queen’s University Belfast in Northern Ireland to tell us more about the condition and the review in this podcast.

Gavin: Bipolar disorder is a mental health problem affecting about 1 in 40 people. It is typically characterised by episodes of depression (feeling very low and lethargic) and mania (feeling very high and overactive). The symptoms can lead to disturbances in thoughts, emotions and behaviours, and fluctuating energy levels. We also know that the mortality gap or death rate for people with mental health problems is too large, with life expectancy reduced by up to 15-20 years. In part this is because of an increased risk of co-existing chronic conditions such as cardiovascular disease and obesity and higher rates of poor lifestyle behaviours, such as smoking, sedentary behaviour and substance use problems.

Physical activity might help with some of this, and can be any type of activity, including walking, cycling, playing football, dancing, cleaning, yoga or gardening, to name a few. Physical activity forms an important part of promoting better health and wellbeing and has been shown to be as effective as some medications at preventing cardiovascular disease and reducing symptoms of anxiety and depression. With this in mind, and because bipolar disorder has some of the highest rates of sedentary behaviour of any mental health problem, we wanted to explore what factors promote physical activity for people with bipolar disorder. 

We found 12 research studies, involving a total of just under 600 participants. This evidence shows that many people are not aware of the benefits of physical activity for managing their bipolar symptoms or improving their physical health. We know that experiences of shame and stigma can prevent people from being active, and in the studies in our review, some participants reported feeling embarrassed or anxious and ‘unskilled’. Money constraints were another issue, with people unable to afford equipment, clothing or access to exercise settings, particularly if their spending had been out of control during periods of ill health. 

Additional barriers were medication, being overweight, smoking and symptoms of feeling tired and lethargic, along with other practical difficulties, such as lack of time, poor transport, bad weather, or concerns about personal safety, especially for female participants.

Turning to the positives and possible facilitators of physical activity. People have to be psychologically ready to participate. Workplace or healthcare schemes can provide opportunities for low-cost, supported access. Having good social support was another important factor and developing opportunities to make social connections could strengthen commitment to regular physical activity. Other reported benefits included weight loss, improved quality of life and better mood regulation. Being active outdoors may have additional benefits through connecting to nature.

Trying different types of activity can help people find the one that works for them, and incorporating it into a regular routine, at the right level and intensity, could help to manage mood. However, finding the right balance was really important.

Looking to the future: we need clearer guidelines for service users and those who support them. The potential benefits of physical activity should inform health and care treatment plans and establish links with other teams/disciplines that can provide specialist support. Many people will benefit from support and advice to help establish a balanced activity programme that they could introduce to their daily routines. However, changing lots of negative behaviours at once can be challenging for individuals, so interventions that take a phased approach and take a step-by-step approach to introduce lifestyle changes, such as increasing physical activity, improving healthy eating, and stopping smoking, are likely to be most practical and effective.

There is also a need for new research, covering more countries and including more people to better understand the key issues, including gathering the perspectives of family members, carers, health professionals and service providers. 

Mike: If you would like to read the full review and watch for future updates if that new research gets done, it’s online. If you go to CochraneLibrary.com and search ‘physical activity and bipolar disorder’ you’ll see a link to it.