In today’s blog, we’ll be talking about exercise as a potential treatment for youth with bipolar disorder, including why it’s an important consideration and what the Centre for Youth Bipolar Disorder, based in Toronto, Ontario, is doing to increase aerobic fitness in youth with bipolar disorder.

Bipolar disorder (BD) is a serious and complex mood disorder, particularly when onset occurs early in life¹. In addition to psychiatric symptoms related to depression, mania and co-occurring conditions such as anxiety and ADHD, individuals living with BD also face an increased risk of developing heart disease at an earlier age than the general population^2,3. Aerobic exercise is a potential treatment for BD that offers hope for improvements in both physical and mental health.

Research shows that aerobic exercise (e.g., jogging, biking) is incredibly important for heart health⁴. Beyond the physical benefits, aerobic exercise can also help manage depressive symptoms, reduce cognitive difficulties, and improve overall quality of life in BD^5,6. However, our prior research has found that only 5% of adolescents with BD report exercising regularly, compared to 20% of psychiatrically healthy adolescents⁷. On the flip side, for those who are least fit, they can experience the most gains to their aerobic fitness even with small changes to their physical activity⁴.

With all this data to consider, it’s surprising that, to date, there have been no studies that specifically focus on improving aerobic fitness in youth with BD. With funding support from Brain Canada, the Centre for Youth Bipolar Disorder (CYBD) is running the first study aimed at evaluating the feasibility of an exercise intervention for youth with BD, with the goal of improving their aerobic fitness. This means we want to evaluate whether adolescents with BD will enroll in, and actively participate in, an exercise intervention. CYBD has partnered with CREST.BD and Hope + Me to ensure that results from this intervention are easily accessible across Canada.

In this study, behaviour change counselling (BCC) is used and evaluated as an intervention for increasing aerobic fitness among youth with BD. In BCC sessions, the participant’s motivation and commitment to change are discussed. The therapist and participant work together to maximize the likelihood of success, and collaboratively address how to maintain positive changes in the face of stressors or barriers⁸.

Over the first 12 weeks, participants have weekly contact with their assigned BCC therapist (in person once a month and via phone/text on other weeks) to discuss their goals, motivations, and barriers to achieving their goals. BCC therapists also provide education on the link between bipolar disorder, heart health, and exercise. Therapists learn about the unique exercise needs and challenges of each adolescent and use a flexible, personalized, and motivation-focused approach to help them achieve their weekly goals. In addition, adolescents are encouraged to track their exercise using an activity diary and are given a Fitbit to monitor their heart rate and steps. In the following 12-weeks, we investigate participants’ ability to take what they learned and exercise on their own, and offer 2 booster phone calls/texts.

How much aerobic exercise are we aiming for? The American Heart Association recommendation is⁴:

• 150 minutes/week of moderate exercise (50-70% of maximum heart rate) OR
• 75 minutes/week of vigorous exercise (70-85% of maximum heart rate)

Beyond the BCC sessions, participants are also offered the option to receive exercise coaching sessions with a kinesiologist, which can include creating personalized workouts and learning how to safely engage in aerobic exercise. Other optional modules that participants can choose include involving their parents and siblings in BCC and exercise sessions, or getting peer support by joining a FitBit group or doing group exercises with other study participants.

Stay tuned for Part 2 to learn about the preliminary findings from our participants and study therapists! Here is a sneak peak of feedback we’ve received from one participant:

“I never thought that mental health would be correlated with how much you work out. It’s not like, oh you work out once a week, but… how much and how well you do that helps. It helped me with my mood a lot. And also it’s always a good thing, whether you have BD or not, it’s always a good thing to work out, and…it makes you feel good, I don’t know how else to put it. It’s just very helpful, I don’t know why, it just is.”

References

1. Goldstein, B.I., et al., Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease A Scientific Statement From the American Heart Association. Circulation, 2015.
2. Goldstein BI, Fagiolini A, Houck P, Kupfer DJ. Cardiovascular disease and hypertension among adults with bipolar I disorder in the United States. Bipolar Disord. 2009;11(6):657–662. doi:10.1111/j.1399-5618.2009.00735.x
3. Li C, Birmaher B, Rooks B, et al. High prevalence of metabolic syndrome among adolescents and young adults with bipolar disorder. J Clin Psychiatry. 2019;80(4):18m12422.
4. Ross, R., et al., Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation, 2016: p. CIR. 0000000000000461.
5. Vancampfort, D., et al., Higher cardio-respiratory fitness is associated with increased mental and physical quality of life in people with bipolar disorder: a controlled pilot study. Psychiatry Research, 2017.
6. Kucyi, A., et al., Aerobic physical exercise as a possible treatment for neurocognitive dysfunction in bipolar disorder. Postgraduate medicine, 2010. 122(6): p. 107-116.
7. Jewell L, Abtan R, Scavone A, Timmins V, Swampillai B, Goldstein BI. Preliminary evidence of disparities in physical activity among adolescents with bipolar disorder. Ment Health Phys Act. (2015) 8:62–7. 10.1016/j.mhpa.2015.04.001
8. Lane, C., et al., Measuring adaptations of motivational interviewing: the development and validation of the behavior change counseling index (BECCI). Participant education and counseling, 2005. 56(2): p. 166-173.