The effects of physical activity on physical and mental health among individuals with bipolar disorder: A systematic review Kim. A. Wright a, * , Emma S. Everson-Hock b , Adrian H. Taylor b a University of Exeter School of Psychology, Washington Singer Laboratories, Perry Road, Exeter EX4 4QG, United Kingdom b University of Exeter School of Sport and Health Sciences, St Luke’s Campus, Exeter EX1 2LU, United Kingdom article info Article history: Received 31 March 2009 Received in revised form 3 September 2009 Accepted 4 September 2009 Keywords: Exercise Mania Depression Treatment Therapy abstract Problem: Despite calls for physical activity (PA) to be prescribed to individuals with Bipolar Disorder (BD) as a means of improving physical and mental health there has been no systematic review of the potential health risks and benefits of increased PA for individuals with BD. This paper presents the first such review. Method: Systematic searches of six databases were conducted from database inception until January 2009, using a range of search terms to reflect both PA and BD. Studies were subsequently considered eligible if they reported on quantitative studies investigating the effect of PA upon some aspect of physical or mental health in individuals with BD. Results: Of the 484 articles retrieved, six studies met the inclusion criteria. Discussion: Few studies have considered how PA may impact on the physical and mental health of people with BD. Nevertheless existing studies do suggest that physical activity interventions may be feasible and have a role in promoting mental health in this population. We discuss methodological, practical and ethical challenges to research in this area, and outline three research questions that future work should seek to address. Conclusions: Research into the efficacy and safety of PA as an intervention in BD is required to support the development of detailed, population-specific guidelines. Ó 2009 Elsevier Ltd. All rights reserved. Bipolar Disorder (BD) has a lifetime prevalence rate of around 2– 6% in Europe and North America (Judd & Akiskal, 2003; Merikangas et al., 2007; Regeer et al., 2004; Szadoczky, Papp, Vitrai, Rihmer, & Furedi, 1998). In many cases BD involves repeated episodes of illness spanning many years (Daly, 1997). Significant levels of affective symptoms during inter-episodic periods are common (Judd et al., 2003), whilst episodes of both mania and depression frequently cause great disruption and distress. In addition to the emotional, interpersonal, social and economic burden imposed by the condition itself, there is evidence to suggest that BD is associ- ated with an increased risk of physical health problems such as obesity, circulatory disorders, cancer, and diabetes mellitus (e.g. BarChana et al., 2008; Carney & Jones, 2006; Elmslie, Silverstone, Mann, Williams, & Romans, 2000; Fagiolini, Frank, Scott, Turkin, & Kupfer, 2005; Lin, Tsai, & Lee, 2007; Regenold, Thapar, Marano, Gavireni, & Kondapavuluru, 2002). This increased comorbidity has been ascribed to multiple factors including, but not limited to, the psychological and physiological sequelae of childhood adversity, poor health behaviours associated with the depressive and manic phases of BD, the effects of pharmacological treatment of BD, and disturbances in the hypothalamic-pituitary-adrenal axis (McIntyre et al., 2007). In addition to having a direct impact upon mortality and quality of life, in some cases the presence of a comorbid physical disorder may be associated with a worse course of BD (Fagiolini, Kupfer, Houck, Novick, & Frank, 2003). There are at least four epidemiological studies that have examined physical activity prevalence among individuals with bipolar disorder. Two epidemiological studies have found reduced levels of physical activity (PA) in individuals with BD. Elmslie, Mann, Silverstone, Williams, and Romans (2001) examined self- reported physical activity provided by 89 individuals with a diag- nosis of BD according to DSM-IV criteria, recruited from psychiatric clinics in New Zealand. Participants were required to be currently euthymic with no current major physical illness. Data were compared with a reference group of 445 individuals, matched for sex and age group, and selected randomly from a national database of members of the community. Rates of high and low-to-moderate activity were significantly lower in individuals with BD compared with the reference group. Kilbourne, Rofey, and McCarthy (2007) * Corresponding author. Tel.: þ44 (0)1392 269227; fax: þ44 (0)1392 264623. E-mail addresses: K.A.wright@exeter.ac.uk (Kim.A. Wright), E.Everson-Hock@ sheffield.ac.uk (E.S. Everson-Hock), A.H.Taylor@exeter.ac.uk (A.H. Taylor). Contents lists available at ScienceDirect Mental Health and Physical Activity journal homepage: www.elsevier.com/locate/menpa 1755-2966/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.mhpa.2009.09.001 Mental Health and Physical Activity 2 (2009) 86–94