# Exercise as it relates to Disease/Walking away from Bipolar disorder

This is an analysis of the journal article "The effects of physical activity in the acute treatment of bipolar disorder: A pilot study" written by Ng, Dodd and Berk (2007).

## What is the background to this research?

Bipolar disorder, previously referred to as Manic Depressive Illness is a common disorder, affecting around 1% of the worlds population. This disorder involves a person suffering from a range of mood swings, highs and lows. The cause for this disorder is still unknown, however, it is believed that a number of hereditary implications could be involved. The initial warning signs are strongly associated with the pressures of everyday life so are often ignored. It is not until the moods persist that the patient generally seeks medical advice.

### Types of Bipolar disorder

There are two main types of bipolar disorder, type I and II.
Table 1: Types of bipolar disorder
| Type I | Type II |
| Consists of manic episodes that comprise of very abnormal moods Moods vary from highs to severe depressive states May also experience psychotic episodes, including hallucinations and deliusions | Consists of hypomanic episodes Less severe Comprise of a sustained mood that is either heightened, grand or irritable |
Both these types significantly impact a persons quality of life if left untreated.

## Where is the research from?

This research was carried out by Ng, Dodd and Berk from the Department of Clinical and Biomedical Sciences: Barwon Health, University of Melbourne, Geelong, Victoria. These three authors are professors at the University of Melbourne, majoring in psychology and psychiatry. This research was conducted in a private psychiatric inpatient unit at a hospital. The location of the hospital was unknown.

## What kind of research was this?

This research was a pilot study. This form of study is often used to grasp concepts and is used as a baseline before continuing onto larger studies. The sample sizes are generally smaller than other research methods.

## What did the research involve?

This research involved a group of participants (24 admissions) and non- participants (74 admissions) selected from a private psychiatric inpatient unit. All of these admissions had some form of bipolar disorder, irrespective of type. The participants took part in a walking group (40 minute session), which was lead by nursing staff from the unit. The primary outcome measures used to collect data in the study were the clinician rated Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I) scales and the self reported 21-item version of the Depression Anxiety Stress Scales (DASS). The differences between the groups were obtained through the use of t-tests.

## What were the basic results?

There were some significant improvements noted as a result of the study. Ng, Dodd and Berk found that at the commencement of the study there were no significant differences in CGI-S or total DASS between participants and non- participants. However, the participants had significantly lower results on the DASS-Stress sub scale than non-participants. At the conclusion of the study the differences between CGI-S and CGI-I scores amongst the groups were non- significant. Despite this participants obtained lower scores for total DASS and its sub subscales compared to non- participants.

## What conclusions can we take from this research?

Although there were some significant results in favour of the intervention, there is still not a strong relationship between physical activity and bipolar disorder. For this reason there is still room for further research on the topic. In order to obtain accurate results participants must be willing to stay focused and committed to the study. Without this there is room for error which could take a great toll on the effectiveness of the study.
There were several limitations to this study including, small sample size, likely chance of recall and selection biases and lack of randomisation or control of variables. Also bipolar subtype was not identified and definitions of the criteria for a participant were imprecise.
However, in saying this, the fact that the study was carried out in a psychiatric unit was very beneficial.

## Practical advice

For future studies there should be more variables including, a larger sample size, comparison between different methods of physical activities and groups of both Bipolar Type I and II participants. In order to reduce bias, other scaling systems could also be used. It could also be beneficial to look at the benefits of physical activity during the chronic phase of bipolar disorder.

## Further information

How Can Exercise Help Bipolar Disorder? http://www.healthline.com/health/bipolar-disorder/exercise#Overview1
Physical Activity, Bipolar Disorder and Me http://www.psychosocial.com/IJPR_18/Physical_Activity_Mills.html
Nutrition, Exercise, and Wellness Treatment in bipolar disorder: proof of concept for a consolidated intervention https://journalbipolardisorders.springeropen.com/articles/10.1186/2194-7511-1-24

## References

* 1 2 3 4 5 Ng F, Dodd S, Berk M. The effects of physical activity in the acute treatment of bipolar disorder: A pilot study. Journal of Affective Disorders. 2007;101(1-3):259-262.
* ↑ Grande I, Berk M, Birmaher B, Vieta E. Bipolar disorder. The Lancet. 2016;387(10027):1561-1572.
* ↑ Furnham Anthony E. Lay Theories of Bipolar Disorder: the Causes, Manifestations and Cures for Perceived Bipolar Disorder. International Journal of Social Psychiatry. 2009;56(3):255-269.
* ↑ Skjelstad D, Malt U, Holte A. Symptoms and signs of the initial prodrome of bipolar disorderA systematic review. Journal of Affective Disorders. 2010;126(1-2):1-13.
* ↑ Bega S, Schaffer A, Goldstein B, Levitt A. Differentiating between Bipolar Disorder Types I and II: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Affective Disorders. 2012;138(1-2):46-53.
* ↑ Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios L et al. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10(1).
* ↑ Melo M, Daher E, Albuquerque S, de Bruin V. Exercise in bipolar patients: A systematic review. Journal of Affective Disorders. 2016;198:32-38.