# Exercise as it relates to Disease/Effects of exercise on people with bipolar disorder
### Prevalence

In Australia the prevalence of Bipolar is about 1.3 percent of the population and has a bigger prevalence in the US with the figure being between 3 to 10 percent.

### What is Bipolar Disorder?

Bipolar is a medical condition that effects the normal functioning of the brain, a person with Bipolar will experience extreme moods of highs and lows. Depending on how affected the person is they may not be able to distinguish what is real .

### Symptoms

Bipolar can appear in many ways in different people, with the symptoms varying in their severity and frequency. There are 4 types of mood episodes in Bipolar disorder each with a different set of symptoms;
* Mania - unable to concentrate, high levels of energy with little sleep, delusions and hallucinations.
* Hypomania - less severe than mania with people in this state never losing losing touch with reality, feelings associated with Hypomania include; energetic, euphoric and productive
* Depression -sleep problems, fatigue or loss of energy, feelings of hopelessness, sadness and emptiness
* Mixed Episodes - a mixed episode will have symptoms from both a manic and depressed state.

### Diagnosis

A doctor will diagnose a person with Bipolar into 1 of 4 categories;
* Bipolar 1 Disorder - manic or mixed episodes lasting 7 days
* Bipolar 2 Disorder - depressive and hypomanic episodes, but no manic or mixed episodes
* Bipolar Disorder not otherwise specified - diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II.
* Cyclothymic Disorder - mild form of bipolar, episodes of hypomania and mild depression for at least 2 years.

### Triggers and Causes

Scientists believe there is not one cause for Bipolar disorder but a combination of factors that produce the illness or increase the risk of developing it. These factors are believed to contribute to the risk of developing Bipolar.
| Preventable Factors | Non-Preventable Factors |
| Alcohol and Food consumption | Genetics |
| Sleeping Patterns and Smoking | Environmental Factors |

## Current Treatment Methods

* Medications including mood stabilisers
* Psychotherapy to improve areas such as self esteem and develop coping techniques.
* Change in Lifestyle eg quit smoking, improve diet and sleep patterns.

## Exercise Effects on People with Bipolar Disorder

Exercise based interventions may benefit both physical and mental health among people with Bipolar disorder. Some theories are based upon that there is a mood-specific relationship between exercise frequency and polarity, where less exercise is associated with depression and more exercise associated with mania. These studies often suggest interventions where exercise is increased or decreased depending on mood characteristics.
One study illustrated that exercise can be a doubled edged sword for people with bipolar as it has the effect of increasing symptoms of mania, the intensity and frequency of the exercise seems to play a role in exacerbating symptoms. This same study also suggested that positive effects of exercise were diminished when a person experiences severe mania or depression.
When comparing people with Bipolar disorder to people with no serious medical illness people with Bipolar were shown to;
* Exercise less (walking less than three times per week)
* Bipolar patients were more likely to report a weight gain of more than 10 pounds within the last 6 months and
* Less likely report that their health care provider discussed there exercise habits.

## How Much Exercise is the Right Amount?

| Exercise | Australian Guidelines to Physical Activity From the Department of Health |
| Aerobic | Accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity. |
| Resistance | Do muscle strengthening activities on at least 2 days each week. |
Before beginning exercise patients must be prescreened, assessing a range of factors including current medication and associated comorbidities.
Patients with manic and hypomanic symptoms must also seek medical advice on exercise program to make sure intensity and frequency of exercise is not a contributing factor to the illness.

## Further reading

* Australia’s Physical Activity & Sedentary Behaviour Guidelines
* Head Space - National Youth Mental Health Foundation - Bipolar is it just me?
* Understanding and Managing Bipolar Disorder - List of Helplines Available to Contact

## References

* ↑ Abs.gov.au,. (2014). 4326.0 - National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Retrieved 24 September 2014, from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0
* ↑ Sane.org,. (2014). Bipolar Disorder. Retrieved 24 September 2014, from http://www.sane.org/information/factsheets-podcasts/199-bipolar-disorder
* ↑ Nimh.nih.gov,. (2014). NIMH · Bipolar Disorder in Adults. Retrieved 24 September 2014, from http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml#pub11
* ↑ Nimh.nih.gov,. (2014). NIMH · Bipolar Disorder in Adults. Retrieved 24 September 2014, from http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml#pub11
* ↑ Nimh.nih.gov,. (2014). NIMH · Bipolar Disorder in Adults. Retrieved 24 September 2014, from http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml#pub11
* ↑ Nimh.nih.gov,. (2014). NIMH · Bipolar Disorder in Adults. Retrieved 24 September 2014, from http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-adults/index.shtml#pub11
* ↑ Russell, S. J., & Browne, J. L. (2005). Staying well with bipolar disorder. Australian and New Zealand Journal of Psychiatry, 39(3), 187-193.
* ↑ Scott, J., & Gutierrez, M. J. (2004). The current status of psychological treatments in bipolar disorders: a systematic review of relapse prevention. Bipolar Disorders, 6(6), 498-503.
* ↑ Wright, K., Armstrong, T., Taylor, A., & Dean, S. (2012). ‘It's a double edged sword’: A qualitative analysis of the experiences of exercise amongst people with Bipolar Disorder. Journal Of Affective Disorders, 136(3), 634--642.
* ↑ JL deJONGSTE, M., NAGELKERKE, D., HOOYSCHUUR, C., JOURNEE, H., & PIM WJ MEYLER, M. (2007). nutrition and exercise behavior. among patients with bipolar disorder†. Bipolar Disorders.
* ↑ Wright, K., Armstrong, T., Taylor, A., & Dean, S. (2012). ‘It's a double edged sword’: A qualitative analysis of the experiences of exercise amongst people with Bipolar Disorder. Journal Of Affective Disorders, 136(3), 634--642.
* ↑ JL deJONGSTE, M., NAGELKERKE, D., HOOYSCHUUR, C., JOURNEE, H., & PIM WJ MEYLER, M. (2007). nutrition and exercise behavior. among patients with bipolar disorder†. Bipolar Disorders.
* ↑ Health.gov.au,. (2014). Department of Health | Australia's Physical Activity and Sedentary Behaviour Guidelines. Retrieved 25 September 2014, from http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines