‘It's a double edged sword’: A qualitative analysis of the experiences of exercise amongst people with Bipolar Disorder

Abstract

Background

Little is known about the therapeutic or iatrogenic effects of exercise in individuals with Bipolar Disorder, despite its potential to benefit physical and mental health.

Consequently the aim of the current study was to gather data on experiences of the relationship between exercise and Bipolar Disorder from people with personal experience of the condition. In particular we sought to determine the aspects of this relationship that are pertinent to Bipolar Disorder.

Methods

Twenty five individuals with a diagnosis of Bipolar Disorder participated in a semi-structured interview concerning their views on the relationship between exercise and Bipolar Disorder. The data were subjected to qualitative analysis using an Interpretative Phenomenological Analysis approach.

Results

Both a descriptive content analysis and a population-specific thematic analysis were conducted. The latter revealed three themes, all present in the majority of participants, which reflected key aspects of the relationship between Bipolar Disorder and exercise: regulating exercise for mood regulation, exercise as a double-edged sword, and bringing structure to chaos.

Limitations

Information on past and current treatment regimes was not collected, and additional lifestyle factors, such as diet and alcohol use, were not investigated. Interviews were conducted by telephone.

Conclusions

The data reveal a number of aspects of the relationship between exercise and Bipolar Disorder that require further investigation and that should be taken into account by clinicians or researchers designing exercise-based interventions for individuals with Bipolar Disorder.

Introduction

Exercise-based interventions may benefit both physical and mental health amongst people with Bipolar Disorder. Evidence suggests that regular exercise reduces risk of physical health problems such as diabetes and circulatory disorders, rates of which are increased in individuals with Bipolar Disorder (Carney and Jones, 2006, Lin et al., 2007, Regenold et al., 2002). Furthermore, exercise has been found to reduce symptoms of mild to moderate unipolar depression (Blumenthal and Ong, 2009, Mead et al., 2008). Nevertheless, the evidence base underpinning the application of exercise-based interventions to Bipolar Disorder is extremely limited. A recent systematic review (Wright et al., 2009) identified only six studies on the effects of exercise upon physical or mental health in individuals with Bipolar Disorder, and of these, none were adequately-powered randomized controlled trials. Furthermore, if the framework proposed by the United Kingdom Medical Research Council (MRC) (2008) for developing complex interventions is applied to this body of literature, it is evident that there is very little to inform the initial “development” stage with regard to constructing exercise-based therapies for individuals with Bipolar Disorder. Such research is necessary: The United Kingdom National Institute for Health and Clinical Excellence (NICE), which recommends physical activity for individuals with bipolar depressive symptoms, cautions that “whilst exercise may be a healthy way of using up the excess energy in a person with mania and a useful distraction, it might further arouse the body physiologically, increasing energy, social contact and self-efficacy, exacerbating manic symptoms and potentially increasing further cardiovascular strain” (National Institute for Health and Clinical Excellence, 2006: pp.390). This conclusion is based upon theory and clinical expertise as to date no published research has directly examined the potential of exercise to be harmful to people with Bipolar Disorder, or how the effects of exercise upon Bipolar Disorder may be moderated by varying exercise intensity. More broadly, no studies have attempted to delineate the features of optimal exercise programmes for individuals with Bipolar Disorder in terms of the frequency, intensity, timing and type of the activity. The MRC complex intervention framework suggests that as a starting point for development work, interviews with stake-holders (defined as those who will be targeted by or may deliver the intervention) be conducted to elucidate the likely process of change.

To our knowledge, no research has been conducted which has exclusively involved interviews with individuals with Bipolar Disorder on the topic of exercise. Nevertheless a body of literature exists that speaks to experiences of exercise amongst individuals with depression or severe mental illness. This literature reveals the potential of exercise to act upon individuals in multiple ways, including through increased social contact, social inclusiveness or a shared social experience (Carless and Douglas, 2008a, Crone, 2007, Crone, 2008, Faulkner and Biddle, 2004, Priest, 2007), a sense of purposeful activity, striving, accomplishment or achievement (Carless and Douglas, 2008b, Crone, 2007, Crone, 2008, Priest, 2007), enhanced self esteem or a means of reconstructing positive identity (Carless and Douglas, 2008b, Carless and Douglas, 2008c, Crone, 2008, Faulkner and Biddle, 2004), increased mental alertness and energy (Crone, 2008), distraction (Crone, 2008, Faulkner and Biddle, 2004, Faulkner and Sparkes, 1999), and improvements in sleep or physical health (Crone, 2007).

The aim of the current study was to focus specifically upon issues associated with exercise amongst people with Bipolar Disorder. We conducted a qualitative study, using Interpretive Phenomenological Analysis (IPA: Smith et al., 2009), to explore what it is like to exercise for someone with Bipolar Disorder. A secondary, pragmatic, aim was to gather data to inform the design of future exercise-based interventions for this population.