Exercise tolerance is reduced in bipolar illness

doi:10.1016/j.jad.2007.03.002

Journal of Affective Disorders

Volume 104, Issues 1–3, December 2007, Pages 191-195

https://doi.org/10.1016/j.jad.2007.03.002 Get rights and content

Abstract

Background

Cardiovascular and cerebrovascular disease is 2–3 times more common in bipolar patients than the general population. Asymptomatic bipolar patients have electrocardiogram abnormalities at high rates. The question of heart function in asymptomatic bipolar subjects arises.

Methods

This study examined the impact of exhaustive exercise on cardiac function in untrained euthymic bipolar and control subjects. Twenty-four non-athletic adults, 10 controls and 14 with bipolar type I, exercised on a treadmill at 70% of maximal oxygen consumption until physical exhaustion. Two-dimensional and Doppler echocardiography were performed before and immediately after exercise.

Results

Bipolar subjects had significantly reduced exercise duration (75.9 ± 40.5min for bipolar and 95.0 ± 40.1 min for control, P < 0.01). There were no statistical differences between bipolar illness and normal controls in echocardiographic variables either at rest or after exhaustive exercise.

Conclusion

Medically asymptomatic, euthymic bipolar subjects appear to have reduced exercise tolerance but normal cardiac function.

Limitations

More bipolar patients smoked (28.6% vs. 0% controls) and patients tended to be heavier (189.1 ± 29.3 vs. 165.0 ± 29.5 lb, t = 2.0, P = 0.06). None of the normal controls were taking any medications. These variables could have impacted the reduced exercise tolerance.

Introduction

Bipolar illness is a severe psychiatric condition that is characterized by extensive comorbidity. Psychiatric comorbidity of anxiety disorders and substance abuse is quite high (Kessler et al., 2005). Medical comorbidity is less well studied, but recent surveys have found that bipolar patients suffer from chronic medical problems at two to three times the rate of the general population. For example over 35%–50% of bipolar patients are obese (Fagiolini et al., 2002, Fagiolini et al., 2003, Shah et al., 2006), compared with some 22% of the general population (Ferri, 2005). Cardiovascular disease is particularly more prevalent in bipolar subjects compared to the general population, with hypertension affecting 34.8% of bipolar subjects (Kilbourne et al., 2004) and only about 15% of the general population, and congestive heart failure diagnosed in 3.2% of bipolar subjects (Kilbourne et al., 2004) compared with 1.6% of the general population (Ferri, 2005). Similarly, the standardized mortality ratios (SMRs) for non-suicide deaths in bipolar subjects are nearly twice that of the general population (Osby et al., 2001). Over 26% of bipolar subjects admitted to an inpatient unit for treatment of a mood episode have abnormal electrocardiograms (El-Mallakh et al., 1996).

There may be many reasons for the higher rates of medical problems. For example, some two-thirds of bipolar patients smoke and a larger fraction has a history of smoking (de Leon et al., 2002, Corvin et al., 2001). Medications may contribute to weight gain, and higher rates of obesity (McElroy et al., 2002, Fagiolini et al., 2003). These factors can increase the risk of cardiovascular and cerebrovascular disease. To examine this question, we performed echocardiographs in untrained, medically asymptomatic bipolar subjects and matched normal controls at baseline and after exhaustive exercise.

Section snippets

Methods

The study was approved by the Human Studies committee at our institution. Written informed consent was obtained from all participants.

Results

Demographics of study participants are presented in Table 1. The average age of bipolar subjects was 41.3 ± SD 11.9 years and for the control population it was 37.7 ± 11.5 years (t = 0.74, P = 0.47). Four bipolar subjects smoked, but none of the controls smoked. Bipolar patients tended to be heavier than psychiatrically normal controls (189.1 ± 29.3 vs. 165.0 ± 29.5 lb, t = 2.0, P = 0.06). Six bipolar subjects were obese while none of the controls were obese. Among the bipolar subjects there were 9 men and 5

Discussion

Untrained, medically asymptomatic, euthymic bipolar subjects do not significantly vary from matched normal controls in cardiac function, either at rest or after extensive physical activity. However, patients with bipolar illness do exhibit significantly reduced exercise tolerance, with fewer subjects exceeding 60 min of exercise. This is an important difference since all subjects were exercising at their own pace (70% of maximal capacity individually determined prior to the exercise). This

Acknowledgement

This study was supported by a grant from NARSAD, the Mental Health Research Association, to RSE.

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Cardiovascular risk in bipolar disorder – A case for the hypothalamus-pituitary-adrenal axis?
2023, Journal of Affective Disorders
Citation Excerpt :
Contrarily, investigations analyzing ectopic cardiac fat tissue in patients with BD are not available to date. Potential factors that link mental disorders to general obesity, increased intra-abdominal fat content, and subsequent elevated risk for cardiometabolic disorders include adverse lifestyle behavior, iatrogenic effects of psychotropic medication (Keck and McElroy, 2003; Shah et al., 2007; Wildes et al., 2006), and pathological alterations in stress-response systems (Ostinelli et al., 2021). The hypothalamus-pituitary-adrenal (HPA) axis constitutes a central neuroendocrine pathway in the body's response to psychosocial stress.
Unipolar major depressive disorder (MDD) and bipolar disorder (BD) are associated with elevated mortality risk secondary to natural causes. Cardiovascular disease (CVD) constitutes the most prevalent underlying condition. Patients with BD display higher CVD-associated excess mortality than MDD patients. Epicardial adipose tissue (EAT) volume, a known predictor of premature CV morbidity and adrenal gland (AG) volume, an indicator for chronic hypothalamus-pituitary-adrenal (HPA) axis activation, were compared in BD and MDD patients.
Magnetic resonance imaging was performed to assess EAT and AG volume in age-, gender-, and body mass index (BMI)-matched MDD (N = 27) and BD (N = 27) patients. Ten-year CV mortality risk and diabetes risk were assessed by PROCAM, ESC-SCORE, and FINDRISK, respectively; metabolic syndrome (MetS) was determined following NCEP/ATP III criteria.
Cardiometabolic risk scores and frequency of MetS were comparable, and scores of cardiometabolic risk indices did not significantly differ in both groups. After adjustment for age, BMI, and physical activity, EAT and AG volumes were significantly higher in BD compared to MDD. Partial correlation analyses showed a significant positive association of EAT and AG volumes in BD but not in the MDD.
The modest sample size warrants confirmation in a larger cohort and the cross-sectional design does not allow for temporal or causal inferences.
Our study indicates increased EAT accumulation in BD patients. This was associated with HPA axis dysregulation. Therapeutic lifestyle interventions that reduce EAT volume should be considered in clinical BD management.
Exercise preference and tolerance in youth with bipolar disorder
2023, Journal of Psychosomatic Research
Despite the multiple potential benefits, individuals with bipolar disorder (BD) report lower levels of moderate-vigorous exercise. We examined the correlates of exercise preference and tolerance among youth with BD, to inform future exercise intervention studies.
In this cross-sectional study 107 adolescents (n = 54 BD, n = 53 healthy controls [HC]) completed the self-reported Preference for and Tolerance of the Intensity of Exercise Questionnaire, a 20-minute bout of moderate intensity aerobic exercise, and the Borg Rating of Perceived Exertion. Cardiorespiratory fitness (CRF) was calculated using a proxy measure. Variables associated with either exercise preference or tolerance at p < 0.01 in univariate analyses were entered into multivariable models. Significance was set at p < 0.05 for all analyses.
Exercise tolerance and CRF were significantly lower in the BD group. There was no significant difference in exercise preference. Lower exercise preference among youth with BD was significantly associated with lower CRF (β = 0.39, p = 0.006) and higher perceived exertion (β = −0.33, p = 0.01), while higher exercise preference was associated with lifetime psychiatric hospitalization (β = 0.29, p = 0.04). Female sex (β = 0.31, p = 0.03), higher perceived exertion (β = −0.37, p = 0.007), and non-Caucasian race (β = 0.31, p = 0.02) were significantly associated with lower exercise tolerance in youth with BD.
The current study adds to the limited literature examining exercise preference and tolerance in youth with BD and provides an avenue to examine these correlates further in clinical and exercise interventions.
Exercise on bipolar disorder in humans
2019, International Review of Neurobiology
People with Bipolar disorder (BD) often have a sedentary lifestyle and low level of physical activity which in part contribute to the high co-occurrence of medical diseases including cardiovascular disease, type 2 diabetes, and metabolic syndrome, etc. Exercise especially aerobic exercise may be beneficial not only to mental health but also physical health outcomes. Targeting barriers for exercise such as high BMI and making the best use of facilitators (e.g., concept of fitness) can result in higher levels of exercise engagement in people with BD.
Gender differences in the association between physical activity and cognitive function in individuals with bipolar disorder
2017, Journal of Affective Disorders
Citation Excerpt :
Oestrogen is neuroprotective by inhibiting the release of pro-inflammatory cytokines in glial cells (Arevalo et al., 2012). It was shown that individuals suffering from BD lead a more inactive lifestyle compared to persons without mental illness (Shah et al., 2007). There is data that people with BD spend 78% of their time with sedentary behaviour.
Bipolar disorder (BD) is accompanied by a high number of comorbidities and associated with an overall increased mortality. Especially obesity, systemic inflammatory processes and cognitive deficits are highly prevalent and increase with the course of illness. Physical activity (PA) is associated with beneficial effects on somatic comorbidities such as obesity or cardiovascular disease in individuals without psychiatric disorder. Furthermore, PA might increase neurocognitive performance and reduce systemic inflammation.
The aim of the study was to investigate the association between PA and neurocognitive function in euthymic individuals suffering from BD.
120 individuals with BD, euthymic at test time, completed the self-reported International Physical Activity Questionnaire (IPAQ) assessing PA of the past seven days and were accordingly assigned to a specific activity category (low, moderate or vigorous). Furthermore, clinical parameters were gathered and cognitive tests analysing verbal-dependent intelligence, attention, executive functioning as well as memory were administered.
Female individuals in the vigorous PA group performed significantly higher in most of the cognitive domains compared to females with moderate or low PA. In males, we only found a significant difference in one test for attention between moderate/vigorous and the low activity group.
Differences between PA groups in cognitive performance in female individuals with BD were obvious in almost all cognitive domains. As cognitive deficits are strongly associated with a worse course of disease and outcome, PA might offer a concomitant therapy targeting not only somatic comorbidities such as obesity and cardiovascular disease, but also neurocognition.
Medical comorbidity in bipolar disorder: The link with metabolic-inflammatory systems
2017, Journal of Affective Disorders
Bipolar disorder (BD) is associated with chronic low-grade inflammation, several medical comorbidities and a decreased life expectancy. Metabolic-inflammatory changes have been postulated as one of the main links between BD and medical comorbidity, although there are few studies exploring possible mechanisms underlying this relationship. Therefore, the aims of the current narrative review were 1) synthesize the evidence for metabolic-inflammatory changes that may facilitate the link between medical comorbidity and BD and 2) discuss therapeutic and preventive implications of these pathways.
The PubMed and Google Scholar databases were searched for relevant studies.
Identified studies suggested that there is an increased risk of medical comorbidities, such as autoimmune disorders, obesity, diabetes and cardiovascular disease in patients with BD. The association between BD and general medical comorbidities seems to be bidirectional and potentially mediated by immune dysfunction. Targeting the metabolic-inflammatory-mood pathway may potential yield improved outcomes in BD; however, further study is needed to determine which specific interventions may be beneficial.
The majority of identified studies had cross-sectional designs, small sample sizes and limited measurements of inflammation.
Treatment and prevention of general medical comorbidities in mood disorders should include preferential prescribing of metabolically neutral agents and adjunctive lifestyle modifications including increased physical activity, improved diet and decreased substance abuse. In addition, the use of anti-inflammatory agents could be a relevant therapeutic target in future research.
Correlates of Overweight and Obesity Among Adolescents With Bipolar Disorder in the National Comorbidity Survey–Adolescent Supplement (NCS-A)
2016, Journal of the American Academy of Child and Adolescent Psychiatry
Despite substantial evidence on the prevalence and correlates of overweight and obesity (OW/OB) in adults with bipolar disorder (BD), little is known about this topic in adolescents with BD.
The method consisted of the National Comorbidity Survey–Adolescent Supplement, a face-to-face survey of mental disorders from 2001 through 2004, using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview. Participants were adolescents 13 to 17 years of age, with bipolar disorder I or II (n = 295), major depressive disorder (n = 1,112), or controls with neither mood disorder (n = 8,716). Analyses examined for group differences in the prevalence of OW/OB and for correlates of OW/OB in the group with BD.
There were no significant differences in weight categories across groups. OW and OB in adolescents with BD were associated with significantly higher lifetime rates of suicide attempt (odds ratio 3.02, 95% CI 1.11–8.24), physical or sexual abuse (2.82, 1.20–6.60), binge eating or bulimia (2.66, 1.13–6.26), and conduct disorder (2.60, 1.10–6.13) in covariate-adjusted analyses. OW and OB also were significantly associated with seeing a professional for depression, being hospitalized overnight for depression, and receiving general medical treatment.
The similar prevalence of OW/OB in adolescents with and without BD suggests that this potent association in adults likely comprises a consequence of BD or its correlates. In contrast, the strong association of OW/OB with proxies for depression severity, including suicide attempts and hospitalization, is already evident even in this young, nonclinical sample. Studies are warranted to determine whether early intervention of OW/OB in BD might optimize physical and mental health.

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Brief reportExercise tolerance is reduced in bipolar illness

Abstract

Background

Methods

Results

Conclusion

Limitations

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgement

Schizophr. Res.

Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography

J. Am. Soc. Echocardiogr.

Atypical depressive syndromes in varying definitions

Eur. Arch. Psychiatry Clin. Neurosci.

Effects of acute exercise on mood and well-being in patients with major depressive disorder

Med. Sci. Sports Exerc.

Cigarette smoking and psychotic symptoms in bipolar affective disorder

Br. J. Psychiatry

Evaluating change: a simple technique for determining the statistical significance of proportional criteria

J. Healthc. Qual.

ECG intervals in acute bipolar and schizophrenic relapse

Kentucky Med. Assoc. J.

Prevalence of obesity and weight change during treatment in patients with bipolar I disorder

J. Clin. Psychiatry

Obesity as a correlate of outcome in patients with bipolar I disorder

Am. J. Psychiatry

Ferri's Clinical Advisor

Brief report
Exercise tolerance is reduced in bipolar illness