Exercise Induced Mania

Here’s the latest from Practicing Mental Illness:

Very few people with bipolar disorder get much physical activity.  78% are reported to lead sedentary lives. For those who do exercise, little is known about the effect of exercise on this mood disorder.  And yet, some people maintain that vigorous exercise can bring on manic episodes.

Could this be true?  Well, yes and no.

The ways exercise can help those with depression are well-researched and overwhelmingly positive.  Regular physical activity can lift a person’s mood from despair to upbeat, and many of the physical symptoms of depression can be improved by exercise.

Results of research into the effects of activity on depression lead many to believe that exercise should be considered a primary therapy when treating depression.

For people with bipolar disorder that tend toward mania, the results are a little murkier.

No one is advocating for a sedentary lifestyle.  No one thinks inactivity is good for those with bipolar disorder.  The level of activity is what’s in question. Moderate physical activity can help regulate moods and improve sleep, thus avoiding the onset of manic episodes.  Exercise can also positively impact all of the physical conditions that are co-morbid with bipolar disorder.

Regular, moderate exercise can help anyone live better and live longer.  This is crucial in bipolar disorder, where lifespan is shortened so severely by the effects of co-morbidity.  Exercise can help ameliorate the effects of co-morbid, physical diseases.

But can exercise cause mania?

A study made the rounds a while ago and caused many headlines.  It inferred that vigorous exercise may bring on a manic episode, or at least hypomania, in many with bipolar disorder.

No one will deny that vigorous activity is stimulating.  Runners speak of the “runner’s high,” and exercise addiction, for a small group of people, seems to be a real thing.

I remember a manic episode I had a few years ago.  I began running.  I ran far and fast, every day.  As with many things I have undertaken during episodes, I overdid it.  I ended up with a stress fracture in my femur, the strongest bone in the body, and I could barely walk.  But it’s unclear if the manic episode fueled my running, or if the running fired the manic episode.

Studies on exercise and bipolar disorder have reached the same chicken and egg dilemma.  Researchers can’t be sure which came first, the intense activity or the mania, or if they’re just bidirectional. 

The studies that imply that exercise causes mania are also limited because they’re qualitative (not statistically controlled) and result from small sample sizes.

What these and other studies on bipolar disorder and exercise do conclude is that the type of exercise undertaken by the subject is key.  Regular, moderate exercise seems to have no detrimental effect on mood.  

While vigorous exercise may lift mood into a phase a bit too exuberant for safe mental health in those with bipolar disorder, the type and frequency of exercise can change outcomes.

It seems rhythmic exercises like walking, running, or swimming can have a calming effect, while more multi-directional intense activity may lift the mood too high and lead the exerciser into hypomania, or mania, over time.

The point is to experiment.  Many different types of exercise are available, and the person with bipolar disorder needs to get up, raise the pulse rate, and find a type of exercise that works for them.

It amazes me how headlines stir behavior.  The implication of a link between exercise and mania can lead many with bipolar disorder and sedentary lives to say, “why bother.”  No, you don’t have to run to a cross fit gym, and maybe you shouldn’t.  But you do have to move around.

The physical and mental health benefits of exercise far outweigh any risk.  Just don’t overdo it.

Meditation

For some people seated meditation just doesn’t cut it. I came to meditation through martial arts, and movement is still a key part of my practice. The long walks I would take after dropping my daughter off at school have been interrupted due to school-from-home, and I’ve become edgy and restless - sleeping poorly and grinding my teeth during the day. I’ve had to replace these walks with movement and exercise at home.

Some movement practices seem more suited to meditation than others, and things like yoga or tai chi present themselves as obvious exercises for both the body and focused attention. There’s anecdotal evidence that this is so, even though the science hasn’t quite determined if these practices are any better for stress relief and mood regulation than walking or running. Still, with a lot less opportunity to get out of the house I’ve begun to practice tai chi. While gentler than the martial arts I used to practice, this practice is surely helping me both mentally and somatically.

Here’s a video of Shanghai tai chi teacher Wu Ming demonstrating Chen forms. Yes the music is annoying, the camera moves all over the place and there are too many close-ups of her face, but it’s a great introduction to the art. You can see how it can help one focus and relax while moving: