What People With Bipolar Disorder Need to Know About Exercise

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When was the last time you heard that exercise wasn’t the best thing ever for your body? Was that probably never? Thought so. Which is why what comes next may be a surprise: For people with bipolar disorder, which is characterized by extreme mood swings, working out isn’t always a safe move.

“For an individual with bipolar disorder, the mood regulating circuits in the brain can be supersensitive to conditions and substances that effect mood, including exercise,” says Jim Cummins, M.D., a staff psychiatrist at OhioHealth Behavioral Health in Columbus. “So much like a prescribed antidepressant might trigger a high, too much exercise might fuel manic behavior.”

But this doesn’t mean you can—or should—hang up your sneakers for good. Instead, it means you need to be smart about using them.


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More on Why the Relationship Between Exercise and Bipolar Is Tricky

In some ways, this is a classic catch-22: People with bipolar disorder have an increased risk of cardiovascular disease, and even young patients tend to have higher levels of cholesterol and blood pressure, according to a scientific statement from the American Heart Association published in the journal Circulation. Being sedentary only exacerbates those symptoms and contributes to others including being overweight, smoking, and developing diabetes.

And yet, there is that very real danger of taking exercise to an extreme.


Why Workouts Can Be Risky

People who have bipolar 1 can experience episodes of manic behavior that last for days, weeks, or even longer, says Dr. Cummins. (Those with bipolar 2 tend to experience less severe manic episodes known as hypomania.) The person may need little sleep, due to an overabundance of energy, fast thinking, and talking. And because someone experiencing mania is already feeling larger than life—a workout will increase those feelings by raising their heart rate and releasing endorphins (those feel-good chemicals).

“Bipolar disorder is also associated with grand thinking, so a person might overexert themselves, trying to run too far or lift weights that are too heavy,” says Dr. Cummins. If you’re not thinking clearly, you can hurt yourself.


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How People With Bipolar Can Exercise Safely

First of all, before starting or changing your fitness routine talk to your doctors, talk to your doctors, talk to your doctors. That means checking with your psychiatrist and your primary. You’ll still need to manage bipolar disorder with medication, therapy and any other tailored treatment you’ve been adhering to.

Also important to stress: “If someone is in the midst of a bipolar manic or depressed episode, most non-medical interventions, including exercise, will not be enough to help, and should never be relied upon as treatment,” says Alex Dimitriu, M.D., a double board-certified psychiatrist and sleep-medicine specialist in Menlo Park, CA.


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Why Routines Are Important

“Safeguarding yourself by avoiding drastic deviation from your usual exercise goals is key,” Dr. Cummins says. In fact, following daily routines in general, including maintaining a regular sleep schedule, can help reduce mood-cycle changes, according to research reported by the American Psychological Association (APA). Study participants who used behavioral therapy to increase stability in their daily routines “averted new manic or depressive episodes longer than patients whose therapy focused just on regulating their mood symptoms and medication,” according to the APA.


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How Tracking Your Mood and More Can Help

You might also want to monitor and track your mood, sleeping habits, and medication compliance. This is especially important when you’re newly diagnosed because it helps you identify what causes your episodes.

What’s more, if you notice an uptick in manic behaviors, you’ll have a clear sign to take it easy workout-wise. One to check out: eMoods, which is specifically designed for people with bipolar disorder. You can rate your mood, irritability, and anxiety on a four-point scale as well as log your sleep, meds, and recent therapy appointments, too.


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Why Workout Buddies Are Awesome

Friends who sweat together, stay together! But even more than that: Working out with a friend or trainer can help you remain within healthy limits and in a safe physical space, says Dr. Cummins. Classes can be a great option, too. The more accountability and backup you build into your life, the better. If you suddenly get the urge to go on a 10-mile run and you’re not really a runner, call your buddy—or your doctor—for a reality check.


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What to Know About Yoga and Bipolar

“Yoga and meditation serve to quiet the mind and bring us more into our bodies,” says Dr. Dimitriu. “This is an essential skill and can be beneficial for people with bipolar disorder.” Practicing yoga is also a proven way to reduce stress and anxiety, both of which can worsen bipolar symptoms. That said, one survey of patients by researchers at Brown University in Providence, RI, found that some yoga practices, such as rapid/energetic breathing and hot yoga, can increase agitation or manic symptoms. So just like any other form of exercise, talk with your doctor first and monitor your symptoms afterward.


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Why You Might Want to Give Swimming a Try

“Swimming moves us from our head into our bodies,” says Dr. Dimitriu. “Not only does this type of exercise helps blow off steam, but the water can have a grounding effect for many people.”

If pools aren’t your thing, walk, bike, or jog: Higher levels of cardiorespiratory fitness in those with bipolar disorder are associated with lower risk for premature death, according to a study by researchers from Massachusetts General Hospital in Boston. Yep, just like in everyone else.


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Final Words

Remember, before starting a new exercise regime, consult your doctor. Think of exercise as the side dish to your daily medication, therapy sessions, and any other treatment set in place for you—because exercise is never intended to be the only way to manage your mental health.