Physical activity, sedentary behaviour, and mood symptoms, in people living with bipolar disorder

Background
Previous research has established links between physical activity (PA), sedentary behaviour (SB), and mental wellbeing. Little is known about PA and SB engagement in relation to (hypo)manic and depressive symptoms in people living with bipolar disorder (BD).
Aims
The main aims of this PhD were to explore perceived, device-measured, and subjectively measured relationships between PA, SB, and mood in people living with BD. A further aim was to explore the validity of the MSQ as a self-report SB tool in this population.

Method
Participants with DSM-IV BD were recruited from the Bipolar Disorder Research Network.
Study one consisted of semi-structured qualitative interviews on PA, SB and mood analysed using a thematic analysis (N=15).
In study two, PA and SB were measured using an ActivPAL3 over 7-days (N=51). Daily (MoodZoom) and weekly (QIDS & ASRM) mood measures were completed, alongside the MSQ to compare to the ActivPAL3.
For study three, self-report 7-day recall questionnaires subjectively measured PA (IPAQ), SB (MSQ), and mood symptoms (BDI-21 & ASRM) (N=1031).

Findings and Discussion
Interviews revealed that participants were striving to find a balance of not being too sedentary or too physically active to keep mood within manageable limits. Device-measured daily moderate/vigorous PA (MVPA) was positively associated with daily ratings of ‘elation’ (r=0.21,p<0.01) and ‘energy’ (r=0.21,p<0.01) in females only, and negatively associated with ‘sadness’ (r=-0.24,p<0.001). Subjectively measured weekly MVPA was also negatively associated with depression symptom severity (r=-0.13,p<0.001). Device-measured weekly SB was positively associated with (hypo)mania symptom severity in those who reported using anti-depressants (r=0.60,p<0.05), and using the MSQ time spent sitting for ‘leisure’ was positively associated with (hypo)mania symptom severity (r=0.08,p<0.05), but negatively with depression symptom severity (r=-0.12,p<0.01). On average the MSQ underestimated SB by 47mins, however showed acceptable validity (r=0.283-0.344) and agreement with the device-based measure, and so should be used with caution when exploring SB in BD in future studies.
People living with BD experience complex PA, SB, and mood relationships which are challenging to balance. The results suggest MVPA may be helpful for overcoming depressive symptoms however may complicate the self-management of (hypo)mania and disrupt the ‘balance.’ Health professionals could consider personalised recommendations for PA/SB engagement for this population which account for current mood state rather than the standardised PA recommendation of 75-150mins MVPA per week. Future research could consider longitudinal prospective designs to examine temporal relationships between PA, SB and mood in people living with BD.

Abbreviations of measures:
MSQ – Marshall Sitting Questionnaire
QIDS – Quick Inventory of Depressive Symptoms
ASRM – Altman Self-Rating Mania Scale
IPAQ - International Physical Activity Questionnaire
BDI-21 – Beck Depression Inventory