Physical activity as prognostic factor for bipolar disorder: An 18-month prospective study

Determinants and outcomes of health-promoting lifestyle among people with schizophrenia

BACKGROUND

Healthy lifestyle is an important protective factor of developing cardiovascular disease in people with schizophrenia. However, little is known about the determinants of lifestyle and its contribution to metabolic syndrome. This study aimed to explore the influencing factors of health-promoting lifestyle (HPL) and its association with metabolic syndrome among people with schizophrenia.

METHODS

A cross-sectional study was conducted in twenty-two primary health centers of Guangzhou, China between December 2022 and April 2023. A total of 538 patients with schizophrenia were recruited through convenience sampling. Self-administered scales, questionnaires, and clinical data were collected. Scales and questionnaires included social-demographic information, Health-Promoting Lifestyles Profile (HPLP-C), UCLA Loneliness Scale (ULS), and International Physical Activity Questionnaire-Short Form (IPAQ-SF). Cluster analyses were used to divide participants into two groups based on the distribution characteristics of HPLP-C scores. Logistic regression models were used to identify factors associated with HPL and the association between HPL and metabolic syndrome.

RESULTS

There were 271 participants in the high HPL group and 267 participants in the low HPL group. Logistic regression analysis revealed that loneliness posed a risk factor for high HPL, while high education and moderate-vigorous physical activity served as protective factors for high HPL. Low HPL was a risk factor for the prevalence of metabolic syndrome.

CONCLUSIONS

Promotion of high education literacy and a physically active lifestyle should be priority targets in the health management of schizophrenia. Primary healthcare providers can play a pivotal role in assisting patients to mitigate metabolic syndrome by reinforcing healthy lifestyle strategies.

Alternations of vitamin D and cognitive function in first-diagnosed and drug-naïve BD patients: Physical activity as a moderator

BACKGROUND

The pathophysiological mechanism of cognitive impairments of bipolar disorder (BD) has not yet been completely revealed. It is well known that Vitamin D and physical activity (PA) are associated with BD. However, specific links between Vitamin D and cognitive deficits in BD are still unclear.

METHOD

The serum levels of vitamin D were measured. The cognitive performances of 102 first-diagnosed and drug-naïve BD patients were evaluated for analysis. The repeatable battery for the assessment of neuropsychological status (RBANS) and the Stroop Color-Word test was used in this study. PA was collected by international physical activity questionnaire.

RESULT

Patients with BD had high levels of serum vitamin D. Furthermore, immediate and delayed memory was negatively associated with vitamin D levels in patients' group. The serum levels of vitamin D in patients with low PA were positively associated with memory. However, increased PA attenuated the protective effect of vitamin D on executive cognition.

CONCLUSION

It is concluded that the increased levels of vitamin D were observed in the serum of patients with BD. Thus, it is found that more PA is less beneficial to cognition of patients with BD than longer resting.

Poor Agreement between Responses to the International Physical Activity Questionnaire and Objective ActiGraph® Data among Persons with Major Depressive or Bipolar Disorders

The purpose of this research was to investigate the degree of agreement between data from the International Physical Activity Questionnaire-Short Form (IPAQ) and accelerometer (ActiGraph^®) readings for physical activity (PA), classified as moderate, vigorous, and moderate-vigorous PA, and sedentary behavior (SB) in participants with major depressive or bipolar disorder. Following a cross-sectional observational design (n = 30), participants used an accelerometer for 4 to 7 days (minimum of 10 h per day) and answered the IPAQ (for the same period as accelerometer use). Our results suggest significant differences (p < 0.05) when comparing the ActiGraph^® and IPAQ data: for moderate PA, 155 min vs. 25 min per week; for moderate-vigorous PA, 157 min vs. 50 min per week; and for SB, 8 h vs. 3 h per day. Spearman's correlation coefficients (ActiGraph^® and IPAQ) were low for moderate PA, vigorous PA, and moderate-vigorous PA (rho = 0.03 to 0.13). The Bland-Altman plot showed a bias of -75 min for moderate PA, 9 min for vigorous PA, -66 min for moderate-vigorous PA, and -5 h for SB. Considering the differences observed and the objectivity of the ActiGraph^® measurements, whenever possible, we recommend ActiGraph^® measurements of PA and SB for these clinical groups.

[COVID-19 and Bipolar Affective Disorder: Subjective Changes in Lifestyle Variables During the First Lockdown During the COVID-19 Pandemic in Austria]

INTRODUCTION

The COVID-19 pandemic with its protective measures (e. g. lockdown) had far-reaching effects on everyone's well-being. The aim of this study was to examine lifestyle variables during the first Austrian lockdown in patients with bipolar disorder in comparison to a healthy control group and to assess subjective changes caused by the pandemic.

METHOD

At the beginning of April 2020, an online survey of n=75 participants (35 people with bipolar disorder and 40 healthy controls) with standardized questionnaires (Beck Depression Inventory-2, Food Craving Inventory, Altman Self Rating Mania Scale) as well as non-standardized COVID-19-specific questions on the subject of "Psychological stress and effects of the COVID-19 pandemic in bipolar disorder" was created and distributed via LimeSurvey.

RESULTS

Both groups reported a negative impact on their mental health. The participants with bipolar disorder showed significantly higher values in the Beck Depression Inventory-2 score (p<0,001), in emotional distress due to social distancing (p=0,003) and significantly lower values in muscle-strengthening exercise (p=0,039) and in sport units (p=0,003) compared to the control group. In addition, patients with bipolar disorder smoked more often than individuals of the control group. People with bipolar disorder were 42,9% more likely to report they were less efficient during the pandemic, and 22,9% experienced weight gain compared to before the pandemic. The control group, on the other hand, was less efficient at 17,5% and 5,0% reported weight gain. However, a comparison with pre-pandemic data showed a decrease in food craving in both groups.

CONCLUSION

This study provided first evidence of self-reported adverse effects on mental stress and lifestyle in people with bipolar disorder at the beginning of the COVID-19 pandemic. Psychiatric care and early interventions for patients with bipolar disorder would be particularly important in times of crisis in order to help maintain a healthy lifestyle and thus counteract unfavourable developments.

Association between circadian activity rhythms and mood episode relapse in bipolar disorder: a 12-month prospective cohort study

A significant proportion of patients with bipolar disorder experience mood episode relapses. We examined whether circadian activity rhythms were associated with mood episode relapses in patients with bipolar disorder. This prospective cohort study included outpatients with bipolar disorder who participated in a study titled "Association between the Pathology of Bipolar Disorder and Light Exposure in Daily Life (APPLE) cohort study." The participants' physical activity was objectively assessed using a wrist-worn accelerometer over 7 consecutive days for the baseline assessment and then at the 12-month follow-up for mood episode relapses. The levels and timing of the circadian activity rhythms were estimated using a cosinor analysis and a nonparametric circadian rhythm analysis. Of the 189 participants, 88 (46%) experienced mood episodes during follow-up. The Cox proportional hazards model adjusting for potential confounders showed that a robust circadian activity rhythm, including midline-estimating statistic of rhythm (MESOR) and amplitude by cosinor analysis and 10 consecutive hours with the highest amplitude values (M10) by the nonparametric circadian rhythm analysis, was significantly associated with a decrease in mood episode relapses (per counts/min, hazard ratio [95% confidence interval]: MESOR, 0.993 [0.988-0.997]; amplitude, 0.994 [0.988-0.999]; and M10, 0.996 [0.993-0.999]). A later timing of the circadian activity rhythm (M10 onset time) was significantly associated with an increase in the depressive episode relapses (per hour; 1.109 [1.001-1.215]). We observed significant associations between circadian activity rhythms and mood episode relapses in bipolar disorder.

Longitudinal Effects of Motivation and Physical Activity on Depressive Symptoms among College Students

High prevalence of depression and physical inactivity have been consistently reported among college students, especially in females. Guided by Lubans et al.’s conceptual framework, the primary purpose of this study was to examine the longitudinal relationships of PA motivation with leisure-time PA and depressive symptoms among college students over one academic year. Employing a longitudinal repeated measure design, 1004 college students in China were recruited in this study (28.3% males and 71.7% females; M age = 18.93 ± 0.64 years; 18–22 years old). Participants completed previously validated questionnaires assessing PA motivation (perceived competence beliefs and task values toward PA), leisure-time PA participation, and depressive symptoms in Fall 2016 (Time 1) and Fall 2017 (Time 2). Both male and female college students showed a significant increase of depressive symptoms from freshmen to sophomores (p < 0.05). The regression models indicated that perceived competence beliefs and task values toward PA were significant predictors of depressive symptoms at Time 2 (p < 0.05) after controlling for Time 1 measures in males and females, respectively. Physically active college students consistently demonstrated higher PA motivation, and they displayed fewer depressive symptoms compared to inactive peers over time (p < 0.05). The findings suggest sex-specified motivational intervention strategies and PA promotion programs/opportunities are needed to reduce depression symptoms among college students over time.

The Evolutionarily Mismatched Impact of Urbanization on Insomnia Symptoms: a Short Review of the Recent Literature

PURPOSE OF REVIEW

For the most part of human existence, individuals have been living a rural lifestyle in a rural setting. However, such sleep-conducive conditions have largely been transformed dramatically by urbanization within a relatively short span of time in recent history, and the resulting evolved mechanisms-environment mismatch is theorized to bring about an increased risk for insomnia symptoms. This brief review of the recent literature is designed to evaluate the veracity of this proposition.

RECENT FINDINGS

The majority of recent findings have suggested that most proposed evolutionarily mismatched urban factors are indeed related to the presence of insomnia symptoms. However, there is a general paucity of longitudinal evidence (and for some other factors, a lack of enough evidence of any kind). Although there is a preponderance of recent findings indicating a link between evolutionarily mismatched urban phenomena and insomnia symptoms, more longitudinal data are needed before any causative conclusion can be drawn.

Differences in psychomotor activity and heart rate variability in patients with newly diagnosed bipolar disorder, unaffected relatives, and healthy individuals

BACKGROUND

Heart rate variability (HRV) and psychomotor activity have been found reduced in bipolar disorder (BD) but has never been investigated in newly diagnosed BD and unaffected relatives. The present study aimed to compare HRV and psychomotor activity between newly diagnosed patients with BD, their unaffected first-degree relatives (UR), and healthy control individuals (HC).

METHODS

20 newly diagnosed patients with BD, 20 of their UR, and 20 age- and sex-matched HC were included. Measurements of HRV for five minutes and heart rate and acceleration for seven days were conducted. Activity energy expenditure (AEE) was derived from the latter. Linear mixed effect regression models were conducted to compare the three groups.

RESULTS

HRV did not differ in any measure between the three groups of participants. Similarly, AEE (kJ/day/kg) did not differ between the three groups in neither daily means (BD: 63.6, UR: 64.1, HC: 62.1) nor when divided into quarter-daily intervals.

LIMITATIONS

The relatively small size of the study may affect the validity of the results.

CONCLUSION

Patients with newly diagnosed BD and UR do not present with decreased HRV or AEE. These results contrast prior findings from BD patients with more advanced stages of the disorder, suggesting that these outcomes progress with illness duration.

The causal relationships of device-measured physical activity with bipolar disorder and schizophrenia in adults: A 2-Sample mendelian randomization study

BACKGROUND

To examine the causal association of device-measured physical activity with Bipolar disorder (BIP) and schizophrenia (SCZ) in adults by performing 2-sample MR analysis.

METHODS

Summary-level data for exposure variable including overall physical activity, and three different types of physical activities(sedentary, moderate intensity activity, sleep duration) were derived from UK Biobank(n = 91,105). Summary-level data for outcomes were obtained from Psychiatric Genomics Consortium (PGC) including BIP (n = 51,710) and SCZ(n = 65,967). Cochran's Q statistics, MR-Egger regression, and MR-PRESSO global test were used to identify pleiotropy and MR-PRESSO outlier test for removing the pleiotropy of the genetic instruments. For assessing causality, proven MR techniques including one main analysis(IVW)and four sensitive analysis(MLE,SME,WME, MR-PRESSO)were applied for robust results.

RESULTS

Five MR methods provided consistent genetically evidence that overall physical activity was associated with lower risk of BIP(OR, 0.491; 95% CI: 0.314-0.767; p = 0.002), there was no significant relationship between overall physical activity and SCZ(IVW OR; 1.133; 95% CI: 0.636-2.020; p = 0.672). In addition, no significant causal association was observed between any other types of physical activities and both mental disorders.

LIMITATIONS

The nonlinear association of physical activities on BIP and SCZ were unaccessible through MR analysis.

CONCLUSIONS

This study provides genetic evidence that overall physical activity is an effective preventive factor for BIP but not for SCZ. Together with evidence from observational studies, our finding provides further rationale for individuals at risk for BIP to maintain physical activity.

Overlapping mechanisms linking insulin resistance with cognition and neuroprogression in bipolar disorder

Cognitive impairment is highly prevalent in the progression of both diabetes mellitus and bipolar disorder. The relationship between insulin resistance in diabetes and the risk of developing major neurocognitive disorders such as Alzheimer's disease has been well described. Insulin resistance and the associated metabolic deficiencies lead to biochemical alteration which hasten neurodegeneration and subsequent cognitive impairment. For bipolar disorder, some patients experience a cyclical, yet progressive course of illness. These patients are also more likely to have medical comorbidities such as cardiovascular disease and diabetes, and insulin resistance in particular may precede the neuroprogressive course. Diabetes and bipolar disorder share epidemiological, biochemical, and structural signatures, as well as cognitive impairment within similar domains, suggesting a common mechanism between the two conditions. Here we describe the association between insulin resistance and cognitive changes in bipolar disorder, as well as potential implications for therapeutic modulation of neuroprogression.