Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review

BACKGROUND

Bipolar disorder (BD) is a serious mental illness associated with a high risk of medical comorbidities, long-term disability and premature death. This systematic review examined the current literature on therapeutic interventions targeting nutrition, physical activity and wellness in BD and collecting health-related measures such as mood and course of illness.

METHODS

Scopus (all databases), Pubmed and Ovid Medline were systematically searched with no language or year restrictions, up to June 2015, for studies focusing on lifestyle interventions in BD. Search terms were related to bipolar disorder, nutrition, physical activity, wellbeing, psychosocial interventions and course of illness. We hand searched content pages of Bipolar Disorders and Journal of Affective Disorders and checked references of relevant reviews and dissertations to identify additional papers.

RESULTS

After applying inclusion and exclusion criteria to identified hits, this literature search retrieved six papers. Overall findings point towards a beneficial role of lifestyle interventions on mood, weight, blood pressure, lipid profile, physical activity and overall wellbeing. Methodological limitations include small sample size, gender ratio imbalance, inconsistencies in terms of laboratory measures, and lack of randomized controlled trials and absence of follow-up and longitudinal studies to determine the benefits of these factors on clinical and functional outcomes over time

CONCLUSIONS

Lifestyle interventions in BD targeting nutrition, exercise, wellbeing alongside beliefs, coping strategies and attitudes towards health show promise in reducing the risk of comorbid ailments in BD. There is still a strong need for studies a) developing interventions which are informed by the patient's input and b) examining the effectiveness of such interventions targeting general wellness using well-controlled trials.

[Psychoeducation for overweight patients with psychiatric disorders: The Wellness program developed in Quebec]

OBJECTIVES

Patients with severe psychiatric disorders such as psychosis, bipolar disorder, and depression have a greater risk of suffering from being overweight or from obesity than the general population. This can in part be explained by medication-induced weight gain related to the use of antipsychotics, antidepressants and mood stabilizers. Fortunately, non-pharmacological interventions targeting modifications in lifestyle behaviors exist to help patients deal with weight gain and weight management. The main objective of this study is to assess the effectiveness of one of these interventions developed in Quebec (Canada), the Wellness Program.

MATERIALS AND METHODS

The 12-week program, consisting of two to three weekly individual and group sessions, was administered to patients diagnosed with a severe psychiatric disorder (i.e. Psychotic Disorders, Bipolar Disorders, Major Depressive Disorder) and referred to a general hospital for significant weight problems. Topics of program sessions included: physical conditioning, nutrition, meal cooking, psychoeducation, motivation, relaxation training, and optional walking sessions. A total of 47 participants took part in this study and either initially received the intervention (n=31) or were placed in a waitlist control group and later received the intervention (n=16). The effectiveness of the program was measured using objective anthropometric (weight, Body Mass Index, waist circumference) and clinical (psychiatric symptoms, medication adherence, quality of life) variables from both experimental and control groups. Assessments were conducted at the end of the 12-week intervention and at a 3-month follow-up.

RESULTS

After three months of active intervention, there were no significant differences between the two groups for most of the variables studied. Patients in the experimental group did show greater improvements in weight loss, Body Mass Index and waist circumference compared to the control group, but these positive changes were not statistically significant given the small sample size of the study. However, the results obtained at follow-up three months after the end of the program showed a significant impact of the program, albeit small, on weight, Body Mass Index, waist circumference and on some aspects of quality of life in the experimental group.

CONCLUSION

Non-pharmacological interventions targeting healthy lifestyle behaviors and weight management, such as the Wellness Program, seem effective in improving anthropometric variables and quality of life in patients with severe psychiatric disorders such as psychosis and mood disorders. Given the potential clinical benefits, implementation in clinical settings and widespread dissemination is recommended. Indeed, these programs have the potential to limit weight gain associated with medications used to treat psychiatric disorders and to improve quality of life for these patients.