Lafer Beny, Duarte Cicera Claudinea, Greve Julia Maria D'Andrea, Dos Santos Silva Paulo Roberto, de Almeida Karla Mathias, Belizario Gabriel Okawa, Neves Lucas Melo
Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, 785, São Paulo, Brazil.
Movement Studies Laboratory, Department of Orthopedics and Traumatology, University of São Paulo Medical School, São Paulo, Brazil.
Int J Bipolar Disord. 2023 Apr 21;11(1):14. doi: 10.1186/s40345-023-00294-8.
Physical exercise (PE) is a recommended lifestyle intervention for different mental disorders and has shown specific positive therapeutic effects in unipolar depressive disorder. Considering the similar symptomatology of the depressive phase in patients with bipolar disorder (BD) and unipolar depressive disorder, it is reasonable to suggest that PE may also be beneficial for bipolar depression. However, there is an absence of studies evaluating the antidepressant effect of a structured PE intervention in BD.
This is an open-label, single-arm study trial. Fifteen patients with a diagnosis of BD Type I or Type II, presenting a depressive episode were included in the study. After physical and functional evaluation, patients participated in supervised training sessions with aerobics followed by strength exercises, three times per week, for 12 weeks (36 training sessions). Depressive and manic symptoms were assessed at baseline and 2, 4, 8, and 12 weeks. Additionally, quality of Life and functioning were assessed at baseline and 4, 8, and 12 weeks). Finally, we tested cardiorespiratory fitness, muscle strength and body composition at baseline and week-12.
The mean (± SD) Montgomery Asberg Depression Rating Scale (MADRS) score at baseline was 23.6 ± 8.3 points and after 12 weeks of PE the mean score was 10.2 ± 4.8 points. Nine patients (82%) presented an antidepressant response defined as a reduction of more than 50% of depressive symptoms at week 12 with five of those patients (45%) presenting criteria for full remission. A large and significant Cohen's D Effect Size (pre-post) was verified for MADRS reduction [1.98 (95% Confidence interval = 0.88 to 3.08)]. We did not detect a significant change in manic symptoms, functioning, and quality of life during the 12-week follow-up. At week-12, all patients increased their muscular strength (one repetition maximal test - 1RM) and reduced the percentage of body fat (spectral bioelectrical impedance analysis).
This study, using rigorous criteria and a structured intervention, provides valid pilot data, showing the feasibility of a structured PE intervention for the treatment of depressive symptoms in BD, and suggesting a potential adjunctive antidepressant effect. Moreover, PE showed a positive impact on muscle strength and body composition. This should be further verified by randomized controlled studies.
体育锻炼（PE）是针对不同精神障碍推荐的一种生活方式干预措施，并且已在单相抑郁症中显示出特定的积极治疗效果。鉴于双相情感障碍（BD）患者抑郁发作期与单相抑郁症的症状相似，因此有理由认为体育锻炼可能对双相抑郁症也有益。然而，目前缺乏评估结构化体育锻炼干预对双相情感障碍抗抑郁作用的研究。
这是一项开放标签、单臂研究试验。研究纳入了15例诊断为I型或II型双相情感障碍且出现抑郁发作的患者。在进行身体和功能评估后，患者参加有监督的训练课程，先进行有氧运动，然后进行力量训练，每周三次，共12周（36次训练课程）。在基线、第2、4、8和12周评估抑郁和躁狂症状。此外，在基线以及第4、8和12周评估生活质量和功能。最后，在基线和第12周测试心肺功能、肌肉力量和身体成分。
基线时蒙哥马利-阿斯伯格抑郁评定量表（MADRS）的平均（±标准差）得分为23.6±8.3分；经过12周的体育锻炼后，平均得分是10.2±4.8分。9例患者（82%）出现抗抑郁反应，定义为在第12周时抑郁症状减轻超过50%，其中5例患者（45%）达到完全缓解标准。MADRS得分降低的科恩D效应量（前后）经证实有较大且显著的变化[1.98（95%置信区间=0.88至3.08）]。在12周的随访期间，我们未检测到躁狂症状、功能和生活质量有显著变化。在第12周时，所有患者的肌肉力量（一次重复最大值测试 - 1RM）均有所增加，身体脂肪百分比（频谱生物电阻抗分析）降低。
本研究采用严格标准和结构化干预，提供了有效的试点数据，表明结构化体育锻炼干预治疗双相情感障碍抑郁症状的可行性，并提示了潜在的辅助抗抑郁作用。此外，体育锻炼对肌肉力量和身体成分有积极影响。这一点应通过随机对照研究进一步验证。
