IMPACT Research Centre, Northern Health & Social Care Trust, Antrim, UK.
Mental Health Foundation, London, UK.
Cochrane Database Syst Rev. 2024 Jun 4;6(6):CD013557. doi: 10.1002/14651858.CD013557.pub2.
Mental health problems contribute significantly to the overall disease burden worldwide and are major causes of disability, suicide, and ischaemic heart disease. People with bipolar disorder report lower levels of physical activity than the general population, and are at greater risk of chronic health conditions including cardiovascular disease and obesity. These contribute to poor health outcomes. Physical activity has the potential to improve quality of life and physical and mental well-being.
To identify the factors that influence participation in physical activity for people diagnosed with bipolar disorder from the perspectives of service users, carers, service providers, and practitioners to help inform the design and implementation of interventions that promote physical activity.
We searched MEDLINE, PsycINFO, and eight other databases to March 2021. We also contacted experts in the field, searched the grey literature, and carried out reference checking and citation searching to identify additional studies. There were no language restrictions.
We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that focused on the experiences and attitudes of service users, carers, service providers, and healthcare professionals towards physical activity for bipolar disorder.
We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined questions. We used the "best fit" framework synthesis based on a revised version of the Health Belief Model to analyse and present the evidence. We assessed methodological limitations using the CASP Qualitative Checklist. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) guidance to assess our confidence in each finding. We examined each finding to identify factors to inform the practice of health and care professionals and the design and development of physical activity interventions for people with bipolar disorder.
We included 12 studies involving a total of 592 participants (422 participants who contributed qualitative data to an online survey, 170 participants in qualitative research studies). Most studies explored the views and experiences of physical activity of people with experience of bipolar disorder. A number of studies also reported on personal experiences of physical activity components of lifestyle interventions. One study included views from family carers and clinicians. The majority of studies were from high-income countries, with only one study conducted in a middle-income country. Most participants were described as stable and had been living with a diagnosis of bipolar disorder for a number of years. We downgraded our confidence in several of the findings from high confidence to moderate or low confidence, as some findings were based on only small amounts of data, and the findings were based on studies from only a few countries, questioning the relevance of these findings to other settings. We also had very few perspectives of family members, other carers, or health professionals supporting people with bipolar disorder. The studies did not include any findings from service providers about their perspectives on supporting this aspect of care. There were a number of factors that limited people's ability to undertake physical activity. Shame and stigma about one's physical appearance and mental health diagnosis were discussed. Some people felt their sporting skills/competencies had been lost when they left school. Those who had been able to maintain exercise through the transition into adulthood appeared to be more likely to include physical activity in their regular routine. Physical health limits and comorbid health conditions limited activity. This included bipolar medication, being overweight, smoking, alcohol use, poor diet and sleep, and these barriers were linked to negative coping skills. Practical problems included affordability, accessibility, transport links, and the weather. Workplace or health schemes that offered discounts were viewed positively. The lack of opportunity for exercise within inpatient mental health settings was a problem. Facilitating factors included being psychologically stable and ready to adopt new lifestyle behaviours. There were positive benefits of being active outdoors and connecting with nature. Achieving balance, rhythm, and routine helped to support mood management. Fitting physical activity into a regular routine despite fluctuating mood or motivation appeared to be beneficial if practised at the right intensity and pace. Over- or under-exercising could be counterproductive and accelerate depressive or manic moods. Physical activity also helped to provide a structure to people's daily routines and could lead to other positive lifestyle benefits. Monitoring physical or other activities could be an effective way to identify potential triggers or early warning signs. Technology was helpful for some. People who had researched bipolar disorder and had developed a better understanding of the condition showed greater confidence in managing their care or providing care to others. Social support from friends/family or health professionals was an enabling factor, as was finding the right type of exercise, which for many people was walking. Other benefits included making social connections, weight loss, improved quality of life, and better mood regulation. Few people had been told of the benefits of physical activity. Better education and training of health professionals could support a more holistic approach to physical and mental well-being. Involving mental health professionals in the multidisciplinary delivery of physical activity interventions could be beneficial and improve care. Clear guidelines could help people to initiate and incorporate lifestyle changes.
AUTHORS' CONCLUSIONS: There is very little research focusing on factors that influence participation in physical activity in bipolar disorder. The studies we identified suggest that men and women with bipolar disorder face a range of obstacles and challenges to being active. The evidence also suggests that there are effective ways to promote managed physical activity. The research highlighted the important role that health and care settings, and professionals, can play in assessing individuals' physical health needs and how healthy lifestyles may be promoted. Based on these findings, we have provided a summary of key elements to consider for developing physical activity interventions for bipolar disorder.
心理健康问题在全球范围内对整体疾病负担有重大影响，是导致残疾、自杀和缺血性心脏病的主要原因。双相情感障碍患者的身体活动水平低于一般人群，并且更容易患包括心血管疾病和肥胖症在内的慢性健康问题。这些会导致健康状况不佳。身体活动有潜力改善生活质量和身心健康。
从服务使用者、照顾者、服务提供者和从业者的角度确定影响双相情感障碍患者参与身体活动的因素，以帮助设计和实施促进身体活动的干预措施。
我们检索了 MEDLINE、PsycINFO 和其他 8 个数据库，检索时间截至 2021 年 3 月。我们还联系了该领域的专家，搜索了灰色文献，并进行了参考文献检查和引文搜索，以确定其他研究。本研究没有语言限制。
我们纳入了定性研究和混合方法研究，且这些研究具有可识别的定性部分。我们纳入了专注于服务使用者、照顾者、服务提供者和医疗保健专业人员对双相情感障碍身体活动的经验和态度的研究。
我们使用专为本次综述设计的数据提取表提取数据。我们使用一系列预设问题评估方法学局限性。我们使用基于修订后的健康信念模型的“最佳拟合”框架综合分析和呈现证据。我们使用 CASP 定性清单评估方法学局限性。我们使用 GRADE-CERQual（对定性研究证据的信心评估）指南来评估我们对每个发现的信心。我们检查了每个发现，以确定为卫生保健专业人员的实践以及为双相情感障碍患者设计和开发身体活动干预措施提供信息的因素。
我们纳入了 12 项研究，共涉及 592 名参与者（422 名参与者通过在线调查提供了定性数据，170 名参与者参与了定性研究）。大多数研究探索了双相情感障碍患者对身体活动的看法和经验。一些研究还报告了生活方式干预中身体活动成分的个人经验。一项研究纳入了照顾者和临床医生的观点。大多数研究来自高收入国家，只有一项研究在中等收入国家进行。大多数参与者被描述为稳定，且患有双相情感障碍多年。我们将一些发现的信心水平从高置信度降低到中等置信度或低置信度，因为有些发现仅基于少量数据，并且这些发现基于来自少数几个国家的研究，这质疑了这些发现对其他环境的相关性。我们也很少有来自双相情感障碍患者家属、其他照顾者或卫生专业人员的观点支持这种照顾方面。研究中没有任何来自服务提供者的观点关于支持这方面的护理。有许多因素限制了人们进行身体活动的能力。对自己的身体外貌和心理健康诊断的羞耻感和污名化被讨论。有些人觉得他们离开学校后就失去了运动技能/能力。那些能够通过成年期过渡保持锻炼的人似乎更有可能将身体活动纳入他们的日常常规。身体健康限制和合并健康状况限制了活动。这包括双相情感障碍药物、超重、吸烟、饮酒、不良饮食和睡眠，这些障碍与消极应对技能有关。实际问题包括负担能力、可及性、交通联系和天气。提供折扣的工作场所或健康计划受到好评。住院精神卫生机构内缺乏锻炼机会是一个问题。促进因素包括心理稳定和准备好采用新的生活方式行为。在户外进行身体活动并与大自然接触有积极的好处。实现平衡、节奏和常规有助于支持情绪管理。如果在适当的强度和节奏下进行，适度或过度锻炼可能是有益的，因为这可能会加速抑郁或躁狂情绪。身体活动还有助于为人们的日常生活提供结构，并可能带来其他积极的生活方式益处。监测身体或其他活动可以有效地识别潜在的触发因素或早期预警信号。技术对一些人有帮助。那些研究过双相情感障碍并对病情有了更好理解的人，在管理自己的护理或为他人提供护理方面表现出更大的信心。来自朋友/家人或卫生专业人员的社会支持是一个促进因素，就像找到合适的运动类型一样，对许多人来说，这是散步。其他好处包括建立社交联系、减肥、提高生活质量和更好的情绪调节。很少有人被告知身体活动的好处。更好的健康专业人员教育和培训可以支持身体和心理健康的整体方法。让精神卫生专业人员参与身体活动干预的多学科提供可能是有益的，并可以改善护理。明确的指导方针可以帮助人们启动和实施生活方式的改变。
很少有研究专注于影响双相情感障碍患者参与身体活动的因素。我们确定的研究表明，男性和女性双相情感障碍患者在积极活动方面面临一系列障碍和挑战。这些证据还表明，有有效的方法可以促进管理身体活动。研究强调了健康和保健机构以及专业人员在评估个人身体健康需求以及如何促进健康生活方式方面可以发挥的重要作用。基于这些发现，我们为双相情感障碍患者的身体活动干预措施提供了关键要素的摘要。
