Specifically, exercise in this review includes anaerobic (e.g., strength training) as well as aerobic exercise (e.g., walking, cycling, running, swimming). We define exercise broadly in our review given the paucity of data and the lack of consistency in the field. In this review, we summarize findings from studies demonstrating the role of exercise in the treatment of MDD and bipolar disorder as well as comorbid conditions. In summary, exercise is an established adjunct treatment of depression with promise as an effective treatment for bipolar disorder adjunctive to mood stabilizing medication because of its broad-reaching effects on mental and physical health outcomes. Preliminary studies indicate its acceptability, feasibility, and efficacy for depression, bipolar disorder, and anxiety. While there are some promising initial findings for bipolar disorder, there is a paucity of well-controlled studies investigating the efficacy of exercise as an intervention strategy, as well as studies investigating the pathways by which exercise may exert its effects on mood. Preliminary research also reports the benefits of exercise augmentation strategies added to cognitive-behavioral therapy for anxiety disorders or treatment as usual for depression. Given the high rates of partial and non-response to pharmacological treatment and the need to improve mental and physical health outcomes, exercise may be particularly helpful for serving as an adjunctive treatment option for individuals with MDD, treatment-resistant depression, and bipolar disorder. ![]() The data on the efficacy of exercise as an intervention for MDD and bipolar disorder have yielded effect sizes comparable to medications. Exercise represents a cost-effective and easily disseminated intervention that includes the benefits of minimal side effects and improved physical and mental health. Thus, alternative augmentation strategies that target mental and physical health would be desirable. Medications used to treat severe mood disorders, such as quetiapine and lithium, are often associated with weight gain. Moreover, despite major pharmacological advances in the treatment of MDD and bipolar disorder, as many as 19–34% of depressed patients and 30–35% of patients with bipolar disorder do not achieve remission. These risk factors lead to earlier and higher rates of mortality for individuals with MDD and bipolar disorder compared to the general population. Individuals with MDD and bipolar disorder also have a higher incidence of cardiovascular disease, diabetes, and metabolic syndromes, due in part to less engagement in physical activity and more sedentary behavior as well as medication side effects (e.g., weight gain). More specifically, Forty and colleagues found that the most prevalent comorbid medical conditions of MDD and bipolar disorder are: migraines, asthma, elevated lipids, hypertension, thyroid disease and osteoarthritis. ![]() Similarly, in a national epidemiological study, Merikangas and colleagues found that 92.3% of bipolar individuals have a comorbid psychiatric diagnosis and 58.8% have a comorbid medical diagnosis. At least 64.1% of patients with MDD have another comorbid psychiatric diagnosis, and primary care patients who have MDD have also reported an average of two to three concurrent chronic medical illnesses, which is approximately double those without depression. Both MDD and bipolar disorder are marked by high rates of medical and psychological comorbid conditions as well as functional impairment. adults in their lifetimes and bipolar disorder has a lifetime prevalence of 2.1% in U.S. Major depressive disorder (MDD) affects approximately 16.6% of U.S.
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