Sabine Wyckaert

Health-related physical fitness in patients with bipolar disorder vs. healthy controls: an exploratory study.

BACKGROUND Low physical fitness has been recognized as a prominent behavioral risk factor for cardiovascular diseases and an independent risk factor for all-cause mortality. To date, no studies have systematically assessed physical fitness in patients with bipolar disorder. The aim of the current study was to assess and compare the physical fitness in patients with bipolar disorder against healthy controls. METHODS Thirty patients with bipolar disorder (16♂, 40.8±11.6 years) and 30 age-, gender- and body mass index (BMI)-matched healthy controls were included. All participants performed the Eurofit test battery and the International Physical Activity Questionnaire. Patients were screened for psychiatric symptoms using the Quick Inventory of Depressive Symptomatology and Hypomania Checklist-32. RESULTS Patients with bipolar disorder had a reduced speed of limb movement (15.8±5.7 vs. 11.8±2.2s; p<0.001), explosive leg muscle strength (134.9±49.0 vs. 167.6±32.3cm; p=0.003) and abdominal muscular endurance (11.5±7.8 vs. 18.3±7.6; p<0.001). Backward regression analyses demonstrated that longer illness duration, higher body mass index, higher levels of depression and a lower physical activity level explained the variance in physical fitness. LIMITATIONS Our data are cross-sectional and cannot establish cause and effect. CONCLUSIONS The current findings suggest that a lower physical fitness is emerging as an eminent modifiable risk factor for somatic co-morbidity in people with bipolar disorder. In particular less physically active persons, those with a longer illness duration and those with higher levels of depression might benefit from specific rehabilitation interventions aimed at increasing physical fitness.

Sitting time, physical fitness impairments and metabolic abnormalities in people with bipolar disorder: An exploratory study

A sedentary lifestyle is an independent risk factor for cardiovascular disease and mortality. Little is known however about sedentary behavior in people with bipolar disorder (BD). The primary aim of this study was to explore associations between sitting time (as a proxy for a sedentary lifestyle) and physical fitness and metabolic parameters in BD. A secondary aim was to investigate associations between psychiatric symptoms, psychotropic medication use and sitting time. Thirty-nine (21♀) participants (43.7±12.4 years) completed a full metabolic screening, the sitting time item of the International Physical Activity Questionnaire, the Quick Inventory of Depressive Symptomatology self-report and the Hypomania Checklist-32. Additionally participants performed the Eurofit-test battery and 6-min walk test. The mean time spent sitting per day for the entire sample was 7.0±3.0h. A higher body mass index, worse physical fitness and higher antipsychotic medication dose were identified as independent predictors of higher levels of sitting behavior. The model explained 76.5% of the variability in the sitting time. Given that a sedentary lifestyle is an independent predictor of cardiovascular disease, future interventions specifically targeting time spend sitting are warranted in BD, with a particular emphasis on those with high body mass index and low fitness levels.

The functional exercise capacity in patients with bipolar disorder versus healthy controls: A pilot study

The aim of the current study was to compare the functional exercise capacity of patients with bipolar disorder with age-, gender- and body mass index (BMI)-matched healthy controls. Thirty patients (16 ♂, 40.8±11.6 years) and healthy controls (16 ♂, 40.5±10.8 years) were included. All participants performed a 6-min walk test to assess the functional exercise capacity and completed the International Physical Activity Questionnaire. Patients were screened for psychiatric symptoms using the Quick Inventory of Depressive Symptomatology and Hypomania Checklist-32. Results demonstrated that patients with bipolar disorder demonstrated a significantly poorer functional exercise capacity (590.8±112.6 versus 704.2±94.3m). A backward stepwise regression analyses showed that the level of depression and existing foot or ankle static problems and back pain before the test explained 70.9% of the variance in the distance achieved on the 6-min walk test (functional exercise capacity). The current study demonstrates that foot and back pain appear to be important negative predictors of functional exercise capacity in patients with bipolar disorder. Physical activity interventions delivered by physical therapists may help ameliorate pain symptoms and improve functional exercise capacity.

Concurrent validity of the international physical activity questionnaire in outpatients with bipolar disorder: Comparison with the Sensewear Armband

The International Physical Activity Questionnaire (IPAQ) is a self-report questionnaire commonly used in mental health care settings to assess physical activity. However, despite its frequent use, its validity has not been investigated in people with bipolar disorder. The aim of this pilot study was to examine the concurrent validity of the energy expenditure recorded with the IPAQ compared with an objective measure, the Sensewear Armband (SWA). Twenty outpatients with bipolar disorder wore a SWA for 8 full consecutive days and subsequently completed the IPAQ. There was a significant correlation between the active (moderate and vigorous physical activity) energy expenditure as assessed with the IPAQ and SWA (minimum 10min bouts). The IPAQ overestimated active energy expenditure and underestimated total energy expenditure from physical activity by almost 40% compared with the SWA. Results demonstrate that the IPAQ should be used with caution as a measure for estimating energy expenditure from physical activity in outpatients with bipolar disorder.

Cardiorespiratory fitness in outpatients with bipolar disorder versus matched controls: An exploratory study

BACKGROUND Patients with bipolar disorder (BD) are approximately twice as likely to die prematurely due cardiovascular diseases (CVD) than the general population. Cardiorespiratory fitness (CRF) is an important health outcome measure, predictive for CVD and premature mortality. AIMS The aim of the current study was to compare the CRF of outpatients with BD versus age-, gender-, and body mass index (BMI)-matched healthy controls (HC). A secondary aim was to assess potential correlates of CRF. METHODS All participants underwent a maximal incremental exercise test to measure the maximum oxygen uptake (VO2max, the golden standard assessment of cardiorespiratory fitness), wore a Body Sensewear Armband for 5 subsequent days to assess their physical activity behavior and completed the Positive-and-Negative-Affect-Schedule (PANAS). RESULTS Outpatients with BD (n=20; 47.8±7.6years) had a significantly lower VO2max compared with HC (n=20; 47.8±7.6years) (26.0±7.3 versus 30.4±6.5ml/min/kg, P=0.047). A higher VO2max was correlated with younger age, higher active energy expenditure, higher PANAS positive and lower PANAS negative affect scores and a lower antipsychotic medication dose. LIMITATIONS The limited sample and cross-sectional design preclude definitive conclusions. CONCLUSIONS Compared with HC, outpatients with BD have reduced CRF levels of approximately 4.4ml/min/kg. In the general population such reductions are associated with a 20% increased premature mortality risk. Interventions targeting CRF in BD are required. Although more research is needed, clinicians should consider the utility of objective assessments of CRF for risk stratification in outpatient settings.

Validity of the 6min walk test in outpatients with bipolar disorder.

Cardiorespiratory fitness is a major modifiable risk factor for cardiovascular diseases. People with bipolar disorder have a reduced cardiorespiratory fitness and its assessment within a multidisciplinary treatment therefore is necessary. We investigated the validity of the 6min walk test in people with bipolar disorder. A secondary aim was to assess clinical and demographic characteristics that might interfere with cardiorespiratory fitness performance. 19 (5♂) outpatients (47.1±8.3 years) underwent a 6min walk test and a maximal cardiopulmonary exercise test on a cycle ergometer and completed the Positive-and-Negative-Affect-Schedule (PANAS) and Beck Depression Inventory (BDI). The distance achieved on the 6min walk test correlated moderately with peak oxygen uptake obtained during the maximal cardiopulmonary exercise test. The variance in age, weight and the PANAS negative score explained 70% of the variance in the distance achieved on the 6min walk test. The 6min walk test can be used as a measure-of-proxy to gauge cardiorespiratory fitness in people with bipolar disorder when maximal cardiopulmonary exercise test equipment is not available. Negative mood should be considered when evaluating the cardiorespiratory fitness of this vulnerable population.

A comparison of physical fitness in patients with bipolar disorder, schizophrenia and healthy controls

Abstract Purpose: To compare the physical fitness of inpatients with bipolar disorder, schizophrenia and healthy controls. Method: Twenty-two inpatients with bipolar disorder, and 22 age-, gender- and body mass index-matched inpatients with schizophrenia and healthy controls were included. All participants performed the Eurofit test battery and the International Physical Activity Questionnaire. One way analyses of variance with post hoc Scheffe were applied to examine differences. Results: Both patient groups were significantly more physically inactive and had a significantly impaired speed of limb movement, explosive muscle strength and abdominal muscular endurance compared to the healthy controls. No significant differences between the patient groups were found. Conclusions: The results suggest that physical fitness and physical activity participation are similar among inpatients with bipolar disorder and schizophrenia but markedly lower than healthy controls. Chronic inpatients with lower levels of physical activity may particularly benefit from rehabilitation interventions aimed at increasing physical fitness. Implications for Rehabilitation Physical fitness should receive similar attention in the treatment of bipolar disorder and schizophrenia. Sedentary patients with a longer duration of illness need additional support in changing lifestyle behaviours. Rehabilitation should not only consider cardio-respiratory fitness but also muscular endurance, muscular strength and balance.

Physical activity as a vital sign in patients with bipolar disorder.

The most significant contributor to premature mortality in patients with bipolar disorder is preventable cardiovascular diseases. This study investigated if the Physical Activity Vital Sign (PAVS) assessment (two questions which clarify if a person meets the recommended 150min of physical activity per week) can identify patients with bipolar disorder at higher risk of cardio-metabolic abnormalities. Clinical differences between those who adhere and those who did not adhere to the physical activity guidelines were investigated using an ANCOVA controlling for age and gender. Sixty-five (29♂) in- and outpatients with bipolar disorder (age=45.1±9.8years) completed the PAVS-questions, underwent full-fasting metabolic screening, and performed a six-minute walk test (6MWT). Those patients not meeting the physical activity recommendations had a higher body mass index, performed worse on the 6MWT and were at a significantly higher risk for cardio-metabolic diseases. Relative risks ranged from 1.33 for having dyslipidemia to 5.33 for hyperglycemia. The current data offer the first evidence that the PAVS assessment might be a useful vital sign in the routine assessment of in- and outpatients with bipolar disorder.

Test–retest reliability, feasibility and clinical correlates of the Eurofit test battery in people with bipolar disorder

The physical health of people with bipolar disorder is poorer in comparison to the general population, with an increased prevalence of cardiovascular and metabolic diseases. Due to the established beneficial effects, there is growing interest in the promotion of physical activity and in particular the accurate measurement of physical fitness in this population. Currently, no existing measures of physical fitness used in the general population have been tested for validity and reliability among people with bipolar disorder. Therefore, we examined the reproducibility, feasibility and correlates of the Eurofit test battery in people with bipolar disorder. From 24 men (43.0±13.0 years) and 22 women (43.9±10.2 years) with bipolar disorder two trials of the Eurofit test, administered within three days, were analyzed. All Eurofit items showed good reproducibility with intraclass correlation coefficients ranging from 0.71 for the whole body balance test to 0.98 for the handgrip force test. Significant correlations with Eurofit test items were found with age, illness duration, body mass index, smoking behavior, mean daily lithium dosage, and depressive and lifetime hypomanic symptoms. The current study demonstrates that the Eurofit test can be recommended for evaluating the physical fitness of inpatients with bipolar disorder.

Depressive symptoms and muscular fitness contribute independently to the ability to perform daily life activities in people with bipolar disorder

Abstract Background: Compared with healthy controls, people with bipolar disorder experience muscle weakness. The extent to which muscle weakness influences the performance of daily life activities such as walking in people with bipolar disorder requiring hospitalization is unclear. Aims: The primary aim of the current study was to explore whether depressive symptoms and muscular fitness independently contribute to the walking capacity in people with bipolar disorder. A secondary aim was to identify variables that could explain the variability in muscular fitness. Methods: Forty-two inpatients with bipolar disorder performed a standing broad jump test (SBJ), a measure of muscular performance, and the six minute walk test (6MWT) in addition to the International Physical Activity Questionnaire (IPAQ), the Depressive Symptomatology Self Report (QIDS) and a full-fasting metabolic screening. Results: The correlation between the 6MWT (595.0 ± 127.3m) and SBJ (126.2 ± 48.6m) was high (r = 0.72, p < 0.001). In backward regression analyzes, 82.3% of the variance in 6MWT was explained by SJB, QIDS (7.6 ± 5.1) and the presence of metabolic syndrome (n = 16; 38%), while 83.0% of the variance in SBJ-score was explained by age, and the QIDS and IPAQ (1435.3 ± 1179.8 MET-min/week) scores. Conclusions: Depressive symptoms and muscular fitness contribute independently to daily life functioning in people with bipolar disorder. Thus, muscular rehabilitation strategies might offer a strategy for improving performance of daily life activities in this group.