Recommended amount of physical activity per day for the general population:

Children and adolescents ages 6 through 17 years should do 60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily:

• Aerobic: Most of the 60 minutes or more per day should be either moderate- or vigorous intensity aerobic physical activity and should include vigorous-intensity physical activity on at least 3 days a week.

• Muscle-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days a week.

• Bone-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days a week

For substantial health benefits, adults (18+) should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.

• Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week.

1. Current Physical Activity Guidelines• Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.

• Adults should move more and sit less throughout the day. Some physical activity is better than none.

• Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits.

Recommended amount of physical activity for people with bipolar disorder:

There are no specific physical activity guidelines for people with bipolar disorder, but physical activity is known to reduce the risk of bipolar episodes. Federal guidelines offer general recommendations for adults with chronic conditions (including bipolar among many others). These guidelines are almost identical to those for the general population.

• Adults with chronic conditions or disabilities, who are able, should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.

• Adults with chronic conditions or disabilities, who are able, should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.

• When adults with chronic conditions or disabilities are not able to meet the above key guidelines, they should engage in regular physical activity according to their abilities and should avoid inactivity.

• Adults with chronic conditions or symptoms should be under the care of a health care provider. People with chronic conditions can consult a health care professional or physical activity specialist about the types and amounts of activity appropriate for their abilities and chronic conditions.

Benefits/Risks associated with meeting/not meeting Physical Activity Guidelines

Benefits of meeting guidelines (General Population):

For both children and adults, meeting physical activity guidelines are associated with reduced morbidity and all-cause mortality. In children and adolescents, there are numerous physical and psychosocial benefits associated with engagement in physical activity (e.g., improvements in cardiovascular and metabolic risk profile, depression, and self-esteem). (Janssen et al., 2010; Rasmussen et al., 2013).

Benefits of meeting guidelines (Bipolar disorder):

A 2020 study by Sun et al found genetic evidence that overall physical activity is an effective preventive factor for Bipolar disorder.

Lafer et al (2023) found that a 12-week structured exercise program significantly reduced depressive symptoms in people with bipolar.

Potential harms associated with not meeting guidelines (Bipolar disorder):

People with bipolar disorder have a higher risk of cardiovascular disease (Hayes, 2015), and medications commonly used to treat bipolar disorder can increase risk for metabolic disorder (De Almeida et al, 2012).

Physical Activity Behaviors and Physiological Variables

Why is it important to objectively monitor physical activity?

Self-report has been the most widely used measure of physical activity among people with bipolar disorder historically but is accepted as less reliable than objective measures such as accelerometry.

Predictive Potential of Physical Activity/Physiological Metrics

While no single variable has been shown to accurately predict onset of a manic or depressive episode, it is likely that episodes are preceded by changes across a range of behavioral (e.g. daily MVPA) and physiological (e.g. resting heart rate, and/or heart rate variability) metrics.

References

Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Activ. 2010;7(1):1-16.

Rasmussen M, Laumann K. The academic and psychological benefits of exercise in healthy children and adolescents. Eur J Psychol Educ. 2013;28(3):945-962.

Hayes, J. F., Miles, J., Walters, K., King, M., & Osborn, D. P. J. (2015). A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatrica Scandinavica, 131(6), 417-425. doi:10.1111/acps.12408

De Almeida, K.M., Moreira, C.L., & Lafer, B. (2012). Metabolic syndrome and bipolar disorder: What should psychiatrists know? CNS Neuroscience and Therapeutics, 18: 160–166.

Lafer B, Duarte CC, Greve JMD, Dos Santos Silva PR, de Almeida KM, Belizario GO, Neves LM. Structured physical exercise for bipolar depression: an open-label, proof-of concept study. Int J Bipolar Disord. 2023 Apr 21;11(1):14.

Sun J, Zhao Z, Xu K, et al. (2020). Genetic associations of physical activity and bipolar disorder: A large-scale genome-wide cross-trait analysis. Molecular Psychiatry, 25: 371-387. doi:10.1038/s41380-019-0473-7.