Sitting time, physical fitness impairments and metabolic abnormalities in people with bipolar disorder: An exploratory study
Introduction
A recent meta-analysis (Walker et al., 2015) demonstrated that mortality rates are approximately two to three times higher in people with bipolar disorder than those of the general population. The higher premature mortality rates are largely attributable to cardiovascular disease (Goldstein et al., 2015). In the general population there is evidence that physical activity and exercise are broadly as effective as pharmacological interventions in preventing cardio-metabolic diseases and consequently premature mortality (Naci and Ioannidis, 2013). Data in people with bipolar disorder are however inconsistent with some studies finding a strong association between the level of physical activity participation and the risk for cardio-metabolic diseases (Salvi et al., 2011), while others in a mixed study including people with bipolar disorder and schizophrenia did not (Bly et al., 2014). Physical activity guidelines and recommendations for preventing and treating cardiovascular diseases have historically emphasized moderate-vigorous physical activity, or physical activity at an intensity greater than 45% of the maximum oxygen uptake (Garber et al., 2011). In last years, there has been a rapid emergence of studies indicating that cardiovascular disease risks are also, independent of the physical activity behavior, associated with sedentary behavior (Wilmot et al., 2012). Sedentary behavior can be defined as an energy expenditure ≤1.5 metabolic equivalents of task (METs), while in a sitting or reclining posture during waking hours (Cart, 2012). To date, there is a paucity of data on sedentary behavior among people with bipolar disorder. In an exploratory study among 60 adult outpatients with bipolar disorder, patients were sedentary for approximately 13.5 h per day according to accelerometers worn over seven consecutive days (Janney et al., 2014). This is more than double the level of sedentary behavior reported in older populations (>60 years) (mean=5.3 h per day) (Harvey et al., 2014) and similar to the levels found in people with psychosis (Stubbs et al., 2016). The extent to which sedentary behavior in people with bipolar disorder contributes to the previously observed physical fitness impairments (Vancampfort et al., 2015c, Vancampfort et al., 2015e, Vancampfort et al., 2015g) and metabolic abnormalities (Vancampfort et al., 2015d), both predictors for cardiovascular diseases and premature mortality (Lee et al., 2010), is unknown. Given that sedentary behavior is modifiable, understanding sedentary behavior levels and correlates might offer a unique opportunity to reduce the considerable cardio-metabolic rates seen in people with bipolar disorder (Vancampfort et al., 2015a, Vancampfort et al., 2013).
The primary aim of this cross-sectional study was to explore associations between sitting time, as the most common sedentary behavior, and physical fitness and metabolic parameters in people with bipolar disorder. A secondary aim was the investigate associations between sitting time and psychiatric symptoms and psychotropic medication use.
Section snippets
Participants and procedure
Over a 6-month period, inpatients with a DSM-5 diagnosis of bipolar disorder (American Psychiatric Association, 2013) of the University Psychiatric Center KU Leuven campus Kortenberg in Belgium were invited to participate. Since severe substance abuse might impair the physical fitness test performances (Herbsleb et al., 2013), participants were excluded if they had a co-morbid DSM-5 diagnosis of substance abuse during the previous 6 months. The somatic exclusion criteria included evidence of
Participants
A total of 51 persons with bipolar disorder were initially recruited. Four persons with co-morbid substance abuse during the previous 6 months were excluded. Two persons were excluded as a consequence of a cardiovascular or neuromuscular disorder that might prevent safe participation. Of the 45 included persons with bipolar disorder, 5 declined to participate (i.e. not interested). One patient indicated he could not estimate how much time he spent sitting and was excluded from the analyses.
General findings
The current study is, to our knowledge, the first to investigate sedentary behavior in people with bipolar disorder. Our data show that a higher BMI, worse physical fitness (shuttle run test performance) and a higher antipsychotic medication dose are associated with a more sedentary lifestyle.
A higher BMI is a measure-of-proxy for the presence of obesity. Obesity consistently emerges as a key and potentially modifiable risk factor in the onset and progression of musculoskeletal conditions and
Funding
None.
Conflict of interest
None to report.
Acknowledgements
The first author receives funding from the Research Foundation – Flanders (FWO-Vlaanderen).
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