The Best Lifestyle Intervention For Bipolar Disorder: Exercise
Staying active has benefits beyond the body: it heals the mind
Many of us are given a diagnosis of bipolar but no tools to manage it. Instead, we have to learn these on our own or through the recommendations of other bipolar folks. Sadly, many of us aren’t clued into our local NAMI chapters or encouraged to check out resources like bpHope, and so we may not recognize the value of non-pharmacological interventions.
One of the most powerful tools I’ve found to manage my bipolar is the one I struggle with the most: exercise. I mostly attribute this dislike of exercise with compulsory physical education. For those of us who aren’t natural athletes, PE is excruciating, as we are rarely given actual education about how to do any of the exercises or sports we’re told to do. Instead, we’re handed a ball and a bat and expected to figure it out — or fail.
Now that I’m an adult, I’ve had to rebuild my relationship with exercise from the very foundations, and it starts with this most powerful lesson.
Exercise isn’t a punishment, it’s a treatment.
One of the most harmful things we do to children is teaching them that physical activity is something they should dread and fear. When teachers force students to run laps for being disobedient or fail them for not being able to run a twelve-minute mile, it associates physical activity with shame and embarrassment. This has been especially true since the educational system has been restructured around standardized testing.
While means-tested education is terrible in nearly every subject, it’s perhaps the worst when applied to physical education, which impacts young peoples’ relationships with their bodies for decades to come. I, and many others, have come to associate exercise with being mocked for not being able to do 30 push-ups in a minute or hearing the popular girls snicker about my legs in those dreadful Soffe shorts.
As adults, and especially as bipolar adults, we need to re-educate ourselves about why exercise is important for us and renavigate our relationship with physical activity.
Perhaps the most important part of appreciating exercise better is changing what we see as an acceptable outcome.
For AFAB people, this means divorcing exercise from weight loss outcomes. I mentioned in the previous instalment of this series how bipolar makes us more likely to gain weight and less likely to lose it; thus, it would be tempting to think that exercise is the magic bullet that will take that weight off, or that weight loss is the reason we should exercise in the first place. However, viewing physical activity in that way means you’ll become frustrated if the scale doesn’t budge, and you might give up on exercise entirely.
So, before you even think about picking up weights or lacing your running shoes, you need to stop thinking of weight loss as the sole reason to work out. Instead, view it as a potential side effect, a little perk if it happens. You are now going to see exercise as an important element of your treatment plan because of its other benefits — the ones you were probably never taught about in school.
I should point out now that these benefits and recommendations are applicable for everyone, not just people with bipolar, and anyone can implement these steps no matter whether they have bipolar or not. However, the mood, concentration, and sleep benefits of exercise are so critical to bipolar people that it’s appropriate to direct these interventions mainly at my fellow bipolar patients.
The greatest benefits of exercise do not involve weight loss.
Again, when you read these, recognize how critical they are to your well-being as a bipolar person and come to appreciate them as the reasons you need to privilege exercise.
Improved mood
Obviously, this is huge for bipolar people, which is why I’m putting it first; it’s the most immediate effect of exercise and the one that is often most important to us. Exercise releases endorphins and other hormones like dopamine and serotonin: the very neurotransmitters that psychiatric medication helps our brains to produce and use. Research shows that it’s not just a temporary effect, either; it can help reduce emotional lability in the long term.
Stress reduction
This is another big impact, as symptoms of bipolar can be extremely stressful on our bodies and minds. Cortisol, the chemical released in response to stress, is often too high or low in bipolar patients, and chronically high levels of cortisol can do serious damage, especially to our cardiovascular systems. Exercise helps the body manage cortisol levels, which is why we often feel so much calmer after a good workout. Regular exercise can lower cortisol levels in the long term, helping us feel more relaxed and better able to manage daily life.
Better sleep
The above effects of exercise also help improve sleep quality. You’ve probably already noticed that when you have a really busy day, you usually sleep like the dead that night. As we’ve already discussed, sleep is an absolutely essential part of controlling bipolar symptoms, and anything that helps us to do so is an important part of the toolkit.
Neurogenesis
Neurogenesis, in short, is the regeneration of brain tissue. We used to believe that you had a fixed amount of brain cells after puberty that were slowly picked off and could never be regained. Newer research has proven this isn’t completely true and that, instead, the brain functions much like other organs: it can repair itself to some extent after injury, and it can be strengthened and protected.
And just like other organs, the brain benefits from exercise. Some of this is due to the fact that exercise encourages the body to recycle damaged cells, and it revs up the immune system to fight inflammation. But the most important benefit is the development of new neurons in the hippocampus, an incredibly important section of the brain that plays a major role in bipolar disorder.
The size of the hippocampus is notably diminished in patients with bipolar, which can explain the symptoms of memory loss and emotional lability. While neurogenesis from exercise can’t make up for major shrinkage in the hippocampus, it can help reduce symptoms and prevent further deterioration.
Autophagy
Autophagy is the process of your body “eating” old, damaged cells and recycling those nutrients to make new, healthy cells. Older cells may have harmful mutations that, should they replicate, could become cancerous or produce misfolded proteins like the tangles responsible for Alzheimer’s. Autophagy is one of the responsibilities of the immune system, which is benefited by exercise.
Mental clarity and focus
Given how exercise improves your brain’s function, releases feel-good hormones, and helps to clean up damaged cells, it’s no surprise that it can improve your focus and concentration. This is no small benefit, as psychiatric medications are notorious for producing “brain fog” that make it difficult to focus, and bipolar is often comorbid with attention-deficit disorders that compound this symptom.
Inflammation reduction
Like mentioned above, exercise reduces systemic inflammation. This is critical because bipolar is often comorbid with autoimmune disorders, which are triggered in part by chronic inflammation, and because bipolar patients are more vulnerable to disorders like dementia, which are exacerbated, and perhaps triggered, by inflammation.
Energy production
This might seem contradictory, especially if you, like Trump, believe that the body has a limited store of energy that is drained by exercise. After all, you expend energy to exercise, so wouldn’t that mean you have less of it? To the contrary, exercise charges your internal batteries and amps up your energy production on a cellular level. For those of us who suffer from medication-induced fatigue, routine exercise can combat this side effect and help us function more efficiently.
I could go on for a whole book about the benefits of exercise, and people certainly have, but I hope by now you’re convinced that working out is a great addition to your tools to tackle bipolar. However, knowing the benefits and being able to consistently work out are two very different things.
How should you go about developing a good exercise routine? Here’s some advice.
Find your excuses and remove them
I know that this sounds critical and perhaps insensitive, but we are always going to find reasons not to do something we don’t want to do or don’t consider important. But it’s not enough to just recognize that you have excuses: you need to look each one in the eye and slay it, like a big whiny Hydra.
Take some time and write down every single excuse you can find, and then figure out a concrete solution to that excuse. (Many of the suggestions I make here are direct counters to those excuses.)
Do brief five-minute exercises throughout the day rather than an hour-long session
One of the major arguments people will make against exercise is that they don’t have enough time to go to the gym, or that they’re too tired to exercise after getting home from work, and so on.
Unless you are the busiest person on the planet, you can find five minutes throughout your day to move around. It can be as simple as getting up from your desk and taking the long way to the bathroom, or standing up and doing some stretches. I like to do squats or stretches while I wait for my tea to brew, or while I’m taking the dogs out to the bathroom.
Engineer your environment around activity
Until you use a standing desk once or twice, you may not realize just how much time you spend sitting. While I don’t really believe that sitting is the new smoking, I do recognize that it can wreak havoc on your energy levels and make you feel achy and lazy. However, you don’t need to buy a fancy new desk to work standing up: take a few thick books or a milk crate and put your computer on top of it
This is actually better because if you feel you can’t stand up any longer, you can remove the books and sit down for a while. I often rest my knee on my chair while I’m standing up and switch up which leg I’m standing on every few minutes.
Instead of getting a standing desk, you might opt for a low desk, like about the height of a coffee table, and squat on a cushion instead of using a chair. This position, which has unfortunately died out in Western society, helps to strengthen your leg muscles and improves balance; it can even help with your digestion and bowel movements.
Make your home or office more “inconvenient”
It makes perfect sense to keep all the things you’d need for an activity in the same place, and for those of us with attention problems it might make the difference between finishing something or leaving it half-done. However, if you’re really struggling to get up throughout the day, you can try moving things you use regularly out of arm’s reach, forcing you to at least get out of your chair, if not walk across the house.
Since I work from home on the second floor, I will often leave things downstairs so I have to retrieve them later, or I’ll use the downstairs bathroom instead of the one right next to the office. Instead of keeping lip balm or moisturizer by my desk, I’ll keep it in my bedroom, forcing me to walk to the next room to get it. While this can be annoying if I’m in the groove but have chapped lips, it also makes sure I’m not sitting for hours at a time.
Combine exercise with another favorite activity
The most obvious one for this is watching TV. One thing I like to do is designate a certain show on Amazon Prime that I only watch while I’m working out. Not only does this keep me from binge-watching an entire series in a night, it also keeps me motivated to work out on those days I might feel otherwise “blah,” because I just have to know what’s going to happen on the next episode. My brother and I are wrestling fans, so we often do steps or lift weights while we’re watching a pay-per-view. This brings me to my next point:
Make exercise social
This doesn’t mean you have to sign up for a spin class or take up Zumba; it can just mean that you and your family are active together. This keeps you accountable as well, because it’s much harder to make excuses to another person than it is to make excuses to yourself. Simply seeing a friend or family member being active can stir you to get your butt in gear, too; often my brother will start doing steps while watching TV, and it’ll convince me to get up and get a few steps in, too.
Take up hobbies that encourage activity
I learned this one from my brother, who has been a huge motivator in becoming more active myself. For the past three years, my brother has used roller coasters as his biggest motivator to stay in shape. My brother hadn’t been on a roller coaster in years because he couldn’t fit in the restraints. After we moved to Cleveland and the world-famous Cedar Point was within an hour’s drive, Sean decided that he wanted to ride every roller coaster he could, no matter what.
I can’t imagine how demoralizing it must have been those first few trips to Sandusky, where he could only fit on one or two rides, but instead of being disheartened, he used it as rocket fuel for his workouts. Within two years, he could fit on nearly every single roller coaster at Cedar Point, and he hasn’t stopped there: he’s traveled all across North America to get his adrenaline fix.
One of the great things about his theme park addiction isn’t just the motivation from getting on rides: it’s that theme parks themselves are built for walking. While most parks do have shuttles or trains to get from one side of the park to the other, it’s often just easier to walk from one coaster to the next. Theme parks also are designed with plenty of places to stop and rest if your endurance is low, and they are filled with water stations and bathrooms for those of who get dehydrated easily.
If you’re not big on roller coasters, there are plenty of other activities that require tons of walking or movement, like hiking, biking, kayaking, caving, horseback riding, or visiting museums. You can find local walking tours for nearly any interest, and many cities are starting to offer alternatives to pub crawls centred around interests like chocolate, fibre arts, local history, and sports. These are also awesome ways to make friends and support local businesses!
Base success on consistency rather than results
This is counter-intuitive because you would think that your success or failure should be based on metrics like weight loss. However, results from your efforts may take a while to show; you may exercise for weeks or months and never actually lose weight, or you might actually gain weight due to increased muscle mass. If you’re a patient person, this might be fine, but many of us with bipolar are not so patient and might give up before we ever see results.
This is why you should instead consider success to be consistency, and science backs it up. Long-term results for aerobic activity are mostly based on the frequency of exercise rather than intensity. Walking for twenty minutes every single day is going to improve your health metrics more than working yourself to exhaustion once a week, and doing a little bit of strength training everyday or every other day will improve muscle tone more than one or two intense sessions a week.
If you’re a visual person, you might consider getting a calendar and putting a sticker on every day where you exercised for half an hour or more. If you can afford it, a Fitbit analyzes how many minutes per day you were active, regardless of whether this is a traditional workout or just walking around your house. It can also help you set activity goals, such as steps per day or active minutes per day.
Develop rewards that amplify your success
This means no food-based rewards, as tempting as they may be! Instead, pick rewards for yourself that encourage further activity. For example, you could decide that if you are active every day for a whole month, you’ll buy yourself a new pair of sneakers or a new pair of yoga pants.
My whole family loves Yes.Fit, which allows you to run virtual races and get prizes when you complete one. The races are all themed and based on a real-world location. Right now, my brother and I are completing the Manatees race, which takes place in Florida. These are great because you can take as long as you need to complete a race and they send you motivating emails showing you where you are in the race. You can choose to get a medal, a t-shirt, or both. I love getting the t-shirts because they make me feel like a “real” athlete when I wear them to work out!
Decide on a minimum
If you’re making real change, you need to acknowledge that some days you’re just going to feel like garbage and won’t want to do anything, much less work out. This is especially true for bipolar people; after all, the whole point of the disorder is that sometimes you feel terrible.
Instead of saying eff it and not doing anything because you don’t feel good, decide on a bare minimum that you need to do every day. Maybe it’s 20 minutes of walking, maybe it’s 5,000 steps, maybe it’s just getting out of bed: whatever you feel you could reasonably do on your very worst day. This encourages you to stay consistent and keeps you from punishing yourself when you’re not up to a full workout. Remember, you’re basing your success on consistency, not physical results.
Play the long game
You’re setting yourself up for disaster if you set only short-term goals, like losing twenty pounds in time for your best friend’s wedding. At best, you’ll reach the goal, celebrate, and then feel you’ve “achieved” fitness and don’t have to do anything else. At worst, you won’t reach the goal, feel like a failure, and decide that because you can’t do that, you might as well give up on the whole project.
Short-term goals can be great if you recognize that they are just that, short-term goals that are a part of a bigger plan. However, your short-term goals are probably not sustainable in the long run, either physically or psychologically. You may run like a maniac to lose those twenty pounds, but you can’t keep that pace up forever, much less continue to get the same results.
Again, this is why it’s better to base your goals only on your consistency and not on physical results. While it might not be as flashy and exciting, it is more sustainable, and it is also self-perpetuating, helping you to develop fitness as a habit.
Set up a reward scheme that is based on how long you continue to be active, one that acknowledges how much motivation you really need. For some people, they will be happy buying themselves a small gift after a month; for others, they’ll need to reward themselves every week or they’ll get discouraged and give up. Only you know how motivating an extrinsic reward is for you personally, so figure out what works for you.
Ideally, you are working to create a lifelong habit of health, one that supports your other bipolar treatments and helps you better function in your everyday life. This means it’s tailored to your own needs and your own goals, rather than an arbitrary ideal or someone else’s habits.
One of the most freeing things I ever learned was that everyone has their ideal body and everyone’s ideal body is different. Some of us are simply not going to look like Instagram models, and that’s ok. It doesn’t mean you’ve failed if you don’t have rock-hard abs or an hourglass silhouette. The only person you can fail is yourself, and the only way you can fail is if you don’t honour your commitment to yourself — your commitment to be your best self.