Exercise is medicine: a new perspective for health promotion in bipolar disorder

Altered resting-state functional connectivity of amygdala subregions in adults with subthreshold depression after aerobic exercise

Aerobic exercise has been proved to reduce the risk of major depression in subthreshold depression (StD) individuals effectively, yet previous studies ignored the different functions of amygdala subregions. In this study, 44 StD individuals and 34 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging before and after eight weeks of aerobic exercise respectively. Transverse and longitudinal analyses were conducted based on the seed-based functional connectivity (FC) analysis between amygdala subregions and the whole brain of the two groups. The transverse analyses showed that compared to HCs, StD individuals showed abnormal FC between the right dorsal amygdala (DA) and right superior frontal gyrus, the left medial amygdala (MA) and left gyrus rectus, right caudate, as well as the right ventrolateral amygdala (VA) and right angular gyrus before the exercise intervention, while increased FC between the right DA and left supramarginal gyrus after the exercise intervention. The longitudinal analysis showed decreased FC between the left DA and left caudate, left middle frontal gyrus, while increased FC between the right MA and posterior central gyrus in StD individuals after exercise intervention. As for HCs, the DA showed FC differences with the insula, frontal lobe, parietal lobe, temporal lobe and thalamus. The MA showed FC differences with the central posterior gyrus, occipital lobe and thalamus. The VA showed FC differences with the calcarine cortex and parietal lobe. The findings demonstrated the alleviative effect of aerobic exercise on depression from the perspective of brain function.

The role of torso stiffness and prediction in the biomechanics of anxiety: a narrative review

Although anxiety is a common psychological condition, its symptoms are related to a cardiopulmonary strain which can cause palpitation, dyspnea, dizziness, and syncope. Severe anxiety can be disabling and lead to cardiac events such as those seen in Takotsubo cardiomyopathy. Since torso stiffness is a stress response to unpredictable situations or unexpected outcomes, studying the biomechanics behind it may provide a better understanding of the pathophysiology of anxiety on circulation, especially on venous impedance. Any degree of torso stiffness related to anxiety would limit venous return, which in turn drops cardiac output because the heart can pump only what it receives. Various methods and habits used to relieve stress seem to reduce torso stiffness. Humans are large obligatory bipedal upright primates and thus need to use the torso carefully for smooth upright activities with an accurate prediction. The upright nature of human activity itself seems to contribute to anxiety due to the needed torso stiffness using the very unstable spine. Proper planning of actions with an accurate prediction of outcomes of self and non-self would be critical to achieving motor control and ventilation in bipedal activities. Many conditions linked to prediction errors are likely to cause various degrees of torso stiffness due to incomplete learning and unsatisfactory execution of actions, which will ultimately contribute to anxiety. Modifying environmental factors to improve predictability seems to be an important step in treating anxiety. The benefit of playful aerobic activity and proper breathing on anxiety may be from the modulation of torso stiffness and enhancement of central circulation resulting in prevention of the negative effect on the cardiopulmonary system.

Developing "MinDag" - an app to capture symptom variation and illness mechanisms in bipolar disorder

Introduction

The illness course of bipolar disorder (BD) is highly heterogeneous with substantial variation between individuals with the same BD subtype and within individuals over time. This heterogeneity is not well-delineated and hampers the development of more targeted treatment. Furthermore, although lifestyle-related behaviors are believed to play a role in the illness course, such mechanisms are poorly understood. To address some of these knowledge gaps, we aimed to develop an app for collection of multi-dimensional longitudinal data on BD-relevant symptoms and lifestyle-related behaviors.

Methods

An app named MinDag was developed at the Norwegian Center for Mental Disorders Research in Oslo, Norway. The app was designed to tap into selected areas: mood, sleep, functioning/activities (social, occupational, physical exercise, leisure), substance use, emotional reactivity, and psychotic experiences. Ethical, security and usability issues were highly prioritized throughout the development and for the final app solution. We conducted beta- and pilot testing to eliminate technical problems and enhance usability and acceptability.

Results

The final version of MinDag comprises six modules; three which are presented for the user once daily (the Sleep module in the morning and the Mood and Functoning/Activities modules in the evening) and three which are presented once weekly (Substance Use, Emotional Reactivity, and Psychotic Experiences modules). In general, MinDag was well received in both in the beta-testing and the pilot study, and the participants provided valuable feedback that was taken into account in the final development. MinDag is now in use as part of the research protocol at the NORMENT center and in a specialized treatment unit for BD at Oslo University Hospital in Norway.

Discussion

We believe that MinDag will generate unique longitudinal data well suited for capturing the heterogeneity of BD and clarifying important unresolved issues such as how life-style related behavior may influence BD symptoms. Also, the experiences and knowledge derived from the development of MinDag may contribute to improving the security, acceptability, and benefit of digital tools in mental health.

Effect of online aerobic exercise training in patients with bipolar depression: Protocol of a randomized clinical trial

INTRODUCTION

Bipolar disorder (BD) is a common and debilitating mental illness that affects about 400 million people worldwide, decreasing their functionality and quality of life. Medication and psychotherapy are recommended for treatment of BD, while some evidence indicates that exercise could improve the clinical outcome of BD. This study aims to investigate whether exercise intervention could reduce the mood symptoms and inflammation level of BD.

METHODS

This is a longitudinal, interventional, randomized, and single-blind trial. We plan to recruit 94 patients diagnosed with BD in depression episode. Patients will be randomly assigned to treatment as usual + aerobic exercise group (intervention group) and treatment as usual (TAU) only group, at a ratio of 1:1. The intervention group will undergo 40-min aerobic exercise training twice a week for eight weeks. The primary outcome of this study is the mean change of Hamilton Depression Rating Scale 17 (HAMD 17) scores from baseline to week 8. The Young Manic Rating Scale (YMRS), Self-Rating Depression Scale (SDS), and Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) levels will also be measured. The measurements will be performed at baseline, immediately after intervention and two months after intervention.

DISCUSSION

Aerobic exercise training + treatment is expected to bring more benefits to BD patients than TAU only. This trial might provide stronger evidence of physical exercise efficacy for BD treatment.

CLINICAL TRIAL REGISTRATION

This study was approved by the Chinese Clinical Trial Registry (Registration Code: ChiCTR2200057159). Registered on 1 March 2022.

Bibliometric Review to Explore Emerging High-Intensity Interval Training in Health Promotion: A New Century Picture

Background: High-intensity interval training (HIIT) is an emerging exercise strategy and is considered to be a recipe for health promotion. This study aimed to systematically identify collaboration networks, track research trends, highlight current hotspots, and predict future frontiers in HIIT and its applications in health promotion since the start of the new century. Methods: Relevant original publications were obtained from the Science Citation Index Expanded of the Web of Science Core Collection (WoSCC) database between 2001 and 2020. CiteSpace and VOSviewer software were used to perform bibliometric visualization and comparative analysis of involved indexes that included countries, institutions, journals, authors, references, and keywords. Results: A total of 572 papers were included, and the trend of annual publications showed a remarkable growth. The United States and the University of Exeter were the most productive country and institutions, respectively, with 107 and 18 publications, respectively. European Journal of Applied Physiology took the lead in the number of published articles, and Medicine and Science in Sports and Exercise ranked first in the cocitation counts. Barker AR and Gibala MJ were considered as the most productive and the most highly-cited authors. Conclusions: "Health risks," "adolescent," and "aging" are the three noteworthy topics during the evolution of HIIT-health promotion (HIIT-HP) research. The current research hotspots of HIIT and its practices in the health promotion domain lies in "metabolic diseases," "cardiovascular diseases," "neurological diseases," and "musculoskeletal diseases." The authors summarize that "prevention and rehabilitation," "micro and molecular level," and "cognition and mental health" are becoming frontiers and focus on the health topics related to HIIT in the upcoming years, which are worthy of further exploration.