Keywords:
Bipolar disorder
aerobic exercise
depressive symptoms
mood stability
cognitive function
physical health

  • Abstract

    Bipolar affective disorder is associated with substantial physical health burden, mood disturbance, and cognitive difficulty, yet lifestyle-based approaches remain weakly integrated into routine psychiatric care, particularly in low-resource settings. Aerobic exercise has been proposed as a useful adjunctive strategy, but evidence specific to bipolar disorder populations remains limited. This study examined whether participation in aerobic exercise is associated with physical health, mood stability, depressive symptoms, and cognitive functioning among patients with bipolar affective disorder receiving care in a Nigerian tertiary psychiatric hospital. A retrospective cross-sectional observational design was employed. The participants were adults with a clinical diagnosis of bipolar affective disorder receiving inpatient or outpatient care (N = 103). Aerobic exercise participation and biopsychological functioning were assessed using a structured self-report questionnaire. Associations between aerobic exercise participation and each outcome domain were examined using simple linear regression analyses. Higher levels of aerobic exercise participation were associated with better perceived physical health, greater mood stability, lower depressive symptom severity, and better cognitive functioning. The associations were strongest for depressive symptoms and moderate for physical health, mood stability, and cognitive functioning. All the observed relationships were statistically significant and consistent in direction. Aerobic exercise participation was associated with multiple domains of biopsychological functioning among patients with bipolar affective disorder in routine psychiatric care. These findings indicate that aerobic exercise participation is associated with multiple domains of biopsychological functioning; however, no causal or intervention effect can be inferred from the present cross-sectional design. The results should be interpreted as associative rather than causal, given the observational design.

  • References

    1. Adasik, D., Bonarska, M., Łocik, G., Szymczyk, S., & Król, K. (2025). Running from depression: a review of aerobic exercise as an adjunctive treatment for mood disorders. Quality in Sport, 40, 59789-59789. https://doi.org/10.12775/qs.2025.40.59789
    2. Al-Mhanna, S. B., Batrakoulis, A., Ghazali, W. S. W., Mohamed, M., Aldayel, A., Alhussain, M. H., ... & Rojas-Valverde, D. (2024). Effects of combined aerobic and resistance training on glycemic control, blood pressure, inflammation, cardiorespiratory fitness and quality of life in patients with type 2 diabetes and overweight/obesity: a systematic review and meta-analysis. PeerJ, 12, e17525. https://peerj.com/articles/17525/
    3. Amin, M., Kerr, D., Atiase, Y., Aldwikat, R. K., & Driscoll, A. (2023). Effect of physical activity on metabolic syndrome markers in adults with type 2 diabetes: a systematic review and meta-analysis. Sports, 11(5), 101. https://doi.org/10.3390/sports11050101
    4. Ancín-Osés, A., Izquierdo, M., Cuesta, M. J., & de Asteasu, M. L. S. (2025). Effects of physical exercise on metabolic syndrome in psychotic disorders: A systematic review with meta-analysis of randomized controlled trials. European Psychiatry, 68(1), e101. https://doi.org/10.1192/j.eurpsy.2025.10064
    5. Banyard, H., Edward, K. L., Garvey, L., Stephenson, J., Azevedo, L., & Benson, A. C. (2025). The Effects of Aerobic and Resistance Exercise on Depression and Anxiety: Systematic Review With Meta‐Analysis. International Journal of Mental Health Nursing, 34(3), e70054. https://doi.org/10.1111/inm.70054
    6. Bernstein, E. E., & McNally, R. J. (2017). Acute aerobic exercise helps overcome emotion regulation deficits. Cognition and Emotion, 31(4), 834–843. https://doi.org/10.1080/02699931.2016.1168284
    7. Bi, X., Fang, J., Jin, X., & Thirupathi, A. (2024). The interplay between BDNF and PGC-1 alpha in maintaining brain health: role of exercise. Frontiers in Endocrinology, 15, 1433750. https://doi.org/10.3389/fendo.2024.1433750
    8. Brobakken, M. F., Nygård, M., & Wang, E. (2022). Physical health impairment and exercise as medicine in severe mental disorders: A narrative review. Sports Medicine-Open, 8(1), 115. https://doi.org/10.1186/s40798-022-00490-3
    9. Cefis, M., Chaney, R., Wirtz, J., Méloux, A., Quirié, A., Leger, C., Prigent-Tessier, A., & Garnier, P. (2023). Molecular mechanisms underlying physical exercise-induced brain BDNF overproduction. Frontiers in Molecular Neuroscience, 16, 1245244. https://doi.org/10.3389/fnmol.2023.1275924
    10. Choi, J. W., Jo, S. W., Kim, D. E., Paik, I. Y., & Balakrishnan, R. (2024). Aerobic exercise attenuates LPS-induced cognitive dysfunction by reducing oxidative stress, glial activation, and neuroinflammation. Redox Biology, 71, 103101. https://doi.org/10.1016/j.redox.2024.103101
    11. Etxaniz‐Oses, J., Maldonado‐Martín, S., Zorrilla, I., Gorostegi‐Anduaga, I., Apodaca‐Arrizabalaga, M. J., & González‐Pinto, A. (2025). Are Adults with Bipolar Disorder at Increased Cardiovascular Risk due to Their Physical, Biochemical, and Physiological Profiles? The FINEXT‐BD Study. Brain and Behavior, 15(2), e70297. https://doi.org/10.1002/brb3.70297
    12. Filho, A. S., Cheniaux, E., de Paula, C., Murillo-Rodríguez, E., Teixeira, D., Monteiro, D., … Machado, S. (2020). Exercise is medicine: A new perspective for health promotion in bipolar disorder. Expert Review of Neurotherapeutics, 20(11), 1099–1107. https://doi.org/10.1080/14737175.2020.1807329
    13. Gomes-Da-Costa, S., Fernández-Pérez, I., Borràs, R., Lopez, N., Rivas, Y., Ruíz, V., Pons-Cabrera, M., Giménez-Palomo, A., Anmella, G., Valentí, M., Berk, M., Vieta, E., & Pacchiarotti, I. (2024). Is a vegetarian diet beneficial for bipolar disorder? Relationship between dietary patterns, exercise and pharmacological treatments with metabolic syndrome and course of disease in bipolar disorder. Acta Psychiatrica Scandinavica, 150, 209–222. https://doi.org/10.1111/acps.13733
    14. Guo, Z., Lai, A., Thygesen, J., Farrington, J., Keen, T., & Li, K. (2024). Large language models for mental health applications: Systematic review. JMIR Mental Health, 11, e57400. https://doi.org/10.2196/57400
    15. Hamada, F., Hori, H., Iida, H., Yokoyama, H., Sugawara, H., Hatanaka, A., Gotoh, L., Ogata, M., Kumagai, H., Yano, R., Tomiyama, Y., Yoshida, T., Yamaguchi, Y., Asada, R., Masuda, M., Okamoto, Y., & Kawasaki, H. (2023). Effects of exercise on functional recovery in patients with bipolar depression: A study protocol for a randomized controlled trial. Metabolites, 13(9), 981. https://doi.org/10.3390/metabo13090981
    16. He, J., Liu, F., Xu, P., Xu, T., Yu, H., Wu, B., Wang, H., Chen, J., Zhang, K., Zhang, J., Meng, K., Yan, X., Yang, Q., Zhang, X., Sun, D., & Chen, X. (2024). Aerobic exercise improves the outcome of type 2 diabetes mellitus among people with mental disorders. Depression and Anxiety, 6651804. https://doi.org/10.1155/da/6651804
    17. Hearing, C. M., Chang, W. C., Szuhany, K. L., Deckersbach, T., Nierenberg, A. A., & Sylvia, L. G. (2016). Physical exercise for treatment of mood disorders: A critical review. Current Behavioral Neuroscience Reports, 3, 350–359. https://doi.org/10.1007/s40473-016-0089-y
    18. Ishihara, T., Drollette, E. S., Ludyga, S., Hillman, C. H., & Kamijo, K. (2021). The effects of acute aerobic exercise on executive function: A systematic review and meta-analysis of individual participant data. Neuroscience & Biobehavioral Reviews, 128, 258–269. https://doi.org/10.1016/j.neubiorev.2021.06.026
    19. Jia, Y., Yao, Y., Zhuo, L., Chen, X., Yan, C., Ji, Y., ... & Zhu, Y. (2022). Aerobic physical exercise as a non-medical intervention for brain dysfunction: state of the art and beyond. Frontiers in neurology, 13, 862078. https://doi.org/10.3389/fneur.2022.862078
    20. Kandola, A., Hendrikse, J., Lucassen, P. J., & Yücel, M. (2016). Aerobic exercise as a tool to improve hippocampal plasticity and function in humans: Practical implications for mental health treatment. Frontiers in Human Neuroscience, 10, 373. https://doi.org/10.3389/fnhum.2016.00373
    21. Kucyi, A., Alsuwaidan, M. T., Liauw, S. S., & McIntyre, R. S. (2010). Aerobic physical exercise as a possible treatment for neurocognitive dysfunction in bipolar disorder. Postgraduate Medicine, 122(6), 107–116. https://doi.org/10.3810/pgm.2010.11.2228
    22. Lafer, B., Duarte, C. C., Greve, J. M. D., dos Santos Silva, P. R., de Almeida, K. M., Belizario, G. O., & Neves, L. M. (2023). Structured physical exercise for bipolar depression: An open-label, proof-of-concept study. International Journal of Bipolar Disorders, 11(1), 14. https://doi.org/10.1186/s40345-023-00294-8
    23. Li, X., Liu, F., Ding, F., Ma, X., & Zhu, Y. (2025). Exercise interventions for depressive, manic, and anxiety symptoms in bipolar disorder: A systematic review and meta-analysis. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1648008
    24. Lindell, M. K., & Whitney, D. J. (2001). Accounting for common method variance in cross-sectional research designs. Journal of Applied Psychology, 86(1), 114–121. https://doi.org/10.1037/0021-9010.86.1.114
    25. Lukkahatai, N., Ong, I., Benjasirisan, C., & Saligan, L. (2025). Brain-derived neurotrophic factor as a marker of physical exercise effects on fatigue, pain, depression, and sleep: A scoping review. Biomedicines, 13, 332. https://doi.org/10.3390/biomedicines13020332
    26. MacIntosh, B. J., Shirzadi, Z., Scavone, A., Metcalfe, A. W., Islam, A. H., Korczak, D., & Goldstein, B. I. (2017). Increased cerebral blood flow among adolescents with bipolar disorder at rest is reduced following acute aerobic exercise. Journal of affective disorders, 208, 205-213. https://doi.org/10.1016/j.jad.2016.08.060
    27. Marx, W., Manger, S., Blencowe, M., Murray, G., Ho, F., Lawn, S., … O’Neil, A. (2022). Clinical guidelines for lifestyle-based mental health care in major depressive disorder. World Journal of Biological Psychiatry, 24, 333–386. https://doi.org/10.1080/15622975.2022.2112074
    28. McGurk, S. R., Otto, M. W., Fulford, D., Cutler, Z., Mulcahy, L. P., Talluri, S. S., ... & Mueser, K. T. (2021). A randomized controlled trial of exercise on augmenting the effects of cognitive remediation in persons with severe mental illness. Journal of Psychiatric Research, 139, 38-46. https://doi.org/10.1016/j.jpsychires.2021.04.033
    29. Melo, M. C. A., Daher, E. D. F., Albuquerque, S. G. C., & de Bruin, V. M. S. (2016). Exercise in bipolar patients: A systematic review. Journal of Affective Disorders, 198, 32–38. https://doi.org/10.1016/j.jad.2016.03.004
    30. Metcalfe, A. W. S., MacIntosh, B. J., Scavone, A., Ou, X., Korczak, D. J., & Goldstein, B. I. (2016). Effects of acute aerobic exercise on neural correlates of attention and inhibition in adolescents with bipolar disorder. Translational Psychiatry, 6, e814. https://doi.org/10.1038/tp.2016.85
    31. Milic, J., Zrnic, I., Vucurovic, M., Grego, E., Djurdjevic, S., & Sapic, R. (2025). Short Communication on Proposed Treatment Directions in Bipolar Disorder: A Psychotherapy Perspective. Journal of Clinical Medicine, 14(6), 1857. https://doi.org/10.3390/jcm14061857
    32. Morres, I., Hatzigeorgiadis, A., Stathi, A., Comoutos, N., Arpin-Cribbie, C. A., Krommidas, C., & Theodorakis, Y. (2019). Aerobic exercise for adults with major depressive disorder in mental health services: A systematic review and meta-analysis. Depression and Anxiety, 36(1), 39–53. https://doi.org/10.1002/da.22842
    33. Neto, H., Moreira, A., Hosken, L., Langfus, J., Cavalcanti, M., Youngstrom, E., & Telles-Correia, D. (2023). Inter-rater reliability between structured and non-structured interviews in schizophrenia and bipolar disorders: A systematic review and meta-analysis. Diagnostics, 13(3), 526. https://doi.org/10.3390/diagnostics13030526
    34. Popel, N., Kennedy, K. G., Fiksenbaum, L., Mitchell, R. H., MacIntosh, B. J., & Goldstein, B. I. (2021). Clinical and neuroimaging correlates of cardiorespiratory fitness in adolescents with bipolar disorder. Bipolar Disorders, 23(3), 274-283. https://doi.org/10.1111/bdi.12993
    35. Ringin, E., Dunstan, D. W., Meyer, D., McIntyre, R. S., Owen, N., Berk, M., Rossell, S. L., Hallgren, M., & Van Rheenen, T. E. (2025). Relationships of cognitive function with subsequent device-measured physical activity and sedentary time in healthy individuals and those with bipolar disorder: Findings from the UK Biobank. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.70011
    36. Rodrigues, G., Pellini, G., Rocha, R., Lima, A., De Almeida Fleck, M., Panzenhagen, A., Shansis, F., & Capp, E. (2024). Diagnosis of bipolar and major depressive disorders: Appropriateness of the MINI compared with clinical interview. Journal of Psychiatric Research, 169, 341–346. https://doi.org/10.1016/j.jpsychires.2023.11.012
    37. Sallis, J. F., & Saelens, B. E. (2000). Assessment of physical activity by self-report: Status, limitations, and future directions. Research Quarterly for Exercise and Sport, 71(2), 1–14. https://doi.org/10.1080/02701367.2000.11082780
    38. Schmitt, A., Maurus, I., Rossner, M. J., Röh, A., Lembeck, M., von Wilmsdorff, M., … Falkai, P. (2018). Effects of aerobic exercise on metabolic syndrome and cardiorespiratory fitness in schizophrenia. Frontiers in Psychiatry, 9, 690. https://doi.org/10.3389/fpsyt.2018.00690
    39. Silva, R. C., Meattini, M., Perusi, G., Carletto, S., Bortolomasi, M., Gennarelli, M., Baune, B. T., & Minelli, A. (2025). Biological mechanisms underlying the effects of physical exercise in major depressive disorder: A systematic review of randomized controlled trials. Psychological Medicine, 55, Article e197. https://doi.org/10.1017/S0033291725100743
    40. Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., … Maher, C. (2023). Effectiveness of physical activity interventions for depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine, 57(16), 1045–1054. https://doi.org/10.1136/bjsports-2022-106195
    41. Siritzky, E., Cox, P., Nadler, S., Grady, J., Kravitz, D., & Mitroff, S. (2023). Standard experimental paradigm designs and data exclusion practices introduce systematic bias. Cognitive Research: Principles and Implications, 8, 66. https://doi.org/10.1186/s41235-023-00520-y
    42. Smith, P. J., & Merwin, R. M. (2021). The role of exercise in the management of mental health disorders: An integrative review. Annual Review of Medicine, 72, 573–587. https://doi.org/10.1146/annurev-med-060619-022943
    43. Stubbs, B., Vancampfort, D., Hallgren, M., Firth, J., Veronese, N., Solmi, M., … Kahl, K. G. (2018). EPA guidance on physical activity as a treatment for severe mental illness. European Psychiatry, 54, 124–144. https://doi.org/10.1016/j.eurpsy.2018.07.004
    44. Sun, W., Lu, E. Y., Wang, C., & Tsang, H. W. H. (2023). Neurobiological mechanisms for the antidepressant effects of mind-body and physical exercises: A systematic review. Mental Health and Physical Activity, 25, 100538. https://doi.org/10.1016/j.mhpa.2023.100538
    45. Sylvia, L. G., Friedman, E. S., Kocsis, J. H., Bernstein, E. E., Brody, B. D., Kinrys, G., ... & Nierenberg, A. A. (2013). Association of exercise with quality of life and mood symptoms in a comparative effectiveness study of bipolar disorder. Journal of affective disorders, 151(2), 722-727. https://doi.org/10.1016/j.jad.2013.07.031
    46. Talari, K., & Goyal, M. (2020). Retrospective studies: Utility and caveats. Journal of the Royal College of Physicians of Edinburgh, 50, 398–402. https://doi.org/10.4997/jrcpe.2020.409
    47. Teh, W., Abdin, E., A., P. V., Kumar, F., Roystonn, K., Wang, P., Shafie, S., Chang, S., Jeyagurunathan, A., Vaingankar, J., Sum, C., Lee, E., Van Dam, R., & Subramaniam, M. (2023). Measuring social desirability bias in a multi-ethnic cohort: Associations with self-reported physical activity and dietary habits. BMC Public Health, 23, 415. https://doi.org/10.1186/s12889-023-15309-3
    48. Thomson, D., Turner, A., Lauder, S., Gigler, M. E., Berk, L., Singh, A. B., Pasco, J. A., Berk, M., & Sylvia, L. (2015). A brief review of exercise, bipolar disorder, and mechanistic pathways. Frontiers in Psychology, 6, 147. https://doi.org/10.3389/fpsyg.2015.00147
    49. Wang, X., Luo, H., Zhang, Y., Mao, M., Lu, Y., Zhang, Z., ... & Luo, Q. (2022). Effect of online aerobic exercise training in patients with bipolar depression: Protocol of a randomized clinical trial. Frontiers in Psychiatry, 13, 1011978. https://doi.org/10.3389/fpsyt.2022.1011978
    50. Xie, Y., Wu, Z., Sun, L., Zhou, L., Wang, G., Xiao, L., & Wang, H. (2021). Effects and mechanisms of exercise in the treatment of depression. Frontiers in Psychiatry, 12, 705559. https://doi.org/10.3389/fpsyt.2021.705559
    51. Yang, L., Yuan, Z., & Peng, C. (2025). Effects of aerobic exercise on cognitive function and quality of life in Alzheimer disease: A systematic review and meta-analysis. BMJ Open, 15. https://doi.org/10.1136/bmjopen-2024-090623
    52. Yuk, K., Lim, J., Kim, S., Kim, T. Y., & Moon, H. Y. (2025). Exploring the effects of aerobic and resistance exercise on mood-related symptoms and EEG activity. Frontiers in Human Neuroscience, 19, 1562702. https://doi.org/10.3389/fnhum.2025.1562702
    53. Zahn, R. (2025). Psychopathology of mood disorders and implications for neurocognitive intervention targets. Journal of Affective Disorders, 385, 119423. https://doi.org/10.1016/j.jad.2025.119423
    54. Zarza-Rebollo, J., López-Isac, E., Rivera, M., Gómez-Hernández, L., Pérez-Gutiérrez, A., & Molina, E. (2024). Relationship between brain-derived neurotrophic factor, physical activity, and depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 134, 111033. https://doi.org/10.1016/j.pnpbp.2024.111033
    55. Zhao, J. L., Jiang, W. T., Wang, X., Cai, Z. D., Liu, Z. H., & Liu, G. R. (2020). Exercise, brain plasticity, and depression. CNS neuroscience & therapeutics, 26(9), 885-895. https://doi.org/10.1111/cns.13385
    56. Zimmerman, M. (2016). A review of 20 years of research on overdiagnosis and underdiagnosis in the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. The Canadian Journal of Psychiatry, 61(2), 71-79. https://doi.org/10.1177/0706743715625935
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Ogabor, J. O., Apie, M. A., Odok, A. O., Oyo-Ita, I. E., Osaji, N. N., Ahueansebhor, E., Odok, E. A., Adie, B. U., Ukpata, C. O., Ntino, M. O., Apeh, C. A., Akpa, S. U., Etta, E. E., Ufford, I. I., Akan, H. A., & Owan, V. J. (2026). Influence of aerobic exercise on bio-psychological functioning among patients with bipolar affective disorder in Nigeria. Multidisciplinary Science Journal, (| Accepted Articles). Retrieved from https://malque.pub/ojs/index.php/msj/article/view/16672
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