Exercise interventions for depressive, manic, and anxiety symptoms in bipolar disorder: a systematic review and meta-analysis.

IF 3.2 3区医学 Q2 PSYCHIATRY

Frontiers in Psychiatry Pub Date : 2025-09-22 eCollection Date: 2025-01-01 DOI:10.3389/fpsyt.2025.1648008

Xinmo Li, Feike Liu, Feng Ding, Xiaochen Ma, Yongguo Zhu

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Abstract

Background: To evaluate the efficacy of exercise interventions on depressive, manic, and anxiety symptoms in patients with bipolar disorder (BD) through a systematic review and meta-analysis, and to explore the impact of different exercise parameters (session duration, frequency, etc.) on these symptoms.

Methods: We comprehensively searched Embase, Web of Science, PubMed, The Cochrane Library, Wan fang, Weipu Database(VIP), and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trials (RCTs) published until May 2025. Included studies met the following criteria (1): participants aged ≥18 years with BD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or International Classification of Diseases, 11th Revision (ICD-11) criteria (2); exercise as the primary intervention (3); control groups receiving standard rehabilitation treatment. Study quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Meta-analyses were performed using Stata 18.0, and evidence quality was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: A total of 7 RCTs n=576 were included. Meta-analysis demonstrated that exercise significantly improved depressive symptoms (SMD =-0.63, 95%CI: -1.11 to -0.14, P=0.01) and anxiety symptoms (SMD =-0.70, 95%CI: -1.26 to -0.15, P<0.05) in BD patients, but showed no significant effect on manic symptoms (SMD =-0.23, 95%CI: -0.67 to 0.21, P>0.05). Subgroup analyses revealed that exercise protocols featuring session duration ≤1 hour/session (SMD= -0.86, P=0.02), frequency >5 sessions/week (SMD = -0.76, P<0.01), and intervention period ≤12 weeks (SMD = -0.79, P=0.02) produced more pronounced improvements in depressive symptoms. The GRADE approach rated the quality of evidence as low for all outcomes (depression, anxiety, mania), with downgrading factors including substantial heterogeneity, imprecision, and risk of bias.

Conclusion: Current low-quality evidence suggests that exercise may alleviate depressive and anxiety symptoms in BD patients (particularly with high-frequency, prolonged-duration, short-term protocols), while its effect on manic symptoms remains inconclusive. These findings should be interpreted cautiously due to methodological limitations of included studies.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251041926.

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运动干预双相情感障碍患者抑郁、躁狂和焦虑症状：系统回顾和荟萃分析

背景：通过系统综述和荟萃分析，评价运动干预对双相情感障碍（BD）患者抑郁、躁狂和焦虑症状的疗效，并探讨不同运动参数（运动时长、运动频率等）对这些症状的影响。方法：综合检索Embase、Web of Science、PubMed、The Cochrane Library、万方、唯普数据库（VIP）、中国知网（CNKI）等数据库，检索截至2025年5月发表的随机对照试验（RCTs）。纳入的研究符合以下标准(1)：受试者年龄≥18岁，根据精神障碍诊断与统计手册第五版（DSM-5）或国际疾病分类第11版（ICD-11）标准诊断为双相障碍(2)；运动作为主要干预措施(3)；对照组接受标准康复治疗。使用物理治疗证据数据库（PEDro）量表评估研究质量。meta分析采用Stata 18.0进行，证据质量采用分级推荐评估、发展和评价（GRADE）方法进行评价。结果：共纳入7项rct， n=576。meta分析显示，运动显著改善抑郁症状（SMD =-0.63, 95%CI: -1.11 ~ -0.14， P=0.01）和焦虑症状（SMD =-0.70, 95%CI: -1.26 ~ -0.15, P0.05）。亚组分析显示，运动时长≤1小时/次（SMD= -0.86， P=0.02），频率为bbb50次/周（SMD= -0.76， P）的运动方案。结论：目前的低质量证据表明，运动可能减轻双相障碍患者的抑郁和焦虑症状（特别是高频、长时间、短期方案），而其对躁狂症状的影响仍不确定。由于纳入研究的方法学局限性，这些发现应谨慎解释。系统综述注册：https://www.crd.york.ac.uk/prospero/，标识符CRD420251041926。

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来源期刊

Frontiers in Psychiatry Medicine-Psychiatry and Mental Health

CiteScore

6.20

自引率

8.50%

发文量

2813

审稿时长

14 weeks

期刊介绍： Frontiers in Psychiatry publishes rigorously peer-reviewed research across a wide spectrum of translational, basic and clinical research. Field Chief Editor Stefan Borgwardt at the University of Basel is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. The journal''s mission is to use translational approaches to improve therapeutic options for mental illness and consequently to improve patient treatment outcomes.