Integrating movement into the care of patients living with bipolar I disorder
When we think about treating bipolar I disorder (BD-I), the conversation often starts with pharmacotherapy as medication playing a foundational role in managing the manic and depressive symptoms associated with the disease. However, if that is where the conversation ends, we’re missing one of the most readily available tools to support wellness: structured physical activity.
In my clinical experience, for people living with serious mental illnesses, such as BD-I, engaging in sports (or any kind of exercise) can contribute to not just physical health, but also cognitive and emotional well-being. As someone who has spent years treating patients with BD-I – and who also happens to be the mother of a professional baseball player – I have come to see sports as more than just a physical outlet. Team sports foster continuity, nurture a sense of belonging, and help develop personal resilience through shared goals and experiences.
BD-I and the need for stability
BD-I can pull people to extremes. In depressive episodes, we can see low motivation, low energy, disrupted sleep and feelings of hopelessness. In manic episodes, there is commonly a surge in activity, decreased need for sleep, goal-driven hyperfixation, and sometimes reckless behaviour. What many people overlook is that both the manic and depressive phases of bipolar disorder can be destabilising – and that structure and routine are beneficial for managing both.
Structured physical activity, especially when done consistently, creates natural rhythms in the body. It helps regulate sleep, appetite, and energy levels, all of which tend to be disrupted during depressive and manic episodes. It also creates markers in time that act as built-in cues to help orient the body and mind to daily structure. For patients who struggle with extremes, anchoring the day with exercise can be grounding.
Movement looks different for everyone
Movement or exercise doesn't have to look a certain way to make a meaningful impact on your health. Whether it is a morning walk, yoga in the living room, or a neighborhood basketball league, any form of movement can reduce stress, improve emotional regulation, and help stabilise mood. The key is consistency.
That said, team sports can offer additional benefits for those who are interested and able to participate. In particular, they provide a sense of community. Many of my patients tell me they feel isolated by their diagnosis; the stigma of BD-I can keep people from opening up about what they’re experiencing, and that isolation can feed depression. However, being part of a team can help people feel needed and build meaningful relationships. Sometimes, participating in something larger than themselves, even if it’s no more formalised than a local rec league, can be the nudge a person needs to begin reconnecting with others and, ultimately, themselves.
As organised team sports are not accessible to everyone or at all times. I encourage the people I support to start wherever they feel comfortable. Maybe it is walking to the mailbox or maybe it is stretching on the living room floor. Over time, these activities can build confidence, perhaps evolving into a walk around the neighborhood, or a yoga class at a community centre. I have observed that, when someone begins to feel physically capable again, their self-worth starts to shift as well.
The science behind the sweat
There is clear science about the benefits of exercise. Physical activity increases endorphins and dopamine, reduces cortisol levels, and strengthens the brain’s ability to manage stress and maintain balance. These effects are particularly relevant for individuals with BD-I, who often experience dysregulation in mood-related neurotransmitters and stress response systems. Dopamine, for example, plays a key role in reward processing and motivation, both of which can be impaired during depressive episodes and overstimulated during manic phases. Regular movement helps modulate dopamine activity, promoting a more stable emotional baseline.
In patients with BD-I, who are also at higher risk for obesity, cardiovascular disease, and metabolic disorders, the physical benefits are especially critical. A combination of factors contributes to these elevated risks, including medication side effects, disrupted sleep patterns, irregular eating habits, and long stretches of low motivation or energy during depressive episodes. Sedentary behaviour, often exacerbated by these depressive symptoms, can compound physical health comorbidities over time. Additionally, the stress associated with mood instability can further strain the cardiovascular and endocrine systems. Exercise addresses both the psychiatric and metabolic vulnerabilities associated with BD-I, helping reduce long-term health complications that contribute to reduced life expectancy in this patient population.
The cognitive “lift” from exercise is equally important. Exercise improves executive function, reduces brain fog and helps stabilise mood. Neuroplasticity, the brain’s ability to adapt and form new connections, is often compromised by chronic mood episodes. Physical activity supports the release of brain-derived neurotrophic factor (BDNF), which enhances neuroplasticity and supports cognitive resilience. By improving executive function, patients can find they are better able to organise thoughts, make decisions, and self-regulate – skills that are highly valuable when navigating the shifting mental states inherent with BD-I.
That being said, it’s our responsibility as clinicians to ensure consistent and thoughtful communication with the people we serve Patients in a manic or hypomanic state may overdo exercise. If someone starts working out compulsively or becomes hyper-focused on performance, it can exacerbate manic symptoms, such as decreased need for sleep, heightened goal-directed activity, and impaired insight, which may destabilise their overall mood. That does not mean we avoid exercise, it just means we tailor it. Some people may need help identifying their limits or building in rest days, especially when early signs of mood elevation are present. This is also why it is so important to have support systems in place and to build self-awareness over time. The focus is on mindful, balanced activity that promotes well-being and helps the patient feel stable and connected.
The power of partnership
One of the most valuable aspects of regular physical activity, especially in group settings, is the opportunity for others to notice when something is “off”. A coach, teammate, or even a walking buddy can often notice shifts in mood, energy, or focus – even without knowing someone’s diagnosis. For example, maybe someone who’s typically steady becomes unusually irritable, suddenly driven to excel higher than before or speaking with more intensity and passion. Maybe they stop sleeping, start skipping meals, or hyper-fixate on winning. All of these can be early warning signs of a mood shift. Consistent engagement with a group creates a sense of accountability and observation that helps flag early signs of struggle. Exercise partners, therefore, play an important role in someone’s broader support system.
Adopting any sort of consistent exercise or activity routine can offer a level of predictability that people with BD-I often crave. That structure, combined with psychosocial support, contributions to personal identity, and the physical effects of movement, makes sports an underutilised, but profoundly effective, piece of the treatment puzzle. Whether it is joining a team, walking, stretching, or swimming laps, the real power lies in finding movement that brings consistency and meaning to someone’s life.
About the author
Jo A. Hughes, DSMc, PA-C, CAQ-PSYCH, is clinical director and managing partner/founder of Piedmont Partners for Mental Health, PLLC. Dr Hughes is a psychiatric certified physician associate (PA) with early career experience in Emergency Medicine and Psychiatry for over 10 years. She provides medication management and assessments for psychiatric disorders including but not limited to: depression, anxiety and panic disorders, bipolar, schizophrenia, PTSD, ADHD, personality disorders, OCD, eating disorders, and other conditions of the mind. She also specialises in neurodevelopmental disorders in children, adolescents, and adults and with extensive training and experience in substance use disorders. Dr Hughes completed her PA training and Master of Medical Science at Wake Forest University School of Medicine and additionally holds a Doctor of Medical Science in Psychiatry from Rocky Mountain University of Health Professionals. She is a certified PA with a Certificate of Added Qualification in Psychiatry. Dr Hughes and her husband are frequently seen visiting and promoting a non-profit coffee house (A Special Blend) they co-founded employing adults with neurodiversity in Greensboro, North Carolina.
