New research from Sunnybrook reveals physical activity's power to improve symptoms of bipolar disorder and OCD
Fay Ganz is 56 and has bipolar disorder. She feels fine today, happily balancing volunteer work in mental health care, renovations to her Toronto home and daily power walks with friends, but it has been a long and rocky road to wellness.
For the first 20 years of her illness, Fay weathered severe manic episodes followed by bouts of deep depression. Throughout her 20s and 30s, she says, the ups and downs of her illness "felt like riding a roller coaster at the Exhibition." She accomplished a lot in that time – marrying the love of her life, Howard, finishing university, having three kids and becoming a nurse – but the unpredictable nature of her disorder exacted a terrible toll.
She endured a taxing journey, moving from doctor to doctor, from drug to drug, in and out of hospital, all the while without a clear diagnosis, baffling and scaring family and friends.
Manic behaviour in the early days meant going into hyperdrive: trying to be the best at everything. "Something snapped, and I had to prove myself. I didn't sleep. Sleeping was weakness. I was going to be the best daughter, the best employee, the best friend, the best girlfriend. The more I experienced the ability to be the best, the more I pushed for more. Until I started becoming psychotic," she says.
Later in her illness, Fay's mania often led her away from her husband and children. Sometimes she saw things that weren't there, resulting in erratic behaviour. "I would fall off the rails and my husband would have to go and get me," she says. In between the times when Fay felt high, depressive episodes robbed her of joy. "I kept going because of the kids, but I had no quality of life."
In 1999, Howard implored Fay to get the help she needed. She came to Sunnybrook and became a patient of Dr. Ari Zaretsky, chief of psychiatry, who is also vice-president of education. They developed a treatment plan that would ultimately stabilize her mood. The therapy had several pillars: a medication regime designed specifically for Fay, a commitment by both doctor and patient to cognitive behavioural therapy, regular mindfulness meditation by Fay and a fourth, quite surprising, component: exercise.
"I work with a trainer and I also power walk with friends first thing in the morning," says Fay. "It makes a big difference. It gives you a sense of accomplishment. You get out of the house and see things. You say hi to people; you get endorphins. I really
Psychiatrists in Sunnybrook's Brain Sciences Research Program treat mood and anxiety disorders from adolescence to old age. Exercise, which is part of the new trend toward self-management, is an increasingly recognized treatment tool in illnesses such as depression, bipolar disorder and obsessive-compulsive disorder (OCD). "There is burgeoning literature on how it works and the deliberate use of exercise," says Dr. Zaretsky.
Research reveals that exercise increases production of a protein called brain-derived neurotrophic factor (BDNF), which encourages the growth of new neurons. BDNF increases brain plasticity and the resilience of brain cells to stress. Dr. Zaretsky calls it brain fertilizer.
"Exercise is now viewed in those with severe mental illness not just as recreation, but also as brain rehab. That's relatively new," he says.
Aerobic exercise and its effect on adolescents with bipolar disorder are being studied by Dr. Benjamin Goldstein, director of Sunnybrook's Centre for Youth Bipolar Disorder, together with his colleague Dr. Brad MacIntosh in the Brain Sciences Research Program. In the study, adolescents with bipolar disorder completed a concentration task in a magnetic resonance imaging (MRI) scanner before and after 20 minutes of stationary cycling. Brain scans revealed they were able to complete the task with less brain effort after exercising. Importantly, obesity and blood vessel functioning impacted the effects of exercise, suggesting brain-body connections that can inform personalized treatment approaches. "In real life, if adolescents are able to better focus and maintain their attention, then exercise will have major benefits to their quality of life," says Dr. Goldstein.
New research at Sunnybrook has also found that exercise is helpful as an add-on therapy in OCD. The World Health Organization lists OCD among the top 10 causes of medical morbidity worldwide. It affects 2.5 per cent of the population and can often be chronic and lifelong. Known treatments, such as medication and cognitive behavioural therapy, tend to only reduce symptoms by 25 per cent and 50 per cent, respectively. "So if someone is hand washing four hours a day and improves by 25 per cent, that person is still hand washing three hours a day," says Dr. Peggy Richter, director of Sunnybrook's Frederick W. Thompson Anxiety Disorders Centre. "Quality of life is not substantially restored."
Dr. Richter and colleagues at the centre did a pilot study of exercise to see if OCD patients benefited. "It looks extremely promising," she says. Exercise led to a decrease in obsessions, such as incessant worries about germs or bad things happening, and compulsions, such as checking and cleaning. Sunnybrook is now leading a multisite, national trial testing exercise in 400 to 500 patients with OCD.
"I think it's extraordinarily exciting," says Dr. Richter. "Here's something we should be doing anyway. If you exercise, not only do you increase your cardiovascular health and feel better and lower your risk for type 2 diabetes, on top of that you may improve your mood, and we believe improve symptoms of OCD, too. And this treatment is completely safe and free of side-effects. How do you beat that?"
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.