title: Getting to wellness: The potential of the athletic model of marginal gains for the treatment of bipolar disorder.
abstract: OBJECTIVE
  People with bipolar disorder frequently have persistent symptoms, continued problems functioning and comorbid medical conditions. We propose applying the athletic coaching concept of marginal gains to help patients address these challenges to achieve wellness.
  
  
  METHODS
  We review the concept of marginal gains and potential interventions to improve long-term outcomes for bipolar patients.
  
  
  RESULTS
  Evidence exists to help bipolar patients with diet and exercise, gradual behavioral change, mobile applications and peer support.
  
  
  CONCLUSIONS
  Marginal gains, small and doable improvements across a broad range of areas, have great potential to improve the lives of people with bipolar disorder.
authors.affiliation: Bipolar Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: Bipolar Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Casey M
authors.initials: CM
authors.lastname: Hearing
authors.affiliation: CAPES/Brasil Sponsorship, Faculdade de Medicina, Universidade Federal da Bahia (UFBA), Salvador, Brasil.
authors.forename: Isadora
authors.initials: I
authors.lastname: Sande Mathias
authors.affiliation: CAMH, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: L Trevor
authors.initials: LT
authors.lastname: Young
authors.affiliation: Bipolar Clinic and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA lsylvia2@partners.org.
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
mesh_terms: D018692:Antimanic Agents / Q000627:therapeutic use*; D001521:Behavior Therapy; D001714:Bipolar Disorder / Q000628:therapy*; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005247:Feeding Behavior; D006801:Humans; D063731:Mobile Applications; D008962:Models, Theoretical; D010379:Peer Group; D012944:Social Support; D013177:Sports
chemical_list: D018692:Antimanic Agents
keywords: Bipolar disorder; behavioral change; marginal gains; supplements