title: Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review.
abstract: BACKGROUND
  Bipolar disorder (BD) is a serious mental illness associated with a high risk of medical comorbidities, long-term disability and premature death. This systematic review examined the current literature on therapeutic interventions targeting nutrition, physical activity and wellness in BD and collecting health-related measures such as mood and course of illness.
  
  
  METHODS
  Scopus (all databases), Pubmed and Ovid Medline were systematically searched with no language or year restrictions, up to June 2015, for studies focusing on lifestyle interventions in BD. Search terms were related to bipolar disorder, nutrition, physical activity, wellbeing, psychosocial interventions and course of illness. We hand searched content pages of Bipolar Disorders and Journal of Affective Disorders and checked references of relevant reviews and dissertations to identify additional papers.
  
  
  RESULTS
  After applying inclusion and exclusion criteria to identified hits, this literature search retrieved six papers. Overall findings point towards a beneficial role of lifestyle interventions on mood, weight, blood pressure, lipid profile, physical activity and overall wellbeing. Methodological limitations include small sample size, gender ratio imbalance, inconsistencies in terms of laboratory measures, and lack of randomized controlled trials and absence of follow-up and longitudinal studies to determine the benefits of these factors on clinical and functional outcomes over time
  
  
  CONCLUSIONS
  Lifestyle interventions in BD targeting nutrition, exercise, wellbeing alongside beliefs, coping strategies and attitudes towards health show promise in reducing the risk of comorbid ailments in BD. There is still a strong need for studies a) developing interventions which are informed by the patient's input and b) examining the effectiveness of such interventions targeting general wellness using well-controlled trials.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Isabelle E
authors.initials: IE
authors.lastname: Bauer
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA; Department of Psychiatry, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Gálvez
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Hamilton
authors.affiliation: Teaching Unit of Psychiatry, Department of Medicine, La Fe University and Polytechnic Hospital, University of Valencia, CIBERSAM, ISNPR, Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Balanzá-Martínez
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Giovana B
authors.initials: GB
authors.lastname: Zunta-Soares
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, Houston, TX, USA. Electronic address: Thomas.D.Meyer@uth.tmc.edu.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Meyer
mesh_terms: D001714:Bipolar Disorder / Q000534:rehabilitation*; D015444:Exercise; D005247:Feeding Behavior; D006801:Humans; D008019:Life Style; D000067250:Psychiatric Rehabilitation / Q000379:methods*
keywords: Bipolar disorder; Lifestyle intervention; Nutrition; Physical activity; Psychosocial intervention; Wellbeing