Interventions targeting motor activity and energy may be more efficacious than current approaches targeting depressed mood in adults with bipolar disorder, according to study results published in JAMA Psychiatry.

Real-time monitoring that included both objective clinical assessments and self-report measures enabled the researchers to investigate the “direction of the associations among activity, energy, mood, and sleep in the natural context of daily life,” seeking to characterize specifically the relationship between physical activity and psychological health.

Between January 2005 and June 2013, investigators used mail to recruit 242 adults (average age 48): 54 with bipolar disorder, 91 with major depressive disorder, and 97 controls. Investigators used the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, to evaluate participants for mood disorders at the National Institutes of Health Clinical Center in Maryland.

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The study combined 2 mobile monitoring techniques: actigraphy wrist devices to monitor motor activity and sleep, and ecological momentary assessment to track subjective mood and energy levels. Participants wore the devices on their non-dominant wrists for 2 weeks and used a personal digital assistant to complete assessments 4 times a day.

Analyses revealed directional associations between motor activity in one period and mood in the subsequent period: a worse mood after an inactive period (P =.04) and more positive mood after an active period (P =.03). Sad mood levels decreased with age and were lower on weekends (P <.001).

Based on these findings, the investigators proposed that “motor activity may be a more malleable behavioral target of intervention than mood.” While current treatments may target mood elevation, novel therapeutic approaches may focus on increasing energy levels and activity.

The study was limited by its short duration. The researchers reported that they are currently investigating use of this method over longer periods.


Merikangas K, Swendsen J, Hickie I, et al. Real-time monitoring of the dynamic associations among motor activity, energy, mood, and sleep in adults with bipolar disorder [published online December 12, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.3546