[Mechanism of Bushen Yijing Formula improving cognitive function in Alzheimer's disease model mice].

Bipolar disorder (BD) is characterized by dysregulated, fluctuating affect across the domains of emotion, cognition, and activity, with observational work suggesting dysregulated activity is central (; ; ; ; ; ; ; ). Gold standard treatments for BD, such as lithium, focus on mood stabilization through the prevention or treatment of acute mood episodes, which is important given the impairment associated with such episodes (; ). However, such treatments do not work for everyone, take months or longer to take effect in those who do respond, and do not fully address non-acute consequences such as interepisode lability (; ; ; ; ; ). Attention to interepisode stabilization () may lessen the impairment that exists during the interepisode period, extend euthymia and prevent severe episodes, and may additionally benefit long-term outcomes such as improved vascular health. There is a critical need for treatments that address interepisode emotional regulation in BD to promote recovery. Planned or motivated physical activity (exercise) is amenable to direct modification, is an established health indicator to promote brain health (; ; ; ; ; ), and has a demonstrated inverse relationship with depressive symptoms and major depressive disorder (MDD) (; ; ; ; ; ; ) with numerous potential mechanisms for benefits in BD (; ; ; ; ; ; ). In clinical samples of persons with BD, self-reported physical activity has been inversely associated with mood episode recurrence, hospitalization, time depressed, and depressive level, while not exercising regularly has been associated with lower quality of life and functioning (; ). This suggests that changes to physical activity, appropriate to a person’s life stage (; ; ), may be an effective adjunctive treatment in BD. However, gaps remain in the development of exercise interventions. While development, testing, and uptake of physical activity interventions in BD and MDD appear feasible (; ; ; ; ; ; ; ; ), and benefits may happen over time, we do not know when or how quickly they occur. Additionally, while reduction of depressive symptoms is one potential benefit of physical activity for persons with BD, it is not the only important feature of emotional health, and recommendations derived from experience with MDD may not be directly generalizable given the hallmark impairing elevation of BD. Given the effects of aging on the body (; ) as well as the greater prevalence of mood disorders in females () and severe outcomes such as vascular diseases in women with BD (; ; ) it is also important to examine potential age and sex differences in the association between exercise and emotional state in mood disorders. Thus, deeper understanding of the dynamic relationship of exercise on several emotional states within hours during euthymia, and how this may vary by age, sex, and mood disorder subtype, is vital to inform intervention targets.