“You can't take a pill to exercise” – Qualitative findings from the Toward Exercise as Medicine for Adolescents with bipolar disorder (TEAM-BD) study

Objectives Despite multiple potential physical and mental benefits of aerobic exercise, individuals with bipolar disorder (BD) report low engagement in aerobic exercise and decreased cardiorespiratory fitness (CRF). Given the scarcity of interventions that focus on aerobic exercise and CRF in BD, a novel behaviour change counselling (BCC) intervention was developed and conducted to increase aerobic exercise in youth with BD. The aim of this study was to elucidate participant feedback on the BCC intervention, using post-intervention consultation forums. Methods Of 20 youth with BD who enrolled in the 24-week BCC intervention, 11 attended consultation forums after completing the study. Five parents also participated in separate parent consultation forums. Questions included asking about participants’ overall experiences, helpful/unhelpful components, feedback on core and optional modules, and recommendations for future interventions. Forums were audiotaped and transcribed verbatim. Forums were analysed using both content and thematic analyses, with deductive and inductive qualitative approaches. Results For feasibility, themes of ‘ managing mood and/or psychiatric symptoms’ , ‘ adapting life to include exercise’ , and ‘ providing structured support through an intervention’ were identified. For acceptability, we identified themes of ‘ awareness of the importance of exercise’ , ‘ adaptable approach to changing needs and wants’ , and ‘ improving clarity of available components and materials’ . For impact, themes of ‘ exercise change is gradual and ongoing’ , and ‘ attitudes and beliefs around exercise can change’ were elucidated. Conclusion Youth with BD and their parents reported experiencing subjective benefits following the BCC intervention. Several challenges and barriers were also noted that will require consideration for future exercise intervention designs. Clinical trials registration number NCT03562520.