A key area that necessitates further examination is the role of exercise on mania. Some evidence suggests that mania is associated with increased exercise [27, 53, 131]. This finding remains limited to cross-sectional data, and, to our knowledge, no studies have examined prospectively the impact of increased exercise on mania and vice versa. Future studies should aim to identify order effects as well as optimal exercise levels that improve depressive symptoms but prevent mania.
