Objectives
STRIDE assessed whether a lifestyle intervention, tailored for individuals with serious mental illnesses, reduced weight and diabetes risk.
Methods
A multi-site, parallel, two-arm randomized controlled trial in community settings and an integrated health plan. Inclusion criteria: Age ≥18; taking antipsychotic medication for ≥30 days; BMI ≥27. Exclusions: significant cognitive impairment; pregnancy/breastfeeding; recent psychiatric hospitalization, bariatric surgery, cancer, heart attack or stroke. The intervention emphasized moderate caloric reduction, DASH diet, and physical activity. Blinded staff collected data at baseline, 6, and 12 months.
Results
Participants (56 men, 144 women), mean age = 47.2(SD =10.6), were randomized to usual care (n =96) or a 6-month weekly group intervention plus 6 monthly maintenance sessions (n =104). 181 participants (90.5%) completed 6-month, and 170 (85%) completed 12-month assessments, without differential attrition. Participants attended 14.5 of 24 sessions over 6 months. Intent-to-treat analyses found intervention participants lost 4.4 kg more than control participants from baseline to 6 months (95% CI [−6.96 kg, −1.78 kg]), and 2.6 kg more than controls (95% CI −5.14 kg, −0.07 kg] from baseline to 12 months. At 12 months, fasting glucose levels in controls had increased from 106.0 mg/dL to 109.5 mg/dL and decreased in intervention participants, from 106.3 mg/dL to 100.4 mg/dL. No serious adverse events were study-related; medical hospitalizations were reduced in the intervention group (6.7%) compared to controls (18.8%)(χ2= 6.66, p = 0.01).
Conclusions
Individuals taking antipsychotic medications can lose weight and improve fasting glucose levels. Increasing reach of the intervention is an important future step.
Funding Source
National Institute of Diabetes and Digestive and Kidney Diseases, Grant R18DK076775
Trial Registration
Clinical Trials.gov, NCT00790517; http://clinicaltrials.gov/ct2/show/NCT00790517?term=STRIDE&rank=1
Objective
Individuals with serious mental illnesses are disproportionately affected by overweight and obesity. Understanding the factors that facilitate or hinder lifestyle change in this population could lead to better interventions and improved health outcomes.
Methods
A subset of intervention and usual-care participants (n = 84) in the STRIDE randomized trial were interviewed at 3, 9, and 18 months, yielding 101 interviews (some were interviewed more than once). Participants had a mean age of 48.1 (SD = 10.1); 64% were female. Participants had diagnoses of schizophrenia or schizoaffective disorder (41%), bipolar disorder (20%), affective psychoses (37%) or PTSD (2%). Interviews were transcribed verbatim, coded using Atlas.ti, and analyzed for common themes.
Results
Barriers to behavior change were similar to those described for the general population, including lack of support from significant others, the lure of unhealthy foods, and poor weather impeding exercise. Additional challenges included the effects of psychiatric symptoms, or consequences of symptoms (i.e., social isolation), on ability to make and sustain lifestyle changes. We found a strong preference for ongoing, group-based support to foster a sense of accountability which motivated and helped to sustain behavior changes.
Conclusions and implications for practice
Individuals with serious mental illnesses encounter many of the same barriers to weight loss seen in the general population, but they may be more vulnerable to additional obstacles. Lifestyle change interventions for this population should help participants develop the ability to iteratively cope with fluctuating mood and subsequent changes in motivation to eat healthfully and exercise regularly.
Veterans report that service dogs help reduce PTSD symptoms and facilitate recovery and realization of meaningful goals. Service dogs may be a reasonable option for veterans who are reluctant to pursue or persist with traditional evidence-based treatments. Additional rigorous research on the effectiveness of service dogs for this population is warranted. (PsycINFO Database Record
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.