Lifestyle Interventions for Adults With Serious Mental Illness: A Systematic Literature Review

Abstract

Objective The promotion of healthy lifestyles among persons with serious mental illness is an integral part of their recovery. The aims of this systematic literature review were to rate the methodological quality of lifestyle intervention outcome studies for persons with serious mental illness, summarize intervention strategies, examine physical health outcomes, and evaluate the inclusion of racial and ethnic minority groups in these studies. Methods Electronic bibliographic database searches were performed to locate studies conducted in the United States. Articles written in English and published in peer-reviewed journals between 1980 and 2009 were included. The authors used a standardized instrument to rate studies' methodological quality. Results Twenty-three articles were reviewed. Based on studies' methodological quality, three levels of evidence were found: single-group reports, quasi-experimental studies, and randomized controlled trials. Most interventions used behavioral techniques to improve dietary habits and increase physical activity. Twelve studies reported significant improvements in either weight loss or metabolic syndrome risk factors associated with receiving a lifestyle intervention. Persons from racial and ethnic minority groups were underrepresented, especially Hispanics and Asian Americans. Only one study included non–English-speaking participants. Conclusions Lifestyle interventions adapted to persons with serious mental illness show promise in reducing weight loss and some risk factors for metabolic syndrome. The under-representation of persons from racial or ethnic minority groups in this literature limits its generalizability. Implications for research and practice are discussed.

Weight Loss Intervention for People With Serious Mental Illness: A Randomized Controlled Trial of the RENEW Program

“…Unlike many previous studies, this multisite randomized controlled trial included a significant number of participants from minority groups and promoted changes in both nutrition and physical activity. Its results are similar to those reported by other studies of weight loss interventions, which found a mean loss of 4.3±5.6 pounds (5). Participants in the RENEW program had maintained their weight loss at six months; other studies indicate that individuals with serious mental illness who have participated in weight loss programs have maintained their weight loss for up to one year (8,9).…”

“…However, other studies of weight loss interventions with this population have reported mean retention rates of 70%±17% (5), in the same range as the 65% retention rate in this study. A higher percentage of female dropouts suggests that women are less likely to continue with the RENEW program.…”

“…However, most studies have been small, short-term investigations at a single site that underrepresented participants from minority groups and focused on either physical activity or dietary changes but not both. Few used randomized controlled trial designs (1,5). …”

Use of a motivational interviewing-informed strategy in group orientations to improve retention and intervention attendance in a randomized controlled trial

“…The average retention rate across lifestyle intervention studies was $70% in various systematic reviews including intervention RCTs in primary care settings specifically [8][9][10][11]. The intervention attendance rates were not always reported in lifestyle intervention RCTs, although the information is critical for interpreting findings [11].…”

Exploring the Economic Implications of a Group-Based Lifestyle Intervention for Middle-Aged Adults with Chronic Schizophrenia and Co-Morbid Type 2 Diabetes

“…Recent systematic reviews suggest positive impacts on weight loss, BMI, glucose tolerance etc. [7,8].…”