Pragmatic Replication Trial of Health Promotion Coaching for Obesity in Serious Mental Illness and Maintenance of Outcomes

Abstract

Objective Few studies targeting obesity in serious mental illness report clinically significant risk reduction, and none have been replicated within community settings or have demonstrated sustained outcomes after intervention withdrawal. This pragmatic clinical trial aims to replicate positive health outcomes demonstrated in a prior randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population. Methods Persons with serious mental illness and BMI>25 receiving services in three community mental health organizations were randomized to the 12-month In SHAPE program (health promotion coach and membership to a public fitness club) or to fitness club membership alone. Primary outcomes were weight and cardiorespiratory fitness (measured with the 6-Minute Walk Test) collected at baseline, 3-, 6-, 9-, 12-, and 18-months. Results Participants (N=210) were ethnically diverse (46% non-White) with mean baseline BMI=36.8±8.2. At 12-months In SHAPE (n=104) compared to a fitness club membership alone (n=106) contributed to greater reduction in weight and improved fitness. Primary outcomes were maintained at 18-months follow-up. Approximately half of In SHAPE participants (51% at 12-month program completion and 46% at 18-month follow-up) achieved clinically significant cardiovascular risk reduction (≥5% weight loss or >50 meter increase on the 6-Minute Walk Test). Conclusions Sustained weight loss and improved fitness can be achieved by community mental health organizations providing health promotion coaching and access to fitness facilities. Health promotion should be integrated into mental health services for persons with serious mental illness at risk for cardiovascular disease and early mortality.

BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

“…An initial clinical trial of the InSHAPE 'health coaching' programme demonstrated effectiveness for weight loss (Bartels et al, 2013). The more recent trial was designed to replicate the application of this programme in normal clinical settings with a full range of service users (Bartels et al, 2014). That trial examined effects on weight and cardiorespiratory fitness in 210 participants who were randomly allocated to the InSHAPE programme or to fitness club membership alone for a 12-month period.…”

Cardiorespiratory Fitness in Severe Mental Illness: A Systematic Review and Meta-analysis

“…This is of particular relevance in people with SMI, given the growing interest in lifestyle interventions aiming to reduce cardiovascular disease risk. Recent clinical trials have demonstrated that achieving weight loss among people experiencing mental illness is possible [14,51,52]; however, the optimal way to translate these findings into cost-effective, pragmatic, and scalable interventions is less clear given that reducing weight, waist circumference, and BMI is challenging for people with SMI [15]. Importantly, even in the absence of a reduction in these parameters, improvements in cardiorespiratory fitness following exercise can significantly improve health and reduce mortality [11,53,54].…”

“…Investigating cardiorespiratory fitness among people with SMI is of considerable clinical interest given its associations with reduced psychiatric symptoms and cognitive deficits in SMI populations [12] and given the increasing focus on lifestyle interventions as integrated components of standard care for various mental disorders [13][14][15][16][17][18]. In addition, two recent meta-analyses demonstrated that exercise interventions significantly improve cardiorespiratory fitness in people with schizophrenia [19] and in people with MDD [20].…”

To Explore the Impact of Medical Education on Sleep Quality toward Quality of Life

“…Bartels et al (2015) pointed out various factors in sleep quality, e.g. social change, work stress, lifestyles, individual psychological and health status, living habits, environmental factors, types of diseases, and other physiological symptoms (Chiu et al, 2015).…”