Clinically Significant Improved Fitness and Weight Loss Among Overweight Persons With Serious Mental Illness

• Published in: Psychiatric services (Washington, D.C.) Vol. 64; no. 8; pp. 729 - 736
• Main Authors: Bartels, Stephen J, Pratt, Sarah I, Aschbrenner, Kelly A, Barre, Laura K, Jue, Kenneth, Wolfe, Rosemarie S, Xie, Haiyi, McHugo, Gregory, Santos, Meghan, Williams, Gail E, Naslund, John A, Mueser, Kim T
• Format: Journal Article
• Language: English
• Published: Arlington, VA American Psychiatric Association 01.08.2013
• Subjects: Adult; Biological and medical sciences; Body Mass Index; Cardiovascular Diseases - prevention & control; Comorbidity; Exercise Therapy - methods; Female; Follow-Up Studies; Humans; Male; Medical sciences; Mental Disorders - epidemiology; Metabolic diseases; Middle Aged; Obesity; Obesity - epidemiology; Obesity - therapy; Overweight - epidemiology; Overweight - therapy; Patient Compliance - psychology; Patient Education as Topic - methods; Physical Fitness - physiology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Social psychiatry. Ethnopsychiatry; Treatment Outcome; Weight Loss - physiology; Social environment; Human; Physical fitness; Weight loss; Mental health; Mental disorder; Public health; Overweight
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.003622012

Overweight persons with severe mental illness tripled their attendance at fitness clubs and were more engaged in vigorous physical activity after joining a fitness health mentor program called In SHAPE. Participants were provided a one-year fitness club membership and paired with a health mentor who provided weekly personal training and nutrition counseling. A one-year controlled trial comparing outcomes with a control group that was given a free gym membership but no mentoring found that twice as many In SHAPE participants had made significant improvements in cardiovascular health. ObjectiveThe objective of this study was to evaluate the effectiveness of a fitness health mentor program (In SHAPE) in improving physical fitness and weight loss among overweight and obese adults with serious mental illness.MethodsA randomized controlled trial was conducted with 133 persons with serious mental illness and a body mass index (BMI) >25 who were assigned either to the In SHAPE program (one year of weekly sessions with a fitness trainer plus a fitness club membership) or to one year of fitness club membership and education. Assessments were conducted at baseline and three, six, nine, and 12 months later.ResultsParticipants had a mean baseline weight of 231.8±54.8 pounds and a mean BMI of 37.6±8.2. At 12-month follow-up, In SHAPE (N=67) compared with fitness club membership and education (N=66) was associated with three times greater fitness club attendance, twice as much participation in physical exercise, greater engagement in vigorous physical activity, and improvement in diet. Twice the proportion of participants (40% versus 20%) achieved clinically significant improvement in cardiorespiratory fitness (>50 m on the six-minute walk test). Weight loss and BMI did not differ between groups. Among In SHAPE participants, 49% achieved either clinically significant increased fitness or weight loss (5% or greater), and 24% achieved both clinically significant improved fitness and weight loss.ConclusionsThe In SHAPE program achieved clinically significant reduction in cardiovascular risk for almost one-half of participants at 12 months. Although the intervention showed promise in improving fitness, optimizing weight loss may require additional intensive, multicomponent dietary interventions.