0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Articles   |    
Clinically Significant Improved Fitness and Weight Loss Among Overweight Persons With Serious Mental Illness
Stephen J. Bartels, M.D., M.S.; Sarah I. Pratt, Ph.D.; Kelly A. Aschbrenner, Ph.D.; Laura K. Barre, M.D.; Kenneth Jue, M.S.S.A.; Rosemarie S. Wolfe, M.S.; Haiyi Xie, Ph.D.; Gregory McHugo, Ph.D.; Meghan Santos, M.S.W.; Gail E. Williams, B.A.; John A. Naslund, M.P.H.; Kim T. Mueser, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.003622012
View Author and Article Information

Dr. Bartels is affiliated with the Department of Psychiatry and the Department of Community and Family Medicine at the Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 200, Lebanon, NH 03766 (e-mail: sbartels@dartmouth.edu). Dr. Pratt and Dr. Aschbrenner are with the Department of Psychiatry and Dr. Barre, Ms. Wolfe, Ms. Santos, and Ms. Williams are with the Department of Community and Family Medicine, all at the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Mr. Jue is with Ken Jue Consulting, Keene, New Hampshire. Dr. Xie and Dr. McHugo are with the Dartmouth Psychiatric Research Center, Dartmouth College, Lebanon, New Hampshire. Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, and with the Dartmouth Psychiatric Research Center, Dartmouth College, Lebanon, New Hampshire.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  The 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.

Methods  A 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.

Results  Participants 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.

Conclusions  The 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.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Figure 1 Proportion of participants achieving clinically significant improved fitness in In SHAPE versus fitness club membership and educationa

a Improvement was defined as >50-m increase on the six-minute walk test, at 3-, 6-, 9-, and 12-month follow-ups.

Figure 2 Proportion of participants achieving clinically significant weight loss in In SHAPE versus fitness club membership and educationa

a Improvement was defined as >5% decrease in weight (in pounds) at 3-, 6-, 9-, and 12-month follow-ups.

Anchor for Jump
Table 1Characteristics of participants in the In SHAPE and fitness club membership and education groupsa
Table Footer Note

a No significant between-group differences were found.

Table Footer Note

b Body mass index is the weight in kilograms divided by the square of the height in meters, with >25 indicating overweight or obese.

Anchor for Jump
Table 2Health behavior, fitness, and weight-loss outcomes between In SHAPE and fitness club membership and education (FCME) groups
Table Footer Note

a Means shown above consist of raw (unadjusted) means, and the main effect calculated for 3–12 months was adjusted for baseline value as a covariate.

Table Footer Note

b Effect size calculated for endpoint effect size (not overall group effect)

Table Footer Note

cIPAQ, International Physical Activity Questionnaire; MET, metabolic equivalent expenditure. Possible IPAQ total vigorous activity scores in this study were continuous and ranged from 0 to 11,520 weekly MET minutes, with higher scores indicating greater weekly participation in vigorous physical activity.

Table Footer Note

d Possible scores range from 1 to 5, with higher scores reflecting a higher stage of readiness (1, precontemplation; 2, contemplation; 3, preparation; 4, action; 5, maintenance).

Table Footer Note

e The six-minute walk test is a measure of the distance in feet that an individual can walk in six minutes.

Table Footer Note

f Body mass index is the weight in kilograms divided by the square of the height in meters, with >25 indicating overweight or obese.

+

References

Colton  CW;  Manderscheid  RW:  Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states.  Preventing Chronic Disease: Public Health Research, Practice, and Policy 3:A42, 2006
 
DE Hert  M;  Correll  CU;  Bobes  J  et al:  Physical illness in patients with severe mental disorders: I. prevalence, impact of medications and disparities in health care.  World Psychiatry 10:52–77, 2011
[PubMed]
 
McKibbin  CL;  Patterson  TL;  Norman  G  et al:  A lifestyle intervention for older schizophrenia patients with diabetes mellitus: a randomized controlled trial.  Schizophrenia Research 86:36–44, 2006
[CrossRef] | [PubMed]
 
Daumit  GL;  Dickerson  FB;  Wang  N-Y  et al:  A behavioral weight-loss intervention in persons with serious mental illness.  New England Journal of Medicine  (Epub ahead of print, March 21, 2013)
 
Verhaeghe  N;  De Maeseneer  J;  Maes  L  et al:  Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review.  International Journal of Behavioral Nutrition and Physical Activity 8:28, 2011
[CrossRef] | [PubMed]
 
Alvarez-Jiménez  M;  Hetrick  SE;  González-Blanch  C  et al:  Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials.  British Journal of Psychiatry 193:101–107, 2008
[CrossRef] | [PubMed]
 
Bartels SJ, Desilets RA: Health Promotion Programs for Persons With Serious Mental Illness: What Works? A Systematic Review and Analysis of the Evidence Base in Published Research Literature on Exercise and Nutrition Programs. Washington, DC, SAMHSA-HRSA Center for Integrated Health Solutions, 2012. Available at integration.samhsa.gov/health-wellness/wellnesswhitepaper
 
Ross  R;  Janiszewski  PM:  Is weight loss the optimal target for obesity-related cardiovascular disease risk reduction? Canadian Journal of Cardiology 24(suppl D):25D–31D, 2008
[CrossRef] | [PubMed]
 
Lee  DC;  Sui  X;  Artero  EG  et al:  Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study.  Circulation 124:2483–2490, 2011
[CrossRef] | [PubMed]
 
Moore  SC;  Patel  AV;  Matthews  CE  et al:  Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis.  PLoS Medicine 9:e1001335, 2012
[CrossRef] | [PubMed]
 
Samitz  G;  Egger  M;  Zwahlen  M:  Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies.  International Journal of Epidemiology 40:1382–1400, 2011
[CrossRef] | [PubMed]
 
Van Citters  AD;  Pratt  SI;  Jue  K  et al:  A pilot evaluation of the In SHAPE individualized health promotion intervention for adults with mental illness.  Community Mental Health Journal 46:540–552, 2010
[CrossRef] | [PubMed]
 
First  MB;  Spitzer  RL;  Gibbon  M  et al:  Structured Clinical Interview for DSM-IV Axis I Disorders, Patient Edition (SCID-P), version 2 .  New York,  New York State Psychiatric Institute, Biometrics Research, 1995
 
Folstein  MF;  Folstein  SE;  McHugh  PR:  “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician.  Journal of Psychiatric Research 12:189–198, 1975
[CrossRef] | [PubMed]
 
Balke  B:  A simple field test for the assessment of physical fitness.  Report Civil Aeromedical Research Institute (US) 53:1–8, 1963
 
Larsson  UE;  Reynisdottir  S:  The six-minute walk test in outpatients with obesity: reproducibility and known group validity.  Physiotherapy Research International 13:84–93, 2008
[CrossRef] | [PubMed]
 
Beriault  K;  Carpentier  AC;  Gagnon  C  et al:  Reproducibility of the 6-minute walk test in obese adults.  International Journal of Sports Medicine 30:725–727, 2009
[CrossRef] | [PubMed]
 
Bittner  V;  Weiner  DH;  Yusuf  S  et al:  Prediction of mortality and morbidity with a 6-minute walk test in patients with left ventricular dysfunction.  JAMA 270:1702–1707, 1993
[CrossRef] | [PubMed]
 
Cahalin  LP;  Mathier  MA;  Semigran  MJ  et al:  The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure.  Chest 110:325–332, 1996
[CrossRef] | [PubMed]
 
Chetta  A;  Aiello  M;  Foresi  A  et al:  Relationship between outcome measures of six-minute walk test and baseline lung function in patients with interstitial lung disease.  Sarcoidosis, Vasculitis, and Diffuse Lung Diseases 18:170–175, 2001
 
Curtis  JP;  Rathore  SS;  Wang  Y  et al:  The association of 6-minute walk performance and outcomes in stable outpatients with heart failure.  Journal of Cardiac Failure 10:9–14, 2004
[PubMed]
 
Demers  C;  McKelvie  RS;  Negassa  A  et al:  Reliability, validity, and responsiveness of the six-minute walk test in patients with heart failure.  American Heart Journal 142:698–703, 2001
[CrossRef] | [PubMed]
 
Kosak  M;  Smith  T:  Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke.  Journal of Rehabilitation Research and Development 42:103–107, 2005
[PubMed]
 
Miyamoto  S;  Nagaya  N;  Satoh  T  et al:  Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension: comparison with cardiopulmonary exercise testing.  American Journal of Respiratory and Critical Care Medicine 161:487–492, 2000
[CrossRef] | [PubMed]
 
Pankoff  BA;  Overend  TJ;  Lucy  SD  et al:  Reliability of the six-minute walk test in people with fibromyalgia.  Arthritis Care and Research 13:291–295, 2000
[CrossRef] | [PubMed]
 
Redelmeier  DA;  Bayoumi  AM;  Goldstein  RS  et al:  Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients.  American Journal of Respiratory and Critical Care Medicine 155:1278–1282, 1997
[CrossRef] | [PubMed]
 
Sciurba  F;  Criner  GJ;  Lee  SM  et al:  Six-minute walk distance in chronic obstructive pulmonary disease: reproducibility and effect of walking course layout and length.  American Journal of Respiratory and Critical Care Medicine 167:1522–1527, 2003
[CrossRef] | [PubMed]
 
Rasekaba  T;  Lee  AL;  Naughton  MT  et al:  The six-minute walk test: a useful metric for the cardiopulmonary patient.  Internal Medicine Journal 39:495–501, 2009
[CrossRef] | [PubMed]
 
Wise  RA;  Brown  CD:  Minimal clinically important differences in the six-minute walk test and the incremental shuttle walking test.  COPD 2:125–129, 2005
[CrossRef] | [PubMed]
 
Garrow  JS;  Webster  J:  Quetelet’s index (W/H2) as a measure of fatness.  International Journal of Obesity 9:147–153, 1985
[PubMed]
 
Faulkner  G;  Cohn  T;  Remington  G:  Validation of a physical activity assessment tool for individuals with schizophrenia.  Schizophrenia Research 82:225–231, 2006
[CrossRef] | [PubMed]
 
Sutton  K;  Logue  E;  Jarjoura  D  et al:  Assessing dietary and exercise stage of change to optimize weight loss interventions.  Obesity Research 11:641–652, 2003
[CrossRef] | [PubMed]
 
Prochaska  J:  A transtheoretical model of behavior change: implications for diet interventions; in  Proceedings of Promoting Dietary Changes in Communities: Applying Existing Models of Dietary Change to Population-Based Interventions . Edited by DeRoos  K.  Seattle, Wash,  Fred Hutchinson Cancer Research Center, 1992
 
Fitzmaurice  G;  Laird  N;  Ware  J:  Applied Longitudinal Analysis .  New York,  Wiley, 2004
 
Hedeker  D;  Gibbons  RD:  Longitudinal Data Analysis .  New York,  Wiley, 2006
 
Jennrich  RI;  Schluchter  MD:  Unbalanced repeated-measures models with structured covariance matrices.  Biometrics 42:805–820, 1986
[CrossRef] | [PubMed]
 
Ussher  M;  Stanbury  L;  Cheeseman  V  et al:  Physical activity preferences and perceived barriers to activity among persons with severe mental illness in the United Kingdom.  Psychiatric Services 58:405–408, 2007
[CrossRef] | [PubMed]
 
McDevitt  J;  Snyder  M;  Miller  A  et al:  Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation.  Journal of Nursing Scholarship 38:50–55, 2006
[CrossRef] | [PubMed]
 
Shiner  B;  Whitley  R;  Van Citters  AD  et al:  Learning what matters for patients: qualitative evaluation of a health promotion program for those with serious mental illness.  Health Promotion International 23:275–282, 2008
[CrossRef] | [PubMed]
 
Spencer  L;  Wharton  C;  Moyle  S  et al:  The transtheoretical model as applied to dietary behaviour and outcomes.  Nutrition Research Reviews 20:46–73, 2007
[CrossRef] | [PubMed]
 
Brown  C;  Goetz  J;  Hamera  E:  Weight loss intervention for people with serious mental illness: a randomized controlled trial of the RENEW program.  Psychiatric Services 62:800–802, 2011
[CrossRef] | [PubMed]
 
Iglesias-García  C;  Toimil-Iglesias  A;  Alonso-Villa  MJ:  Pilot study of the efficacy of an educational programme to reduce weight, on overweight and obese patients with chronic stable schizophrenia.  Journal of Psychiatric and Mental Health Nursing 17:849–851, 2010
[CrossRef] | [PubMed]
 
Daumit  GL;  Dalcin  AT;  Jerome  GJ  et al:  A behavioral weight-loss intervention for persons with serious mental illness in psychiatric rehabilitation centers.  International Journal of Obesity 35:1114–1123, 2011
[CrossRef] | [PubMed]
 
Casagrande  SS;  Jerome  GJ;  Dalcin  AT  et al:  Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial.  BMC Psychiatry 10:108, 2010
[CrossRef] | [PubMed]
 
Cabassa  LJ;  Ezell  JM;  Lewis-Fernández  R:  Lifestyle interventions for adults with serious mental illness: a systematic literature review.  Psychiatric Services 61:774–782, 2010
[CrossRef] | [PubMed]
 
Chen  CK;  Chen  YC;  Huang  YS:  Effects of a 10-week weight control program on obese patients with schizophrenia or schizoaffective disorder: a 12-month follow up.  Psychiatry and Clinical Neurosciences 63:17–22, 2009
[CrossRef] | [PubMed]
 
Melamed  Y;  Stein-Reisner  O;  Gelkopf  M  et al:  Multi-modal weight control intervention for people with persistent mental disorders.  Psychiatric Rehabilitation Journal 31:194–200, 2008
[CrossRef] | [PubMed]
 
McKibbin  CL;  Folsom  D;  Meyer  J  et al:  Behavioral interventions to improve management of overweight, obesity, and diabetes in patients with schizophrenia; in  Handbook of Behavioral and Cognitive Therapies With Older Adults . Edited by Gallagher-Thompson  D;  Steffen  AM;  Thompson  LW.  New York,  Springer Science, 2008
 
Lee  SJ;  Choi  EJ;  Kwon  JS:  A naturalistic multicenter trial of a 12-week weight management program for overweight and obese patients with schizophrenia or schizoaffective disorder.  Journal of Clinical Psychiatry 69:555–562, 2008
[CrossRef] | [PubMed]
 
Hayburn  BM:  Motivational enhancement and weight loss intervention with a schizophrenic population .  Ann Arbor, Mich,  La Salle University Press, 2005
 
Anderson  AS:  Nutrition interventions in women in low-income groups in the UK.  Proceedings of the Nutrition Society 66:25–32, 2007
[CrossRef] | [PubMed]
 
Wadden  TA;  Webb  VL;  Moran  CH  et al:  Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy.  Circulation 125:1157–1170, 2012
[CrossRef] | [PubMed]
 
Donnelly  JE;  Blair  SN;  Jakicic  JM  et al:  American College of Sports Medicine Position Stand: Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults.  Medicine and Science in Sports and Exercise 41:459–471, 2009
[CrossRef] | [PubMed]
 
Leslie  DL;  Rosenheck  RA:  Pharmacotherapy and health care costs among patients with schizophrenia and newly diagnosed diabetes.  Psychiatric Services 56:803–809, 2005
[CrossRef] | [PubMed]
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 59.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 48.  >
DSM-5™ Handbook of Differential Diagnosis > Chapter 2.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 59.  >
The American Psychiatric Publishing Textbook of Psychopharmacology, 4th Edition > Chapter 40.  >
Topic Collections
Psychiatric News
PubMed Articles