Randomized, Controlled Trial of a Fitness-Promotion Prgram for People with Serious Mental Illness

Background and Purpose: Individuals with serious mental illness (SMI), who comprise a substantial fraction of the US population, suffer a severe life expectancy disparity unmatched by any other group, dying on average 25–30 years earlier than people in the general population. This disparity arises largely from preventable causes, especially low engagement in exercise, poor diet, and smoking. Only a handful of interventions have been developed to enhance fitness in people with SMI. In SHAPE is a fitness promotion program for adults with SMI developed by a community mental health center (CMHC) in Keene, NH that provides a 12-month fitness club membership, weekly individual meetings with a certified fitness trainer, education on healthy eating, and quarterly group celebrations to provide positive feedback, enhance motivation, and facilitate social contact. We conducted a three-year randomized controlled trial comparing In SHAPE with a control group who received a fitness club membership only (CDC R01 DD000140, “Promoting Health & Functioning in Persons with SMI,” PI: Bartels) to test the hypotheses that In SHAPE would be associated with greater participation in physical exercise, improved dietary behaviors, and improved physical fitness including greater reductions in body mass index (BMI) and greater exercise capacity. Methods: Study participants were133 adults with SMI (defined as Axis 1 disorder of schizophrenia, schizoaffective disorder, major depressive disorder, or bipolar disorder and at least moderate impairment in multiple domains of community functioning) and BMI over 25 who were recruited from a CMHC in Concord, NH using direct advertising (poster and pamphlets in waiting areas) and clinician referral. Trained raters blind to randomization status administered fitness measures (BMI, 6-minute walk test), and exercise and nutrition scales (International Physical Activity Questionnaire, Weight Loss Behavior Stages of Change Scale, 24-hour dietary recall) at baseline and every 3 months for 12 months. Outcome analyses at 3 months were conducted using repeated measures analysis (ANCOVA) including baseline (BL) as a covariate. Results: In SHAPE was associated with significant increases in: 1) minutes of exercise per week (In SHAPE: from 91 to 181; control: from 97 to 106; F = 4.7, p = .032); 2) consumption of fruits and vegetables (F = 8.8, p = .004); and 3) number of visits to the gym over 3 months (t = 3.8, p < .0001). For exercise capacity as measured by the 6-minute walk test, the In SHAPE group increased by 143 ft (1387 ft to 1530 ft) vs. 19 ft for the control group (1457 ft to 1476 ft) (F = 4.039, p = .048). Average weight loss at 3 months did not differ between the two groups. Conclusions and Implications: Although greater weight loss was not achieved, participation in In SHAPE was associated with significantly improved healthy lifestyle behaviors including exercise and healthy eating, and exercise capacity. This study provides critical knowledge about a public-sector, “real world” health program that may serve as a model for systems of care across the nation to help stem the tide of early mortality in people with SMI.