Physical Activity to Reduce Cardiometabolic Risk in Adults with Serious Mental Illness (PARCS Study)

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Project Summary/Abstract The lives of adults with serious mental illness (SMI) are cut short by decades. Chronic illnesses including heart disease are a fundamental cause. Adults with SMI have high cardiometabolic risk compared to the general population. Modifiable risk factors (e.g., physical inactivity, poor fitness) are more prevalent and manifest earlier in the lifecourse in those with SMI. Physical activity (PA) can reduce cardiometabolic risk in SMI populations. Yet, persons with SMI are significantly less likely to meet PA recommendations. Certified peer specialists (CPSs), trained persons with lived mental health recovery experience, are a rapidly growing mental health workforce sector reimbursed by Medicare. CPSs include PA among their wellness goals and offer a sustainable delivery mechanism for PA interventions within mental health services. Yet, effective PA treatment delivery and sustainability remain challenging. Innovative, scalable, evidence-based PA interventions for people with SMI are needed. Parks are free, ubiquitous spaces for PA. Parks offer physical, psychological, and social benefits linked with improved health behaviors and outcomes. Studies, including ours, have related park access and use to greater PA, social support, mood, and quality of life (QOL), and less obesity, stress, morbidity and mortality. 2-37 Outdoor PA is associated with increased enjoyment, satisfaction, and long-term PA adherence, 33 supporting its use for behavior change, especially among those with SMI. Despite park-based PA benefits,34 few park-based interventions have been tested rigorously. None have focused on SMI populations. Our long-term goal is to maximize the reach and clinical impact of evidence-based PA interventions to reduce cardiometabolic risk among SMI populations through use of existing mental health services and community parks. The PARCS Study is an evidence-based park PA intervention incorporating CPSs in adults with SMI. Adapted from previous exercise protocols, and grounded in Social Cognitive Theory (SCT) the PARCS Study will test a 12-week park-based PA intervention (60 min CPS-led, 3 days/week) vs a active control, as part of current peer group services. The aims of this proposal are: 1) To test the feasibility and acceptability of the park-based PA intervention incorporating CPSs in adults with SMI (primary), 2a) to assess the effectiveness of the intervention on SCT mechanisms of action (PA self-efficacy, goal setting, and PA social support, and 2b) to test the preliminary effectiveness of the intervention on minutes of PA, and fitness in adults with SMI (secondary). This novel approach aims to establish a sustainable, scalable, and reimbursable intervention model by leveraging existing resources (CPS services, parks) to reduce cardiometabolic risk in adults with SMI. Exploratory measures include percent body fat, waist circumference, QOL, and depressive symptoms. Our team committed team of interdisciplinary co-investigators and community behavioral health facilities has expertise and resources to achieve the goals of the proposed study. Working with mental health services, we will refine our approach and generate evidence for future large-scale effectiveness testing.