Health Promotion and Fitness for Younger and Older Adults With SMI

描述（由申请人提供）：患有严重精神疾病（SMI）的成年人的预期寿命减少20%，与肥胖率高，久坐不动的生活方式以及不良饮食和健康行为相关的医疗合并症的患病率不成比例地更高。这是一项随机对照试验的申请，旨在评估一种专门为SMI患者量身定制的新型健康促进和健身干预（In SHAPE）的有效性，并在SMI患者中进行试点测试。研究参与者将包括200名按诊断组分层的患有SMI的成人（n=100例精神分裂症谱系障碍和n=100例心境障碍），并随机分配至：a）在SHAPE中，包括个人健康评估和制定饮食和锻炼目标，每周与健康导师会面，每月举行饮食和体重管理小组会议，基督教青年会会员，奖励计划，和小组教育和激励会议;或B）健康俱乐部会员资格和教育材料（HCME）。在SHAPE中，参与者将接受为期一年的强化计划（每周与健康导师接触），然后是6个月的维持期（每两周一次的会议逐渐减少到每月与健康导师的会议），并在基线，3，6，12和18个月进行评估。本研究将解决以下3个具体目标：目标1）比较In SHAPE和HCME在身体健康结果方面的有效性，包括：（a）参与定期锻炼和饮食改变，以及（B）身体健康指标，包括6分钟步行测试的表现、腰围减小和BMI减小;目标2：比较In SHAPE和HCME在心理健康结局方面的有效性，包括阴性症状、抑郁症状和自我效能;和目的3）探讨In SHAPE和HCME在心理社会功能、健康状况和急性服务使用方面的有效性，以及选定的人口统计学、临床和健康行为变量对主要结局的影响。如果被发现是有效的，在形状计划可以提供一个模型，以改善健身，饮食行为，和心理健康结果为这个脆弱和高危人群在公共部门的心理健康设置。对发病率和死亡率的潜在下游影响对大量重度精神病患者具有公共卫生影响。

DESCRIPTION (provided by applicant): Adults with serious mental illness (SMI) have a 20 percent reduced life expectancy and disproportionately greater prevalence of medical comorbidity associated with high rates of obesity, sedentary lifestyle, and poor dietary and health behaviors. This is a application for a randomized controlled trial evaluating the effectiveness of a novel health promotion and fitness intervention (In SHAPE) specially tailored for, and pilot tested among persons with SMI. Study participants will include 200 adults with SMI stratified by diagnostic group (n=100 schizophrenia-spectrum disorders and n=100 mood disorders) and randomized to either: a) In SHAPE, consisting of a personal fitness assessment and development of diet and exercise goals, weekly meetings with a health mentor, monthly group sessions on diet and weight management, a YMCA membership, an incentive program, and group educational and motivational sessions; or b) a health club membership and educational materials (HCME). In SHAPE participants will receive a one-year intensive program (weekly contact with a health mentor), followed by a 6-month maintenance phase (bi-weekly meetings tapering to monthly meetings with a health mentor), with assessments conducted at baseline, 3, 6,12 and 18 months. This study will address the following 3 specific aims: Aim 1) To compare the effectiveness of In SHAPE and HCME with respect to physical fitness outcomes, including: (a) engagement in regular exercise and dietary change and (b) indicators of physical fitness, including performance on the 6-minute walk test, decreased waist circumference, and decreased BMI; Aim 2: To compare the effectiveness of In SHAPE and HCME with respect to mental health outcomes, including negative symptoms, depressive symptoms, and self-efficacy; and Aim 3) To explore the effectiveness of In SHAPE and HCME with respect to psychosocial functioning, health status, and acute service use, as well as the effects of selected demographic, clinical, and health behavior variables on primary outcomes. If found to be effective, the In SHAPE program could provide a model for improving fitness, dietary behaviors, and mental health outcomes for this vulnerable and at-risk population within public sector mental health settings. The potential downstream impact on morbidity and mortality has public health implications for large numbers of persons with SMI.