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Health coaching for serious mental illnesses may curb obesity, reduce cardiovascular risk

Overweight and obese patients with severe mental illnesses who met with a weekly health promotion coach in a public fitness club had clinically significant reductions in cardiovascular risk when compared to a similar group of patients with a fitness club membership alone, according to recent research.

“By comparing In SHAPE [Ken Jue & Associates] to an active comparison condition (a fitness club membership), we were able to test the specific contribution of having a health promotion coach,” Stephen J. Bartels, MD, MS, of the department of psychiatry and department of community and family medicine, Dartmouth Institute for health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, and colleagues wrote in their study. “Having a health promotion coach was associated with more than two and a half times the mean amount of fitness club attendance, which in turn was associated with greater weight loss and improved fitness.”

Bartels and colleagues randomly recruited 210 patients from three Boston mental health providers between 2007 and 2011 and assigned them into the In SHAPE program (n = 104), which included a weekly consultation with a health promotion coach and a membership to a public fitness club, or a public fitness club membership (n = 106). Patients had a mean BMI of 36.8, a mean age of 43.9 years and a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder or major depression.

The fitness club membership was discontinued at 12 months for all patients, and the researchers made transitional support to community-based fitness activities available for In SHAPE program patients only for an additional 6 months. The researchers’ primary outcome measures included a 5% weight reduction or greater from baseline to 12 months, and a greater than 50 meter (164 feet) improvement in the 6-minute walk test.

Patients who met with a health promotion coach significantly reduced their weight (mean 231.8 lbs to 226.5 lbs) and improved in the 6-minute walk fitness test (mean 1,356.8 ft to 1,385.3 ft) from baseline to 12 months compared with patients with a fitness club membership alone. For fitness club members only, there was a slight mean decrease in fitness for the 6-minute walk test, from 1,311.4 feet to 1,247.3 feet.

There are many roadblocks to improving access to exercise facilities as part of community mental health services, according to the researchers.

“Providing health promotion coaches and access to exercise facilities and affordable, healthy food will require significant changes in the way we finance and prioritize community mental health services,” they wrote. – by Jeffrey Craven

Disclosure: Pratt, Barre and Jue report receiving payments from Ken Jue Consulting to provide training in the In SHAPE program at non-research sites. The other authors report no relevant financial disclosures.