Studies of lifestyle interventions conducted in USA for adults diagnosed or classified as having serious mental illnesses were eligible for inclusion. Included studies had to evaluate physical health outcomes such as weight and body mass index (BMI) or health promotion outcomes such as self-efficacy and health-related quality of life.
The included interventions comprised exercise and information about diet and health promotion. Most interventions incorporated behavioural strategies that included goal setting, skills training, motivational counselling, stress management, assertiveness training, rewards or tokens of reinforcements, stimulus control, risk/benefit comparisons, relapse prevention and teaching to address motivational impairment and cognitive deficits associated with mental illness. Interventions were individual and/or group sessions. Intervention durations ranged from 30 minutes to 52 weeks. Delivery of interventions varied between studies. Intervention settings included in-patient units, day treatment programmes, outpatient clinics, residential facilities, clubhouses and vocational agencies. Secondary outcomes evaluated were changes in metabolic syndrome risk factors.
The average age of participants ranged from 32 to 54 years. The proportion of female participants ranged from 4% to 77%. Mean BMI at baseline was 33.6 (which indicated obesity) and mean weight at baseline was 214 lbs. Just over half the studies included only participants with schizophrenia or schizoaffective disorders. Other studies included participants with various disorders that included major depression, bipolar disorder, alcohol dependence and anxiety disorders. Where reported, more than half of the participants were non-Hispanic white. Others were African American, Hispanic, Asian American, or from other racial/ethnic groups. Only one study included non-English-speaking participants.
Two authors selected studies for inclusion.