This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Overweight and obesity are highly prevalent among people with severe mental illness (SMI); these conditions in the SMI likely contribute substantially to hypertension, diabetes mellitus, coronary disease, and early mortality. Through increased appetite and other possible mechanisms, most atypical antipsychotics cause weight gain. Yet, given their effectiveness and fewer neurologic side effects, these medications will likely remain a mainstay of pharmacotherapy for persons with SMI in the foreseeable future. At the same time, weight gain may play a role in non-adherence to antipsychotics. Effective behavioral weight loss interventions exist for the general population; however, they are probably not appropriate for people with SMI, who have special needs. Healthy lifestyle interventions for people with SMI are urgently needed. Psychiatric rehabilitation programs provide a unique context for testing nutrition and exercise interventions through their emphasis on skills building in a supportive environment. ACHIEVE is a pre-post intervention study that will pilot test a multifaceted nutrition and exercise intervention for clients with SMI participating in a psychiatric rehabilitation program. The client population is urban and predominantly African American. Our starting point will be a state-of-the art behavioral lifestyle intervention implemented in the Trial of Non-pharmacologic Interventions in the Elderly (TONE) that accomplished substantial weight loss in the general population. We will modify appropriately and enhance the intervention for this SMI population, and integrate it into a rehabilitation conceptual model. The intervention will include elements of: 1) individual and group nutrition and physical activity education and counseling; 2) an on-site group exercise class and 3) healthy modification of on-site meals and snacks. The primary outcomes to be measured at six months are: a) weight loss and b) level of moderate physical activity measured by accelerometry. Secondary outcomes will be: a) quality of life; b) health status; and, c) depression symptom level. Process outcomes will be: a) self-efficacy and b) participation in the intervention. Other outcomes will be the change in fasting serum glucose, insulin, lipids and CRP. The goals will be to have clients achieve a 10 pound weight loss and participate in 30 minutes of moderate intensity physical activity five times a week. Reflecting a client-centered focus, two sequential cohorts of 25 participants will complete the six month intervention, allowing for interim client feedback and subsequent intervention modification between cohorts. This study will provide important pilot data for future work to improve healthy lifestyle behaviors and reduce chronic medical illness in people with severe mental illness. Use of the GCRC is requested to cover the cost of the proposed serum measures.
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