Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2019

Open Access 01-12-2019 | Research article

Multimodal lifestyle intervention using a web-based tool to improve cardiometabolic health in patients with serious mental illness: results of a cluster randomized controlled trial (LION)

Authors: Anne Looijmans, Frederike Jörg, Richard Bruggeman, Robert A. Schoevers, Eva Corpeleijn

Published in: BMC Psychiatry | Issue 1/2019

Login to get access

Abstract

Background

Unhealthy lifestyle behaviours contribute to alarming cardiometabolic risk in patients with serious mental illness (SMI). Evidence-based practical lifestyle tools supporting patients and staff in improving patient lifestyle are lacking.

Methods

This multi-site randomized controlled pragmatic trial determined the effectiveness of a twelve-month multimodal lifestyle approach, including a web-based tool to improve patients’ cardiometabolic health, versus care-as-usual. Using the web tool, nurses (trained in motivational interviewing) assisted patients in assessing their lifestyle behaviours, creating a risk profile and constructing lifestyle goals, which were discussed during fortnightly regular care visits. Twenty-seven community-care and sheltered-living teams were randomized into intervention (N = 17) or control (N = 10) groups, including 244 patients (140 intervention/104 control, 49.2% male, 46.1 ± 10.8 years) with increased waist circumference (WC), BMI or fasting glucose. The primary outcomes concerned differences in WC after six and twelve months intervention, while BMI and metabolic syndrome Z-score were secondary outcome measures.

Results

General multilevel linear mixed models adjusted for antipsychotic medication showed that differences in WC change between intervention and control were − 0.15 cm (95%CI: − 2.49; 2.19) after six and − 1.03 cm (95%CI: − 3.42; 1.35) after twelve months intervention; however, the differences were not statistically significant. No intervention effects were found for secondary outcome measures. The intervention increased patients’ readiness to change dietary behaviour.

Conclusion

A multimodal web-based intervention facilitating nurses to address lifestyle changes in SMI patients did not improve patient cardiometabolic health. Web-tool use was lower than expected and nurses need more lifestyle coaching knowledge and skills. The type of intervention and delivery mode need optimization to realize effective lifestyle care for SMI patients.

Trial registration

Dutch Trial Registry, www.​trialregister.​nl, NTR3765, 21 December 2012.
Appendix
Available only for authorised users
Literature
1.
Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52–77.CrossRef
2.
Naslund JA, Whiteman KL, McHugo GJ, Aschbrenner KA, Marsch LA, Bartels SJ. Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: a systematic review and meta-analysis. Gen Hosp Psychiatry. 2017;47:83–102.PubMedPubMedCentralCrossRef
3.
Bruins J, Jörg F, Bruggeman R, Slooff C, Corpeleijn E, Pijnenborg M. The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders: a meta-analysis. PLoS One. 2014;9(12):e112276.PubMedPubMedCentralCrossRef
4.
McGinty EE, Baller J, Azrin ST, Juliano-Bult D, Daumit GL. Interventions to address medical conditions and health-risk behaviors among persons with serious mental illness: a comprehensive review. Schizophr Bull. 2016 Jan;42(1):96–124.PubMed
5.
Lutes LD, Winett RA, Barger SD, Wojcik JR, Herbert WG, Nickols-Richardson SM, et al. Small changes in nutrition and physical activity promote weight loss and maintenance: 3-month evidence from the ASPIRE randomized trial. Ann Behav Med. 2008;35(3):351–7.PubMedCrossRef
6.
Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK. Weight regain in US adults who experienced substantial weight loss, 1999–2002. Am J Prev Med. 2007;33(1):34–40.PubMedCrossRef
7.
Sbrocco T, Nedegaard RC, Stone JM, Lewis EL. Behavioral choice treatment promotes continuing weight loss: preliminary results of a cognitive–behavioral decision-based treatment for obesity. J Consult Clin Psychol. 1999;67(2):260.PubMedCrossRef
8.
Searight R. Realistic approaches to counseling in the office setting. Am Fam Physician. 2009 Feb 15;79(4):277–84.PubMed
9.
Schoenberg NE, Tarasenko YN, Snell-Rood C. Are evidence-based, community-engaged energy balance interventions enough for extremely vulnerable populations? Transl Behav Med 2018 09 08,;8(5):733–738.PubMedPubMedCentralCrossRef
10.
Miller WR, Rollnick S. Motivational interviewing: Preparing people for change. New York: Guilford Press; 2002. p. 428.
11.
Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, research & practice. 1982;19(3):276.CrossRef
12.
Greaves CJ, Sheppard KE, Abraham C, Hardeman W, Roden M, Evans PH, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health. 2011;11(1):119.PubMedPubMedCentralCrossRef
13.
Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(9):709–23.PubMed
14.
Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005 Apr;55(513):305–12.PubMedPubMedCentral
15.
Arkowitz H, Miller WR. Learning, applying, and extending motivational interviewing. Motivational interviewing in the treatment of psychological problems. 2008:1–25.
16.
Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice: John Wiley & Sons; 2008.
17.
Naslund JA, Aschbrenner KA, Barre LK, Bartels SJ. Feasibility of Popular m-Health Technologies for Activity Tracking Among Individuals with Serious. Mental Illness. Telemedicine and e-Health. 2015 Mar 1;21(3):213–6.PubMedCrossRef
18.
Bauer S, Moessner M. Technology-enhanced monitoring in psychotherapy and e-mental health. J Ment Health. 2012 Aug;21(4):355–63.PubMedCrossRef
19.
Naslund JA, Aschbrenner KA. Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders. Evid Based Ment Health. 2019 Feb;22(1):17–22.PubMedCrossRef
20.
Faulkner G, Cohn T, Remington G. Interventions to reduce weight gain in schizophrenia. Cochrane Database of Systematic Reviews. 2007;(1).
21.
Meijel B, Hamersveld S, Gool R, der Bijl J, Harten P. Effects and feasibility of the “traffic light method for somatic screening and lifestyle” in patients with severe mental illness: a pilot study. Perspect Psychiatr Care. 2015;51(2):106–13.PubMedCrossRef
22.
Looijmans A, Jörg F, Bruggeman R, Schoevers R, Corpeleijn E. Design of the Lifestyle Interventions for severe mentally ill outpatients in the Netherlands (LION) trial; a cluster randomised controlled study of a multidimensional web tool intervention to improve cardiometabolic health in patients with severe mental illness. BMC Psychiatry. 2017;17(1):107.PubMedPubMedCentralCrossRef
23.
Campbell MK, Piaggio G, Elbourne DR, Altman DG. CONSORT Group. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012 Sep 4;345:e5661.PubMedCrossRef
24.
Eysenbach G. Consort-EHEALTH Group. CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res. 2011:13(4).PubMedPubMedCentralCrossRef
25.
26.
Han TS, Richmond P, Avenell A, Lean M. Waist circumference reduction and cardiovascular benefits during weight loss in women. International Journal of Obesity & Related Metabolic Disorders. 1997:21(2).
27.
Doran GT. There’s a SMART way to write management’s goals and objectives. Manag Rev. 1981;70(11):35–6.
28.
Bartels-Velthuis AA, Visser E, Arends J, Pijnenborg GH, Wunderink L, Jörg F, et al. Towards a comprehensive routine outcome monitoring program for people with psychotic disorders: the pharmacotherapy monitoring and outcome survey (PHAMOUS). Schizophr Res. 2018.
29.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005 Oct 25;112(17):2735–52.PubMedCrossRef
30.
Forouhi NG, Balkau B, Borch-Johnsen K, Dekker J, Glumer C, Qiao Q, et al. The threshold for diagnosing impaired fasting glucose: a position statement by the European diabetes epidemiology group. Diabetologia. 2006;49(5):822–7.PubMedCrossRef
31.
International Expert Committee. International expert committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009 Jul;32(7):1327–34.CrossRef
32.
Bakker SJ, Gansevoort RT, de Zeeuw D. Metabolic syndrome: a fata morgana? Nephrol Dial Transplant. 2007 Jan;22(1):15–20.PubMedCrossRef
33.
Eisenmann JC. On the use of a continuous metabolic syndrome score in pediatric research. Cardiovasc Diabetol. 2008;7(1):1.CrossRef
34.
35.
36.
IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp; 2013.
37.
Daumit GL, Dickerson FB, Wang N, Dalcin A, Jerome GJ, Anderson CA, et al. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med. 2013;368(17):1594–602.PubMedPubMedCentralCrossRef
38.
Bartels SJ, Pratt SI, Aschbrenner KA, Barre LK, Naslund JA, Wolfe R, et al. Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes. Am J Psychiatry. 2015;172(4):344–52.PubMedCrossRef
39.
Green CA, Yarborough BJH, Leo MC, Stumbo SP, Perrin NA, Nichols GA, et al. Weight maintenance following the STRIDE lifestyle intervention for individuals taking antipsychotic medications. Obesity. 2015;23(10):1995–2001.PubMedCrossRef
40.
Speyer H, Christian Brix Nørgaard H, Birk M, Karlsen M, Storch Jakobsen A, Pedersen K, et al. The CHANGE trial: no superiority of lifestyle coaching plus care coordination plus treatment as usual compared to treatment as usual alone in reducing risk of cardiovascular disease in adults with schizophrenia spectrum disorders and abdominal obesity. World Psychiatry. 2016;15(2):155–65.PubMedPubMedCentralCrossRef
41.
Holt RI, Gossage-Worrall R, Hind D, Bradburn MJ, McCrone P, Morris T, et al. Structured lifestyle education for people with schizophrenia, schizoaffective disorder and first-episode psychosis (STEPWISE): randomised controlled trial. Br J Psychiatry. 2018:1–11.
42.
Lovell K, Wearden A, Bradshaw T, Tomenson B, Pedley R, Davies LM, et al. An exploratory randomized controlled study of a healthy living intervention in early intervention services for psychosis: the INTERvention to encourage ACTivity, improve diet, and reduce weight gain (INTERACT) study. J Clin Psychiatry. 2014;75(5):498–505.PubMedCrossRef
43.
Cortellini M, Berrino F, Pasanisi P. “Open mesh” or “strictly selected population” recruitment? The experience of the randomized controlled MeMeMe trial. Patient preference and adherence. 2017;11:1127.PubMedPubMedCentralCrossRef
44.
Naslund JA, Aschbrenner KA, Scherer EA, Pratt SI, Wolfe RS, Bartels SJ. Lifestyle intervention for people with severe obesity and serious mental illness. Am J Prev Med. 2016;50(2):145–53.PubMedCrossRef
45.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.PubMedPubMedCentralCrossRef
Metadata
Title
Multimodal lifestyle intervention using a web-based tool to improve cardiometabolic health in patients with serious mental illness: results of a cluster randomized controlled trial (LION)
Authors
Anne Looijmans
Frederike Jörg
Richard Bruggeman
Robert A. Schoevers
Eva Corpeleijn
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2019
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-019-2310-5

Other articles of this Issue 1/2019

BMC Psychiatry 1/2019 Go to the issue

Research article

Mixed method evaluation of Relational Team Development (RELATED) to improve team-based care for complex patients with mental illness in primary care

Correction

Correction to: Stability of personality traits over a five-year period in Swedish patients with schizophrenia spectrum disorder and nonpsychotic individuals: a study using the Swedish universities scales of personality

Research article

The mediating effect of health anxiety in the relationship between functional somatic symptoms and illness behavior in Chinese inpatients with depression

Research article

Prevalence of behavioral disorders and attention deficit/hyperactive disorder among school going children in Southwestern Uganda

Research article

Effectiveness of multidisciplinary psychiatric home treatment for elderly patients with mental illness: a systematic review of empirical studies

Research article

Efficacy and feasibility of a humor training for people suffering from depression, anxiety, and adjustment disorder: a randomized controlled trial