The Effects of Lifestyle Interventions on (Long-Term) Weight Management, Cardiometabolic Risk and Depressive Symptoms in People with Psychotic Disorders: A Meta-Analysis

Abstract

AimsThe aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined.Material and MethodsWe searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters.ResultsThe search resulted in 25 RCTs -only 4 were considered high quality- showing an overall effect of lifestyle interventions on bodyweight (effect size (ES) = −0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES = −0.52, p<0.0001) and weight-gain-prevention (ES = −0.84, p = 0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES = −0.85, p = 0.0002) and weight loss studies (ES = −0.46, p = 0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES = −0.95, p = 0.05).ConclusionLifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired.

Online physical activity interventions for mental disorders: A systematic review

“…Positive effects of physical activity and exercise (a structured subset of physical activity) have been found across a broad range of mental disorders including depression (Cooney et al, 2013), anxiety (Jayakody et al, 2013), schizophrenia (Gorczynski and Faulkner, 2010;Vancampfort et al, 2012bVancampfort et al, , 2012c and bipolar disorder (Wright et al, 2009) with effect sizes (SMD) ranging from 0.46 to 1.0. Examples of successful physical activity and lifestyle interventions for people experiencing mental illness are increasing (Bruins et al, 2014;Daumit et al, 2013), with growing interest in the role of physical therapists and exercise physiologists to facilitate the delivery of such interventions (Rosenbaum et al, 2014b;Stanton, 2013;Stubbs et al, 2014).…”

The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

“…Bruins et al ., [7] found a significant improvement in fasting glucose levels with lifestyle interventions (standardised MD = -0.24, 95% CI, [-0.32, -0.10]; p = 0.001; n = 8 studies; I 2 = 0%) but did not include HbA 1c in their analysis or explore intervention characteristics. Mizuno et al ., [6] explored pharmacological strategies to counteract the metabolic side effects of antipsychotic medication, and reported statistically significant improvements in fasting glucose for metformin (MD = -0.18mmol/L; 95% CI, [-0.35, 0.00]; n = 9 studies; I 2 = 73%); and in HbA 1c for metformin (MD = -0.08%; 95% CI, [-0.13, -0.03]; n = 3 studies; I 2 = 0%) and aripiprazole (MD = -0.65%; 95% CI, [-1.25, -0.06]; n = 2 studies; I 2 = 89%).…”

“…It is well-established that modest improvements in glycated haemoglobin (HbA 1c ) and blood glucose levels can avoid onset of diabetes and have a significant impact on preventing diabetic complications in the general population [11]. A few reviews have investigated the effect of pharmacological [6, 12] and behavioural [7, 8, 13] interventions on these glycaemic measurements in people with SMI. An older review investigated both pharmacological and behavioural interventions [14].…”

Lithium or Valproate Adjunctive Therapy to Second-generation Antipsychotics and Metabolic Variables in Patients With Schizophrenia or Schizoaffective Disorder

“…It may also be beneficial to provide dietary counseling and encourage patients to start an exercise program before initiating treatment with a conventional mood stabilizer, especially for patients who are already overweight or have metabolic abnormalities. A recent meta-analysis of studies that included a nutritional element, physical activity, and/or a psychological intervention aimed at weight loss or preventing weight gain found that lifestyle interventions can be effective in treating and preventing obesity and reducing cardiometabolic risk factors in patients with psychotic disorders, 41 so that such interventions are recommended for all at-risk individuals. Clinicians should also consider the use of pharmacological interventions (metformin, top-iramate) for weight gain related to treatment with antipsychotics or mood stabilizers as non-pharmacologic interventions may be too challenging and difficult to implement and also because combining the 2 strategies may offer additive benefits.…”