A Meta-Review of Lifestyle Interventions for Cardiovascular Risk Factors in the General Medical Population

OBJECTIVE: Individuals with serious mental illness die years younger than members of the general population, with cardiovascular disease and related risk factors accounting for the majority of deaths. Lifestyle interventions targeting these risk factors have begun to be developed for those with serious mental illness, but they have largely been created de novo rather than with information from work already done in the general population. This review aims to synthesize for a mental health audience the common factors for success in nonpharmacologic lifestyle interventions and identify specific considerations in adapting these models for those with serious mental illness. DATA SOURCES: We searched the PubMed and Cochrane databases for English-language reviews from 2003 to 2013. The search employed combinations of the following terms: diabetes, diabetes mellitus, hypertension, hyperlipidemia, dyslipidemia, obesity, mental illness, schizophrenia, psychosis, bipolar disorder, lifestyle intervention, non-pharmacologic intervention, lifestyle modification, and weight gain. STUDY SELECTION: We identified 8,147 review articles from the PubMed and Cochrane databases. 123 articles were selected. The selected articles were reviews of dietary, behavioral, or exercise interventions that focused on obesity and related cardiometabolic risk factors. DATA EXTRACTION: We undertook a qualitative "review of reviews" focusing on nonpharmacologic interventions for obesity and related cardiometabolic risk factors. RESULTS: Effects of interventions in the general population were meaningful but generally modest. Specific elements of diet, exercise, and behavioral therapy produced larger effects. Additionally, successful programs employed multiple components, personalization, longer duration, more frequent contact, and trained treatment providers. Interventions addressing these risk factors in people with serious mental illness typically incorporated some, but not all, of the elements demonstrated to be effective in general medical populations. CONCLUSIONS: Studies from the general medical literature demonstrate considerable promise in addressing lifestyle risk factors. Existing programs will require tailoring to address the needs of those with serious mental illness and may be harder to implement given the challenges faced by this population. However, successful lifestyle interventions for those with serious mental illness can make a significant impact on the health and well-being of this vulnerable population and may inform future strategies for other underserved groups.