The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial
Abstract
Objectives:
Method:
Results:
Conclusions:
Method
Study Design
Increasing awareness through monitoring: diet, physical activity, and sleep |
---|
Creating personalized diet and physical activity plans |
Reducing calories |
Reducing portion sizes, identifying and choosing alternative foods, modifying meals |
Increasing consumption of fruits, vegetables, fiber, and low-fat dairy products |
Increasing physical activity |
Developing action plans for high-risk eating situations |
Graphing progress and making adjustments |
Addressing mental health effects on lifestyle-change efforts |
Settings
Recruitment, Screening, and Randomization
Intervention
Initial intervention.
Maintenance intervention.
Assessment, Data Collection, and Measurement
Statistical Analyses
Sample Size
Results
Participants
Characteristic | Total (N=200) | Intervention Group (N=104) | Control Group (N=96) | |||
---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | |
Age (years) | 47.2 | 10.6 | 46.2 | 11.4 | 48.3 | 9.7 |
Weight (kg) | 107.7 | 25.1 | 108.6 | 27.2 | 106.6 | 22.7 |
Body mass index | 38.3 | 8.3 | 38.3 | 9.1 | 38.2 | 7.3 |
Female waist circumference (cm) | 114.5 | 19.2 | 114.6 | 20.5 | 114.4 | 17.7 |
Male waist circumference (cm) | 112.4 | 17.5 | 113.8 | 19.6 | 110.9 | 15.1 |
Systolic blood pressure (mmHg) | 119.2 | 14.7 | 117.5 | 14.2 | 121.0 | 15.2 |
Diastolic blood pressure (mmHg) | 79.4 | 10.1 | 78.5 | 9.7 | 80.4 | 10.5 |
Fasting triglycerides (mg/dL) | 188.0 | 138.6 | 188.0 | 130.3 | 188.0 | 147.8 |
Fasting low-density lipoprotein (mg/dL) | 101.4 | 32.9 | 101.4 | 31.3 | 101.4 | 34.7 |
Fasting high-density lipoprotein (mg/dL) | 45.8 | 12.7 | 46.6 | 14.0 | 45.0 | 11.0 |
Fasting total cholesterol (mg/dL) | 181.6 | 39.7 | 183.2 | 38.7 | 179.9 | 40.9 |
Fasting plasma glucose (mg/dL) | 108.9 | 32.5 | 107.6 | 31.2 | 110.3 | 34.1 |
Fasting insulin (μU/mL) | 13.0 | 11.9 | 11.2 | 7.8 | 15.1 | 15.0 |
Number of psychiatric medications | 3.2 | 1.5 | 3.1 | 1.4 | 3.3 | 1.5 |
Modified Colorado Symptom Index score | 19.3 | 11.4 | 18.3 | 11.2 | 20.4 | 11.6 |
Behavior and Symptom Identification Scale-24 item score | 1.37 | 0.68 | 1.29 | 0.70 | 1.47 | 0.64 |
Short-Form 36 Health Survey, Version 2.0, general health item score | 42.08 | 9.99 | 42.79 | 10.94 | 41.33 | 8.84 |
N | % | N | % | N | % | |
Female sex | 144 | 72.0 | 75 | 72.1 | 69 | 71.9 |
Race/ethnicity | ||||||
White | 174 | 87.7 | 90 | 88.2 | 81 | 87.1 |
Nonwhite | 26 | 12.3 | 12 | 11.8 | 12 | 12.9 |
Hispanic | 4 | 2.0 | 3 | 2.9 | 1 | 1.1 |
Education level | ||||||
Less than high school diploma/GED | 15 | 7.5 | 6 | 5.8 | 9 | 9.4 |
High school graduate/GED | 46 | 23.0 | 26 | 25.0 | 20 | 20.8 |
Some college | 87 | 43.5 | 44 | 42.3 | 43 | 44.8 |
College graduate | 52 | 26.0 | 28 | 26.9 | 24 | 25.0 |
Never married | 57 | 28.5 | 37 | 35.6 | 20 | 20.8 |
Currently working | 59 | 29.5 | 27 | 26.0 | 32 | 33.3 |
Receiving disability income | 90 | 45 | 46 | 44.2 | 44 | 45.8 |
Individual monthly income | ||||||
<$500 | 33 | 16.5 | 20 | 20.0 | 13 | 13.7 |
$500–$1,000 | 66 | 33.8 | 35 | 35.0 | 31 | 32.6 |
$1,000–$1,499 | 36 | 18.5 | 20 | 20.0 | 16 | 16.8 |
$1,500–$1,999 | 17 | 8.7 | 6 | 6.0 | 11 | 11.6 |
$2,000–$2,499 | 18 | 9.2 | 8 | 8.0 | 10 | 10.5 |
≥$2,500 | 25 | 12.9 | 11 | 11.0 | 14 | 14.8 |
Mental health diagnoses (from medical records) | ||||||
Schizophrenia spectrum disorder | 58 | 29.0 | 31 | 29.8 | 27 | 28.1 |
Bipolar disorder or affective psychosis | 138 | 69.0 | 71 | 68.2 | 67 | 69.8 |
Posttraumatic stress disorder | 4 | 2.0 | 2 | 1.9 | 2 | 2.1 |
Current medications | ||||||
Blood pressure medications | 59 | 29.5 | 30 | 28.8 | 29 | 30.2 |
Diabetes medications | 30 | 15.0 | 14 | 13.5 | 16 | 16.7 |
Cholesterol medications | 49 | 24.5 | 27 | 26.0 | 22 | 22.9 |
Atypical antipsychotic medications | 182 | 91.0 | 95 | 91.3 | 87 | 90.6 |
Lithium or anticonvulsant medications | 97 | 48.5 | 51 | 49.0 | 46 | 47.9 |
Antidepressant medications | 33 | 16.5 | 15 | 14.4 | 18 | 18.8 |
Current psychiatric medications classified according to weight loss/gain profilea | ||||||
≥1 slight/moderate weight loss | 77 | 38.5 | 39 | 37.5 | 38 | 39.6 |
≥1 weight neutral | 168 | 84.0 | 87 | 83.7 | 81 | 84.4 |
≥1 slight/moderate weight gain | 21 | 10.5 | 10 | 9.6 | 11 | 11.5 |
≥1 severe weight gain | 128 | 64.0 | 68 | 65.4 | 60 | 62.5 |
Study Retention and Intervention Attendance
Analyses
Variable | Δ Baseline–6 Months | Δ 6 Months–12 Months | Δ Baseline–12 Months | pb | |||
---|---|---|---|---|---|---|---|
Coefficienta | 95% CI | Coefficienta | 95% CI | Coefficienta | 95% CI | ||
Weight (kg) | –4.37 | –6.96 to –1.78 | 1.77 | –0.87 to 4.40 | –2.60 | –5.14 to –0.07 | 0.004 |
Body mass index (kg/m2) | –1.55 | –2.47 to –0.63 | 0.58 | –0.35 to 1.50 | –0.97 | –1.88 to –0.06 | 0.004 |
Systolic blood pressure (mmHg) | –1.60 | –5.21 to 2.02 | 1.68 | –1.91 to 5.27 | 0.09 | –3.36 to 3.53 | 0.60 |
Diastolic blood pressure (mmHg) | –1.21 | –3.58 to 1.17 | 0.82 | –1.59 to 3.23 | –0.38 | –2.89 to 2.12 | 0.59 |
Fasting glucose (mg/dL) | –0.02 | –0.08 to 0.05 | –0.08 | –0.14 to –0.01 | –0.09 | –0.16 to –0.02 | 0.02 |
Fasting insulin (μU/mL) | 0.11 | –0.09 to 0.31 | –0.12 | –0.58 to 0.34 | –0.01 | –0.46 to 0.43 | 0.56 |
Homeostasis model assessment-insulin resistance indexc | 0.09 | –0.12 to 0.30 | –0.15 | –0.37 to 0.07 | –0.24 | –0.48 to 0.01 | 0.17 |
Diabetes riskd | 0.17 | –1.55 to 1.89 | –1.56 | –3.39 to 0.26 | –1.39 | –3.09 to 0.31 | 0.17 |
Fasting triglycerides (mg/dL) | 3.72 | –21.57 to 29.01 | 0.67 | –21.52 to 22.86 | 4.39 | –24.18 to 32.96 | 0.95 |
Fasting low-density lipoprotein (mg/dL) | –1.65 | –8.52 to 5.22 | 1.68 | –5.25 to 8.61 | 0.03 | –7.58 to 7.64 | 0.85 |
Fasting high-density lipoprotein (mg/dL) | 1.23 | –0.70 to 3.16 | 1.05 | –1.14 to 3.24 | 2.28 | –0.14 to 1.05 | 0.17 |
Primary outcomes.
Secondary outcomes.
Acute service use and adverse events.
Discussion
Limitations and Opportunities
Conclusions
Acknowledgments
Footnote
Supplementary Material
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