University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
Syst Rev. 2022 Sep 9;11(1):198. doi: 10.1186/s13643-022-02067-3.
People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet.
Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis.
Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (-1.42 kg), achieving 5% weight loss (OR 2.48), weight maintenance (-2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (-0.48 units) and waist circumference (-0.87cm), but not mental health (depression: SMD -0.03; anxiety: SMD -0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low.
Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups.
PROSPERO CRD42019137197.
患有精神健康问题的人群慢性病发病风险较高，健康状况和行为问题更为普遍。生活方式干预旨在通过改变身体活动和饮食等健康行为来降低这种风险。之前探索此类干预措施对该人群疗效的综述通常仅限于患有严重精神疾病（SMI）的个体，并侧重于体重的影响。本综述评估了在社区或门诊环境中为任何精神健康状况的人群提供的生活方式干预措施对体重、身体活动和饮食的效果。
符合条件的研究是在 1999 年 1 月至 2019 年 2 月期间发表的随机或群组随机对照试验，旨在改善任何精神健康状况人群的体重、身体活动或饮食。两名评审员独立完成研究筛选、数据提取和方法学质量评估。主要结局指标为体重、身体活动和饮食。次要结局指标为体重指数（BMI）、腰围、久坐行为和心理健康。在可能的情况下，进行了荟萃分析。对于不适合荟萃分析的研究，使用基于效应方向的投票计数进行叙述性综合。
共纳入 57 项研究（仅 49 项为 SMI），其中 46 项研究纳入荟萃分析。荟萃分析显示，干预对平均体重减轻（-1.42kg）、达到 5%体重减轻（OR 2.48）、体重维持（-2.05kg）、身体活动（国际体力活动问卷 MET 分钟：226.82）和每日蔬菜摄入量（0.51）具有显著影响（<0.05），但对水果摄入量（0.01）没有显著影响。BMI（-0.48 单位）和腰围（-0.87cm）的次要结局也有显著影响，但心理健康（抑郁：SMD-0.03；焦虑：SMD-0.49；心理症状严重程度：SMD 0.72）没有显著影响。报告久坐行为的研究无法进行荟萃分析。大多数试验存在高偏倚风险，体重和身体活动的证据质量为中等，而饮食的证据质量为低。
为精神健康状况人群提供的生活方式干预在体重、BMI、腰围、蔬菜摄入量和身体活动方面均有统计学显著改善。需要进一步开展高质量的试验，以更一致的方式测量和报告结局，从而更好地了解生活方式干预对身体活动、饮食、久坐行为和心理健康的影响，并了解对亚组的影响。
PROSPERO CRD42019137197。
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