Translational Behavioral Medicine

, Volume 6, Issue 3, pp 478–481 | Cite as

Increasing US health plan coverage for exercise programming in community mental health settings for people with serious mental illness: a position statement from the Society of Behavior Medicine and the American College of Sports Medicine

  • Sarah I. Pratt
  • Gerald J. Jerome
  • Kristin L. Schneider
  • Lynette L. Craft
  • Matthew P. Buman
  • Mark Stoutenberg
  • Gail L. Daumit
  • Stephen J. Bartels
  • David E. Goodrich
Practice and Public Health Policies


Adults with serious mental illness die more than 10 years earlier than the average American. Premature mortality is due to the high prevalence of preventable diseases including cardiovascular disease and diabetes. Poor lifestyle behaviors including lack of exercise and physical inactivity contribute to the epidemic levels of obesity, diabetes, and cardiovascular disease observed among adults with serious mental illness. Not surprisingly, people with serious mental illness are among the most costly consumers of health services due to increased visits for poorly managed mental and physical health. Recent studies have demonstrated that exercise interventions based on community mental health settings can significantly improve physical and mental health in people with serious mental illness. However, current funding regulations limit the ability of community mental health settings to offer exercise programming services to people with serious mental illness. Policy efforts are needed to improve the dissemination and sustainability of exercise programs for people with serious mental illness.


Exercise Physical activity Serious mental illness Bipolar disorder Schizophrenia Health policy 



The authors wish to acknowledge the expert review provided by the Society of Behavioral Medicine’s (SBM) Integrated Primary Care and Physical Activity Special Interest Groups, the SBM Scientific and Professional Liaison Council, and the American College of Sports Medicine’s Health and Science Policy Committee. This work was supported by the National Institute of Mental Health grant R34MH086678-01 (KS) and is a product of the Yale Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Number U48DP005018 from the Centers for Disease Control and Prevention (SB, SP). The findings and conclusions in this statement are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the Veterans Health Administration, or the In-SHAPE Implementation study (R01MH102325, Bartels, PI).

Compliance with ethical standards

Conflict of interest

Mark Stoutenberg is a consultant to Exercise is Medicine®, a program of the American College of Sports Medicine, which receives funding from The Coca-Cola Company and Technogym. The remaining authors declare that they have no conflict of interest.


  1. 1.
    Lobelo F, Stoutenberg M, Hutber A. The exercise is medicine global health initiative: a 2014 update. Br J Sports Med. 2014; 48: 1627-1633.CrossRefPubMedGoogle Scholar
  2. 2.
    Goodpaster BH, Delany JP, Otto AD, et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA. 2010; 304: 1795-1802.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Daumit GL, Goldberg RW, Anthony C, et al. Physical activity patterns in adults with severe mental illness. J Nerv Ment Dis. 2005; 193: 641-646.CrossRefPubMedGoogle Scholar
  4. 4.
    Jerome GJ, Young DR, Dalcin A, et al. Physical activity levels of persons with mental illness attending psychiatric rehabilitation programs. Schizophr Res. 2009; 108: 252-257.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Blair SN, Kohl HW 3rd, Barlow CE, Paffenbarger RS Jr, Gibbons LW, Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. 1995; 273: 1093-1098.CrossRefPubMedGoogle Scholar
  6. 6.
    Kessler RC, Berglund P, Demler O, JIn R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62: 593-602.CrossRefPubMedGoogle Scholar
  7. 7.
    Allison DB, Newconer JW, Dunn AL. Obesity among those with mental disorders: a National Institute of Mental Health meeting report. Am J Prev Med. 2009; 36: 341-350.CrossRefPubMedGoogle Scholar
  8. 8.
    Saha S, Chant D, McGrath J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Arch Gen Psychiatry. 2007; 64: 1123-1131.CrossRefPubMedGoogle Scholar
  9. 9.
    Radke AQ, Parks J, Ruter TJ. A call for improved prevention and reduction of obesity among persons with serious mental illness. Psychiatr Serv. 2010; 61: 617-619.CrossRefPubMedGoogle Scholar
  10. 10.
    Daumit GL, Dickerson FB, Wnag NY, et al. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med. 2013; 368: 1594-1602.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bartels S, Desilets R. Health Promotion Programs for People with Serious Mental Illness (Prepared by the Dartmouth Health Promotion Research Team). Washington: SAMHSA-HRSA Center for Integrated Health Solutions; 2012.Google Scholar
  12. 12.
    Gierisch JM, Nieuwsma JA, Bradford DW, et al. Pharmacologic and behavioral interventions to improve cardiovascular risk factors in adults with serious mental illness: a systematic review and meta-analysis. J Clin Psychiatry. 2014; 75: e424-e440.CrossRefPubMedGoogle Scholar
  13. 13.
    Rosenbaum S, Tiedemann A, Sherrington C, Curtis J, Ward PB. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. J Clin Psychiatry. 2014; 75: 964-974.CrossRefPubMedGoogle Scholar
  14. 14.
    Vancampfort D, Rosenbaum S, Probst M. Promotion of cardiorespiratory fitness in schizophrenia: a clinical overview and meta-analysis. Acta Psychiatr Scand. 2015; 132: 131-143.CrossRefPubMedGoogle Scholar
  15. 15.
    Bartels SJ, Pratt SI, Aschbrenner KA, et al. Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes. Am J Psychiatry. 2015; 172: 344-352.CrossRefPubMedGoogle Scholar
  16. 16.
    Bartels SJ, Pratt SI, Aschbrenner KA, et al. Clinically significant improved fitness and weight loss among overweight persons with serious mental illness. Psychiatr Serv. 2013; 64: 729-736.CrossRefPubMedGoogle Scholar
  17. 17.
    Green CA, Yarborough BJ, Leo MC, et al. The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: a randomized trial. Am J Psychiatry. 2015; 172: 71-81.CrossRefPubMedGoogle Scholar
  18. 18.
    Wang D, Wang Y, Wang Y, Li R, Shou C. Impact of physical exercise on substance use disorders: a meta-analysis. PLoS One. 2014; 9, e110728.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Maust DT, Oslin DW, Marcus SC. Mental health care in the accountable care organization. Psychiatr Serv. 2013; 64: 908-910.CrossRefPubMedGoogle Scholar
  20. 20.
    Goldstein BI, Kemp DE, Soczynska JK, McIntyre RS. Inflammation and the phenomenology, pathophysiology, comorbidity, and treatment of bipolar disorder: a systematic review of the literature. J Clin Psychiatry. 2009; 70: 1078-1090.CrossRefPubMedGoogle Scholar
  21. 21.
    Chwastiak L. Making evidence-based lifestyle modification programs available in community mental health centers: why so slow? J Clin Psychiatry. 2015; 76: e519-e520.CrossRefPubMedGoogle Scholar
  22. 22.
    Stumbo SP, Yarborough BJ, Yarborough MT, et al. Costs of implementing a behavioral weight-loss and lifestyle-change program for individuals with serious mental illnesses in community settings. Transl Behav Med. 2015; 5: 269-276.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    O’Donnell AN, Williams M, Kilbourne AM. Overcoming roadblocks: current and emerging reimbursement strategies for integrated mental health services in primary care. J Gen Intern Med. 2013; 28: 1667-1672.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    O’Donnell AN, Williams BC, Eisenberg D, Kilbourne AM. Mental health in ACOs: missed opportunities and low-hanging fruit. Am J Manag Care. 2013; 19: 180-184.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Pronk NP, Remington PL. Combined diet and physical activity promotion programs for prevention of diabetes: community preventive services task force recommendation statement. Ann Intern Med. 2015; 163: 465-468.CrossRefPubMedGoogle Scholar
  26. 26.
    Prost SG, Ai AL, Ainsworth SE, Ayers J. Mental health professionals and behavioral interventions for obesity: a systematic literature review. J Evid Inf Soc Work. 2015: 1–26.Google Scholar
  27. 27.
    Ades PA. A lifestyle program of exercise and weight loss is effective in preventing and treating type 2 diabetes mellitus: why are programs not more available? Prev Med. 2015; 80: 50-52.CrossRefPubMedGoogle Scholar
  28. 28.
    Ackermann RT, Williams B, Nguyen H, Berke EM, Maciejewski ML, LoGerfo JP. Healthcare cost differences with participation in a community-based group physical activity benefit for Medicare managed care health plan members. JAGS. 2008; 56: 1459-1465.CrossRefGoogle Scholar
  29. 29.
    Nguyen HQ, Ackermann RT, Maciejewski ML, et al. Managed-medicare health club benefit and reduced health care costs among older adults. Prev Chronic Dis. 2008; 5. Accessed 03/23/16.
  30. 30.
    Nguyen HQ, Maciejewski ML, Gao S, Lin E, Williams B, LoGerfo JP. Health care use and costs associated with use of a health club membership benefit in older adults with diabetes. Diabetes Care. 2008; 31: 1562-1567.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Beals, R. K. Employees get paid to exercise, while some pay to sit out. US News and World Report. Feb. 14, 2012.Google Scholar
  32. 32.
    Mitchell MS, Goodman JM, Alter DA, et al. Financial incentives for exercise adherence in adults. Am J Prev Med. 2013; 45: 658-667.CrossRefGoogle Scholar
  33. 33.
    Frean ME. What is the optimal subsidy for exercise? Informing health insurance companies’ fitness reimbursement programs. Honors Projects. Paper 43. 2012.
  34. 34.
    Substance Abuse and Mental Health Services Administration (SAMHSA): 2012 CMHS uniform reporting system output tables.
  35. 35.
    Drake RE, Skinner JS, Bond GR, Goldman HH. Social Security and mental illness: reducing disability with supported employment. Health Aff. 2009; 28: 761-770.CrossRefGoogle Scholar
  36. 36.
    Druss BG. Supported employment over the long term: from effectiveness to sustainability. Am J Psychiatry. 2014; 171: 11.CrossRefGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2016

Authors and Affiliations

  • Sarah I. Pratt
    • 1
  • Gerald J. Jerome
    • 2
    • 3
  • Kristin L. Schneider
    • 4
  • Lynette L. Craft
    • 5
  • Matthew P. Buman
    • 6
  • Mark Stoutenberg
    • 5
    • 7
  • Gail L. Daumit
    • 3
  • Stephen J. Bartels
    • 1
  • David E. Goodrich
    • 8
  1. 1.Department of PsychiatryGeisel School of Medicine at DartmouthConcordUSA
  2. 2.Department of KinesiologyTowson UniversityTowsonUSA
  3. 3.Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Rosalind Franklin University of Medicine & ScienceChicagoUSA
  5. 5.American College of Sports MedicineIndianapolisUSA
  6. 6.School of Nutrition and Health PromotionArizona State UniversityPhoenixUSA
  7. 7.Department of Public Health SciencesUniversity of MiamiMiamiUSA
  8. 8.VA Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborUSA

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