Table 1.

Intervention approaches in comprehensive cardiovascular risk reduction intervention for adults with serious mental illness.

CVD risk behavior or risk factor targets	Evidence-based goals*	Intervention approach
Tobacco smoking	Quit smoking	• Smoking cessation behavioral counseling tailored to readiness to quit • Communication with psychiatrist about pharmacotherapy • Contingency management with CO testing
Diabetes mellitus	Control blood sugar, HbA1c < 7%	• Diabetes self-management education • Behavioral counseling to support medication adherence, healthy diet and exercise • Regular monitoring of blood glucose and communication/coordination with physician, mental health program staff and caregivers
Hypertension	Control blood pressure, systolic blood pressure < 140 mmHg, diastolic blood pressure < 90 mmHg	• Hypertension education • Behavioral counseling to support medication adherence, healthy diet and exercise • Regular blood pressure monitoring and communication with PCPs about monitoring and treatment goals.
Dyslipidemia	Lower cholesterol, total cholesterol < 200 mg/dl, LDL < 130 mg/dl**	• Behavioral counseling to support medication adherence, healthy diet and exercise • Communication with the PCP around guideline-concordant treatment with lipid lowering medications.
Overweight/obesity	Healthy weight, encourage 10 pound weight loss for those overweight or obese	• Lifestyle behavioral counseling including simplified dietary messages (e.g., avoid junk food, avoid sugar drinks, limit snacking, limit portion sizes), exercise, weekly weigh-ins, and self-monitoring using paper trackers. • Reinforce the role of weight management in the relevant CVD risk.
Unhealthy diet	Customized based on clinical condition	• Lifestyle behavioral counseling with clear message for healthy diet in context of other risk factors • Self-monitoring to increase awareness and accountability of food choices • Role playing and skill building to support decisions for healthy choices
Physical inactivity	Moderate intensity physical activity, 150 min/week	• Encourage participation in group exercise at PRP • Identify additional exercise strategies e.g., providing pedometers and setting daily step goals, exercise DVDs to guide home-based workouts • Link the role of exercise to the relevant CVD risk.

^*Based on AHA Strategic Goals and prevailing national guidelines modified for the trial, and tailored to participant needs.

^**CVD risk-based target also used (53).