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Exercise Program Specially Fit to Needs of Mentally Ill People

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Times Staff Writer

Until her first breakdown, Pat was trim and active, even playing on the volleyball team in college. But deep scars on her forearms attest to a lifetime of self-abuse. Pat, 53, grew sedentary, obese and reclusive. She said she has been hospitalized 25 times.

“The sicker I got, and the more doped up I became, the more I tended to become isolated,” she said.

This year, Pat enrolled in a program here called In Shape, designed to provide regular structured exercise for people with mental illness. The year-old project also includes education in nutrition, weight loss and behavior modification. Each participant works with a mentor, and all classes and training take place in mixed settings among people who are not mentally ill.

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The unusual, community-based effort targets a population that has been largely overlooked by a physical fitness boom that caters to an array of groups -- from older people to babies to the physically disabled -- but typically not to people with mental illness. Experts view In Shape as a model to improve the lives and life spans of millions of people with mental illness.

“It is absolutely groundbreaking,” said Dr. Stephen Bartels, a psychiatrist at Dartmouth Medical School. “This is a very important project.”

In Shape evolved after Kenneth Jue, a social worker who runs a large community services agency here, noticed that one after another, his mentally ill clients were dying in their 40s and 50s.

After some investigating, Jue learned that the life span of mentally ill people tended to be 10 to 20 years shorter than that of people who were not mentally ill. The health problems that sometimes contribute to their early deaths -- including diabetes and heart disease -- often are related to obesity. Cigarette smoking also was a factor, Jue found, as was a general pattern of poor physical maintenance.

So, Jue told his bosses at Monadnock Family Services: “It is our responsibility to extend the life span of someone with mental illness and to get to the same life-span expectations as anyone else in this country.”

His goal was to sign up 40 people. But as In Shape winds up its first year, about 130 people are enrolled in a free regimen that takes participants to the YMCA, yoga and dance studios, the local state college, an indoor pool at a motel and wooded trails for vigorous group walks.

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In Shape has been so successful in its first year that Monadnock Family Services has budgeted $830,000 to run and expand the program over the next four years. About half the money comes from the Robert Wood Johnson Foundation. In Shape also has received grants from the local United Way and the New Hampshire Endowment for Health, as well as smaller foundations.

The mentors who work with the In Shape participants receive salaries. In Shape pays charges associated with stop-smoking programs, gym memberships, nutrition classes and other expenses.

For participants, bodies are changing, old habits of isolation are shifting -- and spirits are lifting.

A 44-year-old In Shape client named Deborah said her cholesterol level dropped 35 points in three months. Deborah also has lost an inch and a half off her waist.

Most important, she has been able to taper off some of the medication she takes for depression.

“In Shape also has helped me with socialization,” Deborah said at a recent In Shape awards luncheon. “A few months ago, I would not have been able to speak like this in front of a group.”

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Peter, 63, took up water exercise -- “a big change from what I used to do, which was sit home all day and cry.”

Pat -- who, like all the In Shape participants, did not want her last name used -- works out at the YMCA at least three times a week. Pat and her mentor, Pam Buffum, learned racquetball together.

When Pat has an especially grueling psychotherapy session, she likes to go whack racquetballs with Pam. “This has done more for me than any psychotropic drug I have taken, and I have taken a lot,” Pat said -- so much medication, in fact, that she joked that the pile of pills she took each night was her version of dessert.

Finishing up a 30-minute session on the treadmill, Pat said: “I feel like this has saved my life. I keep telling people that I am this 20-year-old, svelte athlete stuck in this 53-year-old, obese body.”

An In Shape mentor named Josh Royce, who began working as a personal trainer in high school and studied physical education in college, said: “People didn’t talk about this special population. You talked about the obese or the elderly or little kids. But nothing about people with severe mental illness.”

Royce, 23, watched with satisfaction as the In Shape clients worked through their exercise routines alongside others in the busy gym.

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“I can’t see any difference between the In Shape people and anyone else who’s here,” he said.

But Kathryn McNulty, director of consumer affairs for the National Alliance for the Mentally Ill in Washington, said mental illness was surrounded by stigma.

“There is an expectation that people with mental illness will be overweight, will smoke and will have a low activity level,” she said. And the reality is that many also are poor: “It is hard enough to buy good quality food,” McNulty said. “It is out of the question to join a gym.”

Although medication can convey “remarkable effects in terms of mental health,” McNulty said, many of the drugs prescribed for mental illness cause people to gain weight.

“Keene sounds like heaven,” said McNulty, who said she knew of no other comprehensive program like In Shape. “They are doing the right things, helping people with lifestyle changes and using a buddy system. This is awesome. They are just not doing this in the rest of the country.”

In Shape has drawn inquiries from Britain and Canada. The U.S. federal government is sending a mental health specialist to Keene next month to observe the program. And doctors at the Dartmouth Medical Center, which has a branch in Keene, are providing free medical evaluations so they can track participants’ progress.

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Jean Hoffman said she and her husband donated $50,000 from their family foundation because they had seen the benefits of exercise in their own lives after they began running together in their mid-40s.

Hoffman, 70, said: “We are really hoping that we can move this program across the state. Then our idea is, if we have one state that is a pilot program and it shows improvements, we can take it across the country.”

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