Peer-Based Support Program Promotes Heart-Healthy Behaviors

November 10, 2015

ORLANDO, FL – Monthly meetings with other individuals in a peer-based support group designed to provide encouragement and assistance had a significantly beneficial effect on cardiovascular risk factors, most notably smoking cessation, after 1 year, according to results of a new study[1].

Presenting the results of the Fifty-Fifty program here at the American Heart Association (AHA) 2015 Scientific Sessions, Dr Valentin Fuster (Icahn School of Medicine at Mount Sinai, New York, NY) said that the concept behind the intervention is based on substance-abuse programs such as Alcoholics Anonymous.

Dr Valentin Fuster

Given the use of peer support in such substance-abuse programs, they opted to study a peer-based support group to modify cardiovascular risk factors and behavior, noting the program was successful in significantly improving a composite score that incorporated five lifestyle/cardiovascular risk factor variables known as BEWAT (Blood pressure, Exercise, Weight, Alimentation, and Tobacco).

"The Fifty-Fifty peer-group–based lifestyle management program had a positive impact on the participants, showing an overall improvement in BEWAT score and its components, especially smoking cessation," said Fuster. "The widespread adoption of such a program might have a meaningful impact on cardiovascular-health promotion."

In the Fifty-Fifty program, which was conducted in seven municipalities in Spain, all patients received education on lifestyle and cardiovascular risk factors in six workshops. The workshops were designed to provide motivation on physical activity, a healthy diet, smoking cessation, stress management, and self-management of blood pressure.

Upon completion of the initial workshops, investigators randomized 543 adults aged 25 to 50 years with at least one cardiovascular risk factor (hypertension, overweight, smoking, or physical inactivity) to a self-management control arm or the peer-based intervention. The peer-based intervention consisted of a small group of approximately 10 individuals led by an individual selected and trained to lead the group during monthly meetings.

The goal of each peer-based meeting was to identify potential barriers to lifestyle improvement and the necessary action individuals needed to take to reduce their cardiovascular risk. During the 60- to 90-minute meeting, participants explained improvements they had made in the past month and difficulties they might have encountered. In addition, the discussions addressed managing emotions, resolving problems, and discussing strategies to prevent relapses of poor cardiovascular habits, among other topics.

At 1 year, both groups improved their BEWAT scores from baseline, but the increase in the intervention arm was significantly larger compared with the control group. In terms of individual components of the BEWAT score, there was a significant improvement only in smoking cessation in the peer-based support group compared with the control group.

"I want to emphasize one point—12% of individuals after randomization decided not to [participate in the peer-based sessions]," said Fuster. "We used an approach where we analyzed on the basis of intention to treat. It was a very conservative approach. If we looked only at those who participated, the results were much more significant. Four out of the five risk factors improved in these individuals. With blood pressure, there was a trend."

The study was published in the Journal of the American College of Cardiology to coincide with the AHA presentation.

Labor Intensive, but Worth It?

Dr Donald Lloyd-Jones (Northwestern University Feinberg School of Medicine, Chicago, IL) told heartwire from Medscape that the Fifty-Fifty program involved a "labor-intensive process," one that started in identifying and training leaders for the peer group. Following that, the leaders were responsible for gathering and motivating their peers to make lifestyle and behavioral changes, which can be difficult.

Despite the inherent challenges, he was encouraged by the results. The Fifty-Fifty program protocol, he said, is an important tool with which individuals can help others drive behavior change. "It requires a lot of professional support, but I'm extremely encouraged to see the kind of changes seen [in the study] because small changes in behaviors at these younger ages upstream can actually have a big impact in the long term, particularly things like smoking cessation."

Even trends toward improvements in other cardiovascular and healthy-lifestyle markers, such as waist circumference and blood pressure, which were observed in this trial, can pay dividends down the road, he added.

To heartwire, Fuster noted that a beneficial aspect of the program was improved self-esteem, with individuals engaged in the peer-based support group deriving satisfaction in "giving back" as they participated in the monthly sessions.

In an editorial[2], Drs Fatima Rodriguez and Robert Harrington (Stanford University, CA) note that clinicians, researchers, and policy makers are starting to recognize the important role of the social determinants of health, including the role of community and peer support for improving and preventing chronic health conditions.

The editorialists noted that an important aspect of the Fifty-Fifty program was that participants selected their peer leaders and that interventions with this type of "community buy-in" tend to be more successful. Also, peer-based interventions are more likely to be self-sustaining and scalable long term, as well as having wide applicability in resource-limited settings.

Although the trial had limitations—including the high attrition rate, lack of follow-up beyond 1 year, and lack of validation of the BEWAT score with clinical outcomes—Rodriguez and Harrington said that the importance of primordial and primary cardiovascular-disease prevention cannot be overemphasized given the global burden of disease.

"Challenging public-health problems necessitate creative community-based and community-endorsed health delivery models," they write.

The study was funded by the Foundation for Science, Health, and Education (SHE) and the Ministry of Health, Social Services, and Equality, Spain. The authors report no relevant financial relationships.


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