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Fifty-Fifty Study: Peer group support proves beneficial for CV health
ORLANDO, Fla. — A peer group-based lifestyle management program had a beneficial impact on CV risk factors, according to data from the Fifty-Fifty Program.
Participants of the peer group-based program exhibited significant improvement in the Fuster-BEWAT score, a composite score related to BP, exercise, weight, alimentation and tobacco [use], with particular benefit seen on smoking cessation, Valentin Fuster, MD, PhD, physician-in-chief at Mount Sinai Medical Hospital and the Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, N.Y., reported at the American Heart Association Scientific Sessions.
Valentin Fuster
The multicenter trial, conducted in seven communities in Spain, included 543 participants (mean age, 42 years; 71% women) with at least one CV risk factor, including overweight (82%), lack of physical activity (81%), smoking (31%) and hypertension (20%). All participants attended six workshops on lifestyle modifications and CV risk factors during a run-in phase and were then randomly assigned to a peer group-based intervention (n = 277) or self-management (n = 266; control group).
The intervention groups included 10 participants each, with two members elected by the group to serve as peer leaders. The peer leaders received additional education on health information related to lifestyle modifications and held monthly meetings lasting 60 to 90 minutes with their groups, with the goal of reducing CVD risk by promoting physical activity, improved dietary behavior and smoking cessation.
“Peer support is a proven beneficial strategy for substance abuse. Why not consider a similar peer support strategy to modify CV global risk factors and behavior?” Fuster said during a presentation here.
The primary outcome was mean change in the Fuster-BEWAT score at 1 year. The mean Fuster-BEWAT score was 8.42 ± 2.35 at baseline.
In an intention-to-treat analysis at 1 year, the peer group-based intervention group had a significantly higher mean Fuster-BEWAT score compared with the control group (8.84 vs. 8.17; P = .02). The increase in the overall score was also significantly greater among those who participated in the intervention (difference, 0.75; P = .02). Analysis of individual components of the Fuster-BEWAT score indicated greater improvement in all five components in the intervention group, with a significant difference for tobacco use.
Fuster reported that a per-protocol analysis of 456 participants with evaluable 1-year follow-up data yielded similar results, with a significantly greater overall score and a greater mean increase in the peer group-based intervention group compared with the control group.
“Wider adoption of such a program may have a meaningful impact on CV health promotion,” Fuster concluded. “A follow-up assessment will be performed 1 year after these final results … to determine long-term sustainability of the improvements.” – by Adam Taliercio
References:
Fuster V, et al. Late-Breaking Clinical Trials 2. Presented at: American Heart Association Scientific Sessions; Nov. 7-11, 2015; Orlando, Fla.
Gomez E, et al. J Am Coll Cardiol. 2015;doi:10.1016/j.jacc.2015.10.033.
Disclosure: Fuster reports no relevant financial disclosures.
Perspective
Back to TopThis study represents confirmation of the importance of lay health counselors and peer coaches. This approach to promoting health and preventing disease has been well-established in other fields; Dr. Fuster mentioned Alcoholics Anonymous as one example. With diabetes, there have been groups, including our group at Wake Forest, that translated the Diabetes Prevention Program curriculum into an intervention that could be delivered by lay health counselors, and these interventions worked really well. I think one of the reasons they work so well is the person who is helping to deliver the intervention has ‘walked the walk.’ Another reason they work is group solidarity; people develop relationships and a commitment to one another, and in some ways it becomes a group obligation to not let each other down.
So, there is a lot of really good evidence behind group interventions, group support and peer leadership, and Dr. Fuster’s study extends that literature into heart disease prevention, which is exciting. The real importance of this work is to drive policy change for reimbursement. At present, there is not reimbursement for this sort of intervention. If you go see a health psychologist or a clinical psychologist they can bill … but if a health system wanted to try to establish and manage a program like this, there is no way to bill for it. This is a very effective intervention that is very difficult to deliver in the real world, because we have no way to bill and pay for it. This is additional evidence that lay health counselors [and] peer coaches, should be paid for their time and that we need to have health reform that enables reimbursement for this kind of service.
Perspective
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We saw two studies today that give me some hope that we are honing in on effective strategies for what I call primordial prevention: Targeting behaviors and health environments with strategies that can improve those health behaviors and ultimately reduce the development of risk factors.
In Dr. Fuster’s study, we saw a very labor-intensive type of intervention, and yet it looked quite effective in the relatively small study. We saw some very nice results with peer-to-peer intervention and counseling once those peers were very well trained together to understand the consequences of their unhealthy behaviors. Then when they worked together as a group with moderation from professional staff, we saw benefits in terms of reducing [CV outcomes], especially smoking prevalence, in a younger, healthier group, but also some trends toward benefit in waist circumference, weight and BP.
This is a nice step forward in helping us understand how we can leverage the social environment and use groups to help people engage in healthier behaviors.