Group therapy is an effective and cost-efficient way to promote cardiovascular health



A simple support-group intervention program aimed at promoting general health, similar to the group-therapy activities of Alcoholics Anonymous, yields significant improvements in the control of the 5 most important cardiovascular risk factors (blood pressure, exercise, weight, diet, and tobacco smoking); the improvement was especially clear for stopping smoking.

The intervention has been tested in the Fifty-Fifty Program, a groundbreaking randomized controlled clinical trial in a group of 543 adults. The Fifty-Fifty Program works with adults to increase their knowledge and develop attitudes and skills conducive to a healthy lifestyle in the context of mutual support among equals. The results of the trial confirm that the intervention helps participants to adopt healthy habits and to improve their control of cardiovascular risk factors. At the end of the 1 year intervention, the results are clear: 67% of the participants showed an improvement in the Fuster-BEWAT index, a measure of the 5 main cardiovascular risk factors, compared with 56% of the control group; moreover, almost half the participants reduced their tobacco consumption.

The results will be presented Nov. 9 at the Scientific Sessions of the American Heart Association annual meeting, and simultaneously published in the Journal of the American College of Cardiology.

The Fifty-Fifty Program is an initiative of the SHE Foundation, led by Valentín Fuster, M.D., Ph.D., Director of the Centro Nacional de Investigaciones Cardiovasculares del Carlos III (CNIC), and the Spanish Agency for Consumer Affairs, Food Safety and Nutrition (AECOSAN), an executive branch of the Ministry of Health, Social Services and Equality. The goal of the program is to achieve fundamental improvements in adult health through training and motivational workshops in which participants support and encourage each other to make and sustain appropriate lifestyle changes. In this way, the program aims to incentivize people to modify their lifestyle habits and learn to control the major cardiovascular risk factors.

The methodology for using peer support to control chronic diseases is well-established; however, there is little hard scientific evidence showing long-term benefits from this type of intervention. Fuster explains that the idea was inspired by the success of Alcoholics Anonymous: 'The effectiveness of these group-therapy interventions got me thinking that the same strategy could be applied to other health problems, including cardiovascular disease.' Two pilot programs were conducted, one on the carribbean island of Grenada and the other in Cardona, Spain. With encouraging results from these studies, the invesigative team undertook a more extensive study with 543 participants (71% women) distributed in locations across Spain. Each participant had at least 1 cardiovascular risk factor.

Two groups: intervention and control

Over a 3-month period, all participants took part in training and motivational group sessions aimed at promoting healthy lifestyle habits. These meetings focused on motivations for change, stress management, stopping smoking, a healthy diet, taking regular exercise, and self-control of blood pressure. From this shared starting point, the participants were divided into 2 groups: 277 in the intervention group and 266 in the control group. Over the next 12 months, the intervention group met for monthly group-therapy sessions aimed at promoting changes in attitudes and behavior, encouraging participants to go beyond simple awareness and make real progress in the control of cardiovascular risk factors. The control group merely received individual medical check-ups during the same period.

After the training sessions at the start of the program, most participants (71%) showed an improvement in the Fuster-BEWAT index, irrespective of group assignment. However, at subsequent stages, significant differences appeared between the intervention and control groups. In the intervention group, 67% of participants showed an improvement in cardiovascular risk factors, compared with 56% in the control group. The results were even more positive for tobacco consumption, with almost twice as many intervention-group participants stopping smoking (39% versus 20%). Similarly, 46% of the intervention group members increased their level of physical activity.

The authors were especially pleased with the results obtained with smokers. Of the 138 smokers at the start of the study, 21 stopped after the educational workshops, but this figure increased after the intervention to 32 (23%), 24 of whom were from the intervention group.
Continuing education

According to the research team, the data confirm that 'although training in healthy habits is important and has a positive impact on health, these benefits tail off if not reinforced over time.' The study clearly shows that although there was an initial general improvement in smoking, 80% of control group participants showed no improvement at the end of the follow-up period. Fuster emphasizes that the data show that a support group intervention is 'effective and cost-efficient'.

A further follow-up is scheduled for 12 months after the intervention period, to monitor the evolution of cardiovascular risk factors in the Fuster-BEWAT index in the intervention and control groups. The team has launched a similar study in Harlem, New York.

The FAMILIA Project is the brainchild of world-renowned cardiologist Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital. Dr. Fuster's initiative is made possible thanks to a $3.8 million in grant support to Mount Sinai Heart by the American Heart Association (AHA). For the FAMILIA Project Mount Sinai has partnered with NYC's Administration for Children's Services (ACS), Division of Early Care and Education Head Start programs.

NYC's new four-year, early-heart health education and assessment project is enrolling 600 children ages 3-5 in participating NYC preschools in the high-risk community of Harlem, along with 1,000 of their caregivers to improve nutritional and lifestyle knowledge , health, and habits of children and their families.

The study assesses the impact of a support-group intervention for health promotion in a mixed (50:50) population of adults and children. This approach is similar to that used in the Programa SI! (Salud Integral), a school-based intervention designed to promote cardiovascular health in preschoolers through to high-school students. Programa SI! works on 4 closely related areas: nutrition, knowing your body and heart, taking regular exercise, and controlling your emotions.

Cardiovascular disease is now the main cause of death in the world. According to WHO figures, cardiovascular disease kills 17.5 million people every year, accounting for 31% of all deaths.

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