title: A Comprehensive Lifestyle Peer Group-Based Intervention on Cardiovascular Risk Factors: The Randomized Controlled Fifty-Fifty Program.
abstract: BACKGROUND
  Cardiovascular diseases stem from modifiable risk factors. Peer support is a proven strategy for many chronic illnesses. Randomized trials assessing the efficacy of this strategy for global cardiovascular risk factor modification are lacking.
  
  
  OBJECTIVE
  This study assessed the hypothesis that a peer group strategy would help improve healthy behaviors in individuals with cardiovascular risk factors.
  
  
  METHODS
  A total of 543 adults 25 to 50 years of age with at least 1 risk factor were recruited; risk factors included hypertension (20%), overweight (82%), smoking (31%), and physical inactivity (81%). Subjects were randomized 1:1 to a peer group-based intervention group (IG) or a self-management control group (CG) for 12 months. Peer-elected leaders moderated monthly meetings involving role-play, brainstorming, and activities to address emotions, diet, and exercise. The primary outcome was mean change in a composite score related to blood pressure, exercise, weight, alimentation, and tobacco (Fuster-BEWAT score, 0 to 15). Multilevel models with municipality as a cluster variable were applied to assess differences between groups.
  
  
  RESULTS
  Participants' mean age was 42 ± 6 years, 71% were female, and they had a mean baseline Fuster-BEWAT score of 8.42 ± 2.35. After 1 year, the mean scores were significantly higher in the IG (n = 277) than in the CG (n = 266) (IG mean score: 8.84; 95% confidence interval (CI): 8.37 to 9.32; CG mean score: 8.17; 95% CI: 7.55 to 8.79; p = 0.02). The increase in the overall score was significantly larger in the IG compared with the CG (difference: 0.75; 95% CI: 0.32 to 1.18; p = 0.02). The mean improvement in the individual components was uniformly greater in the IG, with a significant difference for the tobacco component.
  
  
  CONCLUSIONS
  The peer group intervention had beneficial effects on cardiovascular risk factors, with significant improvements in the overall score and specifically on tobacco cessation. A follow-up assessment will be performed 1 year after the final assessment reported here to determine long-term sustainability of the improvements associated with peer group intervention. (Peer-Group-Based Intervention Program [Fifty-Fifty]; NCT02367963).
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Emilia
authors.initials: E
authors.lastname: Gómez-Pardo
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Fernández-Alvira
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Vilanova
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Haro
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Ramona
authors.initials: R
authors.lastname: Martínez
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Carvajal
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Carral
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Rodríguez
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: de Miguel
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Bodega
authors.affiliation: SHE Foundation, Barcelona, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Santos-Beneit
authors.affiliation: Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Peñalvo
authors.affiliation: Internal Medicine Department, Catalan Health Institute, Viladecans, Spain.
authors.forename: Iñaki
authors.initials: I
authors.lastname: Marina
authors.affiliation: Spanish Agency for Consumer Affairs, Food Safety and Nutrition.
authors.forename: Napoleón
authors.initials: N
authors.lastname: Pérez-Farinós
authors.affiliation: Spanish Agency for Consumer Affairs, Food Safety and Nutrition.
authors.forename: Marian
authors.initials: M
authors.lastname: Dal Re
authors.affiliation: Spanish Agency for Consumer Affairs, Food Safety and Nutrition.
authors.forename: Carmen
authors.initials: C
authors.lastname: Villar
authors.affiliation: Spanish Agency for Consumer Affairs, Food Safety and Nutrition.
authors.forename: Teresa
authors.initials: T
authors.lastname: Robledo
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Sameer
authors.initials: S
authors.lastname: Bansilal
authors.affiliation: SHE Foundation, Barcelona, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: valentin.fuster@mountsinai.org.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D017598:Efficiency, Organizational; D005247:Feeding Behavior / Q000502:physiology / Q000523:psychology; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D017063:Outcome Assessment, Health Care; D050177:Overweight / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D010379:Peer Group; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D020340:Tobacco Use Cessation / Q000379:methods
keywords: cardiovascular risk; healthy lifestyle; motivation; peer education