Reducing Risk in Cardiac Rehabilitation: Partners Together in Health (PaTH) Intervention Study

• Healthy Lifestyle Behaviors. Healthy lifestyle behaviors in the proposed study are operationalized to include physical activity/exercise and dietary intake behaviors. [ Time Frame: 3, 6 months post enrollment ] [ Designated as safety issue: No ]
  
• Physical activity/exercise behavior.By pilot testing the feasibility of the PaTH intervention, important information will be obtained by which to gauge the feasibility of conducting a large scale clinical trial of the intervention. It is anticipated that [ Time Frame: 3, 6 months post enrollment ] [ Designated as safety issue: No ]
  

Behavioral: Partners Together in Health (PaTH) Intervention
Both partners actively participate in comprehensive CR and the usual care group where only the patient participates in CR and the partner is invited to attend the educational sessions with the patient. The CR activities that patients in both groups and partners in the intervention group will be provided with will be the same and are based on the clinical practice guidelines of the core components of CR. These components are: prescribed exercise, education about cardiac risk factor modification, and counseling about self-efficacy strategies that may be effective in assisting with initial lifestyle changes and in preventing and managing relapse. All patients and partners in CR will be provided with a comprehensive, individualized, multidisciplinary risk factor modification program focused on all of the person's risk factors for coronary heart disease.

Long-term maintenance of lifestyle changes to reduce cardiovascular risk factors after coronary artery bypass graft (CABG) surgery is essential to positively influence health outcomes. Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate lifestyle changes, less than 50% of CABG patients maintain lifestyle changes by 6 months post-CABG. It is known that the spouse is the main source of social support for the recovering cardiac patient and frequently attends cardiac rehabilitation with the patient to provide transportation, emotional support, or attend educational classes. In spite of these supportive behaviors, however; adherence still drops off after CR. Lifestyle interventions that specifically target the marital partners as a unit may be more efficacious than current individually-oriented education strategies. The objective of the proposed feasibility study, using an experimental, two-group (n = 30 couples in each group) repeated measures design, will be to pilot test the effects of the Partners Together in Health (PaTH) Intervention versus usual care in improving physical activity and healthy eating behaviors, quality of life, and risk level for heart disease. The specific aims are to assess the feasibility of implementing the PaTH Intervention and generate pilot data on all outcome variables in both the CABG patient and the partner to estimate effect sizes needed to determine the sample size requirements for the larger study. Partners in the PaTH Intervention group will formally join CR with the patient to participate in exercise sessions and educational classes to undertake comprehensive risk reduction for themselves, and to make the same positive physical activity/exercise and healthy eating lifestyle changes as the patient. Partners in the usual care group will be invited to attend the educational sessions with the patient as is currently usual care. The primary variables will be change in outcomes from baseline to 3 and 6 month time points in both the CABG patient and his/her partner. The PaTH intervention is innovative because it allows the couple to build new habits together so they can motivate and support one another on their journey toward health, it uses an existing, well-established treatment method (cardiac rehab) to deliver cost-effective care (Balady et al., 2007), it provides self-efficacy and social support for both members of the dyad in making behavioral changes, and no other studies testing the effects of including the partner in CR were found.