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

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, and functional
capacity. 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 outcomes will be physical activity behavior (minutes per week) and eating behavior
(percent saturated fat) at the 6 month time point in both the coronary artery bypass graft
(CABG) patient and his/her partner. The secondary outcome includes functional capacity in
patients and partners at 6 months. 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.

Inclusion Criteria:

- age 19 or older

- diagnosis of first-time coronary artery bypass graft surgery (CABGs) and enrollment in
outpatient CR

- married or living with partner for more than 1 year

- partner is also willing to participate

- no history of psychiatric illness

- classified as low to moderate risk for the occurrence of cardiac events during
exercise (AACVPR, 2004).

- first-time CABG patients

Eligible partners will:

- be age 19 or older

- have no history of psychiatric illness

- be classified as low to moderate risk for the occurrence of cardiac events during
exercise

- have written permission from the partner's primary health care provider to participate
in the study.

Exclusion Criteria:

- orthopedic problems that would prevent them from walking or exercising

- history of cardiac arrest, sudden death, complex dysrhythmias at rest, or CHF
diagnosis

- resting systolic BP > 200 mmHg or diastolic BP > 100 mmHg

- a concomitant diagnosis or procedure such as valve repair/replacement or
aneurysmectomy

- debilitating non-cardiac disease such as renal failure or anemia

- severe chronic obstructive lung disease (FEV1 < 1 liter)

- poorly controlled diabetics (diagnosed with diabetic ketoacidosis within the past 6
months or a current HgA1c > 11).