Spouses shed more pounds together than alone

"Lifestyle improvement after a heart attack is a crucial part of preventing repeat events," said study author Ms. Lotte Verweij, a registered nurse and PhD student, Amsterdam University of Applied Sciences, the Netherlands. "Our study shows that when spouses join the effort to change habits, patients have a better chance of becoming healthier -- particularly when it comes to losing weight."

The RESPONSE-2 trial previously found that heart attack survivors referred to programmes for weight reduction, physical activity, and smoking cessation were more likely to modify behaviours compared to those receiving usual care. In both groups, living with a partner was linked with greater success in shifting bad habits. The most notable improvements were in patients who took part in lifestyle programmes and lived with a partner.

This follow-up study investigated whether partner involvement in lifestyle programmes had an impact on behaviour change. "If partners contribute to adopting healthy habits, it could become an important recommendation to avoid recurrent heart attacks," explained Ms. Verweij.

A total of 824 patients were randomly assigned to the intervention group (lifestyle programmes on top of usual care) or control group (usual care alone).

This analysis focused on the 411 patients in the intervention group, who were referred to up to three lifestyle programmes for weight reduction, physical activity, and smoking cessation depending on their needs and preferences. Partners could attend for free and nurses encouraged them to participate. Partner participation was defined as attending at least once.

Nearly half (48%) of partners participated in the lifestyle interventions. Compared to those without a partner, patients with a participating partner were more than twice as likely (odds ratio 2.45) to improve in at least one of the three areas (weight loss, exercise, smoking cessation) within a year.

When the influence of partners was analysed on the three areas separately, patients with a participating partner were most successful in reducing weight compared to patients without a partner (odds ratio 2.71).

"Patients with partners who joined the weight loss programme lost more weight compared to patients with a partner who did not join the programme," said Ms. Verweij.

She continued: "Couples often have comparable lifestyles and changing habits is difficult when only one person is making the effort. Practical issues come into play, such as grocery shopping, but also psychological challenges, where a supportive partner may help maintain motivation."

Ms. Verweij noted that the study did not find more improvement in smoking cessation or physical activity when partners actively participated. "These lifestyle issues might be more subject to individual motivation and persistence, but this hypothesis needs more investigation," she said.

Note: Three lifestyle programmeswere used in their existing format:

1) Weight loss: weekly group sessions with a Weight Watchers coach for one year.

2) Physical activity: accelerometer to measure activity and an online coach for personalised feedback for one year (Philips Direct Life).

3) Smoking cessation: motivational interviewing by telephone by trained professionals from Luchtsignaal for three months plus prescription of nicotine replacement or varenicline therapy as appropriate.