Physical activity as a strategy for maintaining tobacco abstinence: A randomized trial
Introduction
Tobacco use is the leading preventable cause of death in the United States (CDC, 2005). Only 3% to 5% of smokers who try to quit unaided achieve prolonged abstinence at 6 to 12 months (Hughes et al., 2004). Even with evidence-based smoking cessation treatments, relapse is common (Piasecki, 2006), often in response to mood changes (Shiffman and Waters, 2004), withdrawal symptoms (Piasecki et al., 2000), weight gain (Borrelli et al., 2001), and cravings (Killen and Fortmann, 1997).
Physical activity (PA) may be useful in addressing the physiological and psychological causes of relapse to smoking (Bock et al., 1999, Ussher et al., 2001). A systematic review of 12 studies comparing a bout of exercise with a passive condition reported a positive effect for reducing cigarette cravings, negative affect, withdrawal symptoms, and smoking behavior (Taylor et al., 2007). Two additional studies concluded the effect of PA was irrespective of the intensity level (moderate vs. vigorous). Further, the mechanism by which PA reduces desire to smoke and nicotine withdrawal symptoms is distinct from simple cognitive distraction (Daniel et al., 2006).
Though most people who quit smoking will gain less than 10 lb (Williamson et al., 1991), weight gain concerns are predictive of smoking initiation, reluctance to quit smoking, and smoking relapse (Gritz and Crane, 1991, Klesges et al., 1989, Perkins et al., 1995). For managing weight gain associated with quitting smoking, clinical practice guidelines recommend PA, rather than dieting (Fiore et al., 2000). In general practice, PA is an effective strategy for weight gain prevention (USDHHS, 1996).
Adults who smoke tend to be less physically active than nonsmokers (Kaczynski et al., 2008). Unger (1996) observed that adults preparing to quit smoking exercised more than smokers in the earlier stages of change. Further, a significant positive association has been found between one's self-efficacy for quitting smoking and self-efficacy for maintaining PA (Boudreaux et al., 2003).
The evidence for PA as a strategy for supporting smoking cessation, however, is not strong. A Cochrane review of 11 randomized controlled trials examining PA as a smoking cessation strategy concluded that while exercise promotion did not appear to harm smoking cessation efforts, there was limited evidence that it helped (Ussher, 2005). Only one of the 11 trials found evidence for PA aiding smoking cessation at long-term follow up (Marcus et al., 1999). The program was highly structured, supervised, and promoted PA of vigorous intensity. A follow up study that promoted engagement in moderate PA and used more of a home-based approach failed to find an effect for long-term cessation relative to a standard cognitive behavioral cessation program (Marcus et al., 2005). In the Cochrane review, only two studies reported changes in PA, limiting our understanding of the feasibility of smokers making changes in their tobacco use and PA patterns concurrently (Ussher, 2005). A follow up study reported no long-term effect of a PA intervention on tobacco abstinence, but also reported no difference in PA levels between the intervention and control conditions (Ussher et al., 2007).
When quitting smoking, the timing of the PA program and the intensity of PA promoted (vigorous vs. moderate) may be important. Moderate or “lifestyle” exercise programs may offer greater efficacy and practicality for dissemination (Dunn et al., 1998, King, 1998), greater participant adherence (King et al., 1995), and greater appeal to sedentary smokers (Ussher et al., 2001). The current study examined: (1) the impact of an extended relapse prevention program on increasing moderate to vigorous PA (MVPA) in adults enrolled in a tobacco cessation treatment trial; (2) whether changes in MVPA were associated with sustained abstinence from smoking; and (3) mechanisms by which MVPA may support sustained abstinence from smoking. Hypothesized mechanisms included enhanced psychological states, reduced withdrawal symptoms, improved health functioning, reduced weight gain, and greater motivation and self-efficacy to stay tobacco-free. Baseline correlates of PA also were examined with sample demographic and tobacco use characteristics.
Section snippets
Participants
Participants were 407 adults who smoked at least 10 cigarettes daily for 5 or more years and smoked within 30 min of awakening. The study, conducted in the San Francisco Bay Area, recruited smokers interested in quitting via direct mail and media advertisements. Recruitment spanned February 2003–December 2005 with the 24 week assessments completed in June 2006. The study was limited to English speakers. Exclusion criteria included contraindications to bupropion use (e.g., elevated seizure
Participant baseline characteristics
The sample was 61% male with a mean age of 40.7 years (SD = 9.8). Race or ethnic identification was Caucasian (71%), African American (8%), Asian/Pacific Islander (6%), Hispanic (3%), multiracial (10%), and other (2%). Most participants (74%) had attended some college; 45% held at least a bachelor's degree; 72% were employed. The measured BMI of the sample averaged 26 (SD = 5) for men and 26 (SD = 6) for women at baseline; 54% of the men and 47% of the women were classified as overweight or obese.
Discussion
The current study examined promotion of PA as part of an extended relapse prevention program for smoking cessation. The PA component was brief (2 sessions), individualized, encouraged self-monitoring with a pedometer, and promoted gradual increases in lifestyle MVPA. As hypothesized, we found significant increases in MVPA from baseline to week 24 among participants receiving the PA intervention, whereas MVPA among control participants declined. Among intervention participants who did their
Acknowledgments
This work was supported by the National Institute on Drug Abuse (#R01 DA015732, #K05 DA016752, #K23 DA018691 and #P50 DA09253) and the State of California Tobacco-Related Disease Research Program (#13KT-0152). The authors have no financial interests related to the material in the manuscript. The study was presented orally at the Annual Meeting of the Society of Behavioral Medicine in San Diego, CA on March 28, 2008. We thank Kevin Ahern for his assistance with data management.
References (56)
- et al.
Exercise effects on withdrawal and mood among women attempting smoking cessation
Addict. Behav.
(1999) - et al.
Changing multiple health behaviors: smoking and exercise
Prev. Med.
(2003) - et al.
Lifestyle physical activity interventions. History, short- and long-term effects, and recommendations
Am. J. Prev. Med.
(1998) - et al.
The acceptability of physical activity programming within a smoking cessation service for individuals with severe mental illness
Patient Educ. Couns.
(2007) - et al.
Prevalence of multiple chronic disease risk factors; 2001 National Health Interview Survey
Am. J. Prev. Med.
(2004) How to promote physical activity in a community: research experiences from the US highlighting different community approaches
Patient Educ. Couns.
(1998)- et al.
Cognitive-behavioral mediators of changing multiple behaviors: smoking and a sedentary lifestyle
Prev. Med.
(1996) - et al.
Smoking status: effects on the dietary intake, physical activity, and body fat of adult men
Am. J. Clin. Nutr.
(1990) - et al.
Promoting walking with pedometers in the community: the step-by-step trial
Am. J. Prev. Med.
(2007) - et al.
Gender, dietary restraint, and smoking's influence on hunger and the reinforcing value of food
Physiol. Behav.
(1995)
Relapse to smoking
Clin. Psychol. Rev.
Meeting recommendations for multiple healthy lifestyle factors; prevalence, clustering, and predictors among adolescent, adult, and senior health plan members
Am. J. Prev. Med.
Stages of change of smoking cessation: relationships with other health behaviors
Am. J. Prev. Med.
Randomized controlled trial of physical activity counseling as an aid to smoking cessation: 12 month follow-up
Addict. Behav.
Diagnostic and Statistical Manual of Mental Disorders
Influences of gender and weight gain on short-term relapse to smoking in a cessation trial
J. Consult. Clin. Psychol.
Using pedometers to increase physical activity and improve health: a systematic review
Jama
Annual smoking-attributable mortality, years of potential life lost, and productivity losses — United States, 1997–2001
MMWR
A global measure of perceived stress
J. Health Soc. Behav.
International physical activity questionnaire: 12-country reliability and validity
Med. Sci. Sports Exerc.
The effect of exercise in reducing desire to smoke and cigarette withdrawal symptoms is not caused by distraction
Addiction
Environmental correlates of physical activity in a sample of Belgian adults
Am. J. Health Promot.
Reliability of pedometer-determined free-living physical activity data in college women
Res. Q. Exerc. Sport
International Physical Activity Questionnaire: validity against fitness
Med. Sci. Sports Exerc.
Use of diet pills and amphetamines to lose weight among smoking and nonsmoking high school seniors
Health Psychol.
The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity
Public Health Nutr.
Commitment to abstinence and acute stress in relapse to alcohol, opiates, and nicotine
J. Consult. Clin. Psychol.
Cited by (88)
Failure to decrease the addictive usage of information technologies: A theoretical model and empirical examination of smartphone game users
2019, Computers in Human BehaviorCitation Excerpt :Research on substance abuse shows the influence of perceived task difficulty on regulation results. For instance, the decreased level of perceived difficulty with staying smoke-free leads to the increased performance of physical activities which is used for maintaining tobacco abstinence (Prochaska et al., 2008). Richard Eiser, van der Pligt, Raw, and Sutton (1985) showed that addicts may use the difficulty in giving up smoking as a refuge from behavioral imperative required by antismoking beliefs.
Adverse physiological effects of smoking cessation on the gastrointestinal tract: A review
2023, Medicine (United States)Physical activity as an aid in smoking cessation
2023, Routledge Handbook of Physical Activity and Mental Health