Physical activity as a coping strategy for smoking cessation in mid-life and older adults

The Efficacy of Individualized, Community-Based Physical Activity to Aid Smoking Cessation: A Randomized Controlled Trial

Objective

The efficacy of individualized, community-based physical activity as an adjunctive smoking cessation treatment to enhance long-term smoking cessation rates was evaluated for the Lifestyle Enhancement Program (LEAP).

Methods

The study was a two-arm, parallel-group, randomized controlled trial. All participants (n = 392) received cessation counseling and a nicotine patch and were randomized to physical activity (n = 199; YMCA membership and personalized exercise programming from a health coach) or an equal contact frequency wellness curriculum (n = 193). Physical activity treatment was individualized and flexible (with each participant selecting types of activities and intensity levels and being encouraged to exercise at the YMCA and at home, as well as to use "lifestyle" activity). The primary outcome (biochemically verified prolonged abstinence at 7-weeks (end of treatment) and 6- and 12-months postcessation) and secondary outcomes (7-day point prevalent tobacco abstinence (PPA), total minutes per week of leisure time physical activity and strength training) were assessed at baseline, 7 weeks, 6 months, and 12 months.

Results

Prolonged abstinence in the physical activity and wellness groups was 19.6% and 25.4%, respectively, at 7-weeks, 15.1% and 16.6% at 6-months, and 14.1% and 17.1% at 12 months (all between-group P values >0.18). Similarly, PPA rates did not differ significantly between groups at any follow-up. Change from baseline leisure-time activity plus strength training increased significantly in the physical activity group at 7 weeks (P = 0.04). Across treatment groups, an increase in the number of minutes per week in strength training from baseline to 7 weeks predicted prolonged abstinence at 12 months (P ≤ 0.001). Further analyses revealed that social support, fewer years smoked, and less temptation to smoke were associated with prolonged abstinence over 12 months in both groups.

Conclusions

Community-based physical activity programming, delivered as adjunctive treatment with behavioral/pharmacological cessation treatment, did not improve long-term quit rates compared to adjunctive wellness counseling plus behavioral/pharmacological cessation treatment. This trial is registered with https://beta.clinicaltrials.gov/study/NCT00403312, registration no. NCT00403312.

Exercise interventions for smoking cessation

BACKGROUND

Taking regular exercise, whether cardiovascular-type exercise or resistance exercise, may help people to give up smoking, particularly by reducing cigarette withdrawal symptoms and cravings, and by helping to manage weight gain.

OBJECTIVES

To determine the effectiveness of exercise-based interventions alone, or combined with a smoking cessation programme, for achieving long-term smoking cessation, compared with a smoking cessation intervention alone or other non-exercise intervention.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialised Register for studies, using the term 'exercise' or 'physical activity' in the title, abstract or keywords. The date of the most recent search was May 2019.

SELECTION CRITERIA

We included randomised controlled trials that compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme alone or another non-exercise control group. Trials were required to recruit smokers wishing to quit or recent quitters, to assess abstinence as an outcome and have follow-up of at least six months.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison, as either smoking cessation or relapse prevention. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models.

MAIN RESULTS

We identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group-based cardiovascular-type exercise supplemented by a home-based exercise programme and combined with a multi-session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi-session cognitive behavioural smoking cessation programme alone. Overall, we judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. Among the 21 studies analysed, we found low-certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I² = 0%; 6607 participants). We excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular-type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular-type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when we excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, we found very low-certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long-term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I² = 0%; 453 participants).

AUTHORS' CONCLUSIONS

There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions.

Patient Perception of How Smoking Status Influences Cardiac Rehabilitation Attendance After an Acute Cardiac Hospitalization

PURPOSE

Patients hospitalized with a cardiac condition are less likely to attend cardiac rehabilitation (CR) if they are smokers despite the benefits of doing so. The present study sought to investigate how, if at all, a patient's decision to attend CR was influenced by his or her tobacco use post-discharge.

METHODS

We surveyed smokers during their hospitalization for a cardiac condition. Four to 8 wk after discharge, a follow-up survey assessed self-reported CR attendance, smoking cessation (SC), and patient opinion of how their smoking status influenced CR attendance.

RESULTS

Of the 81 patients who completed the baseline survey (68% male, 57 ± 10 y), 62 (77%) completed the follow-up survey. Consistent with prior findings, there was a substantial correlation between SC and CR attendance (OR: 16.0, P < .001) with 36 (44%) patients attending CR overall and 38 (47%) abstaining from smoking. Patients reported a wide variety of reasons for not attending CR, but most patients (n = 39, 63%) reported that their smoking status did not influence their decision to attend CR. However, 5 patients (8%) reported attending CR because they successfully quit smoking, and 5 (8%) attended CR anticipating support with SC.

CONCLUSION

A strong relationship exists between SC and CR attendance following a cardiac hospitalization; however, most patients did not feel that their smoking status was a factor in their decision to attend CR. Regardless of the reason, it appears that success with one behavior may be related to the other and that both SC and CR attendance should be encouraged.

The Associations among Psychological Distress, Coping Style, and Health Habits in Japanese Nursing Students: A Cross-Sectional Study

Background: Nursing students in many countries have been reported to experience high levels of stress and psychological distress. Health habits could potentially mediate the association between coping styles and psychological status. The purpose of this study was to evaluate the mediation effect of health habits in the relationship between stress coping styles and psychological distress in Japanese nursing students. Methods: A total of 181 nursing students completed anonymous self-reported questionnaires comprised of the General Health Questionnaire-12 (GHQ-12), the Brief Coping Orientation questionnaire, and an additional questionnaire on health behavior. A mediation analysis using path analysis with bootstrapping was used for data analysis. Results: Multivariate linear regression analysis showed that psychological distress was significantly and positively associated with “Avoidance coping” (β = 0.39, p < 0.001), and was negatively associated with “Active coping” (β = −0.30, p < 0.001), “exercise habit” (β = −0.25, p = 0.001), and “sleeping” (β = −0.24, p = 0.002). In the path model, “Active coping” and “Avoidance coping” had significant or marginally significant associations with “exercise habits” (active: β = 0.19, p = 0.008, avoidance: β = −0.12, p = 0.088), and psychological distress (active: β = −0.25, p < 0.001, avoidance: β = 0.363, p < 0.001). However, these coping style variables did not have a significant association with “sleep”. In general, the size of the correlations was below 0.4. Conclusions: Exercise habits mediated the relationship between coping styles and psychological distress to a greater extent than sleep. The present study suggests the possibility that complex interactions between health habits and coping styles may influence the psychological status of nursing students.

A mixed-method study of the efficacy of physical activity consultation as an adjunct to standard smoking cessation treatment among male smokers in Malaysia

BACKGROUND

This study examined the effectiveness of using Physical Activity Consultation (PAC) as an addition to the standard smoking cessation treatment in Malaysia. We explored participants' experiences in terms of physical activity and smoking abstinence with the combined PAC and smoking cessation intervention.

METHODS

Walk-in smokers from a local smoking cessation clinic volunteered for the 8-week intervention program, while undergoing standard smoking cessation treatment. In Week 1, a facilitator conducted a face-to-face intervention to explore participants' involvement in physical activity and helped to set physical activity strategies and goals for participants to increase physical activity levels. Participants were provided with follow-up phone calls at Weeks 3 and 6. Participants answered questionnaires that measured smoking withdrawal (Shiffman-Jarvik Withdrawal Scale), cessation self-efficacy (Cessation Self-efficacy Questionnaire), physical activity involvement (International Physical Activity Questionnaire), and mood (Brunel Mood Scale) upon recruitment, at post-intervention and at follow-up 3 months after the intervention ended. Participants also responded to interviews about their experiences with the PAC and smoking cessation treatment at post-intervention and at 3-month follow-up.

RESULTS

Seven participants completed the program until follow-up. All were successfully abstinent. Only two participants increased physical activity levels, whereas others maintained their physical activity levels or showed slight decreases. Several themes were identified in this study, including participants' experiences with withdrawal symptoms, smoking cessation self-efficacy, triggers to smoking cessation, thoughts on standard smoking cessation treatment in Malaysia, physical activity involvement, mood, and thoughts and beliefs on combining smoking cessation and physical activity.

CONCLUSIONS

This study suggests PAC was helpful in maintaining or increasing the overall physical activity levels of participants and could assist with smoking abstinence. Findings showed that all participants who stayed in the program were successfully abstinent. In general, the findings in this study provided promising results for further research on PAC as an adjunct to smoking cessation treatments in Malaysia. Trial registration This intervention is registered with the Australian New Zealand Clinical Trials Registry (Trial registration number: ACTRN12616000269437).

Smoking Cessation and Changes in Body Mass Index Among Middle Aged and Older Adults

Objective: This study contributes to the body of literature examining smoking cessation and body mass index (BMI) for adults aged 50 and older. Method: Utilizing the 2004 and 2010 waves of the RAND Health and Retirement Study, this analysis utilized Fixed Effects (FE) regression on a sample of 1,316 adults aged 50 and older. Results: Older adults undergo a small change in BMI after a transition from smoking to nonsmoking during a 6-year period, and this occurs after accounting for individual-level unobserved heterogeneity. More specifically, men experience a BMI gain of 1.24 ( p< .01) and women experience a BMI gain of 1.58 ( p< .01). Discussion: Gerontologists/health professionals can use these results to inform older adults about the potential for a small increase in BMI and, in the process, assuage any apprehensions about excessive weight gain. This insight may encourage a greater number of older adults to cease smoking.

Exercise interventions for smoking cessation

BACKGROUND

Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain.

OBJECTIVES

To determine whether exercise-based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2014, and searched MEDLINE, EMBASE, PsycINFO, and CINAHL Plus in May 2014.

SELECTION CRITERIA

We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme (which we considered the control in this review). Studies were required to recruit smokers or recent quitters and have a follow-up of six months or more. Studies that did not meet the full inclusion criteria because they only assessed the acute effects of exercise on smoking behaviour, or because the outcome was smoking reduction, are summarised but not formally included.

DATA COLLECTION AND ANALYSIS

We extracted data on study characteristics and smoking outcomes. Because of differences between studies in the characteristics of the interventions used we summarized the results narratively, making no attempt at meta-analysis. We assessed risk of selection and attrition bias using standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS

We identified 20 trials with a total of 5,870 participants. The largest study was an internet trial with 2,318 participants, and eight trials had fewer than 30 people in each treatment arm. Studies varied in the timing and intensity of the smoking cessation and exercise programmes offered. Only one included study was judged to be at low risk of bias across all domains assessed. Four studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow-up and a benefit for exercise of borderline significance (p = 0.05) at the 12-month follow-up. Another study reported significantly higher abstinence rates at six month follow-up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow-up but not at the end of treatment or 12-month follow-up. The other studies showed no significant effect for exercise on abstinence.

AUTHORS' CONCLUSIONS

Only two of the 20 trials offered evidence for exercise aiding smoking cessation in the long term. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which may not have been sufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions in terms of both exercise intensity and intensity of support being provided, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups.