Tobacco harm reduction strategies: The case for physical activity

Effect of Aerobic Exercise on Arterial Stiffness in Individuals with Different Smoking Statuses

This study aimed to investigate the immediate effects of acute bout of aerobic exercise on arterial stiffness in individuals with different smoking statuses. A total of 940 male individuals (mean age of 36.82±7.76 years) in the Kailuan study cohort were selected to participate in the fifth National Physical Fitness Monitoring. All participants completed measurements of brachial - ankle pulse wave velocity (baPWV) before and after twice-quantitative cycle ergometer exercise. Four groups were defined: (1) non-smokers (n=231), (2) former smokers (n=165), (3) light smokers (1-10 cigarettes/day, n=254), (4) heavy smokers (>10 cigarettes/day, n=290). Generalized linear models were established to analyze between-group differences in the change in baPWV before and after acute aerobic exercise in individuals with different smoking statuses. Overall, after acute aerobic exercise, baPWV was immediately decreased significantly (-33.55 cm/s [95% CI, - 39.69 to -27.42]). Compared with non-smokers, former smokers, light smokers, and heavy smokers showed a greater decrease in baPWV (-12.17 cm/s [95%CI, - 30.08 to 5.75], - 18.43 cm/s [95%CI, -34.69 to - 2.16], and -22.46 cm/s [95%CI, - 38.39 to - 6.54]) respectively. There is a transient decrease in baPWV in individuals with different smoking statuses. Compared with non-smokers, baPWV decreased more significantly in light and heavy smokers.

Visit-to-visit variability in triglyceride-glucose index and diabetes: A 9-year prospective study in the Kailuan Study

INSTRUCTION/AIMS

It is unknown whether variability in the triglyceride-glucose index (TyG-index) is associated with the risk of diabetes. Here, we sought to characterize the relationship between TyG-index variability and incident diabetes.

METHODS

We performed a prospective study of 48,013 participants in the Kailuan Study who did not have diabetes. The TyG-index was calculated as ln [triglyceride (TG, mg/dL) concentration × fasting blood glucose concentration (FBG, mg/dL)/2]. The TyG-index variability was assessed using the standard deviation (SD) of three TyG-index values that were calculated during 2006/07, 2008/09, and 2010/11. We used the Cox proportional hazard models to analyze the effect of TyG-index variability on incident diabetes.

RESULTS

A total of 4,055 participants were newly diagnosed with diabetes during the study period of 8.95 years (95% confidence interval (CI) 8.48-9.29 years). After adjustment for confounding factors, participants in the highest and second-highest quartiles had significantly higher risks of new-onset diabetes versus the lowest quartile, with hazard ratios (95% CIs) of 1.18 (1.08-1.29) and 1.13 (1.03-1.24), respectively (P trend< 0.05). These higher risks remained after further adjustment for the baseline TyG-index.

CONCLUSIONS

A substantial fluctuation in TyG-index is associated with a higher risk of diabetes in the Chinese population, implying that it is important to maintain a normal and consistent TyG-index.

If You Pay, Will They Come? Evaluating the Impact of Subsidies on Cessation Outcomes in the Walk or Run to Quit Program

Introduction

Exercise interventions may assist smoking cessation attempts. One such publicly available 10-week program, Walk or Run to Quit (WRTQ), demonstrated success in smoking cessation and physical activity (PA) outcomes. However, initial WRTQ participants (2016-2017) were fairly homogenous in their demographic profile. To increase diversity, subsidies for participation were offered in 2018. This study assessed how the subsidies affected participant demographics, running frequency, smoking cessation, intention to quit, and program attendance and completion.

Methods

The $70 registration fee was subsidized for 41% of participants in 2018. A pre-postdesign was used, with participants completing surveys on their demographics and smoking and physical activity behaviours. Descriptive statistics compared the year subsidies were available (2018) and unsubsidized years (2016-2017) and subsidized and unsubsidized participants' data from 2018.

Results

The 2018 participants had lower average attendance and program completion rates compared to 2016-2017 and no statistically significant differences in demographics or smoking cessation and PA outcomes. There were no differences in smoking cessation, run frequency, or demographic variables between the subsidized and unsubsidized participants in 2018.

Conclusions

Offering subsidies did not diversify the participant profile. Subsidies did not have a negative impact on attendance nor primary outcomes. Subsidies may not have addressed barriers that prevented a more diverse sample from participating in WRTQ, such as program location, timing, and design. Equitable access to smoking cessation programs remains essential. As subsidies may play a role in reducing financial barriers disproportionately faced by marginalized groups, the implementation of, and recruitment for, such subsidized programs requires further investigation.

Relationship of cumulative exposure to the triglyceride-glucose index with ischemic stroke: a 9-year prospective study in the Kailuan cohort

BACKGROUND

A single measurement of the triglyceride-glucose (TyG) index, a simple and reliable surrogate marker of insulin resistance, is associated with ischemic stroke. However, evidence for an effect of a long-term elevation in TyG index on ischemic stroke is limited. Therefore, we evaluated the relationship between cumulative TyG index exposure and the risk of ischemic stroke.

METHODS

A total of 54,098 participants in the Kailuan study who had not experienced ischemic stroke underwent three measurements of fasting blood glucose and triglycerides during 2006-2007, 2008-2009, and 2010-2011. Cumulative exposure to TyG index was calculated as the weighted sum of the mean TyG index value for each time interval (value × time). Participants were placed into four groups according to the quartile of the weighted mean: Q1 group, < 32.01; Q2 group, 32.01-34.45; Q3 group, 34.45-37.47; and Q4 group, ≥ 37.47. Cox proportional hazard models were used to assess the relationships of the cumulative TyG index with incident ischemic stroke by calculating hazard ratios (HRs) and 95% confidence intervals (95% CIs).

RESULTS

There were 2083 incident ischemic stroke events over the 9 years of follow-up. The risk of ischemic stroke increased with the quartile of cumulative TyG index. After adjustment for multiple potential confounders, participants in groups Q4, Q3, and Q2 had significantly higher risks of ischemic stroke, with HRs (95% CIs) of 1.30 (1.12-1.52), 1.26 (1.09-1.45), and 1.09 (0.94-1.27), respectively (P_trend < 0.05), compared with the Q1 group. The longer duration of high TyG index exposure was significantly associated with increased ischemic stroke.

CONCLUSIONS

High cumulative TyG index is associated with a higher risk of ischemic stroke. This finding implies that monitoring and the maintenance of an appropriate TyG index may be useful for the prevention of ischemic stroke.

The effects of exercise with nicotine replacement therapy for smoking cessation in adults: A systematic review

OBJECTIVE

This systematic review aimed to evaluate the efficacy of exercise programmes with nicotine replacement therapy (NRT) for smoking cessation in adults.

INTRODUCTION

Nicotine addiction is mediated by dopamine. Exercise can also activate the dopamine reward system. Therefore, exercise may effectively facilitate NRT to reduce cigarette cravings and withdrawal symptoms.

INCLUSION CRITERIA

Clinical trials between 2000 and 2022 used exercise protocols of any intensity for smoking cessation, in current smokers or recent quitters of both genders, aged 18-70, without severe diseases and pregnancy. Mental disorders were not excluded, as exercise can improve mental health status. Therefore, it may be as effective among people with mental health issues as the general population in preventing nicotine cravings and supporting abstinence.

METHODS

Four databases (PubMed, Embase, Cochrane, and Medline) were searched for papers in English using the terms "nicotine replacement therapy', "exercise," and "smoking cessation." Titles and abstracts were screened for potentially eligibility before full texts were reviewed. Sample size, gender, study duration, and age was then extracted. The certainty of the evidence was assessed using Joanna Briggs Institute's (JBI's) GRADE approach.

RESULTS

Seventeen studies were identified with a total of 3,191 participants. Three studies are not a randomised control study. There was moderate-high quality evidence that exercise can aid NRT in promoting smoking cessation in the short term. Several studies reported temporary reductions in cravings; however, only one trial reported a decrease in cigarette consumption due to exercise intervention and one demonstrated increased smoking abstinence at 1 year of the intervention.

CONCLUSION

Exercise with NRT aids smoking cessation in the short term, but no evidence suggests its efficacy in the long term when combined. Future trials should include larger sample sizes and strategies to increase exercise adherence.

Changes in Impaired Fasting Glucose and Borderline High Low-Density Lipoprotein-Cholesterol Status Alter the Risk of Cardiovascular Disease: A 9-Year Prospective Cohort Study

BACKGROUND

We aimed to characterize the relationships of the changes in impaired fasting glucose (IFG) and borderline high low-density lipoprotein-cholesterol (LDL-C) status with cardiovascular disease (CVD).

METHODS

A total of 36,537 participants who did not have previous CVD, diabetes mellitus, or high LDL-C (≥ 4.1 mmol/L), nor were taking lipid-lowering drugs were recruited from the Kailuan study. The participants were allocated to six groups according to their baseline and follow-up fasting blood glucose (FBG) and LDL-C concentrations: (1) both were normal; (2) both normal at baseline, one abnormality subsequently; (3) both normal at baseline, both abnormal subsequently; (4) at least one abnormality that became normal; (5) at least one abnormality at baseline, a single abnormality subsequently; and (6) at least one abnormality, two abnormalities subsequently. The outcomes were CVD and subtypes of CVD (myocardial infarction and stroke). Multiple Cox regression models were used to calculate adjusted hazard ratio (HR) and confidence interval (95% CI).

RESULTS

During a median follow-up period of 9.00 years, 1,753 participants experienced a CVD event. After adjustment for covariates, participants with IFG in combination with a borderline high LDL-C status at baseline and follow-up had higher risks of CVD (HR: 1.52; 95% CI: 1.04-2.23 and HR: 1.38, 95% CI: 1.13-1.70, respectively) compared with those with normal fasting blood glucose and LDL-C. Compared with participants that remained normal, those who changed from normality to having two abnormalities were at a higher risk of CVD (HR: 1.26; 95% CI: 0.98-1.61), as were those who changed from at least one abnormality to two abnormalities (HR: 1.48, 95% CI: 1.02-2.15).

CONCLUSION

Changes in IFG and borderline high LDL-C status alter the risk of CVD and its subtype, implying that it is important to focus on such individuals for the prevention and control of CVD.

Walk or Run to Quit: a 3-year evaluation of a physical activity-based smoking cessation intervention

Introduction

Walk or Run to Quit was a national program targeting smoking cessation through group-based running clinics. Increasing physical activity may facilitate smoking cessation as well as lead to additional health benefits beyond cessation.

Aim

To evaluate the impact of Walk or Run to Quit over 3 years.

Methods

Adult male and female participants (N = 745) looking to quit smoking took part in 156 running-based cessation clinics in 79 locations across Canada. Using a pre-post design, participants completed questionnaires assessing physical activity, running frequency and smoking at the beginning and end of the 10-week program and at 6-months follow-up. Carbon monoxide testing pre- and post- provided an objective indicator of smoking status and coach logs assessed implementation.

Results

55.0% of program completers achieved 7-day point prevalence (intent-to-treat = 22.1%) and carbon monoxide significantly decreased from weeks 1 to 10 (P < 0.001). There was an increase in physical activity and running from baseline to end-of-program (P's<0.001). At 6-month follow-up, 28.9% of participants contacted self-reported prolonged 6-month abstinence (intent-to-treat = 11.4%) and 35.6% were still running regularly.

Conclusions

Although attrition was a concern, Walk or Run to Quit demonstrated potential as a scalable behaviour change intervention that targets both cessation and physical activity.

Personal and Lifestyle Determinants of HIV Transmission Risk in Spanish University Students

The increase in human immunodeficiency virus (HIV) transmission cases poses a serious public health concern. Although several previous studies have been conducted with the aim of identifying the risk factors for HIV transmission, the number of cases has been increasing, especially in youth. The present study is aimed at the identification of personal and lifestyle determinants of HIV transmission risk in a sample of 335 Spanish university students selected by convenience sampling from a public university located in Alicante (Spain). Sociodemographic factors, lifestyles, and variables of HIV risk of transmission were evaluated. Group differences on risk of HIV transmission were evaluated between participants depending on their sociodemographic characteristics (age, sex, relationship status, employment status, economic status, and sexual orientation) and lifestyle (diet, physical exercise, smoking, alcohol consumption, and stress). Linear regression models were conducted in order to identify those personal and lifestyle variables related to HIV transmission risk. The obtained results indicate that, generally, being older, in a relationship, and employed were factors related to a high risk of HIV transmission. Regarding lifestyle, poor diet, lower intensity of physical exercise, higher alcohol intake, and smoking were fundamentally associated with a higher risk of HIV transmission, through lower use of condoms and higher frequency of risky sexual behaviors. Hence, participants who develop an unhealthy lifestyle exhibit twice the probability of being at a high risk of HIV transmission, especially regarding these previously indicated behaviors. The present study points out the relevance of sociodemographic characteristics and lifestyles of university students in their proneness to developing risky behaviors for HIV infection. Future studies should be developed with larger, randomized, and more representative samples, in order to obtain significant information for the development of effective preventive strategies oriented toward the increase in the adherence to healthy lifestyles and HIV prevention.

The effect of tobacco policies on youth physical activity

Our research examines the effects of tobacco policies on teenagers' physical activity. Smoking and physical activity are both strategies for weight management, and exercise may be a way to reduce some of the ill effects of smoking. These different links suggest that cigarette taxes could either increase or decrease physical activity. We explore this relationship using repeated cross-sectional 1991-2017 data from the national and state Youth Risk Behavior Surveillance System (YRBSS), combined with state-level policies and controls. Our smoking participation results confirm past work; cigarette taxes have a negative effect on smoking that has waned in recent years. The estimated effects of cigarette taxes on physical activity echo those of smoking; cigarette taxes decrease physical activity and, like smoking, these effects have waned recently. However, one likely avenue - sports participation - is unaffected. These results suggest that increased cigarette taxes lead to modest declines in teen physical activity, a finding consistent with youth using exercise to compensate for the health effects of smoking.

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.

‘When you put the Group and the Running Together. . .’: A Qualitative Examination of Participant Experiences of the Canadian Run to Quit program

Introduction: Run to Quit is a national community-based program that combines smoking cessation support with physical activity through learn to run group-based curriculum, self-help and smoking cessation materials. The program is currently in a three-year scaling up phase.

Aims: The aim of the current study is to explore participant experiences of the Run to Quit program after its first year, and identify potential areas of improvement for future iterations of the program.

Methods: Participants (n = 55) were interviewed over the phone at the end of the 10-week program. Participant interviews were recorded and transcribed. A thematic analysis was conducted.

Results/Findings: Participants were satisfied with the program. Strengths of the program were the group aspect, supervised participation and the running. Weaknesses were seen as the variability in walking and running abilities and inadequate engagement by the Smokers Helpline. Many people who successfully quit smoking reported using additional quit aids. Non-completers of the program gave mostly logistical and personal reasons for dropout.

Conclusions: Overall, Run to Quit was well received by participants. Multiple health behaviour interventions at a scalable level appear feasible. Based on participant feedback, key recommendations to improve the program in the future include greater tailoring to walking or running preference, and increasing engagement with the Smokers Helpline.

Cigarette Taxes, Smoking-and Exercise?

This research provides the first in-depth analysis of the effect that increased cigarette taxes have on exercise behavior. Smoking may diminish the ability to exercise; individuals may also use exercise to compensate for the harmful health effects of smoking or to avoid gaining weight if they cut back. Our conceptual model highlights these and several other avenues for effect and reveals that the predicted effect of cigarette costs on exercise behavior is theoretically ambiguous. To investigate the relationship empirically, 1994-2012 data from the behavioral risk factor surveillance system are combined with state level cigarette tax rates and other state level variables. Several measures of both smoking and exercise behavior are created and estimated in reduced form models. Our results suggest that both smoking and exercise are reduced by cigarette taxes. However, the effects on exercise may be more complicated as we find that certain groups, such as young adults or those who have recently quit smoking, are affected differently. Our analyses also show that the responsiveness of both smoking and exercise behavior to cigarette costs is much smaller in the 2000s, an era of high-tax increases. Copyright © 2016 John Wiley & Sons, Ltd.

The period prevalence of risk behavior co-occurrence among Canadians

INTRODUCTION

While the benefits of complying with health recommendations is well documented, a considerable proportion of Canadians engage in multiple modifiable risk behaviors. The purpose of this multi-wave longitudinal study was to identify the individual period prevalence and co-occurrence of multiple modifiable risk behaviors, particularly excessive alcohol consumption, physical inactivity, and tobacco use, within a nationally representative sample of Canadians.

METHODS

Secondary data analysis was conducted on the first seven cycles of the National Population Health Survey. This longitudinal sample included 15,167 Canadians aged 12years of age or older. Gender-specific criteria were employed to define excessive alcohol consumption. Individuals expending <3.0kcal/kg/day during their leisure-time and smoking cigarettes (daily or occasionally) met the criteria for physical inactivity and tobacco use, respectively.

RESULTS

The period prevalence of the Canadian general population that participated in multiple risk behaviors was 21.5% in cycle 7. The most common pairwise combination of co-occurring risk behaviors was physical inactivity and smoking. The proportion of Canadians reporting the co-occurrence of all three risk behaviors in cycle 7 was 2.6%.

CONCLUSIONS

Understanding patterns of modifiable risk behaviors is an initial step in developing and implementing public health interventions. The co-occurrence of these three risk behaviors is a viable concern for one in five Canadians. For these individuals, the likelihood of encountering premature morbidity and mortality is escalated. As the majority of Canadians reported being physically inactive, allocating limited resources towards enhancing leisure-time physical activity levels could have significant population-level implications for improving the health of Canadians.

The association of fitness with reduced cardiometabolic risk among smokers

INTRODUCTION

Despite the health benefits associated with smoking cessation, continued smoking and relapse following cessation are common. Physical activity is associated with reduced risk of cardiovascular disease in general, though less is known about how cardiorespiratory fitness may influence cardiometabolic risk among smokers. Strategies are needed to protect against the health consequences of smoking among those unwilling or unable to quit smoking. The purpose of this study is to determine whether greater cardiorespiratory fitness is associated with reduced metabolic risk among smokers.

METHODS

The prospective influence of estimated cardiorespiratory fitness (i.e., maximal METs) on the development of metabolic syndrome and its components were examined among adult smokers (N=1,249) who completed at least two preventive medical visits at the Cooper Clinic (Dallas TX) between 1979 and 2011. Statistical analyses were completed in 2013 and 2014.

RESULTS

The rate and risk for metabolic syndrome, as well as abnormal fasting glucose and high-density lipoprotein cholesterol levels declined linearly with increases in cardiorespiratory fitness (all p<0.05). Smokers in the moderate and high fitness categories had significantly reduced risk of developing metabolic syndrome and elevated fasting glucose relative to smokers in the lowest fitness category. In addition, smokers in the high fitness category were less likely to develop abnormal high-density lipoprotein cholesterol levels.

CONCLUSIONS

Moderate to high cardiorespiratory fitness among smokers is associated with a reduced likelihood of developing certain cardiovascular disease risk factors and metabolic syndrome.

Central and peripheral cardiovascular changes immediately after waterpipe smoking

BACKGROUND

Tobacco cigarette smoking is a global health problem that kills millions each year. Recently, tobacco smoking using a waterpipe (WP) has become popular worldwide. However, unlike cigarettes, the cardiovascular (CV) risks associated with WP smoking are uncertain. In this study, the immediate effects of WP smoking on central and peripheral CV indices were evaluated in 53 young healthy smokers.

MATERIALS AND METHODS

Strain-gauge plethysmography was used to measure forearm blood flow (Bf), vascular resistance (Vr), and venous capacitance (Vc) and outflow (Vf) at rest (R) and after occlusion (Oc), whereas heart rate (HR) and blood pressure (BP) were measured using standard automated auscultatory methods immediately before and after a 30-min WP smoking session.

RESULTS

Smoking resulted in HR, diastolic BP, mean arterial BP, rate pressure product and OcVr increases (p < 0.05) 6.6, 3.6, 2.5, 8.0 and 16%, respectively, whereas OcBf and OcVf decreased (p < 0.05) 8.8 and 14.3%, respectively. Additionally, smoking-induced changes in the central CV components correlated (p < 0.05) with changes in the periphery.

CONCLUSION

These results demonstrated changes in the CV central and peripheral components immediately after WP smoking. The correlations between the changes in these components suggest that the periphery is controlled, at least partially, by the same mechanism(s) affecting the central CV components during WP smoking.

Neighborhood environment perceptions and the likelihood of smoking and alcohol use

Neighborhood characteristics are important correlates for a variety of health outcomes. Among several health risk behaviors, smoking and alcohol use have significant consequences. Perceptions of neighborhood problems are associated with depressive symptoms, lower physical activity, and lower quality of life. However, it is unclear which perceived aspects of neighborhoods might be related to smoking and drinking. We examined whether perceived neighborhood characteristics were associated with smoking and drinking patterns using data from US metropolitan Midwestern area adults. Participants completed surveys including sociodemographic characteristics, neighborhood perceptions, behavioral and psychological health. For men, negative perceptions of neighborhood infrastructures were significant predictors for smoking and binge drinking. Among women, no perceived environmental factors were associated with smoking or drinking. However, education was a significant negative predictor for smoking. As age increased, the likelihood of using cigarettes, heavy and binge drinking in women decreased significantly. Depression was a positive predictor for smoking and heavy drinking in men and women, respectively. These findings indicate that the perceived neighborhood infrastructure was predictive of health behaviors among men, even after adjusting for key confounders. Closer attention may need to be paid to the role of neighborhood environmental characteristics along with individual-level characteristics in influencing unhealthy behaviors.

Work and Non-Work Physical Activity Predict Real-Time Smoking Level and Urges in Young Adults

INTRODUCTION

Physical activity (PA) and smoking are inversely related. However, evidence suggests that some types of PA, namely work-related PA, may show an opposite effect. Despite growing knowledge, there remains a paucity of studies examining the context of these behaviors in naturalistic settings or in young adults, a high-risk group for escalation.

METHODS

Participants were 188 young adults (mean age = 21.32; 53.2% female; 91% current smokers) who participated in an electronic diary week to assess daily smoking and urges and a PA recall to examine daily PA. PA was coded into non-work-related and work-related activity to examine differential effects. We considered both participants' weekly average PA and their daily deviations from their average.

RESULTS

Mixed-effects regression models revealed that higher weekly average non-work PA was associated with lower smoking level and urges. Daily deviations in non-work PA did not predict urges; however, increased daily non-work PA relative to participants' weekly average was associated with lower smoking for females but higher levels for males. Regarding work PA, only higher weekly average work PA was associated with higher smoking level for both genders; work PA did not predict urges.

CONCLUSIONS

Results extend previous literature by documenting differential associations between non-work and work PA and young adult smoking and suggest that young adults engaged in work PA should be considered a high-risk group for escalation. Findings provide theoretical and clinical implications for the use of PA in intervention and highlight the necessity of considering PA as a multidimensional construct when examining its links to health behavior.

Effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors

The health consequences of smoking are well documented, yet quit rates are modest. While exercise has supported decreased cravings and withdrawal symptoms in temporarily abstinent smokers, it has yet to be applied when smokers are experiencing concurrent stressors. This study examined the effect of an acute bout of moderate intensity exercise on cravings (primary outcome) and ad libitum smoking (secondary outcome) following concurrent stressors (i.e., temporary abstinence and environmental manipulation-Stroop cognitive task+cue-elicited smoking stimuli). Twenty-five smokers (>10cig/day; Mean age=37.4years) were randomized into either exercise (n=12) or passive sitting conditions. A repeated measure (RM) ANOVA showed that psychological withdrawal symptoms (a measure of distress) were significantly exacerbated after temporary abstinence and then again after the environmental manipulation for all participants (p<.0001, η(2)=.50). Furthermore, a treatment by time RM ANOVA revealed decreases in psychological withdrawal symptoms for only the exercise condition (p<.001, η(2)=.42). A treatment by time RM ANOVA also revealed craving reductions for only the exercise condition (p<.0001, η(2)=.82). Exercise had no effect on ad libitum smoking. This is the first study to use a lab-based scenario with high ecological validity to show that an acute bout of exercise can reduce cravings following concurrent stressors. Future work is now needed where momentary assessment is used in people's natural environment to examine changes in cigarette cravings following acute bouts of exercise.

Does aerobic exercise mitigate the effects of cigarette smoking on arterial stiffness?

The largest percentage of mortality from tobacco smoking is cardiovascular-related. It is not known whether regular participation in exercise mitigates the adverse influence of smoking on vasculature. Accordingly, the authors determined whether regular aerobic exercise is associated with reduced arterial stiffness in men who smoke cigarettes. Using a cross-sectional study design, 78 young men were studied, including sedentary nonsmokers (n=20), sedentary smokers (n=12), physically active nonsmokers (n=21), and physically active smokers (n=25). Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV). There were no group differences in height, body fat, and systolic and diastolic blood pressure. As expected, both physically active groups demonstrated greater maximal oxygen consumption and lower heart rate at rest than their sedentary peers. The sedentary smokers demonstrated greater baPWV than the sedentary nonsmokers (11.8±1 m/s vs 10.6±1 m/s, P=.036). baPWV values were not different between the physically active nonsmokers and the physically active smokers (10.8±1 m/s vs 10.7±1 m/s). Chronic smoking is associated with arterial stiffening in sedentary men but a significant smoking-induced increase in arterial stiffness was not observed in physically active adults. These results are consistent with the idea that regular participation in physical activity may mitigate the adverse effects of smoking on the vasculature.

A longitudinal examination of the interrelationship of multiple health behaviors

BACKGROUND

Evaluating the interrelationship of health behaviors could assist in the development of effective public health interventions. Furthermore, the ability to identify cognitive mediators that may influence multiple behavioral changes requires evaluation.

PURPOSE

To evaluate covariation among health behaviors, specifically alcohol consumption, leisure-time physical activity, and smoking, and examine whether mastery acts as a mediating social-cognitive mechanism that facilitates multiple health behavior change in a longitudinal analysis.

METHODS

In 2010, secondary data analysis was conducted on the first seven cycles of the Canadian National Population Health Survey. Data collection began in 1994-1995 and has continued biennially. At the time of this analysis, only seven cycles of data (2006-2007) were available. Parallel process growth curve models were used to analyze covariation between health behaviors and the potential mediating effects of perceived mastery.

RESULTS

Increases in leisure-time physical activity were associated with reductions in tobacco use, whereas declines in alcohol consumption were associated with decreases in tobacco use. Covariation between alcohol consumption and leisure-time physical activity did not reach statistical significance. For the most part, mastery was unsuccessful in mediating the interrelationship of multiple behavioral changes.

CONCLUSIONS

Health behaviors are not independent but rather interrelated. In order to optimize limited prevention resources, these results suggest that population-level intervention efforts targeting multiple modifiable behavioral risk factors may not need to occur simultaneously.

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.

Overcoming limitations in previous research on exercise as a smoking cessation treatment: rationale and design of the "Quit for Health" trial

Aerobic exercise has been proposed as a stand-alone or adjunct smoking cessation treatment, but findings have been mixed. Laboratory studies have shown that individual exercise sessions lead to decreases in withdrawal symptoms and cigarette cravings, but findings are limited by lack of follow-up and artificial settings. On the other hand, smoking cessation treatment RCTs have generally failed to show positive effects of exercise on smoking cessation, but have been plagued by poor and/or unverified compliance with exercise programs. This paper describes the rationale and design for Quit for Health (QFH)--an RCT designed to determine the efficacy of aerobic exercise as an adjunct smoking cessation treatment among women. To overcome limitations of previous research, compliance with the exercise (and wellness contact control) program is incentivized and directly observed, and ecological momentary assessment is used to examine change over time in withdrawal symptoms and cigarette cravings in participants' natural environments.

Understanding physical activity outcomes as a function of teen smoking cessation

OBJECTIVE

Recent evidence suggests physical activity may be protective against smoking initiation and increased smoking among youth. The present study explored the effects of a teen smoking cessation intervention supplemented with a physical activity module on participants' physical activity outcomes. A secondary aim examined the relationship between participants' physical activity outcomes and postprogram smoking intensity.

DESIGN

The study reports primary data from a 3-arm randomized group trial consistent with CONSORT guidelines (Registry # NCT01242657).

SETTING

Public high schools (N = 19) in West Virginia.

PARTICIPANTS

Teens aged 14-19 years (N = 233) who reported current smoking, ≥1 cigarette in the past 30 days.

INTERVENTION

High schools were randomly selected, then randomly assigned to Brief Intervention (standard of care), Not-On-Tobacco (N-O-T, teen cessation program), or N-O-T plus a physical activity module (N-O-T+FIT).

OUTCOME MEASURES

Standardized instruments at baseline and end of treatment/3-months postbaseline measured physical activity outcomes. The study assessed smoking intensity using cigarettes smoked per day. We conducted ANCOVA controlling for school-level variance to measure physical activity changes. Multiple linear and logistic regression analyses explored favorable change influence of physical activity on smoking cessation outcomes, controlling for potential clustering.

RESULTS

Teens who increased the number of days on which they received at least 20 minutes of exercise were significantly more likely to reduce their daily cigarette use, with those in the N-O-T+FIT condition having the highest likelihood of reducing smoking. Teens in the N-O-T+FIT condition who increased the number of days on which they received at least 30 minutes of exercise were significantly more likely than those in other groups to quit smoking.

CONCLUSION

Findings suggest that it is possible to alter simultaneously more than one health behavior among teens-favorable changes in physical activity and smoking cessation may be particularly compatible targets for dual behavior change.

Physical activity and the risk of developing lung cancer among smokers: a meta-analysis

OBJECTIVE

To investigate the relationship between physical activity and lung cancer among smokers and whether this relationship differed according to physical activity intensity, smoking status, and gender.

DESIGN

Meta-analysis.

METHODS

A computerized bibliographical search was conducted in five databases. Study inclusion criteria were: (i) the study population was not diagnosed with lung cancer at baseline; (ii) the study provided information concerning the effect size of physical activity on the risk of developing lung cancer in smokers; and (iii) the study distinguished different physical activity intensity levels. Two authors independently extracted data and assessed the methodological quality. Pooled rate ratios (RR) were calculated for all data, and for subgroups of physical activity intensity, smoking status, and gender.

RESULTS

Pooled RRs of 7 cohort studies showed that physical activity was associated with a reduced risk of lung cancer in smokers (RR=0.82, 95% CI=0.77; 0.87). We did not find clear dose-response relationship regarding exercise or smoking intensity, i.e. high levels of physical activity did not show a higher risk reduction than moderate physical activity levels, and the association between physical activity and risk reduction did not differ between heavy and light smokers. The reduced risk associated with physical activity was greater in women than in men (p=0.03), but this finding was based on only one study that reported data on women.

CONCLUSIONS

Results of this meta-analysis indicate that leisure time physical activity is associated with reduced risk of developing lung cancer among smokers. Future studies should provide insight into a potential dose-response relationship, and should use reliable and valid physical activity measurements.

Exposure to peers who smoke moderates the association between sports participation and cigarette smoking behavior among non-white adolescents

Adolescent sports participants are less likely to smoke cigarettes, and sports participation may prevent young people from smoking. Research suggests that the relationship between sports participation and smoking may vary by race/ethnicity and is also possibly moderated by exposure to peer smoking. We investigated these relationships in a sample of 311 adolescents ages 13-21 presenting for well-visit medical appointments. Participants completed valid assessments of demographics, sports participation, exposure to peer smoking, and smoking behavior. The primary outcome was smoking status (never smoked, tried smoking, experimental/current smoker). Ordinal logistic regression was used separately for non-Hispanic White (n=122) and non-white (n=189; 70.4% black, 14.3% Hispanic, and 15.3% other) adolescents. Among White adolescents, sports participants had significantly lower odds of smoking than non-sports participants, independent of age, gender, and peer smoking. For non-Whites, the adjusted effect of sports participation on smoking depended upon exposure to peers who smoke. Compared with non-sport participants with no exposure to peer smoking, sports participants with no exposure to peer smoking had significantly lower odds of smoking, whereas sports participants with exposure to peer smoking had significantly higher odds of smoking. Sports appear to be protective against smoking among non-Hispanic White adolescents, but among non-White adolescents exposure to peer smoking influences this protection. Interventions incorporating sports to prevent smoking should consider these racial/ethnic differences to address disparities in smoking-related disease.

'Do more, smoke less!' Harm reduction in action for smokers with mental health/substance use problems who cannot or will not quit

Although smoking rates among mental health/substance abusing populations are very high, the focus of treatment and research has tended to be on substances other than tobacco. A range of harm-reduction strategies is needed, including long-term nicotine maintenance, smokeless tobacco and 'clean' nicotine products. For those who cannot or will not quit, assistance in reducing smoking should be given. Interventions for smoking among people with mental health/substance use problems may best be delivered by addressing multiple health-risk behaviours, especially physical activity, around the same time.

“Thinking Outside the Pack”

Introduction. It is estimated that tobacco use kills more than 5 million people annually; it is the leading cause of preventable deaths. Recent public health interventions have likely contributed to a steady decline in rates of smoking over the past decade. Nevertheless, innovative and cost-effective approaches to smoking cessation remain a public health priority. The purpose of this study was to profile physically active smokers. Method. Data from the Canadian Community Health Survey 2007-2008–Ontario Sharing File were used. Responses from 41,800 persons aged 12 years and older were assessed to compare (a) the sociodemographic characteristics of physically active smokers to physically active nonsmokers in Ontario and (b) the types of leisure-time physical activities that are more commonly practiced among active Ontario smokers to active nonsmokers. Results. Pearson χ2 and independent samples t tests revealed that active smokers were more likely to be male, younger, single, and less educated and to have lower income than active nonsmokers. Active smokers were also more likely to report inexpensive, low-intensity, and solitary leisure-time physical activities. Conclusion. Our findings have important implications for physical activity promotion among smokers. Physical activity interventions for smokers need to be tailored differently than for nonsmokers.

Cutting Down One Puff at a Time: The Acute Effects of Exercise on Smoking Behaviour

Research consistently demonstrates that a bout of moderate exercise alleviates cravings to smoke among abstaining smokers. This pilot study examined the effects of an acute bout of brisk walking on cigarette cravings and smoking topography. Using a within-subject, crossover design, two 10-minute treatment sessions were conducted on separate days by 19 participants(Mage = 24.6 years): passive (i.e., sitting) and brisk walking conditions. Participants rated cravings at baseline, midcondition, and at 0-, 10-, and 20-minutes postcondition and objective measures of smoking topography (puff count, puff duration, puff volume, interpuff interval [IPI], time to first puff [TTFP]) were obtained with the first cigarette smoked postcondition. A 2 (condition) × 4 (time) ANCOVA indicated lower desire to smoke (p< .05) during the walking condition than the passive condition. After the brisk walking condition, a series of ANOVAs demonstrated a significantly increased delay to first puff in comparison to the passive condition. Posthoc analyses (controlling for abstinence period) indicated significant lower puff volume and a trend for shorter puff duration following brisk walking in comparison to the passive sitting condition. A greater reduction in cravings was associated with a longer delay to first puff. In addition to reducing cravings, these results suggest that a bout of brisk walking may also change an individual's smoking behaviour.

A Qualitative Perspective on Multiple Health Behaviour Change: Views of Smoking Cessation Advisors Who Promote Physical Activity

There are mixed views on whether smoking cessation advisors should focus only on quitting smoking or also promote simultaneous health behaviour changes (e.g., diet, physical activity), but no studies have qualitatively examined the views and vicarious experiences of such health professionals. Semi-structured interviews were conducted with 11 trained smoking cessation advisors who promote physical activity to their clients. The data were categorised into themes using thematic analysis supported by qualitative data analysis software. We report themes that were related to why advisors promote multiple health behaviour change and issues in timing. Physical activity could be promoted as a cessation aid and also as part of a holistic lifestyle change consistent with a nonsmoker identity, thereby increasing feelings of control and addressing fear of weight gain. Multiple changes were promoted pre-quit, simultaneously and post-quit, and advisors asserted that it is important to focus on the needs and capabilities of individual clients when deciding how to time multiple changes. Also, suggesting that PA was a useful and easily performed cessation aid rather than a new behaviour (i.e., structured exercise that may seem irrelevant) may help some clients to avoid a sense of overload.

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

In July 2011, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise' or 'physical activity'. We also searched MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL using the terms 'exercise' or 'physical activity' and 'smoking cessation'.

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, recruiting smokers or recent quitters, and with a follow up of six months or more.

DATA COLLECTION AND ANALYSIS

We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis.

MAIN RESULTS

We identified 15 trials, seven of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three 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. 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 one of the 15 trials offered evidence for exercise aiding smoking cessation at a 12-month follow up. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups.

Smoking cessation in women with severe mental illness: exploring the role of exercise as an adjunct treatment

OBJECTIVE

The aim of this study was to investigate the potential role of exercise in smoking cessation in women with severe mental illness (SMI).

METHODS

Semistructured interviews with 12 women diagnosed with SMI receiving smoking cessation treatment were conducted.

RESULTS

Participants perceived three roles for exercise in assisting smoking cessation--addressing fears with preexisting chronic health conditions, emotion management and distraction, and weight management. Most participants identified health care providers (HCPs) as needing to play a supportive role in integrating exercise into smoking cessation attempts.

CONCLUSION

Findings support a potential role for exercise in facilitating smoking cessation among women with SMI.

PRACTICE IMPLICATIONS

HCPs should consider developing referral links with exercise specialists to facilitate smoking cessation in women with SMI.

Fitness and abdominal obesity are independently associated with cardiovascular risk

OBJECTIVES

To examine the relationship between cardiovascular fitness (VO(2)max) and abdominal obesity (waist circumference) and individual cardiovascular disease (CVD) risk factors, as well as a clustered risk factor profile, and to study the impact of gender, age and smoking on these relationships.

DESIGN

Cross-sectional.

SETTING

Astrand Laboratory of Work Physiology, Swedish School of Sport and Health Sciences, Stockholm, Sweden.

SUBJECTS

Men (n = 781) and women (n = 890) from two random population-based samples of Swedish women and men aged 20 to 65 years.

MAIN OUTCOMES

Odds ratios.

RESULTS

Each unit of higher fitness was associated with a decrease in all individual risk factors ranging from 2% to 4% independent of waist circumference, each unit of higher waist circumference was associated with an increased risk ranging from 2% to 5% independent of fitness. For clustering of three or more of the risk factors, each unit of fitness was associated with a 5% decrease in risk and each unit of waist circumference with a 5% increase in risk. The clustered risk was higher in unfit participants who were older or smoked daily, regardless of waist circumference. Obese participants were at higher risk if they were men or older, regardless of fitness level. However, neither a higher fitness level nor lean status reduced the risk associated with smoking.

CONCLUSIONS

Higher fitness and lower waist circumference are each independently associated to a similar extent with a lower CVD risk. Simultaneous evaluation of both fitness and abdominal obesity status in clinical practice is important.

[Effect of whole body vibration on the neuromuscular performance of females 65 years and older. One-year results of the controlled randomized ELVIS study]

Sarcopenia is linked to an increased risk of morbidity and mortality in the aging. Whole body vibration (WBV) exercises are currently discussed as a "gentle" alternative to conventional exercises to improve muscle mass. The present study scrutinized whether a multipurpose (exercise) training program using WBV can improve muscle mass and neuromuscular capacity, while lowering fall risk. A total of 151 postmenopausal women were randomized into three groups: exercise group (TG), exercise group with vibration (VTG), and fitness control group (CG). The TG group participated in an exercise program including leg strengthening training twice a week over 12 months, while the VTG carried out an identical program with the leg exercises performed under WBV. Despite a positive trend regarding lean body mass in the two exercise groups, there was no difference between groups. Both exercise groups showed a significant increase (vs. KG) in trunk strength. An improvement in both exercise groups was also measured with respect to leg strength, but only the VTG showed significant differences compared to the CG. In addition, a significant lower risk of falls compared with the CG was evident only in VTG.

[Prescribing exercise in tobacco smoking cessation therapy]

Tobacco is one of the main causes of mortality in industrialized countries, yet there is no treatment that is wholly efficacious for helping smokers to quit the habit. Physical exercise is one of the low-cost nonpharmacologic strategies in rehabilitation therapies in several diseases and its practice offers a way of combating the harmful effects of smoking on health. Studies have shown that physical exercise helps reduce the intensity of some of the main symptoms that may arise when a smoker attempts to quit, yet doctors and sport therapists are generally unaware of this benefit and do not know how to prescribe exercise appropriately. This study aims to present the reasons why physical exercise should be considered as a useful nonpharmacologic aid in combatting the symptoms of smoking and smoking cessation, to review the relevant literature, and to outline basic guidelines that might serve to orient the prescription of physical exercise for smokers attempting to quit.

Nicotine dependence vs. daily smoking as a meaningful variable: implications for clinical and epidemiological psychiatric studies

OBJECTIVE

As an indication of potential psychopathology, our aim was to compare, in a non-psychiatric sample, the variables associated to daily smoking with those associated to nicotine dependence. We also compared dependent and non-dependent smokers on these variables and on the age of onset of daily smoking (AODS).

METHOD

A sample of 290 persons aged 18 or older, recruited in a family medical clinic, were interviewed to inquire about their tobacco, caffeine, alcohol, and illegal drugs consumption, and on their practice of physical exercise. Psychiatric morbidity was assessed with the General Health Questionnaire (GHQ-28) and defined by a score>6. They also were questioned on their use of psychotropic medication and previous suicide attempt. The smokers answered the Fagerström Test for Nicotine Dependence (FTND) and the question on their age of onset of daily smoking (AODS).

RESULTS

In comparison with non-dependent smoking, nicotine dependence was associated with current use of psychotropic medication, psychiatric morbidity, previous suicide attempt, and earlier AODS. Logistic regression analyses showed that nicotine dependence was associated with antecedents of suicide attempt and primary or lower education as well as with high caffeine use and the regular use of illegal drugs; in contrast, daily smoking showed a significant association with high caffeine use, the regular use of illegal drugs and lack of physical exercise.

CONCLUSIONS

In terms of psychopathology or behavioral disturbance-particularly attempting suicide-nicotine dependence adds significant information as opposed to the simple daily smoking, with important implications in clinical and epidemiological psychiatric studies.

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 STRATEGY

In July 2008, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise' or 'physical activity'. We also searched MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL.

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, recruiting smokers or recent quitters, and with a follow up of six months or more.

DATA COLLECTION AND ANALYSIS

We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis.

MAIN RESULTS

We identified 13 trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three 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. 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 one of the 13 trials offered evidence for exercise aiding smoking cessation at a 12-month follow up. All the other trials were too small to exclude reliably an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, measures of exercise adherence and change in physical activity in both exercise and comparison groups.

Physical activity as an aid to smoking cessation during pregnancy: two feasibility studies

BACKGROUND

Pharmacotherapies for smoking cessation have not been adequately tested in pregnancy and women are reluctant to use them. Behavioural support alone has a modest effect on cessation rates; therefore, more effective interventions are needed. Even moderate intensity physical activity (e.g. brisk walk) reduces urges to smoke and there is some evidence it increases cessation rates in non-pregnant smokers. Two pilot studies assessed i) the feasibility of recruiting pregnant women to a trial of physical activity for smoking cessation, ii) adherence to physical activity and iii) women' perceptions of the intervention.

METHODS

Pregnant smokers volunteered for an intervention combining smoking cessation support, physical activity counselling and supervised exercise (e.g. treadmill walking). The first study provided six weekly treatment sessions. The second study provided 15 sessions over eight weeks. Physical activity levels and continuous smoking abstinence (verified by expired carbon monoxide) were monitored up to eight months gestation.

RESULTS

Overall, 11.6% (32/277) of women recorded as smokers at their first antenatal booking visit were recruited. At eight months gestation 25% (8/32) of the women achieved continuous smoking abstinence. Abstinent women attended at least 85% of treatment sessions and 75% (6/8) achieved the target level of 110 minutes/week of physical activity at end-of-treatment. Increased physical activity was maintained at eight months gestation only in the second study. Women reported that the intervention helped weight management, reduced cigarette cravings and increased confidence for quitting.

CONCLUSION

It is feasible to recruit pregnant smokers to a trial of physical activity for smoking cessation and this is likely to be popular. A large randomised controlled trial is needed to examine the efficacy of this intervention.

Social-ecological correlates of active commuting to school among high school students

PURPOSE

It has been suggested that health benefits from physical activity may be accrued through active commuting to school. Considering that active commuting is modifiable via policy and that there is limited research examining active commuting among high school students, this is a domain that warrants further investigation. The purpose of this study is to explore the relationships between demographic, behavioral, social/psychological, and environmental correlates of active commuting to school among a sample of high school students.

METHODS

Students (N = 21,345) from 76 Ontario high schools (grades 9-12) completed the School Health Action, Planning and Evaluation System Physical Activity Module between 2005-2006. Demographic (gender, grade, body mass index), behavioral (smoking status, physical activity, sedentary time), social/psychological (perceived athletic ability, weight status, parental encouragement), and environmental (school location, type, weather) predictors of active commuting (daily or mixed mode) were assessed.

RESULTS

Only 42.5% of high school students reported actively commuting to school. Students were less likely to actively commute to school if they were girls, in grade 12, smoked daily, were low-moderate in physical activity, or attended a rural school.

CONCLUSIONS

Patterns of active commuting to school are influenced by multiple factors, some of which are modifiable through intervention. This has important implications for future school-based programming designed to enhance health and physical activity of adolescents through using active modes of transportation to school.

Characteristics of physically active smokers and implications for harm reduction

OBJECTIVES

We sought to establish the prevalence of physical activity among smokers, whether or not physically active smokers were more likely to attempt cessation, and who these physically active smokers were.

METHODS

We used logistic regression to contrast physically active and inactive smokers in a secondary data analysis of the Canadian Community Health Survey Cycle 1.1.

RESULTS

Physically active smokers represented almost one quarter of the smoking population. Compared with physically inactive smokers, physically active smokers were more likely to have attempted cessation in the past year. Physically active smokers were more likely to be young, single, and men compared with their inactive counterparts. Income had no influence in distinguishing physically active and inactive smokers.

CONCLUSIONS

Skepticism persists regarding the practicality and potential risks of promoting physical activity as a harm-reduction strategy for tobacco use. We found that a modest proportion of the daily smoking population was physically active and that engagement in this behavior was related to greater cessation attempts. Interventions could be developed that target smokers who are likely to adopt physical activity.

Increasing perceived choice about change in smokers: implications

Using a representative sample of 434 daily smokers, this study tested the immediate impact of providing "safer smoking tips". As was predicted, a randomized half of respondents who were asked about their knowledge of "safer smoking tips" before being asked about their perceptions of choice about smoking rated their perceived choice as higher than respondents who were not asked the safer smoking tips first. However, the present study also provided evidence of the need for caution because hearing about safer smoking tips was associated with lower ratings of perceptions of health risks from smoking. Perceived choice has been identified as an important factor in change from negative health behaviors, and the implications and future directions of this research are discussed.

Youth smokers' beliefs about different cessation approaches: are we providing cessation interventions they never intend to use?

INTRODUCTION

Most youth smokers intend to quit, but the majority is neither aware nor interested in most conventional cessation approaches. As such, a critical first step in understanding youth cessation is to better understand the beliefs youth have about different cessation options.

METHODS

This cross-sectional study used self-reported data collected from 26,379 grade 9 to 12 students in Ontario, Canada. We examined both the attitudes of youth smokers toward common smoking cessation approaches and factors associated with intentions to join a school-based cessation program.

RESULTS

The majority of youth smokers intend to quit smoking but tend to have negative attitudes toward most formal smoking cessation approaches; Nicotine Replacement Therapy (NRT) was an exception. Among occasional smokers, self-identification as a smoker and being physically active were positively associated with intending to join a school-based cessation program. Having tried to quit smoking at least once in the past year more than doubled the likelihood of being interested in a school-based program among both occasional and daily smokers.

CONCLUSION

Findings have the potential for informing the development of more effective campaigns for engaging adolescent smokers into smoking cessation treatment. Results also reinforce the need for programmatic innovation within and beyond school settings.

The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect and smoking behaviour: a systematic review

AIM

To review the effects of a single session of exercise on cigarette cravings, withdrawal symptoms and smoking behaviour.

METHODS

A systematic search and critical appraisal of all 14 relevant studies.

RESULTS

All 12 studies that compared a bout of exercise with a passive condition reported a positive effect on cigarette cravings, withdrawal symptoms and smoking behaviour. Two other studies that compared two intensities of exercise revealed no differences in outcomes. Single and multi-item measures of cigarette cravings, withdrawal symptoms and negative affect decreased rapidly during exercise and remained reduced for up to 50 minutes after exercise. Effect sizes for seven studies that assessed "strength of desire to smoke" showed a mean reduction, 10 minutes after exercise, of 1.1 (SD 0.9). Four studies reported a two- to threefold longer time to the next cigarette following exercise. Cravings and withdrawal symptoms were reduced with an exercise intensity from as high as 60-85% heart rate reserve (HRR) (lasting 30-40 minutes) to as low as 24% HRR (lasting 15 minutes), and also with isometric exercise (for 5 minutes). All but one study involved participants temporarily abstaining for the purposes of the experiment. Distraction was probably not the primary reason for the effects.

CONCLUSIONS

Relatively small doses of exercise should be recommended as an aid to managing cigarette cravings and withdrawal symptoms. Further research to understand the mechanisms involved, such as stress reduction or neurobiological mechanisms, could lead to development of more effective and practical methods to reduce withdrawal phenomena.