Figure 5.-Percent distribution of 130 brands of cigarettes and 25 brands of little
     cigars by nicotine content.

40
s
=
e 35
; 30

t 25
3
g 20
;  15

10

CigaretiesB
Little cigars

5

0

SOURCE: U.S. Department of Health, Education. and Welfare (97) and Federal Trade Com-
      mission (34).

226


TABLE 37.-Shipment of smaU and hzrge cigars destined for domestic
        consumption (1970,1971, 1972)

Ye&I              1970            1971            1972

Small cigars

January________--___---    58, 328, 520    85,753,780    123,477,550
February-__--__________    63,431,580    72,092,205    179, 817, 839
March ___________ --__--    85,881,860    46,542,800    198, 165,593
April _______r____ -___-__   101,613,500    59,059,920    125, 335,740
May__--_______________    81,093,180    93, 237,473    159,334, 565
June___-_______.____.--    82,471, 120    94,560, 140    180, 582, 243

Subtotal-----__---   472,819, 760    451, 246, 318    966, 713, 530

July _ _ _ _ . _ _ _ _ _ _ - _ _ _ _ _ _ _
August---- ____ -_-___-__
September ____ ----__.-__
October- _ __ _ __
          _ - _ _ - _ __   _
November ______ -__-__--
December ______ -__-___-

62,143,140    70, 332,500    127,713, 320
68, 220, 365    127, 709, 310    670,936, 869
79,101,045    95,027, 340    422,534, 705
90,752,880    109,567,900    708, 116,830
64, 290, 600    106,666,107    551, 326, 888
63,806,OlO    123,809,553    485,587,014

Subtotal ____ -___-_   428, 314,040    633,112,710   2,966,215,626

Yearly t.otal~~~~~--   901, 133,800  1,084, 359,028   3,932,929, 156

             Large cigars

January___-_-____-_____   581,742,OOl    573,039, 120    534,565,488
February_--_-_-__-_-___   595,249,522    586,810,844    562,414,577
March----_- ______ - ____   629,977, 375    665, 998, 099    654,827, 796
April--- ___________ - ____   652,800,200   655,850,213    554,242,048
May_____--___-________   748,040,796    670,064,933    719,489,529
June-----____--_--_____   644,539,031    692,436,529    578,501,068

   Subtotal ___-_ ____ _  3, 852, 348, 925  3, 844, 199, 738   3,604, 040, 506

July______-______-_____   647, 397,547    619,838, 386    520,873,339
August ________ ____ __ __ -   673,082,971   662,970, 148    682, 331, 630
September..- _ _ _ _ _ _ _ - _ _ _ -   721,561,449    680,476,418    594,843, 957
October- _- _______ _____
              -      797,601,253   679,420,968    693, 150,668
November--- _.___ - ____ -   696,526,464    742,948, 802    650, 746, 540
December- _ _ ___ ____ _-__   596,244, 159   516,879,415    437,429,996

Subtotal _____ -_ _-_  4, 132,413,843  3, 902,534, 137   3,579,356,130

Yearly total- _ _ _ _.  8, 084, 762, 768  7, 746, 733,875   7, 183,396,636

h~ce: U.5. Department of the Treasury (101).

227


TABLE %-Selected compounds in mainstream smoke

Smoke compound

Cigarette A Cigarette B  Little     Little
(nonfilter)                         SIWAll
       (flker)   cigar A    cigar B    cigar c

"Tar", milligram per cigarette- - -
Nicotine, milligram per cigaretk-
Carbon monoxide, volume per-
cent- _____ --- _.____ ---- ____
Carbon dioxide, volume percent-.
Reducing sugars, percent of
tobacco weight _ _ _ _ _ _ _ _ _ _ _ _ - -
Hydrogen cyanide, microgram
per cigarette- _ -. ____ _ __ _ _ _ _ _
Acetaldehyde,  microgram per
cigarette _____ _ _ _ _ _ _ _ _ _ _ _ _ _ - -
Acrolein, microgram per cigar-
ette ______ -_-- ______________
Total pyridines, micrograms per
cigarette---_- _.___________ -_
Phenol, microgram per cigarette--
Benz(a)anthracene, nanogram
per cigarette-- ______________
Benzo(a)pyrene, nanogram per
cigarette _____ __ _. __ _ _ _ _ _ _. _ _

36. 1    20. 3
2. 7     1. 4

4. 6
9. 4

9. 3

536.0

770. 0

105. 0

82. 8
124. 2

74. 0

47. 0

4. 5
9. 6

7. 9

361.0

774. 0

71. 0

27. 3
33. 0

31. 0

20. 0

17. 4     31. 8    40. 6
  .6      1. 8     3. 1

5. 3     11. 1     7. 7
8. 5     13. 2    12. 7

1. 5      2. 9     2. 7

381.0    697. 0  1, 029. 0

630. 0  1, 238. 0  1, 150. 0

41. 0     54. 0    66. 0

58. 0     85. 3    80. 3
35. 1     63. 4    94. 1

34. 0     25. 0    39. 0

18. 0     22. 0    30. 0

Source: Hoffmann, D., Wynder, E. L. (44).

TABLE 39.-The pH of the mainstream smoke oj selected tobacco products

[Numbers in parentheses indicate number of last puff.]

Aversge pH  Cigarette A Cifr;g B    Little      Little      Small     Cigar D
         (nonAlter)           cigar A     cigar B     cigar C

3d puff--..-.  6. 19     6. 15     6. 44     6. 55     6. 53     6. 47
5th puff_--_  6. 14     6. 12     6. 34     6. 46     6. 49      __---_--
7th puff--.._  6.09     6. 01     7. 03     6. 51     6. 56      _ _ _ _ _ _ _ _
9th puff_---  6. 02     5. 83           __  6.98     6. 59     6. 27
13thpuffe_- -____.__ -___-_-_ -_-_____ ________   _ _ _ _ _ _ _ _  6. 39
lSthpuff..- -__._.._ -___-_-_ ________ __-_____   _ _ _ _ _ _ _ _  6. 41
23d puff_--_ -_______ ____-_-_   ________ -_-___--  __- __-_-  6. 81
28thpuffm.w -_______ -_-_---- -_-___-_ ---_-___ __-_-_-_  7. 22
33dpuffe--- -____.._ _.-_---_ -___-___ _--___._   __-_-___  7. 53
38thpuff--- -------_ .__.~.__ --_-_--_ _-_--___ ----_--_ 7.78
Last puff---  5. 96(11)  5. 76(10)  7. 73 (8)  7. 25(10)  7. ll(11)  7. 96(43)

Source: Hoffmann, D., Wynder, E. L. (44).

228


Conclusions

Pipe and cigar smokers in the United States as a group experience
overall mortality rates that are slightly higher than those of nonsmok-
ers, but these rates are substant.ially lower than those of cigarette
smokers. This appears to be due to the fact that the total exposure to
smoke that a pipe or cigar smoker receives from these products is
relat.ively low. The t.ypical cigar smoker smokes fewer than five cigars
a day and the typical pipe smoker smokes less than 20 pipefuls a day.
3Iost pipe and cigar smokers report that they do not inhale the smoke.
Those who do inhale, inhale infrequently and only slight.ly. As a
result, t,he harmful effects of cigar and pipe smoking appear to be
largely limited to increased death rates from cancer at those sites which
are exposed to the smoke of these products. Mortality rates from
cancer of t,he oral cavity. intrinsic and extrinsic larynx?. pharynx, and
esophagus are approximately equal in users of cigars, pipes, and ciga-
rettes. Inhalation is evidently not necessary to expose these sites to
t,obacco smoke. Although these are serious forms of cancer, they account,
for only about, 5 percent. of the cancer mortality among men.

Coronary heart disease, lung cancer, emphysema, chronic bronchitis,
cancer of the pancreas? and cancer of the. urinary bladder are diseases
ivhich are clearly associated with cigarette smoking, but for cigar and
pipe smokers death rates from these diseases are not greatly elevated
above the rates of nonsmokers. These diseases seem to depend on mod-
erate to deep inhalation to bring the smoke. into direct. contact with
the issue at risk or to allow certain constituents, such as carbon mon-
oxide, to be systematically absorbed t.hrough the lungs or to affect the
temporal patterns of absorption of other const.ituents such as nicotine
that can be absorbed either through the oral mucosa or t,hrough t.he
lungs. Evidence from countries where smokers tend to consume more
cigars and inhale t,hem to a greater degree t,han in the United States
indicates that rates of lung cancer become elevated to levels approach-
ing those of cigarette smokers.

Available data on the chemical constituents of cigar, pipe, and
cigarette smoke suggest that there are marked similarities in the com-
position of these products. Pipe and cigar smoke, however, tends to
be more alkaline than cigaretti smoke,, and fermented tobaccos com-
monly used in pipes and cigars contain less reducing sugars than the
rapidly dried varieties commonly used in cigarettes.
Experimental evidence suggests that little difference exists between
the tumorigenic activities of tars obtained from cigar or cigarette

229


tobaccos. Malignant skin tumors appear somewhat more rapidly and
in larger numbers in animals whose skin has been painted with cigar
tars than in those animals painted with cigarette tars.

One must conclude that some risk exists from smoking cigars and
pipes as they are currently used in the United States, but for most
diseases this is small compared to the risk of smoking cigarettes as they
are commonly used. Nevertheless, changes in patterns of usage that
would bring about increased exposure either through increased indi-
vidual use of cigars and pipes or increased inhalation of pipe and cigar
smoke have the potential of producing risks not unlike those now
incurred by cigarette smokers. 3fechanical or chemical modifications
of pipe tobacco and cigars that would result in a smoke more compat-
ible with inhalation could have this effect.

Pipe and Cigar References

(1)

(2)

(3)

(4)

(5)

!G)

(7)

(8)

(9)

(10)

(11)

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230


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236


CHAPTER 7

Exercise Performance


Contents

Page

Introduction____----------------------------------------   241
Studies of Smokers--------------- ______ ---- ____ -- _______   241
Studies Comparing Smokers to Nonsmokers :
Athletic Performance--- ______ --- ______ -__--_-_-----_-   243
Bicycle Ergometer Performance----- _____ ---_-_-_---_-__   244
  Treadmill Performance_- _______ -_- ____ ----_-----_- ____   245
Performance in Other Tests of Fitness _____ ---- _____ ---__   245
Discussion___________------------------------------------   246
Biomechanisms----- ________________ -- ____ -----___-----_   246
Summary-____-_-_-________-__-------------------------   247
References-- ________________________________ -- ______ --_   248

239


Introduction

Although it has long been held by athletes and coaches that cigarette
smoking is associated with "short~ness of wind" and impaired perform-
ance, until recently there has been little scientific evidence to support
this view. In the past few years, a variety of studies have appeared
dealing with the effect of cigarette smoking on the response of man
t.o exercise. The following is a review of these studies.

Age, sex, training, health, weight, and other factors are known to
influence exercise performance. Because most of the investigations
were carried out in healthy, young male volunt,eers, the groups were
quite comparable with regard to age, sex, and healt,h ; however, weight,
training, and other factors were often inadequately controlled.
Furthermore, problems in study design and statistical analysis limit
the value of several of these studies.

Many forms of exercise were performed in these experiments, in-
cluding : pedaling a bicycle ergometer, running on a treadmill, running
on a track, swimming, step climbing, gripping a hand dynamometer,
and doing several different exercise activities as part of a battery of
tests. Small to maximum amounts of work were carried out in the
various studies revewed.

Studies of Smokers

Most of the studies of habitual cigarette smokers followed a similar
format with respect to smoking: (a) The subjects refrained from
smoking for a few hours prior to t.est.ing, and (6) two test runs were
performed, one without smoking and one in which smoking imme-
diately preceded the exercise or was incorporated with the exercise
protocol.

Several investigators (1, 15, 28) studied the effect of smoking on
maximum grip strength. Willgoose (28) reported a greater mean per-
cent recovery of grip strength after the nonsmoking trial than after
the smoking t.rial. Kay and Karpovich (25) and Anderson and Brown
(1) all followed a protocol similar to that of Willgoose e.xcept, that
they randomized the smoking and nonsmoking t.rials, and substituted

241


a "placebo" cigare,tte for the nonsmoking trial. In neither of these
studies were statistically significant differences observed between the
grip scores for the smoking and nonsmoking trials.
Reeves and Morehouse (84) administered a battery of t&s to 15
colleges students. The tests were: A tapping test, a strength test, a
jumping test, and the short form of the Harvard step test. No statis-
t.ically significant differences in performance were noted under con-
ditions of smoking or nonsmoking.
A total of 32 college students from intermediate swimming classes
abstained from smoking for 15 minutes, 2 hours, and 12 hours in a study
conducted by Pleasants, et al. (23). Following the abstinence, they
swam distances of 100 and 206 yards. Although actual swimming times
were not published, t.he authors reported no statistically significant
differences between the mean swimming times after t,he different
periods of abstinence for either distance.
In 1946, Juurup and Muido (13) carried out several experiments
in which three young cigarette smokers exercised on a Krogh's bi-
cycle ergometer. Smoking was found to increase the pulse rate at
rest as well as during exercise. Although the effect was less con-
sistent than on the heart rate, smoking was also associated with
elevated blood pressure. Smoking had no effect on oxygen consump-
tion. Henry and Fit.zhenry (12)) in 1949, using the bicycle ergometer,
also found that smoking exerted no effect on oxygen consumption.
In t.he same year: Karpovich and Hale (24) st.udied bicycle ergometer
performance in eight young men. In all subjects, the average riding
time was better in nonsmoking tests than in smoking tests; how-
ever, the results were statistically significant for only three of the.
eight subjects.
Kerr&an, et, al. (16) more recently measured direct arterial blood
pressure. heart rate, and cardiac output in 25 habitual smokers at
rest and after exercise. Smoking t.wo cigarettes produced statistically
si*gnificant (P<O.Ol) increases in cardiac index, heart rate, and a&r-
in1 mean pressure, compared to the immediately preceding control
period. Exercise after smoking resulted in an increase in cardiac in-
dex over either t,he resting period or the exercise period which fol-
lowed abstinence ; the resultant cardiac index appeared to be approxi-
mately the sum of the exercise and smoking effects. Exercise tests
preceded by smoking were also associated w-till significantly higher
(P<O.Ol) and more prolonged elevations of blood pressure than those
not preceded by smoking.
In the study by Goldbarg, et al. (II) of nine habitual smokers
performing submaximal exercise on a bicycle ergometer, cardiovas-
cular responses were measured via pulmonary and subclavian artery
cat.heters. ,U rest, after smoking, the mean cardiac index and mean
heart rate increased. 1)urinp successively increasing levels of exercise,
the heart, rate was greater and stroke index lower than values for

242


comparable work before smoking. The net effect of smoking was to
decrease the effiicency of t.he heart during exercise in tlie upright
position by causing a smaller stroke volume. and a higher heart
rate.

Rode and Shephard (26) investigated near maximal treadmill exer-
cise performance in six habitual smokers. A l-day abstinence from
cigarette smoking was associated with a 13- to `i9-percent decrease in
the oxygen cost of breathing. Abstinence was also followed by a S~UW-
ing of the heart rate and a decrease in expiratory minute volume after
exercise.

The study of Krumholz, et al. (28) is different from those cited pre-
viously in that bicycle ergometer exercise performance was measured
in habitual smokers both before and after 3 to 6 weeks of abstinence.
Among the 10 subjects who abstained from smoking for 3 weeks, there
was a statistically significant (P<O.O5) decrease in heart. rate, oxygen
debt,, and ratio of oxygen debt to total increase in oxygen uptake pro-
duced by the 5 minutes of exercise.
Using a "double O-inch progressive step test'? Rode and Shephard
(25) studied several hundred participants of a smoking withdrawal
clinic at the t.ime of entry and at a l-year followup. Among those
who returned for the followup and who gave up smoking, absolute
aerobic power increased insignificant.ly ; however, the relative aerobic
power diminished in both sexes among those who quit smoking because
of the weight gain experienced.

Studies Comparing Smokers to Nonsmokers

Athletic Perfonmmce

In 1968 Cooper, et al. (6') evaluated 419 airmen during their initial
6 weeks on active duty in the USAF. A 12-minute maximum running
test was performed at least. 1 hour after cigarette smoking. The mean
distance covered in 12 minutes by the nonsmokers was significantly
greater (P<O.O5) than that covered by the smokers at the beginning,
the middle, and the end of training. All categories of smokers and non-
smokers improved their performance at the end of training; however,
the maximum change in performance of those smoking 10 to 30 cig-
arettes per day was significantly (P<O.OOl) less than that of non-
smokers.

David (`7) administered a battery of tests to 88 military personnel,
aged 19 to 39 years. h l-mile run was included in the testing. and cip-
arette smoking was associated with a significant decrease in perform-
ance in this event.

243


Some 45 special forces soldiers were investigated at sea level and
13,000 feet above sea level by Fine (8). The subjects were randomly
assigned to a placebo group or an acetazolamide treated group. Cig-
arette smoking was positively correlated to decrements in 600-yard
running performance from sea level to altitude in both groups.

Pleasants (??a) studied 106 students from intermediate university
swimming classes. Swimming times were measured for lOO- and 200-
yard dist.ances before and after training and for 800-yard distances
after training. The mean swimming times of nonsmokers were less
than those of smokers in six of seven listed categories, but these dif-
ferences were not statistically significant.

Bicycle Ergomter Perfornmnce

Chevalier, et al. (5) investigated cardiovascular parameters in 32
young physicians after a standard 5-minute ergometer test. Oxygen
debt accumulation among smokers was significantly (P < 0.01) greater
than among nonsmokers. The heart rate at rest and 3 minut.es after
exercise was significantly (P<O.O2) faster in smokers than in non-
smokers.

Using a 5-minute ergometer test, 18 housestaff physicians, half of
whom smoked, were investigated by Krumholz, et al. (27). They noted
the following: Oxygen debt accumulation after exercise was signifi-
cantly (P < 0.02) grea,ter in smokers than non-smokers, the ratio of the
oxygen debt to total increased oxygen uptake during exercise was sig-
nificantly (P<O.OOl) greater in smokers than in nonsmokers, and
the diffusing capacity at rest and with exercise was significantly
(P<O.O5) decreased in smokers compared to nonsmokers.
Kerrigan, et al. (16) studied cardiovascular parameters in smokers
and nonsmokers at rest, during, and after a B-minute bicycle ergometer
ride. Cardiac index and blood pressure values obtained during exercise
performed immediately after smoking were great,er than those found
in nonsmokers performing the same exercise. Similarly, heart rate and
blood pressure remained elevated for longer periods in those who
exercised immediately after smoking than in nonsmokers performing
the same task.

Aerobic capacity scores were examined in 60 university student vol-
unteers by Peterson and Kelley (90). Subjects worked at submaximal
levels on a bicycle ergometer before, during, and after a training
program. At all of these intervals: nonsmokers had significantly
(P<O.O5) higher mean aerobic capacity scores than smokers. Both
groups increased their aerobic capacity during training but non-
smokers consistently performed better throughout, training.

244


TretzdmiZZ Perforwaunce

In 1960 Blackburn, et al. (4) carried out several measurements of
cardiovascular function after different amounts of treadmill exercise
were performed by 233 professional men, 159 university students, and
414 railroad workers. The differences between the smokers and non-
smokers were of small magnitude. Basal oxygen consumption was
slightly higher in smokers than in nonsmokers. Also. resting pulse
rates were higher in smokers of most groups.

Cooper, et al. (6) studied 4i out. of 410 airmen wit.h treadmill test-
ing. Cardiopulmonary indices measured on the treadmill, including
maximum indices, were comparable in smokers and nonsmokers ex-
cept for a significant. (P<O.Ol) reduction in the maximum minute
volume among the smokers.

A total of 277 prospective Canadian firemen performed the Balke-
Ware test of work capacity in treadmill studies carried out by Glass-
ford and Howell (10). The mean performance scores of nonsmokers
were significamly (P<O.Ol) greater than those of smokers.

The effect of vitamin C supplementation on treadmill exercise per-
formance was investigated in 40 male volunteers by Bailey, et al. (3).
Significant differences in oxygen utilization and ventilatory function
between smokers and nonsmokers were noted in only two of the 24
separate analyses of variance performed.

Maximal oxygen intake during treadmill exercise was examined by
McDonough: et al. (19) in 86 healthy. middle-aged male volunteers.
Cigarette smoking was one of six variables which together provided
a multiple correlation coefficient of 0.73.

Performance in Other Tests of Fitness

When physical fitness tests were administered to 88 military per-
sonnel by David (7), cigarette smoking was found to be associated
wit.h a significant (P<0.061) decrease in performance in the dodge
and jump test, and a significant (P<O.O2) decrease in performance in
the crawling test.

ITsing a step test? a breath holding test, and an ergometer test,
Franks (9) examined 58 middle-aged men. Sonsmokers were able to
hold their breath longer and had greater vital capacity residual after
the step test than the smokers.

In 19il. Kysokinski (2.9) studied 200 young Polish soldiers using
Letunov's test which included 20 knee-bending exercises, a fast run for
20 seconds. and a rnn for 3 minutes. Cigarette smoking was associated
with a significant (P<O.Ol) reduction in the vital rapacit.y and a

245


marked rise in the pulse rate at rest and ,after exercise. Intense exer-
cise also caused a greater rise in the systolic blood pressure in smokers
than in nonsmokers.

Discussion

Most of the studies in habitual cigarette smokers compared exercise
performance in "smoking" and %onsmoking" runs after only a few
hours of abstinence. In some studies, smoking adversely affected per-
formance (11,13,14,16,18,26,28), while in others it did not (I, 1.2,
l&23,24). Some of these apparently discrepant results are due to dif-
ferences in methodology and in amounts and types of work performed.
In all of the more recent studies of habitual smokers in which moderate
to near maximal amounts of work were performed and sophisticated
measurements of oxygen transport and cardiopulmonary function
were made, impairment of function during smoking trials was found
(11,16,18,26).
The data of Krumholz, et al. (18) also raise the question of whether
residual effects of cigarette smoking influence "nonsmoking" trials per-
formed after a few hours of abstinence; they found statistically sig-
nificant decreases in heart. rate and oxygen debt produced by exercise
after 3 weeks of cessation.

The work of Rode and Shephard (25) suggests that physical fitness
improves with cessation, but t.his improvement may be negated if t.he
subject gains a substantial amount of weight. after giving up smoking.

Several investigators compared exercise performance or postexer-
cise cardiopulmonary function of smokers to nonsmokers. Although
only minor differences between smokers and nonsmokers mere found
in a few of these studies (3: 4,22), in most of them (5, 6, 7, 8: 10, 16,
17. 20.29) the performance or function of the nonsmokers was better
than that of the smokers. Both nonsmokers and smokers improved
their performance with t,raining, but nonsmokers maintained their ad-
vantage throughout training (6. ZOO).

Biomechanisms

The cited studies indicate that cigarette smoking exerts its adverse
effect on exercise performance through several mechanisms. Cigarette
smoking appears to impair cardiac performance during exercise by
increasing the heart rate and exerting a variable effect on cardiac

246


output (5,11,13,16,18, $X,29). Cigarette smoking is associated with
an increased oxygen debt after exercise (5,18). Also, one study indi-
cated that the oxygen cost of hyperventilation was greater among
smokers than among nonsmokers (26).

Some of these adverse effects of smoking on oxidative metabolism
are mediated by the elevated carboxyhemoglobin levels found in
smokers. CO exerts these effects through one or more of the following
mechanisms : (a) Reduction of the amount of hemoglobin available for
oxygen transport, (b) shift of the oxygen-hemoglobin dissociation
curve to the left with consequent interference in oxygen release at
the tissue level, (c) induction of arterial hypoxemia, and (d) possible
interference with the homeostatic mechanism by which 2,3,DPG
controls the affinity of hemoglobin for oxygen (27). Because carboxy-
hemoglobin has a half life in the body of at least 3 to 4 hours, its influ-
ence may still be measurable several hours after abstinence from
smoking (27).

A recent investigation of maximal muscular exercise during CO in-
toxication in five male volunteers demonstrated reduced maximal 0,
consumption in spite of a much higher heart rate and a relative hyper-
ventilation (21).

Astrand and Rodahl (2) commented recently on the adverse effect
of cigarette smoking on oxygen transport: "All other factors being
equal, a reduction in t,he oxygen-transporting capacity is associated
with a corresponding reduction in physical performance capacity dur-
ing heavy or maximal work * * *. Because a regular physical t,rain-
ing program only increases the maximal oxygen uptake by some 10 to
20 percent, a 5- to lo-percent reduction in maximal aerobic power due
to smoking may play a significant role in many types of athletic even&
and in very heavy work."

Other studies cited in this review document. the adverse effect of
smoking on pulmonary diffusing capacity (18) and on pulmonary
function with exercise (6,29).

Summary

Clinical studies in healt,hy, young men have shown that cigarette
smoking impairs exercise performance, especially for many types of
athletic events and activities involving maximal work capacity. Some
of these effects are mediated by reduced oxygen transport and reduced
cardiac and pulmonary funct,ion.

247


Exercise Performance References

(1) ANDEBBON, J. M., BROWN, C. W. A. study of the effects of smoking upon grip
   strength and recuperation from local muscular fatigue. Research Qnar-
   terly 22 (1) : 102-108, March 1951.

(2) ASTUND, P.-O., RonAuL, K. Factors affecting performance. In: Textbook
   of Work Physiology. New York, McGraw-Hill Book Co., 1970, 669 pp.
(3) BAILEY, D. A., CABRON, A. V., TEECE, R. G., WEHNER H. J. Vitamin c
   supplementation related to physiological response to exercise in smoking
   and nonsmoking subjects. American Journal of Clinical Nutrition 23(7) :
   905-912, July 1970.

(4) BLACKBURN, H., BBOZEE, J., TAYLOR, H. L. Common circulatory measure-
   ments in smokers and nonsmokers. Circulation 22: 11121124, December
    1960.

(5) CHEVALIER, R. B., ISOWERS, .J. A., BONDURANT, S., Ross, J. C. Circulatory
   and ventilatory effects of exercise in smokers and nonsmokers. Journal
   of Applied Physiology U(2) : 357360, March 1963.
(6) COOPER, K. H., GEY, G. O., BOTTENBERG, R. A. Effects of cigarette smoking
   on endurance performance. Journal of the American Medical Association
   203 (3) : 189-192, Jan. 15,1968.

(7) DAVID, K. H. Age, cigarette smoking, and tests of physical fitness. Journal
   of Applied Psychology 52 (4) : 296-298. August 1968.
(8) FINE, B. J. Personality traits as related to symptomatology and running
   performance at altitude under normal and drug (acetazoleamide) condi-
   tions. Perceptual and Motor Skills 27: 975-990, 196%
(9) FIUNKB, B. D. Smoking and selected cardiovascular-respiratory measures.
   Research Quarterly 41(2) : 140-144, May 1970.
(10) GLASSFORD, R. G., HOWELL, Jf. L. Smoking and physical fitness: A prelim-
   inary report. Canadian Family Physician 15(10) : 69-62, October 1969.
(II) GOLDBARG. A. S., KROXE, R. J.. RESNE~O~, L. Effects of cigarette smoking
   on hemodynamics at rest and during exercise. I. Normal subjects. Chest
   60( 6) : 531-536, December 1971.

(12) HENRY, F. M., FITZIIENRY, .J. R. Oxygen metabolism of moderate exercise,
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