# Exercise as it relates to Disease/Exercise and smoking cessation in women

Nicotine smoking is a major cause of premature mortality in industrialised nations and has been identified as a major risk factor for cardiovascular disease, cancer and hypertension. According to Hughes the success rate of unaided quitting attempts is only around 3-5%. Success rates remain relatively low even with assisted intervention tactics such as nicotine replacement and behavioral counselling.
Smoking prevalence rates among women are declining slower than among men. There are a number of sex specific variables which are thought to effect women more than men such as concerns about weight gain, need for social support, belief that smoking reduces stress and depressive moods. Exercise is thought to positively affect many of these variables. This page will discuss the use of exercise as a smoking cessation intervention, with a primary focus on women smokers.

# Health Risk of Smoking

16.3% of Australian women were identified as smokers in 2011-2012. Smokers are at greater risk of coronary heart disease, multiple types of cancer, emphysema, bronchitis and other lung diseases. This makes smoking one of the leading causes of death among women. During pregnancy these health risks may also negatively affect the unborn foetus.

# Traditional Smoking Cessation Interventions

The most common intervention for smokers is Nicotine Replacement Therapy (NRT). This involves the smoker using nicotine supplements to help them cut down and eventually stop smoking. Another common intervention is behavioural counselling and group therapy meetings. These interventions are designed to give smokers better strategies to handle stress and withdrawal symptoms. These interventions can improve chances of success from 5% to 18%, which is still quite low.

# How Exercise Intervention Works

Numerous studies have shown a positive relationship between physical activity and smoking cessation, however there is no consensus in the research on why it works. One explanation is that exercise releases beta-endorphins which counteract the depressive affect and tension many smokers experience when they attempt to quit. Exercise is also thought to have a similar stimulating effect on the nervous system as smoking has and is therefore able to help reduce withdrawal symptoms.
The fear of weight gain is a larger factor for women than for men. During quitting attempts an increase in energy intake and a decrease in metabolic rate are sometimes reported. These two factors together contribute to weight gain feared by women. Exercise is a great was to increase energy expenditure and counteract these weight gaining factors.

# Evidence

The evidence around exercise intervention as a tool for smoking cessation is not very conclusive. Most studies viewed were invalidated to a degree by problems such as; small sample size (less than 50), poor adherence to exercise protocols, insufficiently taxing exercise, and poor long term follow up. Future studies plan to address these issues, particularly in regards to number of participants.
Bock’s (1999) study found vigorous aerobic exercise reduces negative affect, craving for cigarettes and symptoms of smoking withdrawal. Marcus’ (2010) pilot study found that adherence to moderate intensity exercise enhanced the efficacy of the nicotine patch and brief cessation counselling for short term smoking cessation. Prochaska’s (2008) study found changes in moderate to vigorous physical activity predicted sustained abstinence. All of these studies reported positive benefits; however none of them had a sample size large enough to support conclusive findings.

# Recommendations

All studies found used cardiovascular exercise as the primary form of exercise intervention. Successful abstinence from smoking was best associated with vigorous physical activity rather than moderate intensity exercise. Further research into the potential use of resistance training and its effect on smoking cessation could be beneficial. For effective smoking cessation an intervention 30–60 minutes of daily vigorous intensity exercise is recommended.

# Reference List

* ↑ Hughes, J. et al. (2004) ‘Shape of the Relapse Curve and Long-Term Abstinence Among Untreated Smokers’, Society for the Study of Addiction, Vol 99, pp 29-38.
* ↑ Escobedo, L. et al. (1996) ‘Smoking Prevalence in US Birth Cohorts: The Inflience of Gender and Education’, American Journal of Public Health, Vol 86, pp 231-236.
* 1 2 3 4 Marcus, B. et al. (1999) ‘The Efficacy of Exercise as an Aid for Smoking Cessation in Women’, American Medical Association, Vol 159, pp 1229-1234.
* ↑ Australian Bureau of Statistics (2013), ‘Gending indicators – Smoking’, Available online: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4125.0main+features3320Jan%202013
* 1 2 3 Marcus, B. et al. (2005) ‘The Efficacy of Moderate-Intensity Exercise as an Aid for Smoking Cessation in Women: A Randomized Controlled Trial’, Nicotine & Tabacco Research, Vol 7(6), pp 871-880.
* ↑ Best Practice (2008), ‘Smoking Cessations Interventions and Strategies’, Available online: http://connect.jbiconnectplus.org/ViewSourceFile.aspx?0=464
* 1 2 Ussher, M. et al. (2000) ‘Does Exercise Aid Smoking Cessation? A Systematic Review’, Addiction, Vol 95(2), pp 199-208.
* 1 2 3 Bock, B. et al. (1999) ‘Exercise Effects on Withdrawal and Mood Among Women Attempting Smoking Cessation’, Addictive Behaviours, Vol 24(3), pp 399-410.
* 1 2 3 Faulkner, G. et al. (2012) ‘Exercise Interventions for Smoking Cessations’, The Cochrane Collaboration, Issue 1, pp 1-49.
* ↑ Marcus, B. et al. (2010) ‘Moderate Intensity Exercise as an Adjunct to Standard Smoking Cessation Treatment for Women: A Pilot Study’, Psychology of Addictive Behaviours, Vol 24(2), pp 349-354.
* ↑ Prochanska, J. et al. (2008) ‘Physical Activity as a Strategy for Maintaining Tobacco Abstinence’, Preventive Medicine, Vol 42(2), pp 215-220.