Can physical activity help with stopping smoking?

1
Can physical activity help with stopping smoking?

• Michael Ussher
• Department of Community Health Sciences
  (Psychology)
• St. Georges, University of London
• mussher_at_sgul.ac.uk
• UKSCC 9th June 2005

2
Outline

• Rationale Why might physical activity aid
  smoking cessation?
• Evidence Has involvement in physical activity
  been shown to increase quit rates?
• Practice How can I encourage smokers to become
  more active?

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What is physical activity?

• Any bodily movement produced by skeletal
  muscles that results in energy expenditure
• Includes
• Structured exercise (e.g. weight-training,
  aerobics)
• Sport
• Lifestyle activities (e.g. walking, gardening,
  housework)

4
Why might physical activity aid smoking
cessation?

• Can you think of any reasons why being more
  active might help a smoker to quit?

5
Some reasons why physical activity might aid
smoking cessation?

• Physical activity
• Reduces withdrawal symptoms and cravings
• Reduces weight gain
• Improves self-esteem and reduces
  anxiety/depression
• Boosts immune system
• Reduces risk for chronic diseases e.g. CV
  disease, cancers
• Smokers who are planning to quit are motivated
  towards exercise
• Exercise is incompatible with smoking

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Does exercise reduce tobacco withdrawal symptoms
and cravings?
Ussher et al 2001
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What is the evidence for exercise reducing
withdrawal/desire to smoke?

• 1. Withdrawal/desire to smoke lower after
• 30-40 mins on exercise bicycle at vigorous
  intensity (Bock et al 1999)

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What is the evidence for exercise reducing
withdrawal/desire to smoke?

• 2. Withdrawal/desire to smoke lower during
  after
• 5 or 10 mins, exercise bicycle, moderate
  intensity (Ussher et 2001, Daniel et 2004)
• One mile self-paced walk
• (Taylor et al 2005)

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What is the evidence for exercise reducing
withdrawal/desire to smoke?

• 3. Desire to smoke lower after
• 5 minutes of isometric exercise
• (Ussher et al submitted)

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What is the evidence for exercise reducing
withdrawal/desire to smoke?

• 3. Withdrawal symptoms reduced during
• a seven week walking programme
• (Ussher et al 2003)

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Why does exercise reduce withdrawal and cravings?

• Can you think of any explanations
• for why a short bout of exercise
• might reduce a smokes withdrawal
• symptoms and cravings?

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Why does exercise reduce withdrawal and cravings?

• Psychological explanations
• Distraction (Ussher et 2001, Daniel et in press)
• Expectations (Daniel et submitted)
• Achievement
• Physiological explanations
• Exercise mimics the effects of nicotine (e.g.
  simulates CNS,
• increased blood glucose).
• Opioids (e.g Beta-endorphins)

13
Has physical activity been shown to increase quit
rates?

• Do you think that there is sufficient evidence to
  
• recommend exercise during smoking cessation?

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Has physical activity been shown to increase quit
rates?

• (see Ussher et al 2005 Cochrane Review)
• Physical activity programme (e.g. 30-40 mins
  exercise, three times a week) plus standard
  treatment
• 13 studies reviewed
• Three studies showed significantly higher quit
  rates for exercise versus control at end of
  treatment (Marcus et 91, Marcus et 99, Martin et
  97)
• One study (Marcus et 1999) Higher quit rates at
  three and 12 month follow-up for exercise versus
  control (12 versus 5 at 12 mths)

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.Has physical activity been shown to increase
quit rates?

• One study (Marcus et 2003, N217) Increased
  abstinence for exercise versus control at three
  months follow-up, but not at end of treatment or
  12 months
• - Poor adherence only 27 achieved at least 110
  mins/week of physical activity

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Has physical activity been shown to increase
quit rates?

• Remaining nine studies no difference in quit
  rates for exercise versus control.
• Only two of nine studies recruited sufficient
  numbers of smokers
• - Ussher et 2003 (N299) exercise counselling
  only,
• - exercise adherence poor
• - Mustonen et (2005) (N182) 26 sessions of
  supervised exercise (x2 week for 5weeks, x1 week
  for 14 weeks)
• - poor exercise adherence

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Has involvement in physical activity been shown
to increase quit rates?

• Despite good evidence that physical reduces
• cravings and withdrawal
• Evidence from only one study for physical
  activity increasing quit rates at 12 months
• This lack of evidence may be due to poor
• adherence to the physical activity programme.

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The challenge How do we encourage smokers to
become more active?

• Can you think of any ways in which we might help
• smokers to become more active while they are
• quitting?

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The challenge How do we encourage smokers to
become more active?

• What we already know
• Smokers need help to become more active 449
  smokers were
• offered free gym membership only 40 (9) took up
  the offer (Lee 2005)
• Exercise counselling alone increases levels of
  physical activity, but on its own is insufficient
  to raise levels of exercise sufficiently to
  increase quit rates
• Exercise counselling plus supervised exercise
• at least once/twice a week is probably optimum
  (Cornuz in preparation)

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What is the ideal physical activity programme for
aiding smoking cessation?

• We need to consider
• When should the exercise programme start?
• How much effort is required?
• How frequently?
• How long should each bout of exercise last?
• How long should the exercise programme last?
• Are there special considerations for some smokers
  (e.g. pregnant, obese)

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When should the exercise programme start?

• Before quitting?
• At the same time as quitting?
• After starting to quit?

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How much effort is required?

• Strenuous (e.g. jogging, sport)
• Moderate (e.g. brisk walking, gardening)
• Light (e.g. routine house work)

Which of these intensities are best for aiding
smoking cessation?
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How frequently do I need to exercise and for how
long?

• Chief Medical Officer 2005 Five days of at least
  30 minutes of exercise of at least a moderate
  intensity

Is this recommendation appropriate for smokers?
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How active is the UK population?

• 1998 Health Survey for England Adults
• Average of one day a week of 30 minutes of
  exercise of at least a moderate intensity
• 27.5 achieving five days of 30 minutes
• Heavy housework the most popular mode, followed
  by walking

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How long should the exercise programme last?

• While cravings/withdrawal are high?
• For the whole treatment period?
• For 12 months?
• For life?

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What are the main barriers to exercise among
smokers trying to quit?

• Lack of time?
• Lack of confidence as regards exercise?
• Living in a sedentary culture?
• Low motivation?

Can you think of any other barriers to exercise
for smokers?
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Do pregnant smokers have specific barriers to
exercise?

• Lack of child care?
• Unwilling to exercise in a group?
• Tiredness and sickness?
• Back ache?

Can you think of any other sub-groups of smokers
who would need special consideration ?
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How can you increase a smokers motivation
towards exercise?
Can you think of any ways of increasing a
smokers motivation towards exercise?
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How can you increase a smokers motivation
towards exercise?

• Monitor their levels of physical activity
• Discuss benefits of exercise
• Provide guidance on appropriate exercise and
  agree goals
• Discuss barriers to exercise and ways of
  overcoming them
• Provide some supervised exercise

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How do I monitor my clients level of physical
activity?

• Self-report
• - Simple questions (difficult to recall, bias
  towards overestimation)
• - Exercise recall (e.g. seven day recall
  questionnaire) - - Exercise diaries
• Objectively e.g. step counters

Try using the seven day recall questionnaire with
your neighbour
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Is an exercise diary useful?
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How do I help my client set goals for physical
activity?

• Set goals which are specific
• to exercise
• Mode
• Intensity
• Duration
• Frequency

e.g. To walk briskly so that I am breathing
heavier than normal, for 15 minutes continuously,
on five days a week
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Is it useful to ask my client to consider the
benefits of and barriers to exercise?
Discuss with your neighbour the main advantages
and disadvantages of you doing more regular
exercise
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Can I help my client overcome barriers to
exercise?
If its raining Ill use it as an excuse not to
go out for a walk
Discuss with your neighbour your main barriers to
regular exercise and agree a strategy for
overcoming them.
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How do I provide supervised exercise?

• Does your local PCT have an exercise referral
  scheme?
• Could you provide an exercise class or walk as
  part of your stop smoking group?

Can you think of any other ways of providing
supervised exercise for your clients?
36
Summary

• There is good evidence that physical activity can
  help smokers to reduce withdrawal symptoms and
  cravings?
• There is some evidence to suggest that physical
  activity can increase a smokers chances of
  quitting and can reduce weight gain after
  quitting.
• The main challenge is of how to encourage smokers
  to become more active.
• Increases in exercise can be achieved through a
  combination of supervised exercise and use of
  motivational techniques (e.g. checking exercise
  levels, setting goals, overcoming barriers to
  exercise)

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Can physical activity help with stopping smoking?
THE END!

• Michael Ussher
• Department of Community Health Sciences
  (Psychology)
• St. Georges, University of London
• mussher_at_sgul.ac.uk
• UKSCC 9th June 2005