Sign up for alerts

Spring 2008 | Vol 11 No 3

News

Lace up, don’t light up: Incorporating exercise into smoking cessation programs

By Elizabeth Scott

It’s not news that regular exercise and staying away from smoking are healthy lifestyle choices. It’s also not news that starting a regular exercise routine or quitting smoking can be difficult. So what happens when you try to do both? Trying to quit and get physically active may seem like too much to tackle at once, but research is showing that exercise may actually help with smoking cessation.

A 2007 review of a dozen studies on exercise and smoking published in the journal Addiction found that smokers abstaining from smoking who did moderate exercise like walking or isometrics reported reduced cravings and withdrawal symptoms from nicotine.

Dr. Guy Faulkner, an assistant professor in the Faculty of Physical Education and Health at the University of Toronto, says that research to support the connection is growing and clinicians are starting to get the message. “Trying to get someone to quit smoking and increase their exercise may  once have seemed too challenging,” says Faulkner, adding that this fear of setting clients up for failure has prevented some clinicians from using exercise to help clients manage cravings and withdrawal symptoms. But that’s starting to change, as evidence shows that exercise as an adjunct to standard care such as counselling and nicotine replacement therapy (NRT) increases short-term abstinence compared to standard care alone.

Exercise is not just for people who are trying to butt out. It may play a harm reduction role for those who feel they cannot or do not want to quit. Studies have found that smokers who are physically active live longer and have lower rates of cardiovascular disease than inactive smokers. They also report more cessation attempts – and more attempts means more chances for success.

Faulkner says that choosing to make exercise an integral part of their lifestyle may give some smokers the boost they need to quit: “A person who is thinking of quitting may be looking to change their identity from someone who is a smoker to someone who is more health conscious,” he says. Exercise is a natural fit. Indeed, raising client awareness and concern for their overall health – and turning that concern into real action – is any health care provider’s goal.

The real challenge for clinicians often lies in how to encourage inactive smokers to get moving and stay that way. “A change in perceptions of what we mean by physical activity and exercise is needed,” says Faulkner. “If you think of exercise as just 30 minutes of moderate activity such as a brisk walk most days of the week, you can start setting small goals with clients – maybe five or 10 minutes a day,” gradually increasing the time to 30 minutes. Faulkner says that although it may be challenging, “clinicians often have the skills to motivate people to become more physically active. It’s more a question of whether clinicians buy into the potential that physical activity can have.”

Evidence shows that using exercise as an adjunct to standard care such as counselling and nicotine replacement therapy (NRT) increases short-term abstinence compared to standard care alone

Members of one online smoking cessation support group who were contacted by CrossCurrents wholeheartedly support the role of exercise in quitting. Richard Krueger, for example, who decided to make “2008 the year of better health,” says that while exercise distracts from cravings, it gives him much more: “My breathing has become easier and my daily workout routine reminds me of how good it feels to be a non-smoker after 10 years of addiction.” Krueger’s workout, which involves 45 minutes on a recumbent bicycle or elliptical machine, has also helped him shed five pounds – impressive to many of the smokers who fear the weight gain that may accompany quitting. Smoke-free at the two-month mark, Krueger says, “It feels great to pair smoking cessation and exercise, and I continue both because I never want to feel the way I used to again.”

Meghan Carlson, who smoked three-quarters of a pack a day for 16 years, also knows the benefits of exercise. “It gives me an outlet for a lot of nervous energy, alleviated the withdrawal headaches and gave me something other than smoking to focus on.” Carlson identified weight gain as a concern, adding that some women use this fear as an excuse for not quitting or for resuming smoking. But, Carlson says, exercise relieved some of her fear, giving her a focus and improving her physical health and overall mood. “A big part of quitting is making the decision to quit and being able to defend that decision to yourself,” says Carlson. “Exercise really helped keep me on an even keel by minimizing some of the worst symptoms of withdrawal.”

From a population health perspective, the ideal strategy would involve innovative smoking cessation programs that include an exercise component, targeting the public. Romilla Gupta, a health promotion consultant with the City of Toronto, says that currently the public health sector does not have well-researched exercise and smoking cessation or relapse prevention programs for people to use. However, existing public health messages encourage people to exercise as part of other behavioural strategies to deal with cravings and withdrawal symptoms. Exercise advice is embedded into a number of other messages, such as use NRT, talk to a support group or have a buddy system in place.

On the research front, studies are now looking beyond the short-term effectiveness of exercise in smoking cessation. Faulkner is involved in research that examines exercise maintenance for long-term cessation success, which, as he explains, “is about trying to help people develop the skills to become independent exercisers.” In the meantime, Faulkner offers this simple evidence-based strategy for clinicians to use with clients: “Short bouts of moderate activity can help people deal with cravings.”