Smoking cessation: exercise had no clear effect on continuous abstinence.

Clinical bottom line (level 1b-)

  1. Women smokers who are given a vigorous exercise program and a smoking cessation program, have no clear difference in continuous abstinence from smoking than those given supervised contact and a smoking cessation program.
Marcus et al: Archives of Internal Medicine 1999; 159: 1229-1234
Expires March 2003

The study

Unblinded ?concealed randomised trial ?with intention-to-treat
Setting: general hospital, Rhode Island, USA

281 patients (aged mean 40 years, 100% female) healthy sedentary women who regularly smoked 10 or more cigarettes a day for at least 3 years and exercised less than twice a week for at least 6 months

Excluded if
  • aged <18 or >65 years
  • current or planned use of nicotine replacement therapy
  • medical problems
  • use of medications that would make compliance with the study protocol difficult or dangerous
  • current psychiatric illness
  • alcohol or another substance abuse problem


    • Note:
  • Baseline fitness was assessed with a graded maximal exercise test performed on a stationary bicycle prior to randomisation.


    • Control Group: (n = 147, 147 analysed): no exercise- patients began the 12 week wellness program 3 weeks before the quit date, and were required to participate in three 45 to 60 minute supervised sessions per week. Controls were asked not to take regular, vigorous exercise during the study.
    Experimental Group: (n = 134, 134 analysed): exercise- an exercise prescription was calculated using the peak heart rate achieved on the baseline exercise test. The target heart rate range for training the subjects was resting heart rate plus 60% to 85% of heart rate reserve. Exercise began 3 weeks before the quit date, and subjects had to attend 3 exercise sessions per week, which consisted of a 5 minute warm-up, 30 to 40 minutes of aerobic exercise and a 5 minute cool-down period with stretching.
    All subjects participated in a group-based smoking cessation program consisting of a 12 session, cognitive-behavioural program designed for women.
    100% followed for 12 months
    Outcome notes:
    • continual abstinence : carbon monoxide level of less than 8 ppm and a cotinine level less than 57 nmol/L from the quit day (week 4)

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    continual abstinence 12 months 8
    (5.44%)    		 16
    (11.9%)    		 7%
    (0% to 13%)    		 6.50%
    (-0.10% to 13.1%)    		 15
    (NNT = 8 to infinity;
    NNH = 959 to infinity)

    Comments

    1. Control subjects attended an average of 72.2% of smoking cessation sessions and 69.0% of the contact sessions. Exercise subjects attended an average of 69.6% of the smoking cessation sessions and 67.3% of the exercise training sessions.
    2. Other health benefits of exercise are not addressed

    Citation

    1. Marcus BH, Albrecht AE, King TK, et al: The efficacy of exercise as an aid for smoking cessation in women: A randomized controlled trial. Archives of Internal Medicine 1999; 159: 1229-1234
    Contributor: Clare Wotton and Musab Hayatli, January 2000
    Reviewer: Chris Del Mar

    Clinical Question.
    Patient women smokers
    Intervention or Exposure exercise program
    Comparison no exercise program
    Outcome smoking cessation