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Acute Exercise Effects on Craving and Withdrawal Symptoms Among Women Quitting Smoking with NRT

Explore the potential benefits of acute exercise as a quit smoking aid, specifically among women using nicotine replacement therapy (NRT). Results show exercise can reduce cigarette cravings and withdrawal symptoms, adding to the effectiveness of NRT.

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Acute Exercise Effects on Craving and Withdrawal Symptoms Among Women Quitting Smoking with NRT

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  1. Acute exercise effects on craving and withdrawal symptoms among women attempting to quit smoking using nicotine replacement therapyDr. Therese HarperPolicy Analyst/PlannerChief Mental Health and Addictions Office

  2. Acute Exercise as a Quit Smoking Aid • Well examined as a quit smoking aid in an acute setting with temporarily abstinent smokers • Nine out of ten studies showed exercise to reduce cigarette cravings during temporary smoking abstinence (Taylor et al., 2007) • Isometric exercise of a very low intensity and duration (five minutes) has been shown to reduce the urge to smoke by .7 on a seven point scale (Ussher et al., 2006) • 15-20 minutes of self-paced walking reduced the urge to smoke by 4.6 on a seven point scale (Taylor, Katomeri, & Ussher 2005) • 15 mins moderate intensity exercise delays ad libitum smoking by up to 50 minutes, even when the individual is presented with a challenging mental task or a lit cigarette (Taylor et al., 2005; Taylor & Katomeri 2006; Taylor & Katomeri 2007)

  3. Limitations - Acute Framework • Results from the acute exercise and smoking paradigm are promising – lack ecological validity • Temporarily abstinent smokers rather than quitters • Severity of symptoms may not correspond with a true quit attempt • Laboratory setting • Artificial environment – how would it work in the real world • Not using nicotine replacement therapy (NRT)

  4. Rationale for Present Study • 50% of Canadians who attempt to quit will use pharmacotherapy, NRT is the most popular – does exercise have any acute benefit over and above NRT? • Examine the acute effects of exercise in a more ecologically valid environment

  5. Intensive Exercise Framework‘Getting Physical on Cigarettes’ • 178 women recruited (mass emails and newspaper) as part of ‘Getting Physical on Cigarettes’ • Inclusion criteria – exercise and use NRT patch, 18-70 years, 10+ cigarettes per day, female • Initial baseline assessment • Smoking history, general demographics, fitness test, body composition, vascular health, carbon monoxide (CO) • Signed up for 14 weeks of structured exercise in groups • Exercise sessions weaned • Mild working their way to vigorous, personalised • First four weeks all they do is exercise • Week four quit smoking, continue to exercise + NRT patch

  6. Acute Effects of Exercise Framework • Weeks five, 11 and 13 craving and withdrawal were measured before and after moderate intensity exercise (Shiffman-Jarvik) • Weeks chosen as they were either right after quit (week five) or NRT drop down weeks (11 and 13) • Carbon monoxide was measured prior to exercise • CO < 6ppm considered a non-smoker

  7. Analyses • Is there a reduction in craving and withdrawal at each time point (week five, 11, and 13)? • Repeated measures ANOVA’s

  8. Baseline assessments (n=178) Removed from study (n=19) Declined further participation (n=18) Advised to stop by Doctor (n=1) Week 4 (n=108) Received NicoDerm patches Removed from study (n=2) Declined further participation (n=1) Advised to stop by Doctor (n=1) Week 5 (n=157) Included in analysis (n=96) Excluded from analysis (n=61) CO>6; No patch; No show Removed from study (n=20) Declined further participation (n=19) Advised to stop by Doctor (n=1) • Week 11 (n=137) • Included in analysis (n=45) • Excluded from analysis (n=92) • CO>6; Did not drop down; No show; No patch Removed from study (n=10) Declined further participation (n=9) Advised to stop by Doctor (n=1) • Week 13 (n=127) • Included in analysis (n=29) • Excluded from analysis (n=98) • CO>6; Did not drop down; No show; No patch

  9. Demographics

  10. Cigarette Craving

  11. Psychological Withdrawal Symptoms

  12. Sedation Withdrawal Symptoms

  13. Strengths and Limitations • Strengths • Combined NRT plus exercise to see if exercise adds anything over and above NRT • Real quit attempt not temporarily abstinent • Limitations • More ecologically valid e.g. mimics a gym setting but still a lab • Cannot say for sure that the effects were just due to exercise – no control, restrained by larger clinical trial • High attrition – Using NRT, moderate intensity exercise, CO<6ppm, NRT as per manufacturer • Generalisability – females and strict inclusion criteria

  14. Conclusions • Highlights the utility of exercise as a quit smoking aid when used in conjunction with NRT – adds something over and above • Promoting exercise among women using NRT is appropriate – as it can further reduce: • Craving • Psychological withdrawal symptoms • Fatigue (sedation) withdrawal symptoms

  15. Further Research • Credibility beliefs and exercise as a quit smoking intervention • How else might exercise work to help people quit smoking - coping study • Acute bout of exercise and pregnant smokers

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