Physical Activity-Based Smoking Cessation Intervention Was Not More Effective

An individually tailored physical activity intervention for smoking cessation was slightly less effective than a traditional wellness intervention in improving smoking cessation outcomes, according to study findings in the Journal of Smoking Cessation.

Investigators sought to evaluate the effectiveness of a smoking cessation intervention that incorporated a personalized physical activity intervention component. Toward that end, the investigators conducted the randomized controlled Lifestyle Enhancement Program trial (ClinicalTrials.gov Identifier: NCT00403312), in which participants were randomly assigned 1:1 to receive either an adjunctive physical activity intervention or a contact frequency-matched wellness comparison intervention. Both interventions involved use of behavioral counseling and the transdermal nicotine patch. The primary outcome was biochemically verified prolonged smoking abstinence at 7 weeks, 6 months, and 1 year.

The 392 study participants were adults aged 18 to 65 years who smoked at least 5 cigarettes per day for at least 1 year and were interested in quitting. The physical activity group included 199 participants and the wellness group included 193 participants. Participants’ average (SD) age was 44.6 (10.2) years; 67% were women; and 67% were White.

Individuals in the physical activity intervention received 16 face-to-face physical activity/cessation sessions, 11 telephone activity/cessation sessions, and 11 supportive mailings. The physical activity intervention included an individualized exercise plan based on personal characteristics and preferences. Those in the wellness intervention received the same smoking cessation intervention plus a general wellness program that included 8 face-to-face wellness/cessation sessions, 12 telephone wellness/cessation sessions, and 18 follow-up mailings.

Biochemically confirmed prolonged smoking abstinence for the physical activity and wellness groups, respectively, was 19.6% and 25.4% at 7 weeks, 15.1% and 16.1% at 6 months, and 14.1% and 17.1% at 12 months in the intent-to-treat analyses. The between-group differences were not significant at any time point (all P >.18).

The biochemically confirmed 7-day point prevalent abstinence rates in the physical activity and wellness groups, respectively, were 24.6% and 31.6% at 7 weeks, 19.6% and 21.8% at 6 months, and 22.6% and 23.3% at 12 months. The between-group differences were not significant (all P >.14).

Linear mixed modeling involving the number of minutes spent in strength training plus leisure time activity by group, time of assessment, and group by time indicated an interaction between time and group in strength training at 7 weeks (P =.04).

Greater perceived social support from family and friends, fewer years smoked, less temptation to smoke due to habit, positive affect/social situations, and negative affect situations were associated with an increased likelihood of prolonged abstinence at 12 months. The participants’ likelihood of quitting decreased over time (odds ratio at 7 weeks=4.435; P ≤.001; odds ratio at 6 months=2.752; P ≤.001).

A majority of participants in both interventions believed that the intervention was beneficial in helping to quit smoking (physical activity group, 89.5%; wellness group, 80.0%; P =.01).

Limitations include the absence of a control group that did not receive treatment; mediocre attendance at face-to-face sessions for the physical activity and wellness groups (63% and 72% attendance, respectively); and use of self-reports to assess physical activity change.

“Given the continuing burden of smoking, the high comorbidity of smoking and a sedentary lifestyle, and evidence from several studies that physical activity can aid quit attempts, more work is needed to determine how to best encourage the adoption and maintenance of active lifestyles among those who smoke and want to quit,” stated the study authors.