Acute exercise effects on craving and withdrawal symptoms among women attempting to quit smoking using nicotine replacement therapy Dr. Therese Harper Policy Analyst/Planner Chief Mental Health and Addictions Office

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) 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)

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

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

Intensive Exercise Framework ‘Getting Physical on Cigarettes’ 178 women recruited (mass s and newspaper) as part of ‘Getting Physical on Cigarettes’ Inclusion criteria – exercise and use NRT patch, 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

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

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

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

Demographics VariableM (SD)% Age41.29 (13.28) Language spoken at home (% English)95 Fagerstrom nicotine dependence score 5.40 (2.06) Employed Student Unemployed Smoking behaviour Cigarettes per day Number of years smoking Number of quit attempts (6.88) (12.40) 4.37 (4.94) Note. M = mean; SD = standard deviation.

Cigarette Craving

Psychological Withdrawal Symptoms

Sedation Withdrawal Symptoms

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

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

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