Do exercise interventions help people quit smoking

Review question

We reviewed the evidence about the effect of exercise programmes in people who want to quit smoking. We looked at whether exercise programmes, either alone or combined with stop smoking programmes, helped more people to quit at six months or longer than stop smoking programmes alone or stop smoking programmes combined with health education.

Background

Specialist clinics and self-help materials regularly recommend exercise to people who want to quit smoking. Taking regular exercise may help people give up smoking by helping with withdrawal and cravings, and by helping to manage weight gain.

Study characteristics

The evidence is current to April 2014. We found 20 trials with a total of 5,870 participants. Nine studies were in women only and one study was in men only. Studies varied in the timing and intensity of programmes offered. We only included studies that measured smoking at six months or longer. In most of the trials, the exercise programmes included group and home-based exercise.

Key results

Since these studies used different types and intensities of exercise programmes, the results were not combined.

In four studies, people who received the exercise programme were significantly more likely to quit smoking at end of treatment than people who only received a stop smoking programme. Only two of the 20 trials offered evidence for exercise helping people to quit smoking in the long term. In one of these studies, the people in the exercise group had significantly higher quit rates at three-month follow-up and at 12 months, the results from this study were borderline significant. In this study, people who received the exercise programme were more than twice as likely to still be quit at 12 months. Another study reported significantly higher quit rates at six month follow-up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice. The other studies did not find an effect of exercise programmes on quit rates but that could have been because they were small studies or because the exercise programmes were not intense enough.

Quality of evidence

The level of evidence for whether exercise programmes help people quit smoking is very low and more research is needed. There are issues with study design, possible risk of bias, and differences between the studies.

Authors' conclusions: 

Only two of the 20 trials offered evidence for exercise aiding smoking cessation in the long term. All the other trials were too small to reliably exclude an effect of intervention, or included an exercise intervention which may not have been sufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions in terms of both exercise intensity and intensity of support being provided, equal contact control conditions, and measures of exercise adherence and change in physical activity in both exercise and comparison groups.

Read the full abstract...
Background: 

Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain.

Objectives: 

To determine whether exercise-based interventions alone, or combined with a smoking cessation programme, are more effective than a smoking cessation intervention alone.

Search strategy: 

We searched the Cochrane Tobacco Addiction Group Specialized Register in April 2014, and searched MEDLINE, EMBASE, PsycINFO, and CINAHL Plus in May 2014.

Selection criteria: 

We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme (which we considered the control in this review). Studies were required to recruit smokers or recent quitters and have a follow-up of six months or more. Studies that did not meet the full inclusion criteria because they only assessed the acute effects of exercise on smoking behaviour, or because the outcome was smoking reduction, are summarised but not formally included.

Data collection and analysis: 

We extracted data on study characteristics and smoking outcomes. Because of differences between studies in the characteristics of the interventions used we summarized the results narratively, making no attempt at meta-analysis. We assessed risk of selection and attrition bias using standard methodological procedures expected by The Cochrane Collaboration.

Main results: 

We identified 20 trials with a total of 5,870 participants. The largest study was an internet trial with 2,318 participants, and eight trials had fewer than 30 people in each treatment arm. Studies varied in the timing and intensity of the smoking cessation and exercise programmes offered. Only one included study was judged to be at low risk of bias across all domains assessed. Four studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow-up and a benefit for exercise of borderline significance (p = 0.05) at the 12-month follow-up. Another study reported significantly higher abstinence rates at six month follow-up for a combined exercise and smoking cessation programme compared with brief smoking cessation advice. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow-up but not at the end of treatment or 12-month follow-up. The other studies showed no significant effect for exercise on abstinence.