Rationale, Design, and Baseline Data forCommit to Quit:An Exercise Efficacy Trial for Smoking Cessation among Women

doi:10.1006/pmed.1997.0180

Preventive Medicine

Volume 26, Issue 4, July 1997, Pages 586-597

https://doi.org/10.1006/pmed.1997.0180 Get rights and content

Abstract

Background.TheCommit to Quittrial was designed to address the methodological problems of prior studies that have examined the contribution of exercise to smoking cessation.

Methods.This paper provides an overview of the study design and describes the sample of women who participated in this trial (N= 281). Interrelationships among eating, exercise, and smoking behavior are examined.

Results.Subjects randomized into the study compared with the sample of women who completed the initial assessment but were not randomized were more likely to be white, to have at least a high school education, and to smoke fewer cigarettes per day. Overall, the most frequent ineligibility criteria were health-related issues and scheduling conflicts. On average, participants in this study smoked more cigarettes per day than national samples of women smokers. Significant interrelationships include the positive association of motivational readiness for quitting smoking and enhanced levels of dietary restraint and the positive association of motivational readiness for exercise adoption and high levels of weight concern.

Conclusions.This study represents the first adequately powered randomized controlled clinical trial comparing the relative efficacy of a cognitive-behavioral smoking cessation treatment plus vigorous exercise with the same treatment plus contact control.

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Exercise Videogames, Physical Activity, and Health: Wii Heart Fitness: A Randomized Clinical Trial
2019, American Journal of Preventive Medicine
Adults who engage in regular physical activity have lower rates of morbidity and mortality than those who do not. Exercise videogames may offer an attractive, sustainable alternative or supplement to traditional modes of exercise. This study compared exercise videogames with standard exercise modalities for improving uptake and maintenance of moderate to vigorous physical activity, and health risk indices.
A three-arm clinical RCT including 12 weeks of supervised laboratory-based moderate to vigorous physical activity followed by 6 months follow-up.
This study was conducted at a university affiliated hospital research lab. Healthy, sedentary adults were eligible.
This study compared a 12-week program of supervised exercise videogames versus standard exercise (e.g., treadmill) versus control. Data were collected from January 2012 to September 2017 and analyzed in 2018.
The primary outcome was weekly minutes of moderate to vigorous physical activity at end of treatment, assessed at 3 and 6 months post-intervention by using self-report and accelerometer data. Health risk indices (e.g., HbA1c, lipids) were also assessed.
Participants (N=283) had an average age of 46.2 ±13.5 years; 79% were female. At end of treatment, those in the exercise videogame arm engaged in 30 minutes/week more moderate to vigorous physical activity compared with standard exercise and 85 more minutes/week than controls (all p<0.05). Exercise videogame participants had greater reductions in cholesterol, HbA1c, and body fat versus other groups. Reductions in cholesterol were twice as large in exercise videogame versus standard participants.
Exercise videogames produced greater uptake and maintenance of moderate to vigorous physical activity compared with standard exercise and improvements in multiple health risk indices. Exercise videogames may promote sustainable physical activity with significant health benefits.
This study is registered at www.clinicaltrials.gov NCT03298919.
Run to Quit: An evaluation of a scalable physical activity-based smoking cessation intervention
2017, Mental Health and Physical Activity
Citation Excerpt :
In comparison, the continuous abstinence rates in Run to Quit were 13.1% at end of program & 13.6% intent-to-treat at 6-month follow up. These outcomes were higher than, or comparable to, Commit to Quit continuous abstinence rates when implemented in YMCAs with women only (2.3% & 13.9%; Whiteley et al., 2007, 2012) but not the clinical lab trial (19.4%; Marcus et al., 1997), though it is also worth noting that Run to Quit does not have a control group. Results of this year's Run to Quit program can also be compared to the pilot where 7-day PPA for those present at the last week were similar between studies (50% in Run to Quit pilot, 50.6% in Run to Quit year 1).
Physical activity may hold promise as a potential smoking cessation tactic. Further, increasing activity levels in smokers may lead to additional physical and mental health benefits beyond smoking cessation. This study evaluated Run to Quit, a national initiative targeting smoking cessation through group-based running clinics.
Adult male and female smokers (N = 168) took part in running clinics in 21 locations across Canada. The program was investigated using a pre-post design. Participants completed questionnaires assessing physical activity, running, smoking, and other markers of health at weeks 1, 3, and 10 in the 10-week program as well as at 6-month follow up. Carbon monoxide (CO) testing at weeks 1 and 10 provided an objective indicator of smoking status and weekly coach logs were used to assess implementation.
50.8% of participants who completed the program achieved 7-day point prevalence (intent-to-treat = 19.6%), 90.8% reported reducing their smoking, and there was a significant decrease in CO (p = 0.001). There was a significant increase in self-reported running frequency (times/week) and physical and mental health from baseline to end of program, p's < 0.05. Results of the 6-month follow-up indicated that 19.6% of participants self-reported not smoking and 20.8% were still running regularly (M = 3 times/week).
Although attrition was high and future program refinement is required, Run to Quit demonstrates potential as a multiple health behaviour change intervention that may improve both physical and mental health in individuals who smoke.
Exercise videogames for physical activity and fitness: Design and rationale of the Wii Heart Fitness trial
2015, Contemporary Clinical Trials
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Effect size and power calculations for the primary outcome were as follows: Effect sizes for the EVG arm were based on data from our pilot study [44]. Effect sizes for the Standard and Control arms were based on previous studies [45–48]. Based on these prior studies, we anticipate the mean minutes of physical activity reported at 12 weeks would be 124.6 (SD = 39.27) for EVG participants, 71.5 (SD = 67.3) for Standard participants, and 41.3 (SD = 41.6) for Controls.
Despite numerous health benefits, less than half of American adults engage in regular physical activity. Exercise videogames (EVG) may be a practical and attractive alternative to traditional forms of exercise. However there is insufficient research to determine whether EVG play alone is sufficient to produce prolonged engagement in physical activity or improvements in cardiovascular fitness and overall health risk. The goal of the present study is to test the efficacy of exercise videogames to increase time spent in moderate to vigorous physical activity (MVPA) and to improve cardiovascular risk indices among adults.
Wii Heart Fitness is a rigorous 3-arm randomized controlled trial with adults comparing three 12-week programs: (1) supervised EVGs, (2) supervised standard exercise, and (3) a control condition. Heart rate is monitored continuously throughout all exercise sessions. Assessments are conducted at baseline, end of intervention (week 12), 6 and 9 months. The primary outcome is time spent in MVPA physical activity. Secondary outcomes include changes in cardiovascular fitness, body composition, blood lipid profiles and maintenance of physical activity through six months post-treatment. Changes in cognitive and affective constructs derived from Self Determination and Social Cognitive Theories will be examined to explain the differential outcomes between the two active treatment conditions.
The Wii Heart Fitness study is designed to test whether regular participation in EVGs can be an adequate source of physical activity for adults. This study will produce new data on the effect of EVGs on cardiovascular fitness indices and prolonged engagement with physical activity.
Testing the efficacy of yoga as a complementary therapy for smoking cessation: Design and methods of the BreathEasy trial
2014, Contemporary Clinical Trials
Citation Excerpt :
This study builds on our previous work [10,11] demonstrating that aerobic exercises such as cycling and walking were an effective addition to smoking cessation treatment. The yoga intervention provides the active components of the aerobic exercise shown to be effective in our previous studies [10,11], plus additional features specific to yoga that may further improve smoking cessation outcomes. In particular, yoga may offer both behavioral and psychological benefits that may be especially valuable for smokers who are attempting to quit [26,27].
Smokers trying to quit encounter many challenges including nicotine withdrawal symptoms, cigarette craving, increased stress and negative mood and concern regarding weight gain. These phenomena make it difficult to successfully quit smoking. Studies in non-smoking populations show that yoga reduces stress and negative mood and improves weight control. By increasing mindfulness we anticipate that yoga may also improve smokers' ability to cope with the negative symptoms associated with quitting. Yoga may also improve cognitive deliberation which is needed to make effective choices and avoid smoking in tempting situations.
The BreathEasy study is a rigorous, randomized controlled clinical trial examining the efficacy of Iyengar yoga as a complementary therapy to cognitive–behavioral therapy for smoking cessation. All participants are given an 8-week program of smoking cessation classes, and are randomized to either twice weekly yoga (Yoga) or twice-weekly health and wellness classes which serve as a control for contact and participant burden (CTL).
Assessments are conducted at baseline, 8 weeks, 3, 6, and 12 months of follow-up. The primary outcome is prolonged abstinence using an intention-to-treat approach. Multiple internal and external audits using blind data collection are employed to ensure treatment fidelity and reliability of study results. To understand why yoga may be more effective than CTL, we will examine the mechanisms of action (i.e., mediators) underlying intervention efficacy. We will examine the maintenance of yoga practice and smoking status at each follow-up. Focus groups and interviews will be used to enrich our understanding of the relationship of yoga practice and smoking abstinence.
This study will provide a stringent test of the relative efficacy of yoga compared to a condition that controls for contact time and attention. The use of mixed methodology also provides the opportunity to validate existing knowledge about yoga and helps to explore new themes for future mindfulness and yoga research.
YMCA commit to quit: Randomized trial outcomes
2012, American Journal of Preventive Medicine
Citation Excerpt :
The current trial was designed to randomize a total of 392 participants in order to have 80% power to test the null hypothesis that the intent-to-treat effect was equal to zero versus the one-sided alternative that exercise would have a positive benefit (with α=0.05). Effect size estimates for the power calculation were based on the continuous abstinence rates at end of treatment and at 3- and 12-month follow-up from the original Commit to Quit.11,12 An intent-to-treat approach was taken, such that all randomized participants were included in the analyses under the assumption that those with missing outcomes had returned to smoking.
Vigorous-intensity exercise has been shown to aid in smoking cessation, especially among women. In a previous trial, cognitive behavioral therapy (CBT) for smoking cessation plus regular vigorous aerobic exercise enhanced cessation rates, improved exercise capacity, and reduced weight gain compared to CBT plus equal contact time.
This study examined the effectiveness of this program adapted for and implemented in the YMCAs.
An RCT comparing CBT + Exercise (Exercise) to CBT + Contact Control (Control).
Apparently healthy female smokers were recruited to four local YMCAs.
YMCA staff members were trained to lead the manualized CBT smoking-cessation intervention and a standardized YMCA exercise program.
Seven-day point prevalence and continuous abstinence.
Participants (330 women, mean age=44 years) were randomized to the Exercise (n=166) or Control (n=164) group. Results revealed no differences in 7-day point prevalence (29.5% vs 29.9%) nor continuous abstinence (13.9% vs 14.0%) between the Exercise and Control groups, respectively, at end of treatment or at the 3-, 6-, and 12-month follow-up. An examination of the relationship between exercise dose and quit status at end of treatment revealed that over 12 weeks, the odds of being quit (7-day point prevalence) grew by 4.5% for each additional aerobic exercise session (OR=1.05, 95% CI=1.01, 1.08) and by 7.7% for each additional resistance training session (OR=1.08, 95% CI=1.02, 1.14). Analyses were conducted between August 19, 2010, and December 16, 2011.
No differences were seen between groups in smoking outcomes. The association between greater exercise participation and higher odds of quitting within the exercise condition suggests that the lack of between-group differences might be a result of poor compliance with the exercise program.
This study is registered at clinicaltrials.gov NCT01615380.
Prescribing Exercise in Tobacco Smoking Cessation Therapy
2009, Archivos de Bronconeumologia
El tabaco es una de las principales causas de mortalidad en los países industrializados y, sin embargo, no hay ningún tratamiento que sea completamente eficaz a la hora de ayudar a los fumadores a abandonar el hábito. El ejercicio físico es una de las estrategias no farmacológicas de bajo coste que se utilizan en el tratamiento de rehabilitación para varias enfermedades, y su práctica constituye un modo de combatir los efectos perjudiciales del tabaquismo sobre la salud. Los estudios han mostrado que el ejercicio físico ayuda a reducir la intensidad de algunos de los síntomas más importantes a que se enfrenta el fumador cuando intenta abandonar el hábito. No obstante, los médicos y terapeutas del deporte, por lo general, no son conscientes de este beneficio y desconocen cómo prescribir el ejercicio de una forma adecuada. En la presente revisión se pretende presentar las razones por las que el ejercicio físico debe contemplarse como un apoyo no farmacológico y útil para combatir los síntomas del tabaquismo y los relacionados con la deshabituación. Asimismo, se examina la bibliografía pertinente y se esbozan las directrices básicas que pudieran servir de orientación a la hora de prescribir el ejercicio físico a los fumadores que desean deshabituarse.
Tobacco is one of the main causes of mortality in industrialized countries, yet there is no treatment that is wholly efficacious for helping smokers to quit the habit. Physical exercise is one of the low-cost nonpharmacologic strategies in rehabilitation therapies in several diseases and its practice offers a way of combating the harmful effects of smoking on health. Studies have shown that physical exercise helps reduce the intensity of some of the main symptoms that may arise when a smoker attempts to quit, yet doctors and sport therapists are generally unaware of this benefit and do not know how to prescribe exercise appropriately. This study aims to present the reasons why physical exercise should be considered as a useful nonpharmacologic aid in combatting the symptoms of smoking and smoking cessation, to review the relevant literature, and to outline basic guidelines that might serve to orient the prescription of physical exercise for smokers attempting to quit.

View all citing articles on Scopus

^☆: This project was supported in part through grants from the National Cancer Institute (K07CA01757 and R29CA59660) and by a supplement to R29CA59660 from the Office of Research on Women's Health, to Dr. Marcus.

^☆☆: J, L, DurstineA, C, KingP, L, PainterJ, L, RoitmanL, D, ZwirenW, L, Kenney, editors

²: To whom correspondence and reprint requests should be addressed at Division of Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906.

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Regular ArticleRationale, Design, and Baseline Data forCommit to Quit:An Exercise Efficacy Trial for Smoking Cessation among Women☆,☆☆

Abstract

Addict Behav

Am J Prevent Med

Behav Ther

Prev Med

Am J Cardiol

Addict Behav

Addict Behav

Addict Behav

J Am Coll Cardiol

Addict Behav

Addict Behav

Addict Behav

Prev Med

Am J Clin Nutr

J Am Diet Assoc

J Am Diet Assoc

J Psychosom Res

Addict Behav

J Psychosom Res

J Subst Abuse

Cancer facts and figures

Trends in cigarette smoking in the United States: the changing influence of gender and race

JAMA

Determinants of quitting smoking

Am J Public Health

Occupational and sex differences in smoking and smoking cessation

J Occup Med

Smoking, body weight, and their effects on smoking behavior: a comprehensive review of the literature

Psychol Bull

Cigarette smoking as a dieting strategy in a university population

Int J Eating Disord

Attitudes toward smoking cessation among men and women

J Behav Med

Knowledge and beliefs regarding the consequences of cigarette smoking and their relationship to smoking status in a biracial sample

Health Psychol

The smoking and body weight relationship: implications for intervention and postcessation weight control

Ann Behav Med

Tryptophan and high-carbohydrate diet as adjuncts to smoking cessation

J Behav Med

Weight gain prevention and smoking cessation: cautionary findings

Am J Public Health

Smoking cessation in women concerned about weight: 12 month outcomes of a randomized trial

Am J Public Health

Can physical activity minimize weight gain in women after smoking cessation?

Am J Public Health

Changes in food intake and activity after quitting smoking

J Consult Clin Psychol

Affect regulation, nicotine addiction, and smoking cessation

J Psychoactive Drugs

Relapse following smoking cessation: a situational analysis

J Consult Clin Psychol

Regular Article
Rationale, Design, and Baseline Data forCommit to Quit:An Exercise Efficacy Trial for Smoking Cessation among Women☆,☆☆