Yoga as a Complementary Therapy for Smoking Cessation

Despite the existence of effective medications for smoking cessation, approximately 50-80% of
smokers attempt to quit without using pharmacotherapy. Efforts to encourage medication use
during cessation attempts have met with mixed success. Many do not use medications because of
concerns about side effects, contraindications that make medication use inappropriate, and
individual preferences for chemical-free quit attempts. This leaves many smokers seeking an
effective alternative to assist them in attempting to quit smoking. Each year, over 41% of
smokers report failed attempts to quit smoking. Thus, effective non-pharmacological
interventions to increase rates of successful cessation are greatly needed.

Our research, and the research of other investigators, has demonstrated that traditional
(Western) exercise (e.g., brisk walking, bicycling) improves smokers' ability to successfully
quit. Exercise may help smokers quit by reducing concerns regarding post-cessation weight
gain, and by reducing nicotine withdrawal and enhancing mood. Recent research suggests that
yoga is an acceptable and potentially effective alternative therapy for smoking cessation for
several reasons: As a form of exercise, yoga shares many of the same properties as
traditional (Western) aerobic exercise in that yoga has been shown to improve mood, physical
fitness, weight control, self-image and quality of life in healthy and ill populations.
Moreover, features of yoga, including a focus on breathing, mental concentration, meditation,
stress reduction and enhanced mood are likely to have special relevance for smokers who are
trying to quit. Thus, yoga may be particularly attractive as an alternative for individuals
who either cannot use medications, or who choose not to use medications while quitting.

The proposed study will test the efficacy of Yoga as a complementary therapy for smoking
cessation using a randomized, controlled study design. Adult smokers will be randomly
assigned to either; 1) Yoga, or 2) an equal contact time Control group (CTL) given a health &
wellness program to control for contact time. All participants will be provided (separately
by treatment group assignment) with the same cognitive-behavioral Smoking Cessation
Counseling (SCC). Smoking abstinence will be measured at the end of treatment (week 8) and at
3, 6 and 12 months follow-up. We hypothesize that abstinence will be significantly higher in
the SCC+Yoga group compared to SCC+CTL. We will also test theoretically posited mediators of
intervention efficacy (e.g., perceived stress, cognitive/perceptual changes), examine the
cost-efficacy of the yoga intervention, and examine the relationship between maintenance of
yoga practice during the post-treatment period and smoking status. This study builds on our
programmatic line of research developing innovative, theory-driven smoking cessation
therapies.

Inclusion Criteria:

- Age 18 years or older (physician clearance for age > 65)

- English-speaking

- Currently Healthy

- Smoking smoked 5 or more cigarettes/day

- Must accept randomization procedure

- BMI< 40

- Will be Living in RI/MA/CT for next year

Exclusion Criteria:

- Participated in any Yoga, Tai Chi, Qi Gong or Mindfulness-based therapy program twice
in the past month or 10 times within the past year

- MD refused consent or Unable to obtain MD consent

- Unable to attend program due to work or home schedule

- Currently using medications or in active treatment to quit smoking

- Currently or planned participation in research or treatment programs that would
interfere with this study

- Presence of health conditions that would make participation in yoga difficult or
dangerous

Medical Exclusion Criteria

- Cardiovascular disease

- Stroke/TIA

- Chest pain with physical activity

- Current or recent (< 6 months) cancer treatment

- Uncontrolled Hypertension

- Untreated major depression or hospitalization < six months

- Bone joint problems

- Liver or Kidney Disease

- Fainting within the past year

- History of seizures

- Balance condition that interferes with ability to exercise

- Respiratory Condition - COPD (e.g., emphysema requiring oxygen)

- Liver Disease

- Kidney Disease

- Other medical condition that would interfere with ability to exercise

- Hypothyroid (not on stable medication for 3 months)