Increasing Physical Activity as Part of a Smoking Cessation Program

Tobacco use is the single most preventable cause of death in the United States, with
cigarette smoking accounting for nearly one-third of all cancer deaths each year. While a
number of inexpensive and effective smoking cessation methods exist, including the nicotine
patch and nicotine gum, smoking rates have not declined in the past few years. Individuals
who engage in regular exercise, in addition to participating in a smoking cessation program,
are often successful at quitting smoking and reducing post-cessation weight gain. However,
past studies on this topic have consisted of highly structured, supervised physical activity,
which made study recruitment and long-term adherence difficult. Additionally, these studies
generally have had low long-term quit rates, which may be attributed to the lack of a
nicotine replacement component. The purpose of this study is to evaluate the effectiveness of
a community-based physical activity intervention, in combination with a behavioral smoking
cessation program and nicotine replacement, at increasing smoking cessation rates among
sedentary adult smokers.

This 7-week study will enroll sedentary or minimally active cigarette smokers. All
participants will take part in a behavioral smoking cessation program and will wear a
nicotine patch. In addition, they will be randomly assigned to take part in either a
community-based physical activity intervention or a wellness control group intervention. All
participants will attend sixteen 60- to 90-minute face-to-face counseling sessions and twelve
20-minute telephone counseling sessions. They will also receive twelve informational
mailings. Participants in the physical activity intervention will focus on increasing
physical activity; the general wellness control group will receive information on general
health topics. Outcome measures, including smoking status, physical activity levels, and body
mass index, will be assessed at the end of the intervention and at 6- and 12-month follow-up
visits.

Inclusion Criteria:

- Smokes five or more cigarettes each day in the year prior to study entry

- Sedentary or minimally active physical activity level

- Willing to be randomly assigned to either intervention group

- Willing to use the nicotine patch

Exclusion Criteria:

- Pregnant, breastfeeding, or planning to become pregnant in the year following study
entry

- Planning to move out of the area in the year following study entry

- Blood pressure greater than 160/95 mm Hg

- Body weight greater than 140% of ideal body weight

- History of heart attack, stroke, unstable angina, coronary artery bypass grafting,
angioplasty, or stent in the 6 months prior to study entry

- Symptomatic peripheral artery disease

- History of congestive heart failure (New York Heart Association [NYHA] Class III or
IV)

- Electrocardiogram (EKG) evidence of 2nd or 3rd degree atrioventricular (AV) block

- History of a serious illness that might limit longevity (e.g., significant kidney
disease, liver disease, cancer)

- Current substance abuse

- Current alcohol use of more than 21 drinks per week

- Uncontrolled arrhythmia or hyperthyroidism