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1 Effects of Exercise on Smoking Cessation Julia Wigfall SOCW 5313 Shamsun Nahar, Ph.D. School of Social Work The University of Texas at Arlington 10 April 2023

EXERCISE AND SMOKING CESSATION 2 Effects of Exercise on Smoking Cessation in a Heavy Smoker Over 16 million Americans engage in the harmful habit of smoking cigarettes ( Health Effects of Cigarette Smoking , 2021), for various reasons including pleasure, stress relief, and concentration. Since I was a child, I was taught through multiple avenues like television commercials or talks at school about the dangers of cigarettes due to the addictive nicotine and harmful effects of tobacco. I distinctly remember a commercial with a woman talking with a voice box since she developed throat cancer due to smoking and there were pictures of smokers’ teeth and gums that scarred me. According to the Surgeon General, some of the effects of smoking cigarettes include harming nearly every organ of the body and causing many diseases (2014). Also, the same report states smokers increase their risk for coronary heart disease by two to four times, stroke by two to four times, and developing lung cancer by 25 times when compared to nonsmokers. Because of the nicotine in cigarettes, they are addictive and hard to stop with less than one in ten adults successfully quitting each year (Babb et al. 2017), but it is possible as the Surgeon General reports there have been more former smokers than current smokers since 2002 (2020). Background Nicole is a twenty-nine-year-old woman that has been smoking for over a decade. She stated she first tried smoking cigarettes when she was about thirteen years old, and it has been a habit since. She disclosed she was able to develop the habit as a child since both of her parents are chain smokers and she would sneak a few cigarettes from their cartons. Nicole stated her smoking habit was the worst when she was in undergrad as she would smoke almost two packs, or forty, cigarettes per day. Now, she states she buys six packs of cigarettes per week and smokes

EXERCISE AND SMOKING CESSATION 3 about a pack a day to cope with her high-stress job as an ICU nurse while in grad school for her MSN. Nicole exhibits a high motivation to stop smoking as she states smoking has affected her job performance, takes up a lot of time, and is becoming increasingly expensive. She disclosed she becomes very winded and struggles running up flights of stairs, when needed, to help her patients and team like during a code, and expressed dismay when detailing how she is constantly taking smoke breaks and washing her hands, and applying perfume after to cover the smell. Also, Nicole expressed discontentment with the amount of money she spends on cigarettes, about sixty dollars per week. Overall, her high motivation to quit smoking and her ability to decrease the number of cigarettes on her own will benefit Nicole as Robert West stated success in quitting smoking depends on the balance between an individual’s motivation to stop and their dependence on cigarettes (2004). Literature Review As stated previously, there are many harmful effects caused by smoking cigarettes, but a lot of these can be changed with smoking cessation and some positive changes can take place within as soon as twenty-four hours. The Cleveland Clinic states within twenty-four hours of a person’s last cigarette, their risk of heart attack decreases, blood pressure lowers, pulse rate reduces, and their body temperature begins to return to normal (2020). By the second day, taste and smell receptors will start to heal from an abnormally flattened state to a more normal, rounded configuration and damaged nerve cells will start to self-repair as myelin gradually rebuilds itself around exposed nerve endings (Cleveland Clinic, 2020). While there are many benefits within this short amount of time, it is important to note that nicotine withdrawal symptoms are typically the worst during the first 72 hours of quitting before gradually subsiding

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EXERCISE AND SMOKING CESSATION 4 (McLaughlin, Dani, & De Bias, 2015). Within two weeks of quitting, breathing is easier, circulation improves, and cravings should ease (Cleveland Clinic, 2020) which will be beneficial for Nicole since a major factor for her quitting is to perform her job functions more efficiently. Regarding smoke cessation and exercise, there have been numerous studies conducted to find if there is a positive or negative correlation between the two. A systematic review conducted by Ussher, Taylor, West, and McEwen assessing the effectiveness of exercise-based interventions in smoking cessation found two of eight trials found a positive effect of exercise on smoking abstinence (2002). Priebe et al. evaluated Run to Quit, a Canadian initiative targeting smoking cessation through group-based running clinics, over ten weeks using a pre-post design. 168 adult male and female smokers in twenty-one running clinics participated and completed questionnaires assessing their physical activity, running, smoking, and other markers of health at weeks one, three, and ten. There was also a six-month follow-up completed. This study showed a positive correlation as participants’ smoking decreased while their running and health increased (2017). In women, exercise can significantly reduce negative affect, nicotine withdrawal, and cigarette cravings as found in a twelve-week cognitive behavioral smoking cessation program study conducted by Bock et al. (1999). The study was conducted twice using the same protocol with women being randomly assigned to a group attending a vigorous exercise program or contact control three times per week. After each study, there were significant reductions in negative affect, nicotine withdrawal, and cigarette craving in participants that attended exercise most weeks of the program but not in the contact condition participants. Overall, the study found that vigorous exercise appears to produce acute improvements in withdrawal symptoms, cigarette craving, and negative affect among women attempting to quit smoking. Bess et al. examined

EXERCISE AND SMOKING CESSATION 5 women attending cognitive behavioral therapy (CBT) and engaging in moderate-intensity exercise against those just attending CBT and found that while both groups were equally likely to attain smoking cessation at the end of treatment women attending CBT and engaging in exercise were more likely to report smoking cessation at the 3-month follow-up when compared with the CBT group (1999). Research Question or Hypothesis Based on previous literature, it can be concluded that smoking cessation has positive effects on overall health with plenty of alternatives to assist in cessation like patches and gum. There isn’t much recent data on the effects of exercise on smoking cessation, but older studies show significant impacts exercise can have on women trying to quit smoking. Also, Nicole’s high motivation to quit smoking will increase her chances of successfully quitting. This single- system research design study hypothesizes that if Nicole works out every other day, then the target behavior of smoking fewer cigarettes will improve during the intervention phase. In other words, it is hypothesized that Nicole will smoke fewer cigarettes will during the intervention phase when compared to when she did work out. Overall, the purpose of this study is to contribute to the numerous studies on smoking cessation and provide another look at an alternative used for smoking. Exercise releases endorphins that trigger pleasure and could help relieve stress, reasons why people, including Nicole, smoke cigarettes. Methods The MSW student provided Nicole with a journal and worked with her to research an appropriate workout regime she could complete during the intervention period. The study utilized an A-B design as Nicole smoked freely with no intervention for seven days, the baseline (A) phase, followed by two weeks of working out, the intervention (B) phase. The intervention

EXERCISE AND SMOKING CESSATION 6 consisted of Nicole following a thirty-minute high-intensity interval training (HIIT) at her local gym every other morning or night for two weeks. The decision was made for Nicole to work out every other day as opposed to every day since she doesn’t work out often, it would be easier to fit into her schedule, and everyone needs off days. Also, since running upstairs and being winded were a point of concern, it was decided to use exercise in this study instead of alternatives like nicotine patches or gum. To track her exercise, Nicole wore her Apple Watch, and she kept track of the number of cigarettes she smoked by counting how many were left in each box each night, twenty cigarettes come in a box. While the MSW student kept in contact with Nicole every two days through texts or phone calls and recorded the number of cigarettes smoked on an Excel data sheet, Nicole also kept track of the number of cigarettes she smoked in the journal provided by the MSW student. Figure 1 is a representation of the A-B experimental design used with “o” representing a measurement or observation and “x” representing exposure to an experimental variable, the intervention. Baseline Intervention o-o-o-o-o-o-o Day 8-14: x-o-x-o-x-o-x Day 15-21: o-x-o-x-o-x-o Figure 1. Representation of A-B Method Results The results of this A-B single-subject deign indicate the baseline was affected by the intervention. Nicole was able to decrease the number of cigarettes she smoked when exercise was made a part of her lifestyle. Figure 2 shows that during the first seven days, the baseline (A) phase, Nicole averaged 20.29 cigarettes per day, or one pack. Also, Figure 2 also shows that during the next fourteen days, the intervention (B) phase, Nicole’s average of cigarettes smoked decreased to 10.5, almost half. The graph visually demonstrates Nicole smoked less during the intervention (B) phase and her target behavior was improved during the intervention (B) phase. It

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EXERCISE AND SMOKING CESSATION 7 is important to note that Nicole stated her breathing greatly improved after decreasing the number of cigarettes she smoked and increasing her exercise as well. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 0 5 10 15 20 25 20 18 23 20 19 22 20 17 15 12 10 10 9 10 8 9 9 11 10 9 8 Smoking Cessation Baseline Intervention Number of Cigarettes Smoked Discussion The purpose of this single-system research design study was to examine if exercise could aid in smoking cessation. In this SSRD, the MSW student analyzed the effect exercise had on the number of cigarettes Nicole smoked for fourteen out of twenty-one days, and the visual displayed a clear difference between the number of cigarettes smoked during the baseline and intervention phases. Also, Figure 2 indicated a significant decrease in the number of cigarettes Nicole smoked daily during the intervention phase. By keeping track of the number of cigarettes and counting the number of cigarettes left in the box each night, Nicole had to be more conscious of the number of cigarettes she smoked daily. Although this was a short study, it can be assumed that if Nicole continued to exercise and track the number of cigarettes she smoked, she would continue to decrease how much she smokes and eventually accomplish her goal of quitting smoking. Previous literature, along with this single-system research design study, make it evident that exercise can be a great alternative to aid in smoking cessation. The overall results of the

EXERCISE AND SMOKING CESSATION 8 study confirmed the MSW student’s hypothesis with the number of cigarettes Nicole smoked decreased during the intervention phase.

EXERCISE AND SMOKING CESSATION 9 References Babb S., Malarcher A., Schauer G., Asman K., & Jamal A. (2017). Quitting Smoking Among Adults—United States, 2000–2015. Morbidity and Mortality Weekly Report, 65 (52),1457-1464. Bock, B. C., Marcus, B. H., King, T. K., Borrelli, B., & Roberts, M. R. (1999). Exercise effects on withdrawal and mood among women attempting smoking cessation. Addictive behaviors, 24 (3), 399-410. Health Effects of Cigarette Smoking . (2021, October 29). Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/ effects_cig_smoking/index.htm McLaughlin I., Dani J.A., & De Biasi M. (2015). Nicotine withdrawal. Curr Top Behav Neurosci. 24 , 99–123. Nierkens, V., Hartman, M. A., Nicolaou, M., Vissenberg, C., Beune, E. J., Hosper, K., & Stronks, K. (2013). Effectiveness of cultural adaptations of interventions aimed at smoking cessation, diet, and/or physical activity in ethnic minorities. A systematic review. PloS one, 8 (10), e73373. Priebe, C. S., Atkinson, J., & Faulkner, G. (2017). Run to Quit: An evaluation of a scalable physical activity-based smoking cessation intervention. Mental Health and Physical Activity, 13 , 15-21. Smoking: Effects, Risks, Addiction, Quitting, Treatment . (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/17488-smoking US Department of Health and Human Services. (2014). The health consequences of smoking— 50 years of progress: a report of the Surgeon General.

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EXERCISE AND SMOKING CESSATION 10 Ussher, M. H., Taylor, A. H., West, R., & McEwen, A. (2002). Does exercise aid smoking cessation? A systematic review. Addiction, 95 (2), 199-208. West, R. (2004). Assessment of dependence and motivation to stop smoking. BMJ 328 , 338-339.

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