Determinants of physical activity promotion by smoking cessation advisors as an aid for quitting: Support for the Transtheoretical Model

Objectives: Physical activity (PA) can reduce cigarette cravings and aid quitting but little is known about its promotion by smoking cessation advisors. This study aimed to: (1) determine the extent to which smoking cessation advisors promote PA; and (2) examine the relationship between PA promotion as a cessation aid and advisor characteristics and cognitions, within the Transtheoretical Model (TM) framework. Methods: Self-report surveys assessing PA promotion, TM variables, advisors’ own PA levels and demographics were completed by 170 advisors in England and Scotland. Results: Advisors reported spending 29 minutes promoting PA over a 6/7-week clinic. Those in later stages of readiness for promoting PA as a cessation aid and those spending more time promoting PA held more positive beliefs regarding pros and cons, self-efficacy, outcome efficacy and importance of PA within smoking cessation. Time spent promoting PA and stage of readiness were strongly associated. There was a trend for the more physically active advisors to promote PA more often. Conclusions: About half the advisors promoted PA and TM variables predicted this variability. Practice Implications: PA promotion among smoking cessation advisors may be facilitated by enhancing self-efficacy, outcome efficacy and pro and con-beliefs related to PA promotion

A qualitative perspective on multiple health behaviour change: views of smoking cessation advisors who promote physical activity

There are mixed views on whether smoking cessation advisors should focus only on quitting smoking or also promote simultaneous health behaviour changes (e.g. diet, physical activity), but no studies have qualitatively examined the views and vicarious experiences of such health professionals. Semi-structured interviews were conducted with 11 trained smoking cessation advisors who promote physical activity to their clients. The data were categorised into themes using thematic analysis supported by qualitative data analysis software. We report themes that were related to why advisors promote multiple health behaviour change and issues in timing. Physical activity could be promoted as a cessation aid and also as part of a holistic lifestyle change consistent with a non-smoker identity, thereby increasing feelings of control and addressing fear of weight gain. Multiple changes were promoted pre-quit, simultaneously and post-quit, and advisors asserted that it is important to focus on the needs and capabilities of individual clients when deciding how to time multiple changes. Also, suggesting that PA was a useful and easily performed cessation aid rather than a new behaviour (i.e. structured exercise that may seem irrelevant) may help some clients to avoid a sense of overload

Exercise interventions for smoking cessation

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: In July 2008, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise' or 'physical activity'. We also searched MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL. 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, recruiting smokers or recent quitters, and with a follow up of six months or more. Data collection and analysis: We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis. Main results: We identified 13 trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three 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. 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. Authors' conclusions: Only one of the 13 trials offered evidence for exercise aiding smoking cessation at a 12-month follow up. All the other trials were too small to exclude reliably an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, measures of exercise adherence and change in physical activity in both exercise and comparison groups

Exercise interventions for smoking cessation

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 methods: 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.  Authors' conclusion: 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

Effect of suppressing thoughts of desire to smoke on ratings of desire to smoke and tobacco withdrawal symptoms

Studies indicate that while suppressing smoking thoughts increases subsequent smoking, it may have no impact on desire to smoke. However, previous research has examined suppression of general smoking thoughts rather than thoughts specifically related to desire to smoke. The present study investigated whether suppression of thoughts of desire to smoke results in subsequently elevated ratings of desire to smoke. An experimental study examined the effects of suppressing thoughts of desire to smoke, versus expressing thoughts of desire to smoke, versus a control group thinking about anything, on ratings of desire to smoke and tobacco withdrawal symptoms at four time points (before manipulations, just after manipulations, 5 min after, 10 min after). In addition, effects of suppressing thoughts of desire to smoke on subsequent reports of thoughts of desire to smoke were examined. Suppressing the thoughts of desire to smoke caused thought rebound (i.e., greater subsequent reports of thoughts of desire to smoke). However, compared with control groups, this suppression did not elevate subsequent ratings of desire to smoke. Suppressing the thoughts of desire to smoke does not elevate subsequent ratings of this desire. Increased cigarette consumption following suppression of smoking thoughts may be mediated by mechanisms other than increased desire to smoke

Perceived Effects of Menopause Among Women Master Swimmers

This study assessed female master swimmers’ perceptions of the influence of menopause on their swimming. Using a cross-sectional design, 183 women completed an internet-based survey. Measures related to menopause status, physical activity levels, perceived effect of menopause on swimming and attitudes to swimming and menopause. Perimenopausal women reported the least physical activity and the greatest reduction in intensity of swimming training due to menopause, relative to other menopause groups. A quarter of women reported that the intensity of their swimming had reduced due to menopause. Additionally, a quarter reported that menopausal symptoms, particularly weight gain and sleeplessness, negatively affected their swimming. A third said that their confidence for competing at swimming had reduced due to menopause and that their swimming improved once menopause stopped. These findings suggest that menopause may have some detrimental effects on female master swimmers

Readiness to use physical activity as a smoking cessation aid: a multiple behaviour change application of the Transtheoretical Model among quitters attending Stop Smoking Clinics

Objective: Physical activity (PA) reduces cigarette cravings during smoking abstinence. However, little is known about quitters’ use of PA. This study aimed to: (1) determine the extent of quitters’ past and current use of PA as a cessation aid, while attempting to quit; (2) examine the relationship between use of PA and quitter characteristics and cognitions, within the Transtheoretical Model framework. Methods: Self-report surveys were completed by 181 smokers attending Stop Smoking Services in England and Scotland. Results: Twenty-two percent of quitters reported currently using PA to control their smoking, and 35% had used it during a previous quit attempt. Those in a more advanced stage of readiness for using PA as a cessation aid, held more positive beliefs regarding self-efficacy and outcome efficacy. Conclusion: Quitters were more likely to use PA to help them quit when they had greater belief in their own ability to use PA and in the efficacy of PA to help them to quit, and were also meeting weekly PA targets for health. Practice implications: Strategies by stop smoking advisors that aim to enhance client self-efficacy and outcome efficacy beliefs regarding PA as a cessation aid may help to increase the use of this behavioural strategy, since it seems that most quitters do not use PA

Pregnant smokers’ experiences and opinions of techniques aimed to address barriers and facilitators to smoking cessation: A qualitative study

Pregnant women experience certain barriers and facilitators (B&Fs) when trying to quit smoking. This study aimed to elicit women’s views on techniques that could help overcome or enhance these. Semi-structured interviews were conducted with 12 pregnant women who had experience of smoking during pregnancy. Participants were prompted to discuss experiences of B&Fs and give suggestions of techniques that could address these appropriately. A thematic analysis was conducted using the one sheet of paper method. Four themes relating to suggested techniques were identified: accessing professional help, nicotine replacement therapy (NRT), distraction, and social interactions. Experiences of accessing professional help were generally positive, especially if there was a good rapport with, and easy access to a practitioner. Most women were aware of NRT, those who had used it reported both negative and positive experiences. Praise and encouragement from others towards cessation attempts appeared motivating; peer support groups were deemed useful. Women reported experiencing B&Fs which fell under four themes: influence of others, internal motivation, cues to smoke, and health. Overall, accessing professional support generated positive changes in smoking habits. Establishing ways of how to encourage more women to seek help and raising awareness of different types of support available would seem beneficial

The effectiveness of interventions and intervention components for increasing physical activity and reducing sedentary behaviour in people with persistent musculoskeletal pain: a systematic review and meta-analysis

This systematic review and meta-analysis investigated the effectiveness of physical activity (PA) and sedentary behaviour (SB) interventions on PA and SB levels in people with persistent musculoskeletal pain. We explored the effectiveness of behaviour change techniques (BCTs), the use of behaviour change theory and non-PA/SB outcomes. Randomised controlled trials of PA or SB interventions for people with persistent musculoskeletal pain were eligible. Twenty-three studies were included. Quality of evidence was assessed using the GRADE approach. Meta-analysis demonstrated a small effect for PA post-intervention (Hedge's g = 0.321, CI 0.136 to 0.507, p = 0.001, very low-quality evidence). There was no effect for longer-term follow-up PA (low quality evidence) or SB outcomes (very low-quality evidence). There was a small effect for studies with low risk-of-bias at longer-term follow-up PA. Self-report PA outcomes, PA and education interventions, non-self-selected PA, a combination of supervised and unsupervised PA and a combination of individual and group-based interventions had larger effects. Heterogeneity was moderate to considerable. Risk-of-bias, assessed using Cochrane risk-of-bias tool (version two), was generally low. Five promising BCTs were identified: ‘adding objects to the environment’, ‘goal setting (outcome)’, ‘action planning’, ‘monitoring outcome(s) of behaviour by others without feedback’ and ‘feedback on outcome(s) of behaviour’. In conclusion, there is evidence for a modest benefit for PA interventions immediately post-intervention, however the quality of evidence is very low. There was no evidence for longer-term follow-up PA or SB. Higher quality studies of PA and SB interventions that use objective measures are needed. PROSPERO registration: CRD42020180260