Quitting smoking is one of the healthiest things a person can do, but it's also among the hardest, especially for teenage smokers who battle not only addiction but also the social pressure to keep lighting up.
Now new evidence that suggests a way to make their efforts easier: exercise. In a study involving 233 teens aged 14 to 19 in West Virginia (which has one of the highest smoking rates in the country, at more than 22%), teens who participated in a smoking cessation program combined with exercise were on average up to three times more likely to quit smoking than those who were provided only minimal stop-smoking counseling.
Students were randomly assigned to one of three groups: one group got a single smoking cessation session; a second group got a more intensive, 10-week stop-smoking program known as Not On Tobacco (NOT); and a third received a combination of NOT and fitness education. After three months, nearly 14% of the teens in the combination group had quit, compared with only 5% in the single-session group and 11% of those enrolled in NOT.
The exercise component of the combination intervention consisted only of five minutes of additional advice about exercise given at each weekly session (it wasn't as though the anti-smoking counselors became students' personal trainers). Rather, they counseled them on how physical activity can maintain good health and possibly help in giving up cigarettes. The students didn't exercise during the NOT sessions, but scheduled and participated in physical activity on their own, outside of the program.
The additional information on exercise improved quit rates, compared with the other two groups, but the effect was most striking among boys. Nearly 24% of the boys who participated in the NOT plus exercise program had quit smoking after three months, for example, compared with only 8% of those who participated in NOT alone.
The effect didn't hold for the girls, however. More girls in the NOT alone program quit smoking after three months than those getting smoking and exercise counseling.
Kimberly Horn, a professor of community medicine at West Virginia University and lead author of the paper, published in Pediatrics, can't explain the gender difference — yet. But she has some ideas, suggesting that it may have something to do with the fact that teen girls don't typically engage in as much vigorous physical activity or organized sports as boys do. "We're wondering if perhaps girls have more barriers to overcome in getting more physically active," she says.
Still the results suggest that exercise might help motivate at least some teens, including girls, who want to kick the habit. "Even a small amount of time spent by facilitators, teachers and counselors in motivating kids toward increased physical activity may have pretty significant impacts on health and health economics," says Horn.
She says the extra benefit is important since traditionally, anti-smoking programs have only about a 25% success rate among teens. And the latest data from the Centers for Disease Control and Prevention show that smoking rates among teens, which have recently declined dramatically, are starting to plateau. Between 1997 and 2003, the percentage of adolescents who smoked dropped from 36% to 22%; by 2009, the rate had dropped to 19.5 % but has leveled off since. Anything that can help push that percentage lower would be welcome, say health experts.
In the study, Horn's group recorded both the students' self-reports about whether they had quit, as well as more objective measures of nicotine in their system via a carbon monoxide reader. At the start of the study, all of the students were smoking at least half a pack a day during the week and more over the weekends, and wanted to quit.
It's not clear why exactly exercise may help teens quit, but Horn says she is reviewing her data to learn more about the types of exercise the students used, and how long they were active every day. She hopes it will lead to better advice for teens who might be having a hard time kicking cigarettes.
"We're very hopeful that it may not require a big dose of extra time to get these kids thinking about changing their physical activity behaviors and their smoking behavior at the same time," she says. "In these times of tight funding and limited resources, if we can target two health behaviors with a single intervention, then we can make a great impact on health and health economics."