Smokers tend to have unhealthy habits, including being physically inactive. The combination of smoking and physical inactivity increases the risk of developing chronic diseases. Aerobic exercise may assist smokers to quit. This systematic review aimed to estimate the effects of aerobic exercise compared to usual care on smoking cessation in adults.
Guided by a prospectively registered protocol, citation tracking plus sensitive searches of 6 databases and 4 trial registries were performed to identify randomised controlled trials evaluating aerobic exercise for smoking cessation. To be included, the trials needed to compare aerobic exercise (with or without nicotine therapy replacement) to usual care (with or without nicotine replacement). The aerobic exercise could be delivered with co-interventions, including behavioural support and drug therapy. Usual care was defined as any behavioural support, including educational classes, lectures and health orientations, social support, and strategies for replacing cigarettes. The primary outcome was smoking cessation defined as the prevalence of those reporting abstinence in the short (< 3 months), medium (3-12 months) and long (> 12 months) term. Two reviewers independently selected trials for inclusion, extracted data, and evaluated trial quality and certainty of evidence. Disagreements were resolved by a third reviewer. Trial quality was evaluated using the PEDro scale. Certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analysis was performed to calculate the risk ratio and 95% confidence interval (CI) in the short, medium and long term.
11 trials involving 2,093 participants were included in the meta-analysis. Average participant age ranged from 37 to 48 years. 6 trials exclusively recruited women and 5 recruited a combination of men and women. Aerobic exercise was performed in group sessions in all trials. Average session duration was 20-60 minutes, with 1-6 sessions/week for 7-15 weeks.
Aerobic exercise was better than usual care in achieving smoking cessation at short term, with a risk ratio of 0.79 (95% CI 0.66 to 0.94; 11 trials; 1,945 participants; moderate certainty). In contrast, there were no differences between aerobic exercise and usual care in the medium (risk ratio 0.91; 95% CI 0.72 to 1.15; 9 trials; 1,486 participants; moderate certainty) and long (risk ratio 0.96; 95% CI 0.78 to 1.18; 7 trials; 1,529 participants; moderate certainty) term.
Aerobic exercise (combined with behavioural support and drug therapy) can be used to aid smoking cessation during the first 3 months of cessation.
Santos CP, et al. Effectiveness of aerobic exercise on smoking cessation in adults: a systematic review and meta-analysis. J Phys Act Health 2021;18(2):230-42