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IN THE NAME OF GOD
smoking cessation as reduce cardiovascular disease risk factors
By : Dr. Zahra Abna
Case scenario
A 27 year old heavy smoker man with positive history of cardiovascular
disease in his family refers to clinician , for reduce his cardiovascular risk
factors, which smoking cessation methods is more effective ?
P I C O
Patient or problem
smoking and positive family history for cardiovascular disease
Intervention
smoking cessation with :
• Silver acetate
• Cannabinoid type 1 receptor antagonists
• Anxiolytics
• Exercise interventions
• Aversive smoking
Comparison
• Drugs with plasebo
• exercise programme alone or exercise programme as an adjunct to
a cessation programme with a cessation programme alone
• aversion treatments with ’inactive’ procedures
Outcomes
smoking cessation for reduce risk factor of cardiovascular disease
Key words
• smoking cessation
• Silver acetate
• Cannabinoid type 1 receptor antagonists
• Anxiolytics
• Exercise interventions
• Aversive smoking
Silver acetate for smoking cessation
Tim Lancaster, Lindsay F Stead
1Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Editorial group: Cochrane Tobacco Addiction Group.
Publication status and date: New search for studies and content updated (no
change to conclusions), published in Issue 9, 2012.
Review content assessed as up-to-date: 14 August 2012.
Citation: Lancaster T, Stead LF. Silver acetate for smoking cessation. Cochrane
Database of Systematic Reviews 2012, Issue 9. Art. No.:
CD000191. DOI: 10.1002/14651858.CD000191.pub2.
Copyright © 2012 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
Background
Silver acetate produces an unpleasant taste when combined with
cigarettes, thereby producing an aversive stimulus.
It has beenmarketed in various forms with the aim of extinguishing
the urge to smoke, by pairing the urge with an unpleasant stimulus.
Objectives
The aim of this review was to determine the effectiveness of silver
acetate products (gum, lozenge, spray) in promoting smoking
cessation.
Search methods
We searched the Cochrane Tobacco Addiction Group specialised
trials register. Most recent search was in July 2012.
Selection criteria
We included randomised trials of silver acetate for smoking
cessation with reports of smoking status at least six months after
the beginning of treatment.
Data collection and analysis
We extracted data in duplicate on the type of subjects, the dose and
form of silver acetate, the outcome measures, method of
randomisation, and completeness of follow-up.
The main outcome measure was biochemically validated abstinence
from smoking after at least six months follow-up in patients
smoking at baseline. Subjects lost to follow-up were counted as
continuing smokers. Where appropriate, we performed meta-analysis
using a fixed effects model.
Main results
Two studies provided long-term follow-up data on patients
randomised to silver acetate or placebo. In one of these studies,
there was a third arm, randomised to 2mg nicotine gum.
The pooled risk ratio for quitting for silver acetate vs placebo was
1.04 (95% confidence interval 0.69 to 1.57).
Authors’ conclusions
Existing trials show little evidence for a specific effect of silver
acetate in promoting smoking cessation. The confidence intervals
for the ratio are quite wide. However, the upper limit of the
confidence intervals for a positive effect equates to an absolute
increase in the smoking cessation rate of about 4%. Any effect of
this agent is therefore likely to be smaller than nicotine
replacement therapy.
The lack of effect of silver acetate may reflect poor compliance with
a treatment whose rationale is to create an unpleasant stimulus.
P L A I N L A N G U A G E S U M M A R Y
Does silver acetate help people stop smoking
Silver acetate products (gum, lozenge, and spray) produce an unpleasant
metallic taste when combined with cigarettes, so they are used
as a form of aversion therapy for smoking. However, the review of trials
found little evidence to show that silver acetate helps smokers
quit. Any beneficial effect of silver acetate is likely to be very small, and
less than the effect already proven for nicotine replacement therapy.
B A C K G R O U N D
Silver acetate preparations produce an unpleasant, metallic taste
when combined with cigarettes. Their use for smoking cessation is
based on the principles of aversive conditioning, and is analogous
to the use of disulfiram (Antabuse) for alcoholism. That is, an
aversive stimulus (in this case taste) is systematically paired with a
behaviour (smoking) that the subject wishes to stop. Various silver
acetate products are available including lozenges, gum and sprays.
The aim of treatment is to encourage smokers to use silver acetate,
so that the act of smoking becomes unpleasant, and the urge
to smoke therefore diminished, or ideally, extinguished. Excessive
ingestion of silver can lead to the rare condition of argyrism. To
avoid this, a total dose of silver no greater than 756mg is recommended
and this limits the duration of silver acetate treatment.
M E T H O D S
• Criteria for considering studies for this review
Types of studies
Randomised controlled trials which report smoking status at least
sixmonths after intervention. Studies reporting follow-up between
3 and 6 months only were reviewed, but data were not included
in pooled analyses.
Types of participants
Adult patients who smoke.
Types of interventions
All randomised controlled comparisons of silver acetate with
placebo, or with other smoking cessation treatments were included.
Silver acetate products included lozenges, gums and sprays.
Types of outcome measures
The main outcome measure was sustained abstinence from smoking
at 6 to12 months. Only participants who met criteria for biochemically
validated cessation were counted as quitters.
Search methods for identification of studies
We searched theTobaccoAddictionReviewGroup specialised register
for trials, using the term ’silver acetate’ in the title or abstract,
or as a keyword. This register has been developed from regular
electronic searches of MEDLINE, EMBASE and PsycINFO, together
with handsearching of specialist journals, conference proceedings
and reference lists of previous trials and overviews.
The most recent search for trials was in July 2102 when the Register
included the results of searches of the Cochrane Central Register
of Controlled trials (CENTRAL), issue 7, 2012; MEDLINE
(via OVID) to update 20120622; EMBASE (via OVID) to week
201227; and PsycINFO (via OVID) to update 20120625. See
the Tobacco Addiction Group Module in the Cochrane Library
for full search strategies and list of other resources searched. We
also searched Clinicaltrials.gov using the terms ’silver acetate’ and
’smoking’.
Data collection and analysis
All potentially eligible studies were reviewed by two authors (TL
and LS).Data were abstracted onto a data formwhich detailed the
methods of recruitment and randomisation, types of participants,
interventions and outcomes. A record was made of whether
abstinence was confirmed biochemically.
Trial results were expressed as risk ratios (number of quitters in
intervention group/total randomised to intervention)/(number of
quitters in control group/total randomised to control). Pooled
effects were estimated using aMantel-Haenszel fixed-effect model
(Deeks 2011).
R E S U L T S
Description of studies
Two randomised trialswith follow-up greater than sixmonthswere
identified. In the first (Jensen 1990) 6mg silver acetate chewing
gumwas compared to 2mg nicotine gum, and to ordinary chewing
gum in a three armed, randomised, open study. In the second
(Hymowitz 1996), 2.5mg silver acetate lozenges were compared
to placebo lozenges in a randomised double-blind study.
A third study (Malcolm 1986) was reviewed. In this study,
participants were randomised to silver acetate chewing gum or
placebo. This study was excluded from formal analysis because the
maximum follow-up was only four months.
Risk of bias in included studies
The studies were judged on their attempts to control bias in allocation,
assessment and analysis. All three were randomised, though
the precise method of randomisation was not stated in any of the
studies. One (Jensen 1990) was not blinded. Each of three studies
reviewed confirmed abstinence with biochemical verification. In
all studies, smokers lost to follow-up were counted as continuing
smokers in the analysis.
Effects of interventions
Two studies provided long-term follow-up of patients randomised
to silver acetate or placebo. In the first (Jensen 1990), there were
no significant differences in smoking status between patients randomised
to silver acetate chewing gum, nicotine gum or ordinary
chewing gum. In the second (Hymowitz 1996), 11/ 239 subjects
randomised to silver acetate lozenges had quit at one year, compared to 9/241
randomised to placebo. The combined estimate
for the risk ratio for quitting was 1.04 (95% confidence interval
0.69 to 1.57).
In the comparison between silver acetate and nicotine gum in
Jensen 1990 the risk ratio was 0.98 95% (CI 0.69 to 1.39).
In one further study (Malcolm 1986) 9/127 randomised to silver
acetate gumquit, compared to 4/142 randomised to placebo. This
study was not included in meta-analysis because follow-up was
only four months.
In all trials, the total dose of silver acetate was restricted to reduce
the chance of developing the rare outcome of argyrism (silver
deposition in body tissues), and no subject suffered this side-effect.
The main adverse effects reported were those expected from this
aversive stimulus; unpleasant tastes and sensations in the mouth,
and gastrointestinal disturbances.
D I S C U S S I O N
There is little evidence for a specific effect of silver acetate in
promoting smoking cessation.The confidence intervals for the
pooled risk ratio are quite wide, because the total number of
subjects studied with long-term follow-up is relatively small. The
upper limit of the confidence intervals for a positive effect equates
to an absolute increase in smoking cessation rate of about 4%. Such
an effect would, of course, be worth having.
However, given that other smoking cessation interventions produce
effects comparable to or larger than this (Stead 2008; Cahill 2012),
proving or disproving a small effect of silver acetate is unlikely to
have much clinical relevance. In a direct comparison between silver
acetate and nicotine gum, no advantages were seen for either
product over the other, but the numbers studied were small (Jensen
1990).
In part, the results may reflect the difficulties of complying with a
treatment whose rationale is to create an unpleasant stimulus.
A recent laboratory based study (Rose 2010) assessed the effect of
silver acetate on the taste of nicotine-containing or denicotinized
cigarettes, and nicotine inhaler.
Silver acetate mouth wash made the taste of both types of cigarette
less pleasant but did not affect the taste of the inhaler, implying
that silver acetate interacts with components other than nicotine.
The authors suggest that silver acetate could potentially be used in
combination with NRT products to reduce the chance that a recent
quitter who slipped and tried a cigarette would relapse completely.
A U T H O R S ’ C O N C L U S I O N S
Although a possible small effect of silver acetate in promoting
smoking cessation has not been disproved, any such effect is likely
to be very small, and less than that proven for nicotine replacement
therapy.There is therefore little role for silver acetate for promoting
smoking cessation in the clinical setting.
Cannabinoid type 1 receptor antagonists for smoking cessation
Kate Cahill, Michael H Ussher
Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. Division of
Population Health Sciences and Education, St George’s, University of London, London, UK
Editorial group: Cochrane Tobacco Addiction Group.
Publication status and date: Edited (no change to conclusions), published in Issue 7,
2012.
Review content assessed as up-to-date: 25 January 2011.
Citation: Cahill K, Ussher MH. Cannabinoid type 1 receptor antagonists for smoking
cessation. Cochrane Database of Systematic
Reviews 2011, Issue 3. Art. No.: CD005353. DOI: 10.1002/14651858.CD005353.pub4.
Copyright © 2012 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
Background
Selective type 1 cannabinoid (CB1) receptor antagonists may assist
with smoking cessation by restoring the balance of the
endocannabinoid system, which can be disrupted by prolonged use
of nicotine. They also seek to address many smokers’ reluctance to
persist with a quit attempt because of concerns about weight gain.
Objectives
To determine whether selective CB1 receptor antagonists (currently
rimonabant and taranabant) increase the numbers of people
stopping smoking To assess their effects on weight change in
successful quitters and in those who try to quit but fail.
Search methods
We searched the Cochrane Tobacco Addiction Review Group
specialized register for trials, using the terms (’rimonabant’ or
’taranabant’) and ’smoking’ in the title or abstract, or as keywords.
We also searchedMEDLINE, EMBASE, CINAHL and PsycINFO, using
major MESH terms.
We acquired electronic or paper copies of posters of preliminary trial
results presented at the American Thoracic Society
Meeting in 2005, and at the Society for Research on Nicotine and
Tobacco EuropeanMeeting 2006. We also attempted to contact the
authors of ongoing studies of rimonabant, and Sanofi Aventis
(manufacturers of rimonabant). The most recent search was in
January 2011.
Selection criteria
Types of studies
Randomized controlled trials
Types of participants
Adult smokers
Types of interventions
Selective CB1 receptor antagonists, such as rimonabant and taranabant.
Types of outcome measures
The primary outcome is smoking status at a minimum of six months after the
start of treatment.We preferred sustained cessation rates
to point prevalence, and biochemically verified cessation to self-reported
quitting. We regarded smokers who drop out or are lost to
follow up as continuing smokers. We have noted any adverse effects of
treatment.
A secondary outcome is weight change associated with the cessation
attempt.
Main results
We found three trials which met our inclusion criteria, covering
1567 smokers (cessation: STRATUS-EU and STRATUS-US), and 1661
quitters (relapse prevention: STRATUS-WW).
At one year, the pooled risk ratio (RR) for quitting with rimonabant
20 mg was 1.50 (95% confidence interval (CI) 1.10 to 2.05).
No significant benefit was demonstrated for rimonabant at 5 mg
dosage. Adverse events included nausea and upper respiratory tract
infections.
In the relapse prevention trial, smokers who had quit on the 20 mg
regimen were more likely to remain abstinent on either active
regimen than on placebo; the RR for the 20 mg maintenance group
was 1.29 (95% CI 1.06 to 1.57), and for the 5 mg maintenance
group 1.30 (95% CI 1.06 to 1.59). There appeared to be no
significant benefit of maintenance treatment for the 5 mg quitters.
One trial of taranabant was not included in our meta-analyses, as it
followed participants only until end of treatment; at eight weeks it
found no benefit for treatment over placebo, with an OR of 1.2
(90% CI 0.6 to 2.5).
For rimonabant, weight gain was reported to be significantly lower
among the 20 mg quitters than in the 5 mg or placebo quitters.
During treatment, overweight or obese smokers tended to lose
weight, while normal weight smokers did not. For taranabant, weight
gain was significantly lower for 2-8 mg versus placebo at the end of
eight weeks of treatment.
Authors’ conclusions
From the trial reports available, rimonabant 20 mg may increase the
chances of quitting approximately 1½-fold. The evidence for
rimonabant in maintaining abstinence is inconclusive.
Rimonabant 20 mg may moderate weight gain in the long term.
Taranabant 2-8 mg may moderate weight gain, at least in the short term.
In 2008, development of both rimonabant and taranabant was discontinued
by the manufacturers.
P L A I N L A N G U A G E S U M M A R Y
Can cannabinoid type 1 receptor antagonists help smokers to quit,
and could they also reduce the amount of weight gained
during the quitting process?
Long-term use of nicotine can upset the endocannabinoid system in
the brain, which controls food intake and energy balance.
Rimonabant and similar drugs may help smokers to quit by
rebalancing the system, which then reduces nicotine and food
cravings.
We searched our own specialised register of controlled trials. We
also contacted Sanofi Aventis, the manufacturers of rimonabant,
and researchers who presented early findings at conferences.
We found two randomized controlled trials (RCTs) of rimonabant for
smoking cessation, covering 1567 smokers, and one RCT of
rimonabant for relapse prevention covering 1661 quitters.
The available information shows that rimonabant at the 20 mg dose
increased by 1½-fold the chances of not smoking at one year,
compared with placebo.
Rimonabant 5 mg did no better than placebo at any time point.
Anxiolytics for smoking cessation
Hughes JR, Stead LF, Lancaster T
Dept of Psychiatry, University of Vermont, Burlington, Vermont, USA. Department of
Primary Care Health Sciences, University of
Oxford, Oxford, UK. 3Department of Primary Health Care, University of Oxford, Oxford
Editorial group: Cochrane Tobacco Addiction Group.
Publication status and date: Edited (no change to conclusions), published in Issue 8,
2011.
Review content assessed as up-to-date: 4 October 2009.
Citation: Hughes JR, Stead LF, Lancaster T. Anxiolytics for smoking cessation. Cochrane
Database of Systematic Reviews 2000, Issue 4.
Art. No.: CD002849. DOI: 10.1002/14651858.CD002849.
Copyright © 2011 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
Background
There are two reasons to believe anxiolytics might help in smoking
cessation. Anxiety may be a symptom of nicotine withdrawal.
Secondly, smoking could be due to an attempt to self-medicate an
anxiety problem.
Objectives
The aim of this review is to assess the effectiveness of anxiolytic
pharmacotherapy in aiding long term smoking cessation. The drugs
include buspirone; diazepam; doxepin; meprobamate;
ondansetron; and the beta-blockers metoprolol, oxprenolol and
propanolol.
Search methods
We searched the Cochrane Tobacco Addiction Group specialised
register (most recent search October 2009), which includes trials
indexed in MEDLINE, EMBASE, SciSearch and PsycINFO, and
conference abstracts.
Selection criteria
We considered randomized trials comparing anxiolytic drugs to
placebo or an alternative therapeutic control for smoking cessation.
We excluded trials with less than six months follow up.
Data collection and analysis
We extracted data in duplicate on the type of study population, the
nature of the drug therapy, the outcome measures, method of
randomization, and completeness of follow up.
The main outcome measure was abstinence from smoking after at
least six months follow up in patients smoking at baseline. We used
themost rigorous definition of abstinence for each trial, and
biochemically validated rates if available. Where appropriate, we
performed meta-analysis of relative risks using a fixed effect model.
Main results
There was one trial each of the anxiolytics diazepam, meprobamate,
metoprolol and oxprenolol. There were two trials of the anxiolytic
buspirone. None of the trials showed strong evidence of an effect
for any of these drugs in helping smokers to quit. However,
confidence intervals were wide, and an effect of anxiolytics cannot
be ruled out on current evidence.
Authors’ conclusions
There is no consistent evidence that anxiolytics aid smoking
cessation, but the available evidence does not rule out a possible
effect.
P L A I N L A N G U A G E S U M M A R Y
Do pharmacotherapies which reduce anxiety help smokers to quit
Anxiety can contribute to increased smoking, and may be a smoking
withdrawal symptom. Medications to reduce anxiety (anxiolytics) may
theoretically help smokers trying to quit. There have not been many
trials, and none of them showed strong evidence of an effect on
quitting.
Aversive smoking for smoking cessation
Peter Hajek, Lindsay F Stead
Wolfson Institute of Preventive Medicine, Queen Mary’s School of Medicine and
Dentistry, London, UK. Department of Primary Care Health Sciences, University of
Oxford, Oxford, UK
Editorial group: Cochrane Tobacco Addiction Group.
Publication status and date: Edited (no change to conclusions), published in Issue 8,
2011.
Review content assessed as up-to-date: 14 October 2009.
Citation: Hajek P, Stead LF. Aversive smoking for smoking cessation. Cochrane
Database of Systematic Reviews 2001, Issue 3. Art. No.:
CD000546. DOI: 10.1002/14651858.CD000546.pub2.
Copyright © 2011 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
Background
Aversion therapy pairs the pleasurable stimulus of smoking a
cigarette with some unpleasant stimulus. The objective is to
extinguish the urge to smoke.
Objectives
This review has two aims: First, to determine the efficacy of rapid
smoking and other aversive methods in helping smokers to stop
smoking; Second, to determine whether there is a dose-response
effect on smoking cessation at different levels of aversive
stimulation.
Search methods
We searched the Cochrane Tobacco Addiction Group specialised
register (latest search date October 2009) for studies which
evaluated any technique of aversive smoking.
Selection criteria
Randomized trials which compared aversion treatments with
’inactive’ procedures or which compared aversion treatments of
different intensity for smoking cessation. Trials must have reported
follow up of least six months from beginning of treatment.
Data collection and analysis
We extracted data in duplicate on the study population, the type of
aversion treatment, the outcome measure,method of
randomization and completeness of follow up.
The outcome measure was abstinence from smoking at maximum
follow up, using the strictest measure reported by the authors.
Subjects lost to follow up were regarded as smokers. Where
appropriate, we performed meta-analysis using a fixed effect
model.
Main results
Twenty-five trials met the inclusion criteria. Twelve included rapid
smoking and nine used other aversion methods. Ten trials included
two or more conditions allowing assessment of a dose-response to
aversive stimulation. The odds ratio (OR) for abstinence following
rapid smoking compared to control was 2.01 (95% confidence
intervals (CI): 1.36 to 2.95). Several factors suggest that this finding
should be interpreted cautiously.
A funnel plot of included studies was asymmetric, due to the
relative absence of small stu negative results. Most trials had a
number of serious methodological problems likely to lead to
spurious positive results. The only trial using biochemical validation
of all self reported cessation gave a non-significant result.
Other aversion methods were not shown to be effective (OR 1.15,
95% CI 0.73 to 1.82). There was a borderline dose-response to the
level of aversive stimulation (OR 1.67, 95% CI 0.99 to 2.81).
Authors’ conclusions
The existing studies provide insufficient evidence to determine the
efficacy of rapid smoking, or whether there is a dose-response to
aversive stimulation. Milder versions of aversive smoking seem to
lack specific efficacy. Rapid smoking is an unproven method with
sufficient indications of promise to warrant evaluation using
modern rigorous methodology.
P L A I N L A N G U A G E S U M M A R Y
Does smoking in a way that is unpleasant help smokers to quit
Aversion treatments pair undesirable behaviours with negative
sensations. In smoking cessation, several approaches have been
suggested such as rapid smoking, which requires smokers to take a
puff every few seconds to make smoking unpleasant.
The results of the existing trials suggest that this may be effective,
but the evidence is not conclusive because most of the studies of
this approach have methodological problems.
A recent laboratory study also suggests that the method has an
active ingredient. Further research may be
worthwhile.
Exercise interventions for smoking cessation
Michael H Ussher, Adrian Taylor, Guy Faulkner
Division of Population Health Sciences and Education, St George’s, University of
London, London, UK. 2School of Sports & Health Sciences, University of Exeter, Exeter,
UK. 3Faculty of Physical Education and Health, University of Toronto, Toronto, Canada
Editorial group: Cochrane Tobacco Addiction Group.
Publication status and date: New search for studies and content updated (no change
to conclusions), published in Issue 1, 2012.
Review content assessed as up-to-date: 26 September 2011.
Citation: Ussher MH, Taylor A, Faulkner G. Exercise interventions for smoking
cessation. Cochrane Database of Systematic Reviews
2012, Issue 1. Art. No.: CD002295. DOI: 10.1002/14651858.CD002295.pub4.
Copyright © 2012 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
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
In July 2011, we searched the Cochrane Tobacco Addiction Group
Specialized Register for studies including the terms ’exercise’ or
’physical activity’. We also searchedMEDLINE, EMBASE, PsycINFO,
Dissertation Abstracts and CINAHL using the terms ‘exercise’
or ‘physical activity’ and ‘smoking cessation’.
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 studieswe summarized the results
narratively, making no attempt at meta-analysis.
Main results
We identified 15 trials, seven 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 15 trials offered evidence for exercise aiding
smoking cessation at a 12-month follow up. All the other trials were
too small to reliably exclude 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, and measures of exercise adherence and change in
physical activity in both exercise and comparison groups.
P L A I N L A N G U A G E S U M M A R Y
Do exercise interventions help people quit smoking
Exercise is routinely recommended as an aid to smoking cessation by
specialist clinics and self-help materials. Fifteen trials have
compared an exercise programme plus a smoking cessation
programme, or an exercise programme alone, to a cessation
programme alone or a cessation programme plus a health education
programme, among smokers who were motivated to quit.
Since these studies used different types of exercise programmes, and
varied in the duration of follow up, the results were not combined.
In one study with a difference in quit rates of borderline significance,
the exercise component more than doubled the likelihood of not
smoking after 12 months.