Smoking cessation program with exercise improves cardiovascular disease biomarkers in sedentary women

Abstract

Background: Several cardiovascular disease (CVD) biomarkers sensitive to tobacco exposure have been identified, but how tobacco use cessation impacts them is less clear. We sought to investigate the effects of a smoking cessation program with an exercise intervention on CVD biomarkers in sedentary women.

Methods: This is a cohort study on a subsample of a 2×2 factorial randomized controlled trial (RCT) (exercise setting: home vs. facility; level of exercise counseling: prescription only vs. prescription and adherence counseling) conducted January 2004 through December 2007. The analyses were completed in October 2010. In the greater Boston area, 130 sedentary female smokers aged 19-55 completed a 15-week program. All participants received nicotine replacement therapy (transdermal patch) and brief behavioral counseling for 12 weeks. They all received an exercise prescription on a moderate intensity level. All exercise interventions lasted for 15 weeks, from 3 weeks precessation until 12 weeks postcessation. Main outcome measures were selected CVD biomarkers hypothesized to be affected by smoking cessation or exercise measured at baseline and 12 weeks postcessation.

Results: Independent of tobacco abstinence, improvement was seen in inflammation (white blood cells [WBC]), prothrombotic factor (red blood cells [RBC]), and cardiovascular fitness level (maximum oxygen consumption [Vo(2)max]). This suggests that even if complete abstinence is not achieved, reduction in tobacco exposure and increase in exercise can improve the cardiovascular risk profile. A significant decrease was seen for total cholesterol and the total cholesterol high-density lipoprotein cholesterol (HDL-C): ratio only among the abstainers. The heart rate was reduced among all participants, but this decrease was more profound among abstainers. A significant weight gain and body mass index (BMI) increase were observed among abstainers and those who relapsed. We also found an increase in hemoglobin A1c (Hb A1c), although significant only when the groups were combined.

Conclusions: A smoking cessation intervention including exercise reduced tobacco-induced cardiovascular damage selectively within 3 months.

FIG. 1.

Flow diagram of the study. CBC, cognitive-behavioral counseling; ExRx, exercise prescription; FacBased, facility-based exercise intervention; Home Based, home-based exercise intervention; NRT, nicotine replacement therapy.

FIG. 2.

Changes in white blood cells (WBC) from baseline to week 12 among abstainers and relapsers.

FIG. 3.

Changes in total cholesterol and total cholesterol/high-density lipoprotein cholesterol (HDL-C) from baseline to week 12 among abstainers and relapsers.

FIG. 4.

Changes in heart rate from baseline to week 12 among abstainers and relapsers.