Efficacy of Combined Relaxed Deep-Breathing with Chest Mobilization Exercise and Vernonia cinerea-Hard Candy on Smoking Cessation and Oxidative Stress in Active Teenage Smokers

Abstract

Background: Smoking cessation is very important worldwide. Chronic smoking can induce oxidative stress and inflammatory status and induce dangerous diseases such as hypertension and lung cancer. Standardized counseling is an important process in a routine program for smoking cessation. Withdrawal symptoms from smoking cessation are a significant barrier to a successful result, and they can be relieved by relaxed deep-breathing exercise. At present, the Thai herb, Vernonia cinerea (VC), has been claimed to reduce cigarette smoking because of its antioxidant compounds and nicotine that are modified and used as lozenges, gum, and hard candy. However, its efficacy in smoking cessation has not been confirmed. Furthermore, the efficacy of relaxed deep-breathing (rDB) during the chest mobilization exercise (CME) with VC hard candy on smoking cessation and oxidative stress is unclear. Objective: This study aimed to evaluate the combined effects of rDB/CME and VC-hard candy on smoking cessation and oxidative stress status in active teenage smokers. Methods: Hard candy with honey and VC powder from whole mixed parts of the stem, flowers and leaves was developed industrially under the spray dry technique. Thirty active smokers were randomized into three groups; product group (rDB/CME+ product) (aged 25.0 ± 3.0 years, n = 10), placebo group (rDB/CME + placebo) (aged 26.9 ± 3.7 years, n = 10), and a control group with no product or placebo administered (aged 25.6 ± 2.7 years, n=10). All of the groups received consultation on specific smoking cessation and two weeks of strict observation, which was followed up for 8 weeks. The 7-day point prevalence abstinence rates (7-day PAR) and continuous abstinence rate (CAR) were reported at week 2, 4, 6 and 8. In addition, the oxidative stress status with lipid peroxide and glutathione (GSH) in blood was evaluated before the program and after 2 weeks. Results: The results of 7-day PARs in the control group showed no statistical changes at week 2 (0%), 4 (10%), 6 (20%) and 8 (20%), which was the same in the rDB/CME + placebo group (10%, 20%, 30% and 40%, respectively). Whereas, a significant difference was presented in the rDB/CME+ product group (20%, 60%, 80% and 90% respectively). When comparing between the groups, 7-day PARs at week 2 was not statistically different, but it was in the follow-up period at week 4, 6 and 8. There was no statistical difference at week 4 between the three groups, but there was between the rDB/CME+ product, control and rDB/CME+ placebo groups at week 6 and 8. The results of CAR showed no statistical difference between the control and rDB/CWE+ placebo group in any of the periods. Whereas the rDB/CWE+ product group showed a significant difference after week 4. The CAR was statistically different between the groups after week 6 and 8. At week 6, the CAR of the rDB/CWE+ product group was different to the control group. There was no difference between the control and rDB/CWE+ placebo groups, or between the rDB/CWE+ product and placebo groups. At week 8, the CAR of the rDB/CWE+ product group was different from that of the control, but not from the rDB/CWE+ placebo group. Finally, the GSH level increased significantly in the rDB/CWE + product group when compared to the rDB/CWE+placebo group. Moreover, malondialdehyde (MDA) levels decreased significantly in both the placebo and product groups. In addition, MDA levels showed a significant difference between baseline and after 2 weeks in the rDB/CWE + placebo and product groups. Conclusion: Integrating relaxed-deep breathing with chest mobilization exercise and VC hard candy for 2 weeks can help smoking cessation during consultation, and possibly reduce oxidative stress status among active teenage smokers.