Is Weight Gain Inevitable for Patients Trying to Quit Smoking as Part of Cardiac Rehabilitation?

Ahmad Salman,Patrick Doherty

doi:10.3390/ijerph17228565

Ahmad Salman, Patrick Doherty

Open Access

https://doi.org/10.3390/ijerph17228565

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Abstract

The literature is uncertain about the extent to which those who attend cardiac rehabilitation (CR) gain weight while trying to quit smoking. This study aimed to determine the extent of CR-based smoking cessation provision and whether CR, as delivered in routine practice, is associated with helping patients quit smoking and avoid weight gain. Data from the UK National Audit of Cardiac Rehabilitation database, between April 2013 and March 2016, were used. Smoking status is categorised as smokers and quitters assessed by patient self-report. Outcomes included body weight, blood pressure, depression, and physical activity. A multiple linear regression model was constructed to understand the effect of continuing smoking or quitting smoking on CR outcomes. CR outcome scores were adjusted by the baseline CR score for each characteristic. An e-survey collected information about the smoking cessation support offered to patients attending CR. A total of 2052 smokers (58.59 ± 10.49 years, 73.6% male) and 1238 quitters (57.63 ± 10.36 years, 75.8% male) were analysed. Overall, 92.6% of CR programmes in the United Kingdom (UK) offer smoking cessation support for CR attenders. Quitting smoking during CR was associated with a mean increase in body weight of 0.4 kg, which is much less than seen in systematic reviews. Quitters who attended CR also had better improvements in physical activity status and psychosocial health measures than smokers. As delivered in routine practice, CR programmes in the UK adhere to the guideline recommendations for smoking cessation interventions, help patients quit smoking, and avoid weight gain on completion of CR.

Highlights

Smoking is a risk factor for cardiovascular disease (CVD) and the cause of death for approximately8 million people annually [1]
Evidence suggests that quitting smoking is associated with a mean increase in body weight of 3–5 kg, with most weight gain occurring within 3 months of quitting [3,4,5]; the research findings reported here show that smokers who quit smoking while attending cardiac rehabilitation (CR) do not gain weight, which aligns with the findings of Farley et al that exercise could reduce post-cessation weight gain [30]
One study has shown low levels of cessation support following hospital discharge [32], the e-survey showed that 92.6% of CR programmes in the United Kingdom (UK) offer smoking cessation support for patients attending CR. These results show that CR programmes in the UK adhere to guideline recommendations for smoking cessation interventions [17,33,34,35]

Summary

Introduction

Smoking is a risk factor for cardiovascular disease (CVD) and the cause of death for approximately8 million people annually [1]. A large systematic review and meta-analysis of 35 prospective cohort studies with 63,403 quitters and 388,432 continuing smokers looking at the association between smoking cessation and weight gain found that quitting smoking was associated with a mean weight gain of 4.10 kg and mean body mass index (BMI) gain of 1.14 kg/m2 over an average of 5 years [4]. The participants in this meta-analysis were similar to the general population in contrast to participants in the meta-analysis by Aubin et al [3], making their findings more generalisable. The cohort studies in the meta-analysis by Tian et al [4] had longer follow-up periods than those in the meta-analyses by

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