Abstract
BackgroundEvidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment.ObjectiveThis study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study.MethodsWe enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey.ResultsA total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=−6.95×10−3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=−.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=−.153 per 1000 steps) and 30-min level (mean individualized beta=−1.66 per 1000 steps).ConclusionsAlthough there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study.
Highlights
Smoking is the leading cause of preventable death in the world [1]
Conclusions: there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge
JMIR Mhealth Uhealth 2018 | vol 6 | iss. 5 | e121 | p. 2. For this longitudinal study spanning 12 weeks, the Fitbit Charge HR—a wrist-worn triaxial digital accelerometer with a built-in optical heart rate (HR) monitor that allows for continuous monitoring of activity throughout the day—and smartphone-based short message service (SMS) text messaging were used for data collection
Summary
Smoking is the leading cause of preventable death in the world [1]. public health campaigns, antismoking laws, and new pharmacotherapies have successfully reduced smoking rates [2], further progress has proven difficult due, in part, to the complex psychosocial nature of tobacco addiction [3]. Many smokers wish to quit smoking because of knowledge of its harmful effects [4], self-quitting initiatives have shown largely unsuccessful outcomes [5], suggesting that interventions are necessary to assist smokers in cessation. Physical activity (PA) has been proposed as an aid for smoking cessation [8] and as a means for harm reduction among smokers who do not wish to quit [9]. This review presents evidence that exercise may be an effective means for reducing tobacco cravings among smokers who are not presently motivated to quit [10], thereby suggesting exercise as a mediator of harm reduction. A 2014 pilot randomized trial—Exercise Assisted Reduction Stop (EARS)—found that PA coupled with support for smoking reduction was effective in promoting reduction and cessation among smokers who did not wish to quit immediately [11]. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment
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