Cigarette Craving Research Articles

The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review update and meta-analysis

Smoking cessation is associated with cigarette cravings and tobacco withdrawal symptoms (TWS), and exercise appears to ameliorate many of these negative effects. A number of studies have examined the relationships between exercise, cigarette cravings, and TWS. The objectives of this study were (a) to review and update the literature examining the effects of short bouts of exercise on cigarette cravings, TWS, affect, and smoking behaviour and (b) to conduct meta-analyses of the effect of exercise on cigarette cravings. A systematic review of all studies published between January 2006 and June 2011 was conducted. Fifteen new studies were identified, 12 of which found a positive effect of exercise on cigarette cravings. The magnitude of statistically significant effect sizes for 'desire to smoke' and 'strength of desire to smoke' ranged from 0.4 to 1.98 in favour of exercise compared to passive control conditions, and peaked either during or soon after treatment. Effects were found up to 30min post-exercise. Cigarette cravings were reduced following exercise with a wide range of intensities from isometric exercise and yoga to activity as high as 80-85% heart rate reserve. Meta-analyses revealed weighted mean differences of -1.90 and -2.41 in 'desire to smoke' and 'strength of desire to smoke' outcomes, respectively. Measures of TWS and negative affect were reduced following light-moderate intensity exercise, but increased during vigorous exercise. Exercise can have a positive effect on cigarette cravings and TWS. However, the most effective exercise intensity to reduce cravings and the underlying mechanisms associated with this effect remain unclear.

Separate and Combined Effects of Very Low Nicotine Cigarettes and Nicotine Replacement in Smokers with Schizophrenia and Controls

The prevalence of smoking among people with schizophrenia in the United States is about 3 times that of the general population. Novel approaches are needed to reduce rates of smoking-related morbidity and mortality among these smokers. This study used a within-subjects design to investigate the separate and combined effects of sensorimotor replacement for smoking (very low nicotine content [VLNC] cigarettes vs. no cigarettes) and transdermal nicotine replacement (42 mg nicotine [NIC] vs. placebo [PLA] patches) in smokers with schizophrenia (SS; n = 30) and control smokers without psychiatric illness (CS; n = 26). Each session contained a 5-hr controlled administration period in which participants underwent the following conditions, in counterbalanced order: VLNC + NIC, VLNC + PLA, no cigarettes + NIC, no cigarettes + PLA, usual-brand cigarettes + no patches. Next, participants completed measures of cigarette craving, nicotine withdrawal, smoking habit withdrawal, and cigarette subjective effects, followed by a 90-min period of ad libitum usual-brand smoking. Smoking VLNC cigarettes during the controlled administration periods reduced cigarette craving, nicotine withdrawal symptoms, habit withdrawal symptoms, and usual-brand smoking in SS and CS relative to the no cigarette conditions. VLNC cigarettes were well accepted by both groups and did not affect psychiatric symptom levels in SS. Transdermal nicotine significantly reduced cigarette craving but did not affect usual-brand smoking. These findings suggest that reducing the nicotine content of cigarettes to nonaddictive levels may be a promising approach for reducing nicotine dependence among people with schizophrenia.

Examining the interrelationships between social anxiety, smoking to cope, and cigarette craving

Smokers with symptoms of social anxiety often report smoking as a way to cope with negative affect. These individuals have lower success rates when attempting cessation compared with the general population. However, there is a paucity of research examining the role of social anxiety in nicotine dependence. The present study explored the relationships between symptoms of social anxiety, smoking to cope with these symptoms during social situations (STC), and cigarette craving. Thirty-eight participants completed measures of social anxiety and STC at baseline. Cigarette craving was subsequently assessed pre and post exposure to smoking-related images during periods of nicotine satiation and deprivation. Regression analyses revealed that greater symptoms of social anxiety predicted the frequency of STC behaviors and the number of cigarettes participants thought they would need in order to feel more comfortable in social situations. Symptoms of social anxiety and several behaviors associated with STC (e.g., avoiding social situations in which smoking is not permitted) predicted increases in craving during nicotine deprivation, but not satiation. These findings suggest that symptoms of social anxiety and STC behaviors may play a role in the maintenance of smoking behaviors. Further, targeting symptoms of social anxiety within the context of smoking cessation treatment may be particularly helpful and may improve the rates of smoking cessation among individuals with symptoms of social anxiety.

Sex‐specific differences in GABAA‐benzodiazepine receptor availability: relationship with sensitivity to pain and tobacco smoking craving

Sex differences exist in tobacco smoking behaviors. Nicotine, the primary addictive ingredient in tobacco smoke, indirectly affects γ-amino butyric acid (GABA) function. Previous studies reported sex-by-smoking interactions in brain GABA levels. The goal of the present study was to evaluate if there is a sex-by-smoking interaction at the GABA(A)-benzodiazepine receptors (GABA(A)-BZRs), as well as relationships between GABA(A)-BZR availability and behavioral variables before and after 1 week of smoking cessation. Twenty-six women (8 non-smokers, age 36.0 ± 13.4 years; 19 smokers, age 34.6 ± 8.9 years) and 25 men (8 non-smokers, age 37.9 ± 13.8 years; 17 smokers, 34.1 ± 12.4 years) were imaged using [123I]iomazenil and single-photon emission computed tomography. Smokers were imaged at baseline 7 hours after the last cigarette. A significantly great number of men were able to abstain from smoking for 1 week (P = 0.003). There were no significant differences in nicotine dependence and cigarette craving, mood or pain sensitivity between male and female smokers. There was a significant effect of gender across all brain regions (frontal, parietal, anterior cingulate, temporal and occipital cortices, and cerebellum; P < 0.05), with all women (smokers and non-smokers combined) having a higher GABA(A)-BZR availability than all men. There was a negative correlation between GABA(A)-BZR availability and craving (P ≤ 0.02) and pain sensitivity (P = 0.04) in female smokers but not male smokers. This study provides further evidence of a sex-specific regulation of GABA(A)-BZR availability in humans and demonstrates the potential for GABA(A)-BZRs to mediate tobacco smoking craving and pain symptoms differentially in female and male smokers.

Intermittent exercise in response to cigarette cravings in the context of an Internet-based smoking cessation program

BackgroundInterventions using sustained aerobic exercise programs to aid smoking cessation have resulted in modest, short-term cessation rates comparable to conventional cessation methods. No smoking cessation trial to date has prescribed intermittent bouts of exercise in response to nicotine cravings. ObjectivesThis pilot randomized controlled trial examined the feasibility and efficacy of an Internet-based smoking cessation program alone (CON) vs. the same Internet-based program + intermittent exercise in response to cigarette cravings (EX). Study populationParticipants (N = 38; mean age = 43.6 [SD = 11.5]; 60.5% women) were generally healthy, inactive adult smokers who desired to quit. ResultsThe overall retention rate was 60.5% (n = 23), and no significant retention rate differences were found between groups (EX vs. CON). Although retained participants achieved a higher cessation rate (26.1%) than all enrolled participants (15.8%), adjusted intent-to-treat and per-protocol binary logistic regression analyses revealed no significant cessation rate differences between EX and CON groups. Linear regression results indicated that additional days of self-reported exercise on the study website during the intervention phase predicted significantly higher reduction rates among EX group participants, F(2, 16) = 31.08, p < .001. ConclusionsResults were mixed with regard to the incremental benefit of exercise in the presence of the apparently valuable Internet-based smoking cessation program. The results support findings from related research and underscore the need for additional investigation into both the mechanisms underlying the effect of exercise on cigarette cravings and the challenges of poor adherence in the context of exercise-based smoking cessation interventions.

Rapid Nicotine Clearance is Associated with Greater Reward and Heart Rate Increases from Intravenous Nicotine

The ratio of nicotine metabolites (trans-3'-hydroxycotinine (3HC) to cotinine) correlates with nicotine clearance. In previous studies, high nicotine metabolite ratio (NMR) predicted poor outcomes for smoking cessation treatment with nicotine patch. The underlying mechanisms that associate NMR with treatment outcomes have not been fully elucidated. A total of 100 smokers were divided into quartiles based on their baseline plasma NMR. Following overnight abstinence, smokers received saline followed by escalating intravenous doses of nicotine (0.5 and 1.0 mg/70 kg) given 30 min apart. The effects of nicotine on subjective, plasma cortisol, heart rate, and systolic and diastolic blood pressure measures were obtained. Smokers in the first NMR quartile (slower metabolizers) had lower Fagerstrom Test for Nicotine Dependence (FTND) scores, suggesting lower levels of dependence. In contrast, smokers in the fourth NMR quartile (faster metabolizers) reported greater craving for cigarettes following overnight abstinence from smoking and reported greater ratings of nicotine-induced good drug effects, drug liking, and wanting more drug. Higher NMR was also associated with greater heart rate increases in response to nicotine. These results suggest that enhanced nicotine reward and cigarette craving may contribute to the poor treatment response in smokers with high NMR. These findings warrant further investigation, especially in treatment-seeking smokers undergoing cessation treatment.

The effects of exercise on cigarette cravings and brain activation in response to smoking-related images

Smokers show heightened activation toward smoking-related stimuli and experience increased cravings which can precipitate smoking cessation relapse. Exercise can be effective for modulating cigarette cravings and attenuating reactivity to smoking cues, but the mechanism by which these effects occur remains uncertain. The objective of the study was to assess the effect of exercise on regional brain activation in response to smoking-related images during temporary nicotine abstinence. In a randomised crossover design, overnight abstinent smokers (n = 20) underwent an exercise (10-min moderate-intensity stationary cycling) and passive control (seating for the same duration) treatment, following 15h of nicotine abstinence. After each treatment, participants underwent functional magnetic resonance imaging (fMRI) brain scanning while viewing a random series of blocked smoking or neutral images. Self-reported cravings were assessed at baseline, mid-, and post-treatments. There was a significant interaction effect (treatment × time) for desire to smoke, F (2,32) = 12.5, p < 0.001, with significantly lower scores following the exercise at all time points compared with the control treatment. After both exercise and rest, significant areas of activation were found in areas of the limbic lobe and in areas associated with visual attention in response to smoking-related stimuli. Smokers showed increased activation to smoking images in areas associated with primary and secondary visual processing following rest, but not following a session of exercise. The study shows differing activation towards smoking images following exercise compared to a control treatment and may point to a neuro-cognitive process following exercise that mediates effects on cigarette cravings.

Cue-Induced Cigarette Cravings and Smoking Cessation: The Role of Expectancies

Cue-induced cigarette cravings have been oft studied as potentially important predictors of smoking cessation outcomes. The literature on the relationship between cue-induced cravings and cessation, however, remains mixed. One possible explanation for the discrepant results in the literature may be the as-yet untested variability in expectancies of craving. Indeed, as with many interoceptive responses, cravings and their downstream consequences may be influenced by expectancies. To date, no study has examined the influence of expected cravings following smoking cue exposures on actual craving experiences and cessation outcomes. The objective of this study, therefore, was to test the possibility that smokers' expected craving levels in response to smoking cues would be related to actual cravings following cue exposure and that expected cravings would be related to cessation outcomes. Nicotine-dependent adult smokers (n = 153) were exposed to sets of neutral and smoking cues and completed questionnaires assessing (a) prior to the exposures, the cigarette craving levels they expected to experience following the cue exposures and (b) following the exposures, their actual craving levels. Participants also reported the duration of their most recent quit attempt and their perceived future quit difficulty. Findings indicated that expected cravings assessed prior to the cue exposures were significantly related to actual cravings following the exposures. In addition, both expected cravings and actual cravings were related to shorter previous quit duration and higher perceived quit difficulty. Study results highlight the importance of considering both expected and actual cravings in cue-induced craving paradigms.

Genetic predictors of cue- and stress-induced cigarette craving: an exploratory study.

Cigarette cravings in response to environmental cues and stressors are widely recognized as important predictors of smoking cessation outcomes. Accumulating evidence suggests that genetics plays a role in these craving responses, as well as in smoking cessation more generally. Previous studies of genetic polymorphisms have been limited by examination of single candidate genes and the use of broadly defined phenotypes (e.g., smoking history). In addition, research examining the similarities and differences between cue- and stress-induced cravings has been limited, although some evidence has suggested that they may have common genetic underpinnings. In the current study, we examined associations between a panel of 1,350 candidate genetic polymorphisms and craving responses to laboratory smoking cues and stressors. We hypothesized that common genetic polymorphisms would be predictive of both cue- and stress-induced craving. Nicotine-dependent smokers (n = 210) donated a blood sample, were exposed to neutral, smoking-related, and stress-related stimuli, and completed craving questionnaires immediately prior to and following each stimulus. Findings indicated that craving responses to smoking cues and stressors were moderately correlated (r = .44). However, genetic analysis revealed that cue and stress-induced cigarette craving were predicted by different polymorphisms, such that variants in the glycine and dopamine pathways were predictive of cue-induced craving, whereas variants in the stress-corticotropin pathway predicted stress-induced craving. Study results provide no support for the hypothesis that cue- and stress-induced craving have the same genetic predictors.

Functional Brain Imaging of Tobacco Exposure in Humans

Cigarette smoking represents a major health problem in the United States. Although most cigarette smokers express a desire to quit, only about 14 to 49% will be successful after 6 or more months of treatment. An improved understanding of the acute and chronic effects of smoking on brain function may lead to more efficacious pharmacological and behavioral treatments for smoking dependence. Many research groups have utilized functional brain imaging to examine the effects of tobacco exposure on brain activity. Acute administration of nicotine and cigarette smoking itself have been found to increase activity in the prefrontal cortex, thalamus, and visual system; reduce global brain activity; and increase dopamine (DA) release in the ventral striatum/nucleus accumbens. Chronic tobacco exposure lead to an overall up-regulation of α4β2 nicotinic acetylcholine receptors (nAChRs) across brain regions (other than thalamus), and reduced monoamine oxidase (MAO) A and B levels in the basal ganglia. Functional brain imaging studies of cigarette craving and withdrawal, too, demonstrate important changes in brain activity. Taken together, current research suggests that smoking enhances neurotransmission through cortico-basal ganglia-thalamic circuits by either direct stimulation of nAChRs, indirect stimulation through DA release of MAO inhibition, or a combination of these, and perhaps, other factors. The purpose of this review is to provide a summary of current functional brain imaging studies of tobacco use and dependence, and use this information to develop a greater understanding of brain function in smokers.

Effects of Acute Exercise on Opiate and Cigarette Craving in Methadone Patients

Acute aerobic exercise has been shown to reduce craving for cigarettes in smokers. Over 80% of patients enrolled in methadone maintenance treatment (MMT) programs for opiate addiction are smokers and 29% suffer from diabetes. Many MMT counselors believe that regular physical exercise helps their patients to be successful in the program; however, there have been no previous studies demonstrating that increased physical activity positively impacts MMT patients. Purpose: To determine if acute aerobic exercise changes opiate and cigarette craving in MMT patients. Methods: 9 MMT patients (Age = 45±2 years; BMI=27.5±1.9) completed 3 randomly applied experimental trials immedi- ately before receiving their daily methadone dose. The experimental trials consisted of 20 minutes of rest, moderate exer- cise (65% predicted maximal heart rate), or vigorous exercise (80% predicted maximal heart rate). Craving for opiates, cigarettes, and sweets was recorded before, immediately after (IPE), and 10 minute after exercise (10 Post). Subjects also completed the Subjective Opiate Withdrawal Scale (SOWS) before and 10 minutes after exercise. Results: Craving for opiates was reduced (p<0.05) as a result of vigorous exercise at IPE (-26.8+6.9%) and 10 Post (-5.5+0.5%); however, craving for opiates was unchanged following moderate exercise. Craving for cigarettes was reduced (p<0.05) following both moderate (IPE=-37.9+6.1%; 10 Post=-13.1+9.1%) and vigorous (IPE=-37.1 +7.1%; 10 Post=-8.8+9.2% exercise. Craving for sweets and the SOWS was unchanged as a result of exercise. Conclusion: The results of this investigation suggest that craving for opiates and cigarettes in patients participating in a MMT program may be influenced acute aerobic exercise.

An Attentional Control Task Reduces Intrusive Thoughts About Smoking

Attentional control tasks such as body scanning and following isometric exercise instructions have been shown to reduce smoking cravings, apparently by reducing stress (Ussher, M., Cropley, M., Playle, S., Mohidin, R., & West, R. [2009]. Effect of isometric exercise and body scanning on cigarette cravings and withdrawal symptoms. Addiction, 104, 1251-1257. doi:10.1111/j.1360-0443.2009.02605.x). Related work based upon elaborated intrusion theory (Kavanagh, D. J., Andrade, J., & May, J. [2005]. Imaginary relish and exquisite torture: The elaborated intrusion theory of desire. Psychological Review, 112, 446-467. doi:10.1037/0033-295X.112.2.446) has shown that similar tasks can reduce hungry participants' involuntary food-related thoughts (May, J., Andrade, J., Batey, H., Berry, L.-M., & Kavanagh, D. [2010]. Less food for thought: Impact of attentional instructions on intrusive thoughts about snack foods. Appetite, 55, 279-287. doi:10.1016/j.appet.2010.06.014). This study tests the effect of body scanning instructions upon smoking-related thoughts as well as craving. Twenty-seven smokers took part in 2 counterbalanced sessions, on different days, having been asked to abstain from smoking for 2 hr. In each session, they followed audio instructions for three 10-min blocks during which their thoughts were probed 10 times. In the first and third blocks, they were instructed to let their mind wander; during the second block of the control session, they also let their mind wander, but in the experimental session, they followed body scanning instructions. "Smoking thought frequency" was assessed using thought probes; "Craving" was measured using Factor 1 of the Questionnaire on Smoking Urges (Tiffany, S. T., & Drobes, D. J. [1991]. The development and initial validation of a questionnaire on smoking urges. British Journal of Addiction, 86, 1467-1476. doi:10.1111/j.1360-0443.1991.tb01732.x). Participants reported fewer smoking-related thoughts and lower smoking cravings in the body scanning block of the experimental session, whereas they rose in the comparable mind-wandering block of the control session. The reduction in thoughts during the body scanning correlated with the corresponding reduction in craving. Body scanning reduces cravings and reduces the frequency or shortens the duration of smoking thoughts. Attentional control strategies may form a useful part of smoking cessation practices.

Is It Dangerous to Quit Smoking Shortly before Surgery?

To the Editor: We read with interest the work of Turan et al. ,1who used the American College of Surgeons National Surgical Quality Improvement Program Database and found that cigarette smoking increased risk for perioperative mortality and major morbidity in patients having noncardiac surgery. The accompanying editorial by Katznelson and Beattie2provides a valuable perspective on their work, and we applaud their call for anesthesiologists to take a leadership role in efforts to help surgical patients quit smoking. In addition to potential beneficial effects on the acute perioperative risk nicely documented by Turan et al. , surgery also represents a teachable moment for smoking cessation (e.g. , undergoing a surgical procedure increases the chances that smokers will successfully quit),3and the benefits of smoking cessation to long-term health are unquestioned. The issue of the optimal timing of preoperative smoking cessation is of practical importance, and the duration of preoperative abstinence necessary for maximum benefit is not defined (and may differ among various smoking-related complications). For example, recent data suggest that even prolonging postoperative abstinence in smokers who had smoked up to the time of their surgery may benefit patients who have undergone orthopedic surgery.4Unfortunately, in their excellent commentary Katznelson and Beattie perpetuate a concept that hinders perioperative tobacco control efforts: the fear that brief preoperative abstinence from smoking may actually have deleterious effects. They raise the concern that abstinence from smoking may exacerbate preoperative stress, citing a paper from our group that showed that although smokers report more stress than nonsmokers, stress was not increased by perioperative abstinence, and cravings for cigarettes were surprisingly low.5This finding actually favors attempts at smoking cessation during the immediate perioperative period, especially when considering the forced abstinence created by smoke-free healthcare facilities. They also state that several studies suggest that patients who experience sudden withdrawal from tobacco may be at increased risk for pulmonary complications, referencing two observational studies to support this assertion.6,7However, the study of Bluman et al. did not analyze patients who quit smoking shortly before surgery, but rather those who “cut down” the number of cigarettes smoked by a relatively modest amount.6The study of Nakagawa et al. did not find a significant difference in pulmonary complications between those patients who quit from 2–4 weeks before surgery and those who had smoked within 2 weeks before surgery.7It is beyond the scope of this letter to fully review this topic, but a recent meta-analysis of available studies, which as Katznelson and Beattie note are primarily observational and have significant limitations and potential biases, concluded that relatively brief preoperative abstinence from smoking (less than 8 weeks) does not increase pulmonary risk compared with continued smoking.8Indeed, we are not aware of any individual study that has found a statistically significant increase in pulmonary complications with brief preoperative abstinence, including the two initial studies by Warner et al . that were interpreted by some authors as raising concerns.9,10The conjectured mechanism responsible for increased risk is a transient increase in cough and sputum production after smoking cessation. However, there is no evidence that cough and sputum production actually increase after smoking cessation, either in an ambulatory population11or specifically in anesthetized patients.12It does seem clear that more prolonged abstinence from smoking is necessary to reduce the risk of pulmonary morbidity because it takes several weeks for the lungs to recover from the effects of smoking.13Thus, although more data would be welcome, we do not believe that there is any evidence to support the possibility that short-term smoking cessation increases pulmonary complications. It is very likely that the longer the duration of abstinence the better in terms of reducing risk of pulmonary and other complications. However, given the power of the teachable moment and the long-term benefits to health, anesthesiologists and others should seize any opportunity at any time to help their patients quit smoking, without fearing that brief preoperative abstinence could worsen outcome. The American Society of Anesthesiologists provides several tools to do so.*†Mayo Clinic, Rochester, Minnesota. warner.david@mayo.edu

Reliability of striatal [11C]raclopride binding in smokers wearing transdermal nicotine patches

In studies where [(11)C]raclopride (RAC) positron emission tomography (PET) is used to assess changes in striatal dopamine, it is important to control for cognitive states, such as drug craving, that could alter dopamine levels. In cigarette smokers, transdermal nicotine patches (TNP) can control nicotine craving, but the effects of nicotine patches on RAC binding are unknown. Thus, we sought to determine the test-retest reliability of RAC binding in the presence of nicotine patches. Eleven male smokers were scanned twice with RAC on separate days while wearing TNP. Across the striatum, test-retest variability was 7.63 ± 5.88; percent change in binding potential was 1.11 ± 9.83; and the intraclass correlation coefficient was 0.91 (p < 0.0001). Baseline RAC binding is highly reproducible in smokers wearing nicotine patches. This suggests that TNP are an acceptable method for controlling cigarette craving during studies that utilize RAC to examine changes in dopamine.

Manipulation of Cigarette Craving with Transcranial Magnetic Stimulation

Manipulation of Cigarette Craving with Transcranial Magnetic Stimulation

Emotional reactivity to emotional and smoking cues during smoking abstinence: potentiated startle and P300 suppression.

Negative affect is thought to be an important factor in the maintenance of cigarette smoking, and thus it is important to further develop objective measures of smoking-related emotional responses. Nonsmokers, non abstinent smokers, and abstinent smokers participated in a cue reactivity task where eyeblink startle amplitude and startle probe P300 (P3) suppression were measured during the presentation of emotional pictures.During unpleasant pictures, the amplitude of both measures was smaller in non abstinent smokers than in nonsmokers or abstinent smokers. P3 suppression, but not startle amplitude, was larger in abstinent smokers than in nonsmokers. Abstinence-induced increases in cigarette craving were associated with P3 suppression during tobacco-related pictures. Results suggest that tobacco abstinence increases emotional reactivity to unpleasant stimuli, which is consistent with negative reinforcement models of tobacco addiction.

Acute Effects of Aerobic Exercise and Hatha Yoga on Craving to Smoke

Recent studies have examined the effects of physical activity on craving to smoke and smoking withdrawal. The current study was designed to compare and contrast the effects of 2 different forms of physical activity on general and cue-elicited craving to smoke. Following 1-hr nicotine abstinence, 76 daily smokers were randomly assigned to engage in a 30-min bout of cardiovascular exercise (CE; brisk walk on a treadmill), Hatha yoga (HY), or a nonactivity control condition. Participants completed measures of craving and mood, and a smoking cue reactivity assessment, before, immediately following, and approximately 20 min after the physical activity or control conditions. Compared with the control condition, participants in each of the physical activity groups reported a decrease in craving to smoke, an increase in positive affect, and a decrease in negative affect. In addition, craving in response to smoking cues was specifically reduced among those who engaged in CE, whereas those who engaged in HY reported a general decrease in cravings. This study provides further support for the use of exercise bouts for attenuating cigarette cravings during temporary nicotine abstinence. Results also suggest that CE can attenuate cravings in response to smoking cues. There are several areas for further research that may improve integration of exercise within smoking cessation treatment.

A pilot study examining the acute effects of exercise on cigarette cravings and affect among individuals with serious mental illness

Objectives The present pilot study examined the acute effects of exercise on cravings, mood and affect in 14 persons with severe mental illness (SMI) who were receiving smoking cessation treatment. Method A randomized, within-subject design was used with three components: screening, 10-min passive sitting, and 10-min brisk walking. Measures of cravings, mood and affect were completed during the two testing sessions at pre-condition, mid-condition, 0-, 10- and 20-min post-condition. Results Majority of participants were female, and diagnosed with concurrent types of SMI. All participants reported using nicotine replacement therapy (NRT). Results from the ANCOVA indicated significant effects of the intervention on affect, with participants reporting feeling more pleasant during the brisk walking condition than the passive sitting condition. A significant main effect for time was also found for the activation component of affect, with participants reporting slightly greater activation immediately following (0-min post) the two conditions than 20-min post-condition. No significant effects were found for cravings or mood. Conclusions These findings demonstrate that short bouts of exercise can provide immediate benefit for individuals with SMI in terms of positive affective changes. Such bouts have minimal impact on cigarette cravings and withdrawal symptoms among individuals already receiving smoking cessation treatment. In terms of craving and mood disturbance, future research should examine if and how exercise can provide complementary assistance for quitters receiving NRT.

Acute effects of moderate intensity aerobic exercise on affective withdrawal symptoms and cravings among women smokers

A growing number of laboratory studies have shown that acute bouts of aerobic exercise favorably impact affect and cravings among smokers. However, randomized trials have generally shown exercise to have no favorable effect on smoking cessation or withdrawal symptoms during quit attempts. The purpose of the present study was to explore this apparent contradiction by assessing acute changes in affect and cravings immediately prior to and following each exercise and contact control session during an eight-week smoking cessation trial. Sixty previously low-active, healthy, female smokers were randomized to an eight-week program consisting of brief baseline smoking cessation counseling and the nicotine patch plus either three sessions/week of moderate intensity aerobic exercise or contact control. Findings revealed a favorable impact of exercise on acute changes in positive activated affect (i.e., energy), negative deactivated affect (i.e., tiredness), and cigarette cravings relative to contact control. However, effects dissipated from session to session. Results suggest that aerobic exercise has potential as a smoking cessation treatment, but that it must be engaged in frequently and consistently over time in order to derive benefits. Thus, it is not surprising that previous randomized controlled trials—in which adherence to exercise programs has generally been poor—have been unsuccessful in showing effects of aerobic exercise on smoking cessation outcomes.

Effects of contingency management and bupropion on cigarette smoking in smokers with schizophrenia

Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions. This proof-of-concept study investigated the feasibility and initial efficacy of combining a contingency management intervention with bupropion to reduce smoking in people with schizophrenia. Using a double-blind, placebo-controlled, between-groups design, 57 non-treatment-seeking participants were randomized to receive 300mg/day bupropion or placebo. One week later, participants were randomized to a contingency management (CM) intervention in which reductions in urinary cotinine levels were reinforced, or a non-contingent reinforcement (NR) condition in which session attendance was reinforced, regardless of cotinine level. Over the 22-day study period, participants visited the laboratory approximately three times per week to provide urine samples for analysis of cotinine levels, to give breath samples for analysis of carbon monoxide (CO) levels, and to report number of cigarettes smoked per day, nicotine withdrawal symptoms, cigarette craving, and psychiatric symptoms. Cotinine and CO levels significantly decreased during the study period in participants randomized to the CM condition, but not the NR condition. Bupropion did not reduce cotinine levels or increase the efficacy of CM. Cigarette craving and psychiatric symptom levels significantly decreased during the study in all groups. The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia.