Huffing and Puffing
Tuesday, January 3, 2006
My patient Neal Johnston, 66 followed my clinical advice and regularly ran on his treadmill. At the same time, he ignored my advice to stop smoking. Though he had a history of heart disease and emphysema, he would run almost every day with a cigarette dangling from his mouth.
I tried various established methods to help him quit: the antidepressant medication Wellbutrin, which decreases cravings; the nicotine patch; and hypnosis. Of course, I also subjected him to regular lectures about the dangers of smoking and the benefits of quitting. Nothing worked.
Johnston's vigorous physical activity was unusual for a smoker, a group that studies have shown engages in little exercise and generally has poorer sleeping and eating habits than the general population. Smokers' poor lifestyles, in addition to the toxins in the smoke, are co-factors in their poor health outcomes, which include increased risk of cardiovascular disease, emphysema, lung and other cancers, and premature death.
But it turns out that, by running and smoking, Neal was doing more than acting in a paradoxical fashion. Smokers who exercise reduce some of the harms that smoking causes -- and working out may, preliminary research suggests, help them quit.
Last year a study in the journal Cancer Epidemiology, Biomarkers & Prevention looked at 7,000 current and former smokers and found a marked reduction in cancer occurrence and mortality in those who exercised regularly and vigorously, even among current smokers. For example, there was a 25 percent reduction in cancer deaths in the 54- to 62-year-old smokers who followed a workout program compared to those who did not exercise. The study is among several that shows exercise has a positive effect even in heavy smokers.
A third of all smokers engage in physical activity at least three times a week, according to the 2003 National Health Interview study conducted by the Centers for Disease Control and Prevention (CDC). That's less than the 41 percent of nonsmokers who exercise regularly. (The CDC reported in 2003 that 22 percent of the population smokes.)
Exercise can help protect against some cancers simply by regulating a person's weight. High caloric intake combined with low energy output in non-exercising smokers can lead to obesity, as it can in nonsmokers. This in turn increases smokers' already elevated risk of cancers of the colon and rectum, prostate, endometrium, kidney and, among post-menopausal women, the breast.
Smokers who exercise also tend to eat better than smokers who don't, as a 2004 Virginia Commonwealth University study emphasized. Improved diet is among the recommendations the American Cancer Society makes for reducing cancer risk. These guidelines advocate a diet rich in fruit, vegetables, grains and beans, and low in meat, dairy products and other high-fat foods.
In fact, studies indicate that certain micronutrients found in fruit and vegetables may protect smokers against the toxic effects of tobacco smoke. According to the New York Academy of Sciences, a variety of nutritional agents, including antioxidant vitamins, appears to reduce or inhibit the cancer-causing properties of cigarette smoke.
Oh, Quit It
So exercise and its often related dietary behaviors can reduce some of the health risks smokers bring on themselves. But can these good habits also promote quitting?
The answer appears to be a qualified yes.
Exercise releases euphoria-inducing endorphins, chemicals that may help break the hold that smoking has on a person. The antidepressant Wellbutrin has a comparable effect when it increases dopamine and noradrenaline in the brain. The regular presence of one of the body's "happy hormones" may similarly decrease the desire for a dangerous stimulant like nicotine.