The case for physical activity as an option in the smoking cessation guidelines: Short and long term benefits beyond expectation from regular exercise

Introduction: Physical activity is currently considered as a desirable behavior for smokers, but a guideline for smoking cessation has never offered it as an option. Objectives: This study is to see its feasibility by quantifying the short and long term beneficial effects from exercise by smokers. Methods: This cohort, consisting of 434190 individuals (23.2% smokers and 6.1% ex-smokers), went through standard medical surveillance program(s) from 1996 to 2008.History for smoking and physical activity was collected in the initial visit and subsequent visits. Exercise volume, expressed in MET·hour/week at each visit, classified each individual into inactive (< 3.75), low-active (3.75-7.49), or fully active (≥ 7.50) group. Fully active individuals met the current recommendation of 30 minute/day for 5 days or more per week. Hazard ratios (HR) were calculated with Cox model for mortality, adjusted for 10 confounders. Life expectancy was calculated using life table method. Results: Active smokers reduced all-cause mortality by 23%, and lengthened life expectancy by 4 years. Active smokers also reduced cancer by 14%, heart disease by 49% and stroke by 25%. Quit rate of active smokers improved by 55%-81%, and relapse rate reduced by 25%-30%. Active smokers had 55% increased quit rate. Smokers who quit and stayed active reduced mortality by 43% and gained 5.6 years in life expectancy. Conclusion(s): Guideline for smoking cessation should include physical activity as a viable option. Because exercise increased smoker’s quit rate and minimized ex-smoker’s relapse rate (in the short run) and reduced all-cause mortality and lengthened life expectancy by 4 years or more (in the long run). Not only much of the harms of smoking could be mitigated by regular exercise, exercise also provided overall benefits in extending smoker’s life expectancy not seen in current guidelines for smoking cessation treatment.