Exercise and Counseling for Smoking Cessation in Smokers With Depressive Symptoms: A Randomized Controlled Pilot Trial

Abstract

Objective: Despite various strategies to help smokers with depressive disorders to quit, the smoking relapse rate remains high. The purpose of this pilot study was to estimate the effects of adding an exercise and counseling intervention to standard smoking cessation treatment for smokers with depressive disorders. We hypothesized that the exercise and counseling intervention would lead to improved abstinence, reduced depressive symptoms, and increased physical activity. Methods: Seventy smokers with current depressive disorders were randomly assigned to standard smoking cessation treatment plus exercise and counseling (n = 35) or standard treatment plus a time-to-contact control intervention on health education (n = 35). Both programs involved 10 sessions over 8 weeks. The primary outcome was continuous abstinence since the quit date and was measured at week 8 (end of the intervention) and again at 12-, 24-, and 52-week follow-ups. Results: Nearly 60% of participants were female (n = 41), 38 (52.3%) were single, 37 (52.9%) had education beyond high school, and 32 (45.7%) met criteria for major depressive disorder or dysthymia. Participants in the two treatment conditions differed at baseline only in marital status (χ² = 4.28, df = 1, p =.04); and smoking abstinence self-efficacy, t(66) = -2.04, p =.04). The dropout rate did not differ significantly between groups and participants attended 82% and 75% of the intervention and control sessions, respectively. Intention-to-treat analysis showed that, at 12 weeks after the beginning of the intervention, continuous abstinence did not vary significantly between the intervention and control groups: 48.5% versus 28.5%, respectively, OR_adj = 0.40, 95% CI [0.12–1.29], p =.12. There were no group differences in depressive symptoms, but the intervention group did outperform the control group on the 6-minute walking test (M_int = 624.84, SD = 8.17, vs. M_con = 594.13, SD = 8.96, p =.015) and perceived physical control (M_int = 2.84, SD = 0.16, vs. M_con = 2.27, SD = 0.18, p =.028). The sample was not large enough to ensure adequate statistical power. Conclusions: This finding, while preliminary, suggests that an exercise and counseling intervention may yield better results than health education in improving smoking abstinence. This study is registered at www.clinincaltrials.gov under # NCT01401569.

Keywords:

• exercise
• counseling
• smoking cessation
• depression
• physical activity
• sedentary
• behavioral change techniques

ACKNOWLEDGMENTS

The authors wish to express their gratitude to all the members of the Respiratory Medicine team at the University Hospital of Montpellier for their assistance, and to Gautier Filhol and Mathieu Artigusse in particular.

DISCLOSURES

Pr Quantin received research funds and served on the scientific board of Lilly, Bohringer, Roche, and Pfizer. Pr Courtet has received grants and served as consultant or speaker for the following entities: AstraZeneca, Roche, Servier, Bristol-Myers Squibb, Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Sanofi-Aventis, and Servier. Dr. Guillaume has received compensation as a consultant for AstraZeneca, Bristol-Myers Squibb, Lundbeck, Otsuka, Servier, and Janssen Cilag. These companies manufacture and/or distribute some antidepressant, mood stabilizer, and/or antipsychotic medications. Drs. Bernard, Cyprien, and Georgescu have no conflict of interest. Pr Ninot and Taylor have no conflict of interest.

FUNDING

This work was supported by the University Hospital of Montpellier (AOI 2009) and French Committee against Respiratory Diseases.