Exercise to Enhance Smoking Cessation for Women at the YMCA
Exercise to Enhance Smoking Cessation for Women at the YMCA
Approximately 21% of women continue to smoke cigarettes despite the increased risk of cancer
 and cardiovascular disease associated with cigarette smoking. Exercise has been shown to be
 an efficacious treatment component in combating nicotine dependence, especially among women
 for whom concerns about weight gain during smoking cessation are an obstacle to successful
 quitting. In previous trials of women smokers, the investigators program of cognitive
 behavioral smoking cessation treatment (CBT) plus regular aerobic exercise was more
 efficacious than CBT plus equal contact time. Recognizing the program's successes, Commit to
 Quit (CTQ) was recently designated an Effective Program by the Substance Abuse and Mental
 Health Services Administration's (SAMHSA) National Registry of Effective Programs. Thus, the
 Commit to Quit program is well poised for a larger trial in a community setting where it has
 the potential to reach a large number of female smokers in a setting in which it can be
 sustained. In response to PA-03-126, Behavioral Therapies Development Program, the
 investigators propose a Stage III study in which they will conduct a trial to test the
 investigators CTQ smoking cessation program in the community setting of the local YMCAs. As
 stated in the PA, Stage III research is aimed at understanding if and how an efficacious
 therapy may be transported to the community. The investigators propose a randomized
 controlled clinical trial to take place in the YMCA setting and delivered by YMCA staff. The
 trial will compare CBT smoking cessation treatment plus a program of regular exercise to CBT
 smoking cessation treatment plus contact control. In order to promote transportability to the
 YMCA, the investigators will use the YMCA's existing Personal Fitness Program, which is
 similar to the investigators CTQ exercise program, in that it is guided by trained staff and
 requires participants to exercise 3 times per week. If the exercise condition is found to be
 more efficacious than contact control when delivered at the YMCA by YMCA staff, then the
 investigators will be well positioned to partner with the YMCA to pursue widespread, national
 dissemination of this program.
We propose a randomized controlled clinical trial to take place in the YMCA setting and to be
 delivered by YMCA staff. The trial will compare CBT smoking cessation treatment plus a
 program of regular exercise (CBT + EXERCISE) to CBT smoking cessation treatment plus an equal
 staff contact control (CBT + CONTACT). In order to promote transportability to the YMCA, the
 exercise program will be the YMCA's existing Personal Fitness Program, which like our CTQ
 exercise program, is guided by trained staff and requires participants to exercise at least 3
 times per week.

 If CBT + EXERCISE is found to be more efficacious than CBT + CONTACT when delivered at the
 YMCA by YMCA staff, then we will be well positioned to partner with the YMCA's initiative of
 Y Total Health to pursue widespread, national dissemination of this program. The proposed
 testing of the efficacy of the CTQ program in the YMCA setting is a necessary intermediate
 step in the eventual dissemination of the CTQ program.

 Primary Aim. To determine the efficacy of CBT + EXERCISE compared with CBT + CONTACT when
 delivered in the YMCAs by YMCA staff to enhance the achievement and maintenance (3, 6, and 12
 months follow-up) of smoking cessation (continuous abstinence) among healthy adult female
 smokers.

 Hypothesis. Participants in the CBT + EXERCISE condition will have significantly greater
 continuous abstinence rates than those in the CBT + CONTACT condition at end-of-treatment, 3,
 6, and 12 months follow-up.

 Additional Questions of Interest.

 1. To perform process-to-outcome analyses on the intermediate variables which influence the
 achievement and maintenance of smoking cessation among healthy female smokers. Specifically,
 to determine if exercise affects weight and/or weight concerns, negative affect associated
 with nicotine withdrawal, and/or self-efficacy and to determine if these hypothesized
 mediators affect the achievement and maintenance of smoking cessation.

 To explore potential moderators of the treatment, such as baseline demographic and
 psychological characteristics (e.g., age, baseline mood) on smoking cessation outcomes.
Inclusion Criteria:

 -  Healthy female smokers

 -  ages 18 - 65

 -  Read and write English

 -  Regularly smoke 5 or more cigarettes a day

 -  Sedentary, or not exercising greater than 20 minutes of vigorous exercise more than
 once a week or greater than 30 minutes of moderate exercise 2 times per week.

 Exclusion Criteria:

 -  known history of cardiovascular

 -  pulmonary or metabolic disease such as coronary artery disease, stroke, hypertension,
 chronic bronchitis, asthma, emphysema, and diabetes

 -  Any musculoskeletal problems that would limit exercise training such as knee or hip
 osteoarthritis or any other serious medical condition that might make exercise unsafe
 or unwise.

 -  The current use of smokeless tobacco, nicotine replacement therapy or other smoking
 cessation treatment, and currently using prescription medication that might impair
 exercise performance or tolerance, specifically beta-blockers or medications used for
 the treatment of hypertension

 -  Pregnant or planning to become pregnant within the next 12 months.

 -  Women hospitalized for a psychiatric disorder

 -  Receiving treatment for bipolar disorder or schizophrenia

 -  Current alcohol abuse or psychological problems when quitting in the past that
 required treatment