Table 1.

Randomized-controlled trials investigating EX as an intervention in nicotine abuse/dependence.

First author, year	Sample characteristics	Study design, standard therapy	Exercise intervention (EX)	Control condition(s)	Outcome variables and findings Exercise > control condition	Comments
Hill (1985) [11]	- N = 36 untrained smokers (f, m) - >10 cig/day - Ethnicity not reported	- Duration: 5 weeks - Group counseling smoking cessation program (10 sessions)	- Duration: 5 weeks - 2 times/week - 30 min of supervised training + instruction to be as physically active as possible, esp., in case of craving - Aerobic EX (type and intensity not reported)	- Standard therapy	- Trend towards lower number of smoked cigarettes and higher percentage of abstinent patients (not significant) -Higher PA (self report) at the end of treatment and after 1, 3, 6 months	- Small N - Lack of equal contact time control - Lack of objective measurement of training effects - EX duration too short to improve fitness
Russell et al. (1988) [12]	- N = 42 - heavy smokers (f) - 23 ± 7 cig/day -Ethnicity not reported	- Duration: 1 + 9 weeks - behavioral smoking cessation program (4 × 1 h during first week) + 9 weeks of maintenance	- Duration: 9 weeks - 3 times/week (once supervised, twice alone) - 20–30 min of walking/jogging at 70–80% of max HR	- A: one 30-min educational meeting per week - B: one 30-min contact control meeting per week	- Abstinence rates comparable in all groups at end of treatment and after 3, 6, 18 months - No increase in fitness in EX group - Higher tension/anxiety in EX group after 6 months	- Small N - Purely female sample - EX compliance only assessed by self-report
Taylor et al. (1988) [13]	- N = 160 - inpatients (m), 10–14 days after acute myocardial infarction (N = 68 smokers) - Ethnicity not reported	- Treadmill EX testing	- Duration: 3–26 weeks - A: home EX training - B: medically supervised group EX - Type, frequency, duration, and intensity not reported	- Standard therapy	- No group differences concerning abstinence and relapse rates, but lower number of smoked cigarettes after 26 weeks in groups A and B - significant fitness increases in groups A and B	- Lack of clarity concerning type and intensity of EX intervention - Nonuniform training durations - No smoking cessation intervention - Special sample and high dropout rate due to cardiac events
Marcus et al. (1991) [14]	- Pilot study N = 20 untrained smokers (f) of >10 cig/day - Ethnicity not reported	- Duration: 4 weeks - 8 sessions of behavioral outpatient smoking cessation treatment	- Duration: 15 weeks - 3 times/week supervised training - 30–45 min aerobic training (walking, rowing, or cycle ergometry) at 70– 85% max HR - Beginning 3 weeks prior to smoking cessation program	- Standard therapy	- Significantly higher abstinence rates after 1, 3, and 12 months - Significant increases in fitness	- Very small N - Purely female sample - Lack of equal contact time control
Hill et al. (1993) [15]	- N = 82 heavy smokers (f, m) - ≥30 y of smoking, 28 ± 14 cig/day - Ethnicity not reported	- Duration: 12 weeks - 12 sessions of behavioral training	- Duration: 12 weeks - Weeks 1–4 : 3 times/ week - Weeks 5–8 : 2 times/ week - Weeks 9–12 : once a week + instruction for individual training - 45 min of walking at 60–70% of HR-R - A: EX + behavioral training - B: EX alone	- C: standard therapy - D: standard therapy + NRT	- Significantly higher abstinence rates in groups with behavioral training (A, C, D) - Trend towards higher abstinence in regular versus nonregular walkers within group B	- Low compliance concerning EX program - Lack of objective measurement of training effects - Lack of blinding: therapists = investigator in each group
Marcus et al. (1995) [16]	- N = 20 untrained smokers (f) 8–40 cig/day - Ethnicity not reported	- Duration: 12 weeks - 12 sessions of behavioral smoking cessation program	- (As in [12]) Duration: 15 weeks - 3 times/ week supervised training - 30–45 min aerobic training (walking, rowing, or cycle ergometry) at 70– 85% max HR - Beginning 3 weeks prior to smoking cessation program	- One 30-min educational meeting per week (12 sessions, same contact time)	- Descriptively increased 7-day abstinence at end of therapy and at 1–3 month followup - Significant fitness gains at end of treatment	- Very small N - Purely female sample - No statistical data analysis
Martin et al. (1997) [17]	- N = 205 smokers of > 10 cig/day (f, m) with history of alcohol dependence (≥3 months of alcohol abstinence) - Sample > 90% Caucasian	- Duration: 8 weeks - CBT smoking cessation program or standard ALA intervention + “Nicotine Anonymous” meetings	- CBT counseling + EX ACSM-based EX prescriptions given during last week of CBT: engaging in 3 times of 15– 45 min walking per week and using the laboratory EX equipment	- A: CBT counseling + NRT (2–12 mg/day) - B: standard ALA intervention + “Nicotine Anonymous” meetings	- Significantly higher validated abstinence rates posttreatment (not maintained at 6- or 12-month followup) - Relapse rates for alcohol/drugs not significantly different between groups	- Late implementation of EX program - EX training not supervised - Lack of objective measurement of training effects
Marcus et al. (1999) [18]	- N = 281 untrained smokers (f) - 23 ± 10 cig/day - Ethnicity not reported	- Duration: 12 weeks - 12 sessions of behavioral smoking cessation program	- Duration: 12 weeks - 3 times/week supervised training - 30–45 min aerobic training (walking, rowing, or cycle ergometry) at 60– 85% HR-R - Beginning 3 weeks prior to smoking cessation program	- One 30-min educational meeting per week (12 sessions, same contact time)	- Higher abstinence rates at all postquit time points (8, 20, 60 weeks) - Lower weight gain at end of treatment (not maintained at followup) - Significant fitness gains	- Purely female sample - Significant group differences in initial body weight (EX > control)
Bock et al. (1999) [19]	- Two subsamples of [18] - N = 62 untrained smokers (f) - Sample > 90% White	- As in [18]	- As in [18]	- As in [18]	- Significant positive acute effects of EX on mood, craving, and withdrawal symptoms (comparison prepost EX sessions) - No significant long-term effects of EX on mood	- Purely female sample - Unequal group sizes (44 : 18) - Only comarisons at baseline and 12 weeks, no time course reported - No between-group comparison reported, but paired t-tests within groups
Ussher et al. (2003) [20]	- N = 299 untrained smokers (f, m) - 22 ± 9 cig/day - Predominantly white sample (88%)	- Duration: 6 weeks - NRT (15 mg/day) + one weekly CBT group session	- EX counseling: prescription of 5–30 min of EX on ≥5 days per week - EX recommended as self-control strategy	- Health education advice (same contact time)	- Significantly higher abstinence rates after 1 and 2 weeks (no difference after 3, 4, 6 weeks) - Reductions in tension, stress, irritability, restlessness 1 week after end of treatment (partly maintained throughout followup) - Significantly higher self-reported PA at 1, 4, 6 weeks postquit No differences concerning weight gain	- No objective measurement of EX adherence or training effects
Marcus et al. (2005) [21]	- N = 217 untrained smokers (f) - 21 ± 9 cig/day - Predominantly white sample (82.5%)	- Duration: 8 weeks - CBT smoking cessation program (8 sessions) +NRT as necessary	- Duration: 8 weeks - once per week: supervised training + prescription to individually train 4 times/week - 30–45 min aerobic training at 50–69% max HR - (resulting in 165 min/week of moderate intensity training) - Beginning 1 week prior to quit day	- Health education advice (same contact time)	- No differences in continuous abstinence or 7-day point prevalence of smoking at posttreatment, and 6 or 12 months followup, except for 7-day point prevalence of smoking at 6-month followup - (EX > control), BUT amount of EX = significant predictor for abstinence - Significant fitness gains - No differences concerning weight gain	- Inclusion of light smokers (≥5 Zig/Tag) - Extremely low abstinence rates in whole sample (<1% after 12 months)
Prapavessis et al. (2007) [22]	- N = 142 untrained smokers (f) - >10 cig/day - Ethnicity not reported	- Duration: 12 weeks - Comparison of CBT and EX, each with and without NRT	- Duration: 12 weeks - 3 times/week supervised training - 45 min aerobic training (walking, rowing, or cycle ergometry) at 60–75% HR-R - Beginning 6 weeks prior to quit day - A: with NRT - B: without NRT	- C: CBT with NRT - D: CBT without NRT	- No significant differences in abstinence rates after 3 and 12 months - Short-term improvement of abstinence up to 6 weeks by nicotine replacement (both in EX and CBT) - Significant fitness gains after 12 weeks (back to baseline at 12-month followup) - Delayed weight gain in EX conditions at end of treatment	- Relatively low abstinence rates in all groups after 3 and 12 months
Chaney and Sheriff (2008) [23]	- N = 101 smokers (f) - (amount of smoking not reported) - Ethnicity not reported	- Duration: 8 weeks - 1 h/week of behavioral counseling and social support+ NRT	- Duration: 8 Wo - ≥3 times/week - 30 min of circuit training (mixed aerobic/anaerobic) in women's gym	- Standard therapy	- Significantly higher abstinence rates at end of treatment - Significantly lower weight gain	- High drop-out rate - No validation of self-reported smoking - No objective measurement of training effects - No follow-up data reported
Kinnunen et al. (2008) [24]	- N = 182 untrained smokers (f) - 19 ± 8 cig/day - Predominantly white sample (81.5%)	- Duration: 19 weeks - 8 brief (10 min) weekly CBT counseling sessions + NRT	- Duration: 19 weeks - Week 1–5: twice a week - Week 6–19: once a week - 30 min of supervised aerobic training (treadmill) at 60–80% max HR - Beginning 3 weeks prior to quit day	- A: standard therapy (CBT counseling) - B: standard therapy (CBT counseling) + health education (same contact time)	- Trend towards higher abstinence rates in EX and control group A at end of treatment and 12 month follow-up - Advantage of EX and control group A in preventing early relapse (at 1 week) - Significant fitness increases in all groups	- High drop-out rate (only 55/182 completed treatment - High relapse rates - No selective training effect in EX group
Prochaska et al. (2008) [25]	- N = 407 - smokers (f, m) - 19 ± 8 cig/day - Mixed sample (71% Caucasian)	- Identical treatment for 12 weeks: - NRT + bupropion (2 × 150 mg/day) + 5 group-based smoking cessation sessions	- Weeks 14–16: baseline PA measurement (pedometer) - Week 16–52: relapse prevention program including two counseling sessions (at week 16 and 20) to increase steps 10% biweekly towards 10.000 steps/day - A: standard therapy + 40 weeks EX - B: standard therapy + 40 weeks EX + another 40 weeks of bupropion - C: standard therapy + 40 weeks EX + 40 weeks of placebo	- D: standard therapy without further intervention - E: standard therapy + another 40 weeks of bupropion - F: standard therapy + 40 weeks of placebo	- Increase in PA-predicted abstinence in week 24 - Significant increase in PA in groups A-C compared to groups D–F	- Group differences in terms of abstinence not reported - Relapse prevention program was no pure EX intervention (included motivational aspects, social support, mood, and weight regulation) → no adequate control group - PA increases partly due to group differences in baseline PA (D–F > A–C) - Pedometer data available from only 15% of subjects - No intention-to-treat analysis - No objective measurement of fitness gains
Williams et al. (2010) [26]	- Pilot study: N = 60 untrained smokers (f) - >5 cig/day - Sample 85% nonhispanic white	- Duration: 8 weeks - Smoking cessation program with brief (15–20 min) counseling sessions + NRT	- Duration: 8 weeks - 3 times/week - 50 min of aerobic training (treadmill) up to 70% of max HR - minimal interaction with groups members and staff	- Wellness videos (3 times/week30 min) - minimal interaction with groups members and staff	- Trend towards higher prolonged abstinence and lower 7-day point prevalence at posttreatment - No significant group differences with regard to withdrawal symptoms, affect, and weight gain - Correlation of abstinence rates and attended EX sessions - Subjects with high self-efficacy more likely to benefit from EX	- Small N, but high compliance - Changes in fitness not reported - EX behavior was not maintained after end of treatment
Vickers et al. (2009) [27]	- N = 60 untrained smokers (f) with current depression - 21 ± 8 cig/day - Almost purely white sample	- Duration: 10 weeks - Behavioral counseling for smoking cessation (10 min/week) + NRT (21 mg/day)	- Duration: 10 weeks - 30 min of CBT-based EX counseling once per week, aiming at increasing PA to 30 min/day on ≥ 5 days/week and using EX to overcome acute craving	- 30 min of general health counseling once per week (same contact time)	No group differences with regard to abstinence, mood, and depression More PA reported in EX group, but no changes in fitness measures - Significant weight gain only in EX group (!)	- Concurrent treatment with different medication and psychotherapy for depression - No direct group comparisons reported (just within pre-post differences)

ALA: American Lung Association, CBT: cognitive-behavioral therapy, cig: cigarettes, EX: exercise, f: female, h: hour(s), HR: heart rate, HR-R: heart rate reserve, m: male, max HR: maximum heart rate, min: minutes, N: sample size, NRT: nicotine replacement therapy, PA: physical activity.