BACKGROUND:Taking regular exercise, whether cardiovascular-type exercise or resistance exercise, may help people to give up smoking, particularly by reducing cigarette withdrawal symptoms and cravings, and by helping to manage weight gain. OBJECTIVES:To determine the effectiveness of exercise-based interventions alone, or combined with a smoking cessation programme, for achieving long-term smoking cessation, compared with a smoking cessation intervention alone or other non-exercise intervention. SEARCH METHODS:We searched the Cochrane Tobacco Addiction Group Specialised Register for studies, using the term 'exercise' or 'physical activity' in the title, abstract or keywords. The date of the most recent search was May 2019. SELECTION CRITERIA:We included randomised controlled trials that compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme alone or another non-exercise control group. Trials were required to recruit smokers wishing to quit or recent quitters, to assess abstinence as an outcome and have follow-up of at least six months. DATA COLLECTION AND ANALYSIS:We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison, as either smoking cessation or relapse prevention. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. MAIN RESULTS:We identified 24 eligible trials with a total of 7279 adult participants randomised. Two studies focused on relapse prevention among smokers who had recently stopped smoking, and the remaining 22 studies were concerned with smoking cessation for smokers who wished to quit. Eleven studies were with women only and one with men only. Most studies recruited fairly inactive people. Most of the trials employed supervised, group-based cardiovascular-type exercise supplemented by a home-based exercise programme and combined with a multi-session cognitive behavioural smoking cessation programme. The comparator in most cases was a multi-session cognitive behavioural smoking cessation programme alone. Overall, we judged two studies to be at low risk of bias, 11 at high risk of bias, and 11 at unclear risk of bias. Among the 21 studies analysed, we found low-certainty evidence, limited by potential publication bias and by imprecision, comparing the effect of exercise plus smoking cessation support with smoking cessation support alone on smoking cessation outcomes (RR 1.08, 95% CI 0.96 to 1.22; I2 = 0%; 6607 participants). We excluded one study from this analysis as smoking abstinence rates for the study groups were not reported. There was no evidence of subgroup differences according to the type of exercise promoted; the subgroups considered were: cardiovascular-type exercise alone (17 studies), resistance training alone (one study), combined cardiovascular-type and resistance exercise (one study) and type of exercise not specified (two studies). The results were not significantly altered when we excluded trials with high risk of bias, or those with special populations, or those where smoking cessation intervention support was not matched between the intervention and control arms. Among the two relapse prevention studies, we found very low-certainty evidence, limited by risk of bias and imprecision, that adding exercise to relapse prevention did not improve long-term abstinence compared with relapse prevention alone (RR 0.98, 95% CI 0.65 to 1.47; I2 = 0%; 453 participants). AUTHORS' CONCLUSIONS:There is no evidence that adding exercise to smoking cessation support improves abstinence compared with support alone, but the evidence is insufficient to assess whether there is a modest benefit. Estimates of treatment effect were of low or very low certainty, because of concerns about bias in the trials, imprecision and publication bias. Consequently, future trials may change these conclusions.

译文

背景:定期进行锻炼,无论是心血管运动还是抵抗运动,都可以帮助人们戒烟,特别是通过减少戒烟症状和渴望,以及帮助控制体重增加。
目的:与单独戒烟干预措施或其他非运动干预措施相比,要确定单独以运动为基础的干预措施或与戒烟计划相结合实现长期戒烟的有效性。
搜索方法:我们在标题,摘要或关键字中使用了“锻炼”或“体育活动”一词,搜索了Cochrane烟草成瘾小组的专门登记册以进行研究。最近一次搜索的日期是2019年5月。
选择标准:我们纳入了随机对照试验,将单独的锻炼计划或作为戒断计划的辅助手段的锻炼计划与单独的戒断计划或另一个非运动对照组进行比较。需要进行试验以招募希望戒烟或最近戒烟的吸烟者,以评估戒酒的结果,并进行至少六个月的随访。
数据收集与分析:我们遵循标准的Cochrane方法。至少六个月后,使用最严格的定义,以意图治疗为基础对戒烟进行了测量。在可能的情况下,我们为每个研究计算了戒烟的风险比(RRs)和95%置信区间(CIs)。我们根据比较类型将符合条件的研究分组,包括戒烟或预防复发。我们在适当的情况下使用Mantel-Haenszel随机效应模型进行了荟萃分析。
主要结果:我们鉴定了24项符合条件的试验,共有7279名成年受试者被随机分配。两项研究的重点是预防最近戒烟的吸烟者的复发,其余22项研究与希望戒烟的吸烟者戒烟有关。十一项研究仅针对女性,一项针对男性。大多数研究招募了相当不活跃的人。大多数试验采用有监督的,基于小组的心血管运动,并辅以基于家庭的运动计划,并与多阶段认知行为戒烟计划相结合。在大多数情况下,比较者仅是一个多阶段认知行为戒烟计划。总体而言,我们认为两项研究的偏倚风险较低,11的偏倚风险较高,11的偏倚风险尚不清楚。在分析的21项研究中,我们发现了不确定性证据,受限于潜在的出版偏倚和不精确性,比较了运动加戒烟支持与单独戒烟支持对戒烟结局的影响(RR 1.08,95%CI 0.96至1.22) ; I2 = 0%; 6607名参与者)。我们没有从这项分析中排除一项研究,因为未报告研究组的戒烟率。根据所促进的运动类型,没有亚组差异的证据。考虑的亚组为:单独的心血管运动(17项研究),单独的阻力训练(一项研究),心血管类型和阻力运动的组合运动(一项研究)和未指定的运动类型(两项研究)。当我们排除偏倚风险高的试验,特殊人群的试验或干预与对照组之间戒烟干预支持不匹配的试验时,结果没有明显改变。在这两项预防复发的研究中,我们发现,由于受到偏倚和不精确风险的限制,非常低的证据表明,与单纯预防复发相比,在预防复发中增加锻炼并不能改善长期禁欲(RR 0.98,95%CI 0.65。 1.47; I2 = 0%; 453位参与者)。
作者的结论:没有证据表明与单独戒烟相比,在戒烟支持中增加锻炼能提高戒酒的能力,但证据不足以评估是否有适度的益处。由于担心试验中的偏倚,不精确和发表偏倚,估计治疗效果的确定性很低或非常低。因此,将来的试验可能会改变这些结论。

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