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By Angela Torry, BSHK, MSc, CSEP-CEP, Health Promotion Facilitator, Chronic Disease Prevention–Healthy Living, Alberta Health Services
Physical activity and healthy eating are often targeted as the key health behaviours in healthy living programming. Tobacco use is rarely discussed in physical activity programming. Find Your Stride is a new learn to walk/run program for individuals who use tobacco or have recently quit. This article provides some rationale and information about incorporating tobacco reduction promotion in healthy living programming.
Most of us are aware that an unhealthy diet, physical inactivity and tobacco use are key, modifiable risk factors associated with the major chronic diseases (e.g., cardiovascular disease, cancer, chronic obstructive pulmonary disease, and type 2 diabetes). An integrated risk factor approach to health promotion has been proposed as an effective intervention strategy for reducing modifiable risk factors1. In the field of health promotion, physical activity and healthy eating are typically promoted together, while tobacco use is often on its own. However, there is a growing interest in changing this.
Programs that combine tobacco cessation and physical activity participation are relatively new. As such, researchers are just starting to explore this area2. This article will explore and provide an overview of:
- tobacco use in Alberta,
- why physical activity and tobacco reduction should be promoted together,
- tobacco use, physical activity participation and stigma,
- highlights of an Alberta pilot program: Find Your Stride - a walk/run program for people who use tobacco, and
- what we can do as practitioners.
Tobacco Use in Alberta
In 2013, 16% of the population (514,000 Albertans) reported smoking, which is higher than the national average of 14.6% 3. In Alberta, smoking is higher among men (18.9%) than women (13.1%) 3.
Two thirds of people who currently smoke are seriously considering quitting in the next 6 months and 3 in 10 are considering quitting in the next month3. Personal health is the main reason people who smoke want to quit3. However, quitting is not easy. The body is physiologically addicted, making the withdrawal process very uncomfortable. Additionally, both emotional and psychological triggers can encourage a person to continue smoking.
Why Physical Activity and Tobacco Reduction Should be Promoted Together
There is growing evidence that physical activity can play a beneficial role for those who use tobacco and for those who wish to quit.
Physical activity can be a harm-reduction strategy.
A person, who uses tobacco and participates in regular physical activity, has a decreased risk of premature death and disease (including cancer) compared to a tobacco user who is not physically active4. It is well known that physical activity can improve cardiovascular, pulmonary and immune functions5. These benefits may partially counteract the negative effects of tobacco use in some individuals6.
Moderate levels of physical activity can reduce cravings and other withdrawal symptoms.
Changes in the body during and after physical activity can help control and manage nicotine cravings2, 6. This in turn can help support a person when they quit tobacco.
Physical activity may help with managing weight gain.
Many tobacco users are concerned about weight gain associated with tobacco cessation7. Weight gain often occurs during tobacco cessation and is typically due to dietary changes, diminished metabolism, decreased physical activity and changes with how the body stores lipids8. Regular and ongoing moderate to vigorous intensity physical activity can help limit weight gain associated with smoking cessation.
Tobacco Use, Physical Activity Participation and Stigma
Physical activity levels in Canada are poor, with only 15% of Canadians engaging in enough physical activity to receive health benefits9. It is speculated that physical activity levels are likely even lower in subsamples of Canadians who use tobacco10.
However, it may not be easy for tobacco users to become active. Anti-tobacco campaigns have de-normalized tobacco and have made the behaviour unappealing. Though this may discourage tobacco use, they have also led to stigmatization of individuals who do use tobacco11. Those who do use tobacco may have lower self-esteem, feel judged and feel social stigma, especially at places where they may not feel welcome12. Recreation centres, fitness classes, and sport or activity clubs may not be aware of the social stigma tobacco users experience. Therefore, it is important for this issue to be addressed.
Find Your Stride - a learn to walk/run program for people who use tobacco
In the fall of 2015, Alberta Health Services piloted Find Your Stride, an 8-week physical activity program that targets individuals who use tobacco or who have recently quit.
The goals of Find Your Stride are to:
- help individuals develop confidence and skills to become physically active, and
- become tobacco-free.
The Find Your Stride program is a non-traditional cessation program. Participants are provided with support to quit or reduce their tobacco-use throughout the program, although there is no expectation or requirement that participants quit. This approach created a welcoming, non-judgmental environment.
Find Your Stride was piloted in partnership with local health promotion departments, Primary Care Networks and recreation facilities. Evaluations will inform the direction and changes to the program. In spring 2016, Find Your Stride will be formally launched, whereby practitioners can access materials and support to deliver the program in their community.
Recommendations: What can we do?
Invite tobacco reduction to the health promotion table in physical activity and healthy eating initiatives.
- Ensure local physical activity opportunities are welcoming and accepting to those who use tobacco. Allow those who use tobacco to discuss their struggles with the addiction, without judgment, and help create a welcoming environment.
- When providing education on physical activity, consider including the benefits of tobacco reduction. You never know who may be using tobacco.
- Get comfortable talking about tobacco by engaging in the training opportunities offered through Alberta Quits (see links below).
- Seek out and partner with a local tobacco reduction expert. They are often found through your local public health office or through Alberta Quits.
Tobacco reduction programs can also consider integrating physical activity.
- Educate participants on the benefits of physical activity as a coping strategy to those attempting to quit or reduce their tobacco use.
- If programming offers counselling, consider walking or other forms of physical activity as part of your sessions.
- Find and partner with physical activity experts, who may be able to support your program. You can find them in local recreation or fitness centres, Primary Care Networks or local health promotion departments.
Finally, you can consider offering a program that promotes physical activity and also addresses tobacco reduction, such as Find Your Stride. Additionally, familiarize yourself with tobacco reduction resources and training available through Alberta Health Services.
By working together, physical activity and tobacco reduction practitioners and programs can help more Albertans see health benefits by becoming physically active and tobacco-free.
About the Author
Angela Torry works on the Chronic Disease Prevention team, within Alberta Health Services. Her current role focuses on the promotion of physical activity and reduction of sedentary behaviour across Alberta. She is currently project lead for Find Your Stride pilot program and can be reached at [email protected]
- World Health Organization [Internet]. Switzerland: World Health Organization; 2015. Integrated chronic disease prevention and control; 2015 [cited 26 November 2015]; [7 screens]. Available from: http://www.who.int/chp/about/integrated_cd/en/
- Ussher M, Taylor A, Faulkner G. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2014;1:CD002295.
- Reid JL, Hammond D, Rynard VL, Burkhalter R. Tobacco use in Canada: patterns and trends. 2015 ed. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo
- deRuiter W, Faulkner G. Tobacco harm reduction strategies: the case for physical activity. Nicotine & Tobacco Research. 2006;8(2):157-168.
- Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. Can Med Assoc J. 2006;174:801-809.
- Roberts V, Maddison R, Simpson C, Bullen C, Prapavessis H. The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review update and meta-analysis. Psychopharmacology. 2012;222(1):1-15.
- Levine M, Bush T, Magnusson B, Cheng Y, Chen X. Smoking-related weight concerns and obesity: differences among normal weight, overweight, and obese smokers using a telephone tobacco quitline. Nicotine & Tobacco Research. 2012;15(6):1136-1140.
- Filozof C, Fernadez Pinilla MC & Fernandex-Cruz A. Smoking cessation and weight gain. Obesity Reviews. 2004; 5(2):95-103.
- Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J. & Tremblay, M. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian health measures survey. Health Reports. 2011;22(1):7-14.
- Azagba S & Asbridge M. Nicotine dependence matters: Examining longitudinal association between smoking and physical activity among Canadian adults. Preventive Medicine. 2013;57(5).
- Bayer R, Stuber J. Tobacco control, stigma, and public health: rethinking the relations. Am J Public Health. 2006;96(1):47-50.
- McCool J, Hoek J, Edwards R, Thomson G, Gifford H. Crossing the smoking divide for young adults: expressions of stigma and identity among smokers and nonsmokers. Nicotine & Tobacco Research. 2012;15(2):552-556.
January 2016, Volume 27, No. 1
Click here for a print copy (4 pages, PDF)