Though the mere title of this post is likely to spur calls of heresy, I believe this is a topic worthy of discussion. First, let's be clear - no one disagrees that quitting smoking permanently provides powerful lasting health benefits, including greater life expectancy and lower incidence of chronic cardiac and respiratory disease among other positive consequences. No one disagrees that stopping permanently is the number one way that smokers can improve their health – quite quickly and dramatically.
But let's be real – smoking cessation success rates are dismal. Somewhere between 4-7% of people who try to stop smoking on their own are successful in abstaining for one year or more. For those who receive cessation assistance through some combination of counseling, nicotine replacement therapy, and other treatments, success rates range from 15-33% abstinence for at least six months. Overall, Nicotine addiction is excruciatingly difficult to shake off – even the minority of smokers who are successful in stopping require 8-10 attempts before they finally break through. The Center for Disease Control reports that in a given year in the U.S. less than 5% of our 43 million current adult smokers successfully stop for 3-12 months!
So why then do many pulmonary rehabilitation programs routinely demand COPD patients enter into (or in some case, complete) a smoking cessation program prior to entry into their rehab programs? To me, they are shutting off access to a valuable treatment option for COPD smokers despite pulmonary rehab's strong success rates for reduced shortness of breath, improved physical conditioning and overall quality of life. I'm certain that many people either forgo the opportunity to enter a PR program because of the smoking cessation requirement or are denied entry because they won't commit to a cessation program.
Research has shown that exercise rehabilitation programs for smokers reduces lung function declines and reduces the risk of developing COPD. For example, see Garcia-Aymerich J, et al. Regular Physical Activity Modifies Smoking-related Lung Function Decline and Reduces Risk of Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2007 Mar 1; 175(5):458-63. Free full version of study results available here: http://ajrccm.atsjournals.org/cgi/reprint/175/5/458
Further, researchers in an article published this month regarding prescribing exercise for smokers noted, "Studies have shown that physical exercise helps reduce the intensity of some of the main symptoms that may arise when a smoker attempts to quit, yet doctors and sport therapists are generally unaware of this benefit and do not know how to prescribe exercise appropriately." Ayan, Perez C. Prescribing Exercise in Tobacco Smoking Cessation Therapy. Arch Bronconeumol.
2009 Nov; 45(11):556-60. (full study is available for free in Spanish but the free full text in English is not available yet).
Numerous other articles/studies reflect similar findings – regular exercise for smokers does generate positive respiratory function compared to smokers who don't exercise. And some researchers have demonstrated that exercise can actually improve smoking cessation success rates.
So why not enroll smokers into pulmonary rehab-style programs prior to attempting smoking cessation (whether they have COPD already or not)? The exercise will benefit them whether they give up smoking or not and it appears the effects of regular exercise may ultimately improve smoking cessation success.
What's for sure is that making a sizeable dent in the swelling tide of worldwide COPD cases will require innovative and provocative approaches to treatment as much as it will new pharmacotherapy research – prescribing pulmonary rehab prior to smoking cessation may be one such provocative step worth further investigation.
