Every year, over two thirds of U.S. current smokers express a desire to permanently quit. Yet despite this broad desire, only about 40% actually try to quit in any given year and of this 40% who attempt to quit less than 10% are ultimately successful in abstaining from cigarettes for more than six months even with the most effective of treatment options. In fact according to research findings it takes the average smoker up to ten attempts to finally kick the habit permanently.
People who attempt to quit on their own without any medical assistance are the least successful with low single digit success rates. Those who combine long-term counseling with nicotine replacement therapy tend to be the most successful with between 8-17% success rates although some of these reported success rates seem dubious because many rely primarily on self-reported abstinence confirmation versus chemical verification.
Pharmaceutical companies pour many millions of dollars into research each year to find new drugs to boost success rates but so far no major breakthrough. Alarmingly though, a number of the newer pharmaceuticals prescribed by doctors for smoking cessation (anti-depressants) have received Food and Drug Administration warnings for some pretty scary side effects. Meanwhile many other companies tout all manner of other products or services to aid in boosting cessation rates ranging from hypnosis to acupuncture to electronic cigarettes (but with little success in moving the needle).
It is a reminder of how addictive nicotine can be and of how challenging it can be to eliminate a long-term habit.
So what’s a smoker to do?
Well, a simple answer that might just double your odds of success and produce positive side effects versus negative ones is…exercise. Seems hard to believe doesn’t it? Not much research has been done on combining exercise with smoking cessation but the research that has been done has shown some promise. Why is exercise a possible valuable addition to a smoking cessation program? According to the exercise researchers, exercise has been shown in other research to improve mood, assist in weight loss and reduce cravings – all three big-time cigarette smoking withdrawal symptoms.
As a case in point, a new study was published online ahead of print last month in the journal Nicotine & Tobacco Research that demonstrated that study subjects undergoing a 12-week resistance training program (weight lifting) boosted abstinence at 3-month and 6-month follow-up checkpoints by 100% over study subjects who did not exercise during the study. Both the control and resistance training groups received one 15-20 minute smoking cessation counseling session and both groups received nicotine patches during the study period so the only differentiating variable between the two groups was the resistance training program. The absolute abstinence success rate for the resistance training group was 15-16% at both the 3-month and 6-month follow-up checkpoints compared to 8% at both time intervals for the control group. These abstinence results were determined by both self-reported questionnaires and by chemical analysis of each subject’s carbon monoxide levels. [1]
The 12-week resistance training program followed by the exercise group was described the researchers as follows, “Participants engaged in two 60-min RT sessions/week for 12 weeks. The full-body routine (ACSM, 2009b), involved 10 exercises, with set intensity and volume adjusted every 3 weeks. For the first 3 weeks, participants completed one set (10 repetitions) of each exercise at 65%–75% of their estimat¬ed maximal strength. From weeks 4–12, participants complet¬ed two sets per exercise. Weight was systematically increased by a researcher to match gains in strength and maintain inten¬sity at weeks 7–10. Researchers monitored exercise for safety, interactions were minimized, and smoking was not discussed. Participants exercised alone and could attend up to three ses¬sions/week to make up for one missed session in the prior week, with no more than one session/day. All were asked not to engage in RT beyond the supervised sessions or change their other exercise.”
To be fair, the study population was small (25 total subjects) and only 50% of the subjects participated all the way through to the 6-month follow-up checkpoint. So one might argue the success rates of both approaches were actually lower if all subjects were tracked the full way through. That said, those engaged in a resistance training program who did make it all the way through this novel study (novel because it examined resistance training versus aerobic training in conjunction with smoking cessation) did achieve higher abstinence, greater weight loss and lower body fat measurements than the control group.
Other studies probing the addition of an exercise component to a smoking cessation program have also shown promise. In one such 2010 study, researchers found 34% of women participating in the study who participated in a 150 minute per week moderate intensity aerobic exercise program achieved chemically verified abstinence at 6-month follow-up compared to 20% for the control group. In this study, both groups also received one smoking cessation counseling session and nicotine patches for the duration of the study. [2]
In yet another 2010 study examining the effect of either high-intensity (running) or moderate intensity (walking) aerobic exercise on craving to smoke, researchers reported, “Significant group x time interactions were identified, demonstrating significant reductions in craving items after the walking and running conditions compared with the passive control. No significant differences in craving reductions were found between walking and running conditions. Post hoc comparisons found that running condition cravings to smoke scores were reduced for a longer duration post-treatment than post-walking condition scores. The decline in cortisol concentration was attenuated in the running group only. Vigorous exercise has a similar effect to moderate exercise in terms of the magnitude of craving reduction. However, performing bouts of moderate-intensity exercise may be a better recommendation for reducing cravings.” [3]
It therefore seems that adding an exercise program (resistance training and/or aerobic training) to a smoking cessation attempt is worthy of your consideration. Not only might exercise improve your odds of kicking the habit permanently, it has also been shown to notably improve heart rate variability (a risk factor in cardiovascular disease), reduce the risk of lung cancer, and reduce chronic shortness of breath – even among smokers who continue to light up!
For smokers interested in experimenting with an exercise program but who aren’t sure where to start or what specific exercises to do, we have three suggestions for your consideration. First, consider asking your doctor to recommend a specific exercise program. Alternatively, consider visiting a local fitness center and ask to speak to a certified fitness instructor. Associations such as the American College of Sports Medicine create recommended exercise protocols for different health conditions and a fitness instructor should be able to help construct one appropriate for you. They will likely charge for their services but most provide an initial consultation free of charge.
If neither of those options appeals to you, I created the Breathe Better for Life guidebook and companion CD-ROM to assist people with poor respiratory health (smokers and people with lung disease) access the principles and practices of the respiratory medical treatment pulmonary rehabilitation. This treatment option combines aerobic exercise, resistance training, breathing technique training, airway clearing technique training and guidance on other respiratory related topics.
In the Breathe Better for Life guide/CD, I developed an exercise program based on guidelines established by the American Thoracic Society, European Respiratory Society and the American College of Sports Medicine to assist people with poor respiratory health start and maintain an aerobic and resistance training program if they cannot access such a program elsewhere. The CD provides narrated, pictorial step-by-step instructions for the specific resistance training exercises in addition to many other valuable education elements geared to help improve one’s ability to breathe. Click here to learn more about Breathe Better for Life.
Regardless of what exercise program you choose, it is always advisable to review the program prior to starting with your physician to ensure it is appropriate for your particular health status.
[1] Ciccolo JT, et al. Resistance Training as an Aid to Standard Smoking Cessation Treatment: A Pilot Study. Nicotine & Tobacco Research. April 18, 2011 [Epub ahead of print].
[2] Williams DM, et al. Moderate intensity exercise as an adjunct to standard smoking cessation treatment for women: a pilot study. Psychol Addict Behav. 2010 June:; 24(2): 349-354.
[3] Scerbo F, et al. Effects of exercise on cravings to smoke: the role of exercise intensity and cortisol. J Sports Sci. 2010 Jan;28(1):11-9.
Wednesday, May 18, 2011
Friday, May 6, 2011
Antioxidants for oxidative stress in COPD patients revisited
Regular readers of our Breathe Better for Life e-letters and Breathe Better Blog are well aware we are strong advocates of antioxidants for people with chronic shortness of breath. Our perspective - we view antioxidants as an excellent addition to a regular exercise program, a Mediterranean-style diet and smoking cessation to reduce inflammation and oxidative stress.
We do not believe that antioxidants will cure, reverse lung disease or improve lung function. However, there is substantial and growing evidence that oxidative stress (an imbalance in damaging pro-oxidant molecules known as free radicals and protective anti-oxidant molecules) is a key contributing factor to the sensation of breathlessness and that most COPD patients are significantly deficient in antioxidants compared to those without persistent shortness of breath.
We are not alone in this belief as a new research paper echoes many of our sentiments. This research review article, published in the journal Current Drug Targets, examines the role of oxidative stress in COPD and the potential of antioxidants as a supportive therapy. In fairness to the review authors, they acknowledge that while antioxidant therapy seems a key area for further exploration there are conflicting study results on the effectiveness of antioxidants for COPD patients. Further, they acknowledge there are few definitive guidelines regarding the optimum human daily dosages for the most promising antioxidants. [1]
Still we’re concerned that it will be decades before enough researchers and practitioners determine these criteria to their own satisfaction. Meanwhile, millions of COPD patients will not learn of the potential benefits that have already been reported in peer reviewed published research for over the past decade.
So, we thought it would be helpful to share some snippets of this research review paper so that readers have access to the emerging potential of antioxidants as a supporting therapy to other traditional COPD treatments.
First, some observations about oxidative stress and COPD offered in the paper’s introduction, “The lung is the organ with the highest exposure to ambient air in the entire human architecture. Due to its large surface area and blood supply, the lung is susceptible to oxidative injury in the form of myriads of reactive oxygen species (ROS) and free radicals. ROS may be produced endogenously by metabolic reactions or have exogenous origins, such as air pollutants or cigarette smoke. Airborne pollutants may result in direct lung damage as well as in activation of inflammatory responses in the lungs. Tobacco smoke is a mixture of over 4700 chemical compounds, including high concentrations of oxidants. Inflammatory cells recruited in airspaces become activated and generate ROS in response to appropriate stimuli.”
“Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease which is characterized by an abnormal inflammatory response of the lungs to external stimuli, the most common being tobacco smoke. This abnormal inflammatory response is attributed to many underlying pathophysiologic mechanisms and one of the most important is the imbalance of oxidative stress and antioxidant defenses.”
For a layman’s understanding of the above process, we recommend readers check out our War of the Worlds in Your Lungs article.
Regarding antioxidants, the review authors explain, “In order to provide defense against the oxidative burden, the lungs produce various endogenous agents called antioxidants. The antioxidant species help the lungs ward off the deleterious consequences of a wide variety of oxidants/reactive oxygen species and reactive nitrogen species, either of endogenous or environmental origin. The major nonenzymatic antioxidants of the lungs are glutathione, vitamins C and E, beta-carotene, uric acid, whereas the major enzymatic antioxidants are superoxide dismutases, catalases and peroxidases. These antioxidants are the first lines of defense against oxidants and usually act at a gross level.”
As a side note, the most powerful of these antioxidants is glutathione. That said the human body does not absorb glutathione well when administered directly. Our bodies are much better at producing our own glutathione when we are provided precursors of the antioxidant. The most effective precursor in assisting the body’s production of glutathione is N-Acetyl Cysteine (NAC).
“Oxidative stress is intimately associated with the progression and the development of exacerbations in COPD. A rational approach for the treatment of COPD would therefore be to consider antioxidant intervention not only aiming to neutralize the increased oxidative stress and the subsequent inflammatory response, but also in an attempt to identify the source of oxidants and overwhelm their generation. This can be achieved through two approaches, either by increasing the endogenous antioxidant enzyme defences or by enhancing the non-enzymatic defences through dietary or pharmacological means. To date, however, most clinical trials of antioxidants for COPD have yielded conflicting or disappointing results.”
Despite these conflicting and disappointing results, however, the study authors conclude, “There is now solid evidence for the role of oxidative stress in the development and evolution of COPD. Several biomarkers of oxidative stress have been evaluated by invasive and non-invasive means in patients with COPD. However, further standardization of methods is imperative for the application of such biomarkers in clinical practice. An effective wide-spectrum antioxidant therapy with bioavailability is urgently needed to control the local and systemic oxidative burst in COPD. In that direction, several antioxidant agents have been evaluated as potential candidates for the management of COPD. However, despite some encouraging results, clinical trials so far have failed to elaborately define the type of antioxidant, the regimen and the time period of treatment that may improve clinically meaningful outcomes in patients with COPD. This may be largely due to the incomplete understanding of the pathophysiology of COPD and the differences within COPD phenotypes. Moreover, some of the antioxidants may not reach the correct cellular/tissue compartment where the oxidative damage is taking place. Well-designed clinical trials investigating the potential role of new antioxidants and combinations of antioxidants with existing anti-inflammatory agents may provide new insights in COPD management."
So the takeaway – not enough evidence yet to satisfy researchers and practitioners regarding efficacy and not enough clear guidance on dosages, but clearly an area that will receive great attention in the future due to the unambiguous connection between shortness of breath, inflammation and oxidative stress.
By the way, the antioxidants with most encouraging study results highlighted by the authors:
• N-Acetyl Cysteine
• Resveratrol
• Curcumin
• Vitamin C
• Vitamin E
• Beta Carotene
Attentive readers will note the above mentioned antioxidants, with the exception of Beta Carotene, are key ingredients of our Resplenish anti-oxidant respiratory support dietary supplement. We’ve further bolstered the formula with other antioxidants that have recently demonstrated promising results in respiratory health studies (including Vitamin D, Quercetin, Coenzyme Q10 and Baicalin). If you are interested to learn more about Resplenish, click here.
Whether our Resplenish supplement is of interest to you or not, we recommend you consider bolstering your daily diet with an antioxidant rich dietary supplement and antioxidant rich foods. While it’s true there is no “gold-standard” when it comes to antioxidant dosages for respiratory health it is also true and undeniable that the primary weapons at the disposal of physicians to combat oxidative stress are the natural agents our bodies already use and/or produce – antioxidants.
[1] Loukides S, et al. Oxidative Stress in Patients with COPD. Current Drug Targets. 2011; 12: 469-477.
We do not believe that antioxidants will cure, reverse lung disease or improve lung function. However, there is substantial and growing evidence that oxidative stress (an imbalance in damaging pro-oxidant molecules known as free radicals and protective anti-oxidant molecules) is a key contributing factor to the sensation of breathlessness and that most COPD patients are significantly deficient in antioxidants compared to those without persistent shortness of breath.
We are not alone in this belief as a new research paper echoes many of our sentiments. This research review article, published in the journal Current Drug Targets, examines the role of oxidative stress in COPD and the potential of antioxidants as a supportive therapy. In fairness to the review authors, they acknowledge that while antioxidant therapy seems a key area for further exploration there are conflicting study results on the effectiveness of antioxidants for COPD patients. Further, they acknowledge there are few definitive guidelines regarding the optimum human daily dosages for the most promising antioxidants. [1]
Still we’re concerned that it will be decades before enough researchers and practitioners determine these criteria to their own satisfaction. Meanwhile, millions of COPD patients will not learn of the potential benefits that have already been reported in peer reviewed published research for over the past decade.
So, we thought it would be helpful to share some snippets of this research review paper so that readers have access to the emerging potential of antioxidants as a supporting therapy to other traditional COPD treatments.
First, some observations about oxidative stress and COPD offered in the paper’s introduction, “The lung is the organ with the highest exposure to ambient air in the entire human architecture. Due to its large surface area and blood supply, the lung is susceptible to oxidative injury in the form of myriads of reactive oxygen species (ROS) and free radicals. ROS may be produced endogenously by metabolic reactions or have exogenous origins, such as air pollutants or cigarette smoke. Airborne pollutants may result in direct lung damage as well as in activation of inflammatory responses in the lungs. Tobacco smoke is a mixture of over 4700 chemical compounds, including high concentrations of oxidants. Inflammatory cells recruited in airspaces become activated and generate ROS in response to appropriate stimuli.”
“Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease which is characterized by an abnormal inflammatory response of the lungs to external stimuli, the most common being tobacco smoke. This abnormal inflammatory response is attributed to many underlying pathophysiologic mechanisms and one of the most important is the imbalance of oxidative stress and antioxidant defenses.”
For a layman’s understanding of the above process, we recommend readers check out our War of the Worlds in Your Lungs article.
Regarding antioxidants, the review authors explain, “In order to provide defense against the oxidative burden, the lungs produce various endogenous agents called antioxidants. The antioxidant species help the lungs ward off the deleterious consequences of a wide variety of oxidants/reactive oxygen species and reactive nitrogen species, either of endogenous or environmental origin. The major nonenzymatic antioxidants of the lungs are glutathione, vitamins C and E, beta-carotene, uric acid, whereas the major enzymatic antioxidants are superoxide dismutases, catalases and peroxidases. These antioxidants are the first lines of defense against oxidants and usually act at a gross level.”
As a side note, the most powerful of these antioxidants is glutathione. That said the human body does not absorb glutathione well when administered directly. Our bodies are much better at producing our own glutathione when we are provided precursors of the antioxidant. The most effective precursor in assisting the body’s production of glutathione is N-Acetyl Cysteine (NAC).
“Oxidative stress is intimately associated with the progression and the development of exacerbations in COPD. A rational approach for the treatment of COPD would therefore be to consider antioxidant intervention not only aiming to neutralize the increased oxidative stress and the subsequent inflammatory response, but also in an attempt to identify the source of oxidants and overwhelm their generation. This can be achieved through two approaches, either by increasing the endogenous antioxidant enzyme defences or by enhancing the non-enzymatic defences through dietary or pharmacological means. To date, however, most clinical trials of antioxidants for COPD have yielded conflicting or disappointing results.”
Despite these conflicting and disappointing results, however, the study authors conclude, “There is now solid evidence for the role of oxidative stress in the development and evolution of COPD. Several biomarkers of oxidative stress have been evaluated by invasive and non-invasive means in patients with COPD. However, further standardization of methods is imperative for the application of such biomarkers in clinical practice. An effective wide-spectrum antioxidant therapy with bioavailability is urgently needed to control the local and systemic oxidative burst in COPD. In that direction, several antioxidant agents have been evaluated as potential candidates for the management of COPD. However, despite some encouraging results, clinical trials so far have failed to elaborately define the type of antioxidant, the regimen and the time period of treatment that may improve clinically meaningful outcomes in patients with COPD. This may be largely due to the incomplete understanding of the pathophysiology of COPD and the differences within COPD phenotypes. Moreover, some of the antioxidants may not reach the correct cellular/tissue compartment where the oxidative damage is taking place. Well-designed clinical trials investigating the potential role of new antioxidants and combinations of antioxidants with existing anti-inflammatory agents may provide new insights in COPD management."
So the takeaway – not enough evidence yet to satisfy researchers and practitioners regarding efficacy and not enough clear guidance on dosages, but clearly an area that will receive great attention in the future due to the unambiguous connection between shortness of breath, inflammation and oxidative stress.
By the way, the antioxidants with most encouraging study results highlighted by the authors:
• N-Acetyl Cysteine
• Resveratrol
• Curcumin
• Vitamin C
• Vitamin E
• Beta Carotene
Attentive readers will note the above mentioned antioxidants, with the exception of Beta Carotene, are key ingredients of our Resplenish anti-oxidant respiratory support dietary supplement. We’ve further bolstered the formula with other antioxidants that have recently demonstrated promising results in respiratory health studies (including Vitamin D, Quercetin, Coenzyme Q10 and Baicalin). If you are interested to learn more about Resplenish, click here.
Whether our Resplenish supplement is of interest to you or not, we recommend you consider bolstering your daily diet with an antioxidant rich dietary supplement and antioxidant rich foods. While it’s true there is no “gold-standard” when it comes to antioxidant dosages for respiratory health it is also true and undeniable that the primary weapons at the disposal of physicians to combat oxidative stress are the natural agents our bodies already use and/or produce – antioxidants.
[1] Loukides S, et al. Oxidative Stress in Patients with COPD. Current Drug Targets. 2011; 12: 469-477.
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