A Yoga Boost to Smoking Cessation

Smoking is one of the leading preventable causes of cancer death. Thankfully, there are many smoking cessation programs available, including counseling and group support, medications, hypnotherapy, as well as quitting “cold turkey,” among other techniques. A recent study published in the Journal of Women’s Health looks at another way to support smokers trying to quit — yoga.

In a study supported by the National Center for Complementary and Alternative Medicine*, lead author Beth S. Bock, Professor in the Department of Psychiatry and Human Behavior at Brown Alpert Medical School, investigated the feasibility and efficacy of an 8-week yoga program for adult woman smokers. The study aimed to determine yoga’s effect on participants’ perceived stress, affect, and smoking cessation.

Previous research has shown that exercise can improve affect among nonsmoking adults and women who are trying to quit smoking, and may enhance smoking cessation efforts by alleviating the rise in negative affect or mood that often accompanies quit attempts, such as irritability, which can cause women to reach for a cigarette to stop these symptoms. Yoga was proposed by the authors because of its perceived ability to help with stress reduction and mood improvement, and the use of pranayama breathing exercises that involve regulation of breath and conscious deep breathing that can stimulate “pulmonary stretch receptions similar to the deep inhalations association with smoking.” These combined outcomes of yoga led the study authors to hypothesize that yoga may also improve chances of successful smoking cessation by reducing stress and negative affect.

Fifty-five women were randomized to either the intervention group of a twice-weekly group based yoga program (Vinyasa style) and a group based cognitive-behavioral therapy (CBT) program for smoking cessation, or to the control group of a group based wellness program plus the group based CBT program for smoking cessation. Groups were capped at 8-10 individuals per group. Study measures were administered at baseline, post treatment (week 8), and 3- and 6-month follow-up. Participants must have been current smokers (>5 cigarettes a day) and could not be currently practicing yoga, among other inclusion/exclusion criteria.

Yoga classes consisted of 5 minutes of breathing exercises and seated mediation followed by 45 minutes of asanas (postures) and a 10 minute closing posture. Participants in the wellness group were shown videos on a variety of health topics followed by a discussion with a psychologist and written materials relevant to each video.

Participants were assessed on their smoking history and nicotine dependence, as well as questionnaires that measured anxiety, depressive symptoms, and overall wellbeing. Participants were also asked about their confidence in achieving smoking abstinence and about their concern about post cessation weight gain. Self reported >24 hour smoking abstinence was confirmed with breath carbon monoxide tests. The primary smoking outcome was 7-day smoking abstinence, called 7-day point prevalence abstinence, and was verified by a saliva test.

Results showed relatively high class adherence. Those randomized to the yoga intervention attended an average of 72% of the yoga classes and 83% of the smoking cessation classes. Control group participants attended 67% of the wellness sessions and 78% of the smoking cessation sessions. At the end of the 8 week treatment period, those in the yoga group increased their odds of 24 hour smoking cessation compared to those in the wellness group, 47% vs. 17%, and were also more likely to have attained 7 day smoking abstinence vs. the wellness group 41% vs. 13%. While not reaching statistical significance the 3 and 6 month follow up assessments showed greater rates of abstinence for those participants in the yoga group for 7 day abstinence, as compared to the control wellness group. The results also showed that yoga participants had significant reductions in anxiety and temptations to smoke and increases in overall well-being, while wellness participants had improvements in temptation to smoke only.

The authors noted that:

“Our results provide preliminary evidence that yoga may be an effective adjunctive treatment for smoking cessation in women. Specifically, yoga appears to enhance the effects of CBT on short-term smoking cessation outcomes. While the sample size precluded formal mediation analysis, results of secondary analyses suggest that the positive effects of yoga on smoking outcomes may occur via reduction of negative symptoms associated with quitting smoking, decreasing stress and cigarette cravings, and improving mood and perception of quality of life.”

While there are many avenues one can take to achieve smoking cessation, yoga may provide a method for those who would like to quit without medications, but with some sort of support and exercise. This study is limited due to its short duration and future studies should attempt longer treatment periods to demonstrate sustained efficacy, since results seemed to weaken over time for these study participants.

To learn more about this study, you may view it online: http://www.ncbi.nlm.nih.gov/pubmed/21992583