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The effects of repeated aerobic and non-aerobic exercise on cigarette smoking Reesor, Kenneth Alan 1983

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THE EFFECTS OF REPEATED AEROBIC AND NON-AEROBIC EXERCISE ON CIGARETTE SMOKING by KENNETH ALAN REESOR B.A.(Honours), The U n i v e r s i t y Of A l b e r t a , 1980 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES Department Of Psychology We accept t h i s t h e s i s as conforming to the r e q u i r e d standard THE UNIVERSITY OF BRITISH COLUMBIA November 1983 © Kenneth Alan.Reesor, 1983 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements for an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and study. I f u r t h e r agree that p e r m i s s i o n fo r e x t e n s i v e copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s or her r e p r e s e n t a t i v e s . I t i s understood that copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n p e r m i s s i o n . Department of Psychology The U n i v e r s i t y of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date: November, 1983 i i A b s t r a c t While there i s strong evidence of an i n v e r s e r e l a t i o n s h i p between l e v e l s of p h y s i c a l a c t i v i t y and c i g a r e t t e consumption, there are few experimental i n v e s t i g a t i o n s of the e f f e c t of e x e r c i s e on c i g a r e t t e smoking. Moreover, the a v a i l a b l e research i s l i m i t e d by r e s e a r c h design flaws such as non-random assignment, lack of a p p r o p r i a t e c o n t r o l s , inadequate s p e c i f i c a t i o n of e x e r c i s e , and r e l i a n c e on s e l f - r e p o r t measures. In t h i s i n v e s t i g a t i o n , twenty-four female and twelve male c i g a r e t t e smokers, who were not attempting to q u i t , were randomly assigned to one of three groups: 1) an a e r o b i c e x e r c i s e c o n d i t i o n c o n s i s t i n g of continuous, h i g h - i n t e n s i t y c y c l i n g on s t a t i o n a r y b i k e s ; 2) a non-aerobic e x e r c i s e c o n d i t i o n c o n s i s t i n g of d i s c o n t i n u o u s , m i n i m a l - i n t e n s i t y muscle s t r e t c h i n g and t e n s i n g e x e r c i s e s ; or 3) a n o - e x e r c i s e c o n t r o l c o n d i t i o n . S u b j e c t s monitored the time and r a t e d t h e i r 'enjoyment' of each c i g a r e t t e smoked on weekdays d u r i n g 4 c o n s e c u t i v e weeks and p a r t i c i p a t e d i n e i g h t s t a n d a r d i z e d e x e r c i s e or c o n t r o l sessions scheduled dur i n g the second and t h i r d weeks. Pre- and post-s e s s i o n measures of s t a t e a n x i e t y and blood pressure were taken at the f i r s t and l a s t e x e r c i s e or corresponding c o n t r o l s e s s i o n . S u r r e p t i t i o u s o b s e r v a t i o n s of smoking topography were taken immediately a f t e r w a r d . Contrary to p r e d i c t i o n s , only the non-aerobic e x e r c i s e produced a s i g n i f i c a n t r e d u c t i o n i n both the ra t e and number of p u f f s taken and a s i g n i f i c a n t i n c r e a s e i n the l a t e n c y to smoke for the f i r s t two c i g a r e t t e s f o l l o w i n g e x e r c i s e . No e f f e c t was i i i found on c i g a r e t t e consumption d u r i n g the o b s e r v a t i o n p e r i o d or on s e l f - r e p o r t e d d a i l y c i g a r e t t e consumption. A l s o c o n t r a r y to" e x p e c t a t i o n s , s e l f - r e p o r t e d a n x i e t y p r i o r to e x e r c i s e i n c r e a s e d over repeated s e s s i o n s i n the a e r o b i c e x e r c i s e c o n d i t i o n , but decreased over s e s s i o n s in the non-aerobic c o n d i t i o n . At the end of the study, s u b j e c t s i n the ae r o b i c c o n d i t i o n r a t e d themselves as s i g n i f i c a n t l y more l i k e l y to q u i t smoking than s u b j e c t s i n e i t h e r of the other c o n d i t i o n s . There were, however, no s i g n i f i c a n t d i f f e r e n c e s i n c i g a r e t t e consumption or i n t e n t i o n to q u i t at a 4-month follow-up. These r e s u l t s do not support the hypothesis that i n c r e a s i n g a e r o b i c e x e r c i s e reduces c i g a r e t t e smoking. They do i n d i c a t e , however, that m i n i m a l - i n t e n s i t y e x e r c i s e can modify smoking topography i n a manner p r e v i o u s l y shown to reduce h e a l t h r i s k . The r e s u l t s a l s o suggest that p r e v i o u s demonstrations of a n x i o l y t i c e f f e c t s of aerobic e x e r c i s e may have been confounded by i n c r e a s e d a n x i e t y o c c u r r i n g i n a n t i c i p a t i o n of a e r o b i c exerc i se. i v Table of Contents A b s t r a c t i i L i s t of Tables v i L i s t of F i g u r e s v i i Acknowledgement v i i i INTRODUCTION 1 C o r r e l a t i o n a l S t u d i e s And Quasi-Experimental Reports Of E x e r c i s e And Smoking 5 Treatment Outcome St u d i e s Using E x e r c i s e With C i g a r e t t e Smokers 10 Experimental A n a l y s i s Of E x e r c i s e E f f e c t s On C i g a r e t t e Smoking 13 E f f e c t s Of E x e r c i s e And T h e i r P o t e n t i a l R e l a t i o n s h i p To C i g a r e t t e Smoking 14 Overview And Hypotheses 20 METHOD 22 Subject s 22 Instruments 23 Procedure 25 RESULTS ' 3 5 Subject C h a r a c t e r i s t i c s 35 Ma n i p u l a t i o n And R e l i a b i l i t y Checks 39 Dependent Measures 43 DISCUSSION 56 E x e r c i s e And R e l a x a t i o n 59 I n t e n t i o n s To Quit Smoking 61 Co n c l u s i o n s And D i r e c t i o n s For Future Research 62 REFERENCES 65 APPENDIX A - AEROBIC EXERCISE SESSIONS 74 APPENDIX B - NON-AEROBIC EXERCISE SESSIONS 77 APPENDIX C - EXPERIMENTER'S INSTRUCTIONS FOR THE SAMPLING OF SALIVA FOR THIOCYANATE ESTIMATIONS 83 APPENDIX D - DATA RECORDING SHEET 84 APPENDIX E - OBSERVATION SESSION RECORDING SHEET 85 APPENDIX F - INITIAL PHONE CONTACT 86 V APPENDIX G - SMOKING ENJOYMENT STUDY DESCRIPTION 87 APPENDIX H - PRE-EXPERIMENTAL QUESTIONNAIRE 89 APPENDIX I - SCHEDULE FORM FOR SUBJECTS SMOKING ENJOYMENT STUDY: SCHEDULE AND PROCEDURE 94 APPENDIX J - SELF-MONITORING CARD AND COMPLIANCE RATIONALE 96 APPENDIX K - ACTIVITY EVALUATION 97 APPENDIX L - POST-STUDY QUESTIONNAIRE 99 APPENDIX M - EXPERIMENTAL ENVIRONMENT 102 v i L i s t of Tables 1. Mean Values f o r F i t n e s s and Smoking V a r i a b l e s at the I n i t i a l Assessment by Group 36 2. Mean Psychometric Scores at the I n i t i a l Assessment by Group 39 3. A c t i v i t y E v a l u a t i o n Ratings 42 4. Mean D a i l y C i g a r e t t e Consumption from Subject Recordings 45 5. Mean Values f o r Topographic Smoking Measures by Group and Assessment 46 6. C o r r e l a t i o n s Among the Topographic Measures 48 7. S e l f - M o n i t o r e d Smoking L a t e n c i e s i n Minutes by Group at each Assessment 50 8. Post-Study Ratings of the L i k e l i h o o d of Q u i t t i n g 54 v i i L i s t of F i g u r e s 1. Pulse Rate During the F i r s t and Last Session 41 2. Mean STAI Scores Across Assessments 52 v i i i Ac knowledgernent I would l i k e to thank Dr. David Lawson f o r h i s v a l u e a b l e help i n the development of t h i s t h e s i s . S p e c i a l thanks to Joe Klancnick and Lorna Neuman f o r t h e i r competent a s s i s t a n c e and c o n t r i b u t i o n to the p r o j e c t . I would a l s o l i k e to thank my committee members, Dr. Bob McMahon and Dr. Peter Suedfeld, f o r t h e i r feedback and sugges t i o n s . 1 INTRODUCTION C i g a r e t t e smoking i s the c h i e f , preventable cause of death, a c c o r d i n g to the most recent r e p o r t by the U n i t e d S t a t e s Surgeon General on the h e a l t h consequences of smoking (U.S. Department of H e a l t h , Education, & Welfare [DHEW], 1982). Of the 400,000 annual deaths from cancer i n the U.S., 129,000 are estimated to be the d i r e c t r e s u l t of c i g a r e t t e smoking. S i m i l a r l y , c i g a r e t t e smoking has been estimated to account f o r 25% of a l l c a r d i o v a s c u l a r d i s e a s e , and 40% of a l l r e s p i r a t o r y d i s e a s e (Boden, 1976). As L i c h t e n s t e i n (1982) notes, c i g a r e t t e smoking i s a proven r i s k f a c t o r i n the three l e a d i n g causes of death i n the U.S.: heart d i s e a s e , cancer, and s t r o k e . Despite the enormous h e a l t h consequences of c i g a r e t t e smoking, over 30% of the a d u l t p o p u l a t i o n i n the U n i t e d S t a t e s and Canada continue to smoke (Health and Welfare Canada [HWC], 1982; U.S. DHEW, 1979). Because such a l a r g e segment of the p o p u l a t i o n smokes, the economic consequences a t t r i b u t e d to smoking are s t a g g e r i n g . Luce and Schweitzer (1976) estimated t h a t , i n the United S t a t e s , smoking cost 19 b i l l i o n d o l l a r s i n terms of l o s t work pro d u c t i o n alone. Danaher (1980) r e p o r t s that smoking c o s t s $3.00 per day per smoking employee based on i n c r e a s e d insurance c o s t s and higher r a t e s of s i c k days, absenteeism, l o s t p r o d u c t i v i t y , and maintenance c o s t s . When medical c o s t s and c o s t s due to a c c i d e n t s a t t r i b u t i b l e to smoking are i n c l u d e d , the t o t a l cost of c i g a r e t t e smoking i n 1974 was estimated at 27.5 b i l l i o n d o l l a r s a n n u a l l y to the U n i t e d S t a t e s economy. Since the h e a l t h and economic consequences are of such vast 2 p r o p o r t i o n s , i t i s l i t t l e wonder that c o n s i d e r a b l e r e s e a r c h has been d i r e c t e d towards modifying t h i s p e r v a s i v e a d d i c t i v e behavior. However, success i n modifying c i g a r e t t e smoking has been l i m i t e d . In a recent review on the smoking problem, L i c h t e n s t e i n (1982) r e p o r t s that f o r the average p a r t i c i p a n t i n a smoking c e s s a t i o n program, the chance of being a b s t i n e n t 6 months a f t e r treatment i s between 15-20%. More s u c c e s s f u l b e h a v i o r a l programs report abstinence r a t e s of between 30-40%. The most s u c c e s s f u l b e h a v i o r a l treatments (with abstinence r a t e s over 50%) g e n e r a l l y i n c l u d e an a v e r s i v e component, the most common being r a p i d smoking. In r a p i d smoking, s u b j e c t s smoke c o n t i n u a l l y , i n h a l i n g every 6 to 8 seconds, u n t i l they reach t h e i r l e v e l of t o l e r a n c e ( L i c h t e n s t i e n , 1982). Although e f f e c t i v e , r a p i d smoking has four disadvantages: (a) i t r e q u i r e s c a r e f u l s c r e e n i n g because of the medical r i s k s i n v o l v e d (Danaher, 1980); (b) i t i s m e d i c a l l y c o n t r a i n d i c a t e d f o r some smokers ( H a l l , Sachs, & H a l l , 1979); (c) i t i s h i g h l y unpleasant; and (d) although i t i s e f f e c t i v e in a l t e r i n g the r e i n f o r c i n g p r o p e r t i e s a s s o c i a t e d with c i g a r e t t e s , r a p i d smoking does not promote the development of e i t h e r s u b s t i t u t e r e i n f o r c i n g behaviors or coping s k i l l s to prevent smoking (Danaher, 1980; Leventhal & McCleary, 1980). The development of a safe and e f f e c t i v e method to reduce smoking remains a c h a l l e n g e f o r b e h a v i o r a l r e s e a r c h ( L i c h t e n s t e i n , 1982). One non-aversive approach, suggested by B e r n s t e i n and Glasgow (1979), i s to develop "adaptive a l t e r n a t i v e s " to c i g a r e t t e smoking. S i m i l a r l y , L i c h t e n s t e i n and 3 Brown (1980) have suggested an approach they c a l l " l i f e s t y l e b a l a n c i n g " . T h e i r idea i s to r e p l a c e smoking (a 'negative' a d d i c t i n g behavior) with an a l t e r n a t i v e ' p o s i t i v e ' a d d i c t i n g behavior such as yoga, m e d i t a t i o n , walking or running. I t i s assumed that t h i s i s most e f f e c t i v e l y accomplished by s c h e d u l i n g " s e l f - t i m e " i n which smokers engage in ' p o s i t i v e ' b ehaviors, the r a t i o n a l e being that a l t e r n a t i v e s to smoking are then enhanced. L i c h t e n s t e i n and Brown's approach i s not u n l i k e a s e l f -managed v e r s i o n of a d i f f e r e n t i a l reinforcement of other behavior (DRO), in which c o n t i n g e n c i e s i n an i n d i v i d u a l ' s environment are rearranged to encourage the development of an a l t e r n a t i v e , u s u a l l y incompatable, behavior. Homer and Peterson (1980) have argued that the DRO procedure i s p r e f e r a b l e over a v e r s i v e techniques s i n c e (a) i t i s e t h i c a l l y more a c c e p t a b l e , (b) i t i s comparable with other procedures i n r a t e and extent of response e l i m i n a t i o n , (c) i t may be s u p e r i o r i n terms of maintenance and g e n e r a l i z a t i o n of response r e d u c t i o n , and (d) i t does not have any unpleasant s i d e e f f e c t s . Developing a s p e c i f i c a l t e r n a t i v e behavior or a c t i v i t y as a s u b s t i t u t e f o r smoking has been d e s c r i b e d i n at l e a s t two s t u d i e s . Barton and Barton (1978) report a s u c c e s s f u l case study i n which gardening was r e i n f o r c e d with garden p l a n t s c o n t i n g e n t on non-smoking. They c o n c e p t u a l i z e d smoking as a s e l f - s t i m u l a t o r y behavior, a c l a s s of behaviors which are e f f e c t i v e l y m o d i f i e d with the DRO s t r a t e g y . In t h i s case, abstinence was s t i l l maintained at a 2 1/2 year follow-up. O'Connor and S t r a v y n k i (1982) e x p e r i m e n t a l l y t e s t e d the 4 hypothesis that b e h a v i o r a l s u b s t i t u t i o n would be e f f e c t i v e i n modifying smoking behavior. They compared a c o g n i t i v e - b e h a v i o r m o d i f i c a t i o n s t r a t e g y and a c o n t r o l group to a b e h a v i o r a l s u b s t i t u t i o n group which engaged i n i n d i v i d u a l l y t a i l o r e d a l t e r n a t i v e a c t i v i t i e s (such as reading, r e l a x a t i o n , motor d i s t r a c t i o n , and p h y s i c a l a c t i v i t y ) depending on an a n a l y s i s of the circumstances under which they normally smoked. At an 8-month follow-up, the b e h a v i o r a l s u b s t i t u t i o n group had the g r e a t e s t r e d u c t i o n (approximately 75%) from s e l f - r e p o r t e d smoking b a s e l i n e compared with the c o g n i t i v e group (approximately 25%) and the c o n t r o l group (approximately 0%). V a r i o u s s u b s t i t u t e a c t i v i t e s have been proposed as a means fo r modifying c i g a r e t t e smoking. These have i n c l u d e d (a) r e l a x a t i o n or r e l a x i n g a c t i v i t i e s such as reading and l o o k i n g at p i c t u r e s ; (b) minor motor d i s t r a c t i o n s such as tapping, t w i d d l i n g or k n i t t i n g ; (c) and o r a l manipulation of non-food o b j e c t s such as chewing or sucking candy (Flaxman, 1976; O'Connor & S t r a v y n s k i , 1982). The e f f e c t i v e n e s s of s p e c i f i c a c t i v i t i e s however, has yet to be e m p i r i c a l l y v e r i f i e d (Pomerleau, 1980). Given the enormous s o c i e t a l consequences of smoking, the l i m i t e d success r a t e s of b e h a v i o r a l smoking c e s s a t i o n techniques, and the l i m i t a t i o n s of a v e r s i v e procedures, r e s e a r c h e x p l o r i n g v a r i o u s b e h a v i o r a l s u b s t i t u t e s appears warranted. One p o t e n t i a l l y t h e r a p e u t i c s u b s t i t u t e f o r smoking i s i m p l i e d i n recommendations that treatment programs i n c o r p o r a t e p h y s i c a l e x e r c i s e to enhance treatment e f f e c t i v e n e s s (Hunt & 5 Matarazzo, 1973; M a r t i n & Dubbert, 1982; Pomerleau, 1979; 1980). While the e f f e c t of e x e r c i s e and p h y s i c a l a c t i v i t y has been more s y s t e m a t i c a l l y e x p l o r e d with a d d i c t i v e behaviors such as e x c e s s i v e a l c o h o l consumption and o v e r e a t i n g ( F o l k i n s & Sime, 1981; Martin & Dubert, 1982), i t s e f f e c t on c i g a r e t t e smoking has yet to be e x p e r i m e n t a l l y e v a l u a t e d . DRO and r e l a t e d response e l i m i n a t i o n s t r a t e g i e s may be more e f f e c t i v e when the a l t e r n a t i v e b e h a v i o r s compete or are incompatible with the t a r g e t response ( L e i t e n b e r g , Rawson, & Bath, 1970). If p h y s i c a l a c t i v i t y i s incompatable with c i g a r e t t e smoking, then e x e r c i s e would be a p a r t i c u l a r l y u s e f u l b e h a v i o r a l a l t e r n a t i v e s i n c e i n c r e a s e d a c t i v i t y should r e s u l t i n decreased smoking. T h i s t h e s i s w i l l review the l i t e r a t u r e p e r t a i n i n g to t h i s hypothesis and i n v e s t i g a t e the e f f e c t s of repeated p h y s i c a l e x e r c i s e on c i g a r e t t e smoking. C o r r e l a t i o n a l Studies And Quasi-Experimental Reports Of E x e r c i s e And Smoking A number of s t u d i e s have reported i n v e r s e c o r r e l a t i o n s between p h y s i c a l a c t i v i t y or f i t n e s s l e v e l and c i g a r e t t e consumption. Since both smoking (U.S. DHEW, 1979) and p h y s i c a l i n a c t i v i t y (Cooper et a l . , 1976) have been i d e n t i f i e d as c o n t r i b u t i n g to c a r d i o v a s c u l a r d i s e a s e , these v a r i a b l e s have been i n c l u d e d i n recent l a r g e - s c a l e e p i d e m i o l o g i c a l s t u d i e s of coronary r i s k f a c t o r s . Holme, Helgeland, Hjernmann, Leren, and Lund-Larsen (1981) surveyed over 1 8 , 0 0 0 Norwegian men and found s i g n i f i c a n t i n v e r s e c o r r e l a t i o n s between s e l f - r e p o r t e d p h y s i c a l a c t i v i t y at l e i s u r e and c i g a r e t t e s consumed. Hickey, Mulcahy, 6 Bourke, Graham, and Wilson-Davis (1975), a l s o found s i g n i f i c a n t i n v e r s e c o r r e l a t i o n s between s e l f - r e p o r t e d p h y s i c a l a c t i v i t y at l e i s u r e and s e l f - r e p o r t e d c i g a r e t t e smoking i n a sample of over 15,000 B r i t i s h men. S i m i l a r l y , Salonen, Puska, and Tuomilchto (1982) surveyed over 7,500 F i n n i s h men and women and found s i g n i f i c a n t l y lower tobacco consumption among men who re p o r t e d being p h y s i c a l l y a c t i v e than among men who re p o r t e d being p h y s i c a l l y i n a c t i v e at work. S i g n i f i c a n t d i f f e r e n c e s were a l s o found in the same d i r e c t i o n between p h y s i c a l l y a c t i v e women and those who r e p o r t e d p h y s i c a l l y i n a c t i v e l e i s u r e and r e c r e a t i o n l i f e s t y l e s . Kannel and S o r l i e s ' s (1979) follow-up of 4,000 American men and women, by c o n t r a s t , found no s i g n i f i c a n t c o r r e l a t i o n s between c i g a r e t t e consumption and p h y s i c a l a c t i v i t y . The authors p o i n t out, however,that t h i s sample was sedentary and had l i t t l e v a r i a b i l i t y i n t h e i r r e p o r t e d p h y s i c a l a c t i v i t y l e v e l s . U n l i k e a l l of these surveys which used s e l f - r e p o r t measures of a c t i v i t y l e v e l , two recent l a r g e - s c a l e surveys compared s e l f -r e p o r t e d smoking rate and a measured l e v e l of f i t n e s s . The Canadian H e a l t h Survey (HWC, 1982) of 15,060 Canadian men and women examined the r e l a t i o n s h i p between s e l f - r e p o r t e d smoking ra t e and f i t n e s s l e v e l as assessed by a step t e s t . A s i g n i f i c a n t l y smaller p r o p o r t i o n of smokers performed at the recommended f i t n e s s l e v e l compared to those who never smoked or who had q u i t smoking. S i m i l a r l y , K u j a l a (1981) t e s t e d 989 men from the F i n n i s h Army on 12 minute running t e s t s and found that non-smokers and ex-smokers performed, s i g n i f i c a n t l y b e t t e r on 7 i n i t i a l and repeated t e s t s . Since these s t u d i e s are c o r r e l a t i o n a l , a c a u s a l r e l a t i o n s h i p or i n c o m p a t i b i l i t y between p h y s i c a l a c t i v i t y and smoking cannot be assumed. More d i r e c t evidence of an e f f e c t of e x e r c i s e on smoking, however, i s p r o v i d e d by q u a s i - e x p e r i m e n t a l and anecdotal r e p o r t s of changes i n smoking behavior r e s u l t i n g from e x e r c i s e . Morgan, G i l d i n e r , and Wright (1976) assessed s e l f r e p o r t of smoking and e x e r c i s e i n 141 members of an a d u l t running c l u b , who ran on average 35 m i l e s a week. Of the t h i r t y - f i v e who were smokers p r i o r to j o i n i n g the c l u b , a l l but three had q u i t . Durbeck et a l . (1972) evaluated 237 NASA employees in a 12-month a e r o b i c e x e r c i s e program c o n s i s t i n g of 30 minutes of e x e r c i s e , 3 times a week. Of those who smoked, the "good adherers" r e p o r t e d the l a r g e s t decrease (16%) while the "poor adherers" rep o r t e d almost no decrease ( 3 % ) . Mann, G a r r e t t , F a r h i , Murray, and B i l l i n g s (1969) e x e r c i s e d 106 men i n a 6 month e x e r c i s e program (5 days a week), and compared them to a randomly assigned n o - e x e r c i s e c o n t r o l in an attempt to evaluate the e f f e c t s of e x e r c i s e i n reducing coronary r i s k f a c t o r s . Of those who smoked i n i t i a l l y , 22% r e p o r t e d a decrease from b a s e l i n e i n the e x e r c i s e group compared to a 7% decrease i n the n o - e x e r c i s e c o n t r o l . In c o n t r a s t , Bonanno and L i e s (1974) compared a group of 20 coronary-prone men i n a 12-week a e r o b i c e x e r c i s e program to a group of 19 matched no - e x e r c i s e c o n t r o l s . Approximately h a l f the s u b j e c t s i n each group smoked. Smokers i n n e i t h e r group repor t e d decreased smoking duri n g the program. Engs and M u l h a l l 8 (1982) compared 200 u n i v e r s i t y undergraduates who e n r o l l e d i n one of two 15-week courses: one r e q u i r i n g strenuous p h y s i c a l a c t i v i t y and the other emphasizing l e i s u r e a c t i v i t y . Twenty-two percent of the s u b j e c t s smoked i n i t i a l l y , but there were no changes in r e p o r t e d smoking r a t e at the end of the courses i n e i t h e r group. Heinzleman and Bagley (1970) e x e r c i s e d 239 men f o r 1 8 months (one hour, 3 times per week) and compared v a r i o u s s e l f - r e p o r t e d h e a l t h behaviors to a randomly assigned no-e x e r c i s e c o n t r o l group. No d i f f e r e n c e s were found between the groups, although 20% of the smokers i n the e x e r c i s e c o n d i t i o n r e p o r t e d c i g a r e t t e consumption was l e s s at the end of the 18 month p e r i o d . I n t e r p r e t i v e problems. These r e p o r t s are impossible to i n t e r p r e t f o r a v a r i e t y of reasons. F i r s t , most of the s t u d i e s have rese a r c h design flaws. In some cases, s u b j e c t s were s e l f -s e l e c t e d or were chosen s p e c i f i c a l l y from a p a r t i c u l a r group (such as coronary-prone p a t i e n t s ) and, t h e r e f o r e , were not r e p r e s e n t a t i v e of a l l smokers. Some s t u d i e s even lacked a no-e x e r c i s e c o n t r o l group. F u r t h e r , most of these s t u d i e s were not designed to i n v e s t i g a t e the e f f e c t s of e x e r c i s e on smoking so no attempt was made to a s s i g n randomly smokers to d i f f e r e n t groups. In some cases the p r o p o r t i o n of smokers w i t h i n treatment groups i s not r e p o r t e d . Secondly, a problem in r e s e a r c h examining the a p p l i c a t i o n of p h y s i c a l e x e r c i s e , i s the inadequate s p e c i f i c a t i o n of the type, d u r a t i o n , and i n t e n s i t y of e x e r c i s e r e q u i r e d to produce c l i n i c a l e f f e c t s (Martin & Dubbert, 1982). O p e r a t i o n a l 9 d e f i n i t i o n s of e x e r c i s e are important because i t i s otherwise d i f f i c u l t or impossible to compare d i f f e r e n t s t u d i e s employing e x e r c i s e i n t e r v e n t i o n s . D i f f e r e n t forms of e x e r c i s e have been d i s t i n g u i s h e d and o p e r a t i o n a l d e f i n i t i o n s are a v a i l a b l e f o r e x e r c i s e a c t i v i t y . For example, a e r o b i c (or oxygen-consuming) e x e r c i s e i s d e f i n e d as p h y s i c a l a c t i v i t y which i n c r e a s e s the endurance of the pulmonary and c a r d i o v a s c u l a r systems (Cooper, 1977). A c t i v i t i e s such as c y c l i n g , rowing, jogging, c r o s s -country s k i i n g , and walking are examples of a e r o b i c e x e r c i s e . These a c t i v i t i e s are d i s t i n g u i s h e d from other types of p h y s i c a l e x e r c i s e designed to inc r e a s e s p e c i f i c muscular s t r e n g t h or f l e x i b i l i t y such as w e i g h t - l i f t i n g , c a l i s t h e n i c s , and yoga. Aerobic e x e r c i s e r e q u i r e s a minimum of 5 minutes of continuous a c t i v i t y i n which the heart r a t e i s e l e v a t e d to 70% of maximum, 10 minutes of a c t i v i t y at 60% of maximum, 20 minutes of a c t i v i t y at 50% of maximum, or 45 minutes of a c t i v i t y at 40% of maximum (Cl a r k e , 1975; Cooper, 1977). T h i r d l y , adherence to e x e r c i s e programs i s not always monitored. T h i s , i s e s p e c i a l l y important with e x e r c i s e i n t e r v e n t i o n s i n smoking s i n c e smokers, as a group, may be l e s s l i k e l y to adhere to an e x e r c i s e regime (Massie & Shepard, 1971; O l d r i d g e , 1979; Shepard, Corey & Kavanagh, 1981). The lack of we l l s p e c i f i e d o p e r a t i o n a l d e f i n i t i o n s of adherence and non-adherence a l s o makes i t impossible to compare or evaluate d i f f e r e n t s t u d i e s employing e x e r c i s e i n t e r v e n t i o n s . Furthermore, c i g a r e t t e smokers' adherence to e x e r c i s e cannot be assumed on the b a s i s of changes i n ae r o b i c c a p a c i t y . For 10 example, Rode, Ross, and Shepard (1972) examined p e r s o n a l i t y and c a r d i o - r e s p i r a t o r y c h a r a c t e r i s t i c s i n a group of 256 men and 187 women, some of whom s u c c e s s f u l l y q u i t smoking and some of whom conti n u e d to smoke a f t e r completing a smoking withdrawal program. They found that a b s o l u t e a e r o b i c c a p a c i t y (as estimated from a step t e s t ) i n c r e a s e d i n those persons who s u c c e s s f u l l y q u i t smoking, whereas there was no change i n c o n t i n u i n g smokers. Thus, a e r o b i c power may i n c r e a s e simply as a f u n c t i o n of g i v i n g up c i g a r e t t e s through b e n e f i c i a l changes i n pulmonary f u n c t i o n ; i t does not n e c e s s a r i l y i n c r e a s e as f u n c t i o n of engaging i n a e r o b i c e x e r c i s e . T h i s i s not s u r p r i s i n g , as the authors p o i n t out, s i n c e average a e r o b i c c a p a c i t y f o r sedentary smokers i s lower than f o r sedentary non-smokers. F i n a l l y , a l l of the s t u d i e s reviewed have r e l i e d s o l e l y on s e l f - r e p o r t of smoking behavior. No attempt has been made to v a l i d a t e s e l f r e p o r t through b i o c h e m i c a l a n a l y s i s (Prue, M a r t i n , & Hume, 1980) or to i n c o r p o r a t e other measures, such as d i r e c t o b s e r v a t i o n ( F r e d e r i k s e n , M a r t i n , & Webster, 1979). Treatment Outcome Studie s Using E x e r c i s e With C i g a r e t t e Smokers Two s t u d i e s have attempted to evaluate p h y s i c a l e x e r c i s e as an i n t e r v e n t i o n i n smoking m o d i f i c a t i o n . Johnston, Rosenbaum, Framer, and Wildman (1979) compared a standard e x e r c i s e group i n which s u b j e c t s were i n s t r u c t e d to walk for 30 minutes per day to an incremental e x e r c i s e group in which the i n t e n s i t y of the e x e r c i s e was i n c r e a s e d over weekly s e s s i o n s i n an 8-week program to q u i t smoking. There was no d i f f e r e n c e between groups at the 11 end of the program; a l l smokers reduced t h e i r smoking to an average of 76% below b a s e l i n e . At a 1-year follow-up, there was s t i l l no d i f f e r e n c e between groups, but the average r e d u c t i o n from b a s e l i n e dropped to 33%, not s i g n i f i c a n t l y d i f f e r e n t from the average r e d u c t i o n r a t e s r e p o r t e d by Hunt and Matarazzo (1973). The major flaw i n t h i s study i s a l a c k of a n o - e x e r c i s e c o n t r o l group without which i t i s impossible to determine with c o n f i d e n c e what incremental e f f e c t i v e n e s s , i f any, i s due to the a e r o b i c e x e r c i s e component of treatment. Johnston et a l . (1979) d i d f i n d that p a r t i c i p a n t s were s i g n i f i c a n t l y improved (pre-treatment to post-treatment) on recovery heart r a t e s on the Harvard Step T e s t , and that heart r a t e recovery measures were s i g n i f i c a n t l y and i n v e r s e l y r e l a t e d to s e l f - r e p o r t e d c i g a r e t t e consumption, both p r i o r to and at the end of the program (r=-.64 and r_=-.84, r e s p e c t i v e l y ) . Low r a t e s of c i g a r e t t e smoking were c o r r e l a t e d with higher i n i t i a l l e v e l s of p h y s i c a l f i t n e s s and with higher f i t n e s s l e v e l s at the end of the 8-week program. In the only other study examining a e r o b i c e x e r c i s e as an i n t e r v e n t i o n , Howley, C a l l a h a n , and Yaeter (1980) compared the e f f e c t s of e x e r c i s e and self-management s t r a t e g i e s , alone and i n combination, with a delayed treatment c o n t r o l group in 7 male and 29 female a d u l t smokers. A l l three treatment groups s i g n i f i c a n t l y reduced smoking at post-treatment. At the 6-month follow-up, the e x e r c i s e alone treatment was s u p e r i o r to the other groups with a r e d u c t i o n of 33.8% from b a s e l i n e . No data, however, were given f o r the other groups and i t was not r e p o r t e d 12 i f t h i s e f f e c t was s t a t i s t i c a l l y s i g n i f i c a n t . The e f f e c t of a e r o b i c e x e r c i s e i n the e x e r c i s e group in the Howley et a l . (1980) study i s a l s o unclear because, a c c o r d i n g to the f i t n e s s measures, over o n e - t h i r d of the e x e r c i s e group d i d not comply with the e x e r c i s e regimes. Other than the pre and post treatment f i t n e s s measures, no other data on adherence was p r o v i d e d . Nonetheless, the authors concluded that the e x e r c i s e c o n d i t i o n was s u p e r i o r to self-management s t r a t e g i e s alone or i n combination with e x e r c i s e even though no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s were r e p o r t e d . One commendable aspect of t h i s study was that s e l f r e p ort of smoking was v e r i f i e d with s a l i v a t h i o c y a n a t e . I n t e r p r e t i v e i s s u e s . In e v a l u a t i n g e x e r c i s e as an i n t e r v e n t i o n f o r smoking behavior, the data from the Johnston et a l . (1979) and the Howley et a l . (1980) s t u d i e s must be t r e a t e d c a u t i o u s l y f o r two reasons. F i r s t , no data were presented on e x e r c i s e adherence. T h i s i s e s p e c i a l l y important s i n c e , as mentioned e a r l i e r , c i g a r e t t e smokers as a group may be l e s s compliant with e x e r c i s e regimes. As mentioned e a r l i e r , the p h y s i o l o g i c a l measures of f i t n e s s improvement, which were used as a compliance check, may not be v a l i d i n d i c a t o r s of e x e r c i s e compliance i n smokers. Secondly, to demonstrate t h e r a p e u t i c e f f e c t s i n e i t h e r smoking c e s s a t i o n or e x e r c i s e r e s e a r c h , i t i s necessary to c o n t r o l f o r the e f f e c t s of s e l f - m o n i t o r i n g , s t r u c t u r e d p a r t i c i p a t i o n , and p a r t i c i p a n t e x p e c t a n c i e s (Martin & Dubbert, 1982; M c F a l l , 1978). In both these treatment s t u d i e s , s u b j e c t s i n the e x e r c i s e groups no doubt expected some change 13 would occur s i n c e the purpose of t h e i r p a r t i c i p a t i o n was to q u i t smoking. T h e r e f o r e , expectancies or b e l i e f s that a e r o b i c e x e r c i s e a t t e n u a t e d the smoking d e s i r e or made smoking more d i f f i c u l t c o u l d a l s o account f o r changes i n smoking frequency. Experimental A n a l y s i s Of E x e r c i s e E f f e c t s On C i g a r e t t e Smoking One experimental i n v e s t i g a t i o n of the e f f e c t s of e x e r c i s e on smoking was undertaken by M i k h a i l (1983). T h i s i n v e s t i g a t i o n i s noteworthy because the amount of e x e r c i s e , though l i m i t e d to two s e s s i o n s , was c a r e f u l l y c o n t r o l l e d and smoking behavior was assessed v i a d i r e c t o b s e r v a t i o n of smoking topography i n a d d i t i o n to s e l f r e p o r t . In a w i t h i n - s u b j e c t s design, smokers e x e r c i s e d over a 3-day p e r i o d at high i n t e n s i t y (approximately 160 bpm f o r 10 minutes) or medium i n t e n s i t y (approximately 130 bpm f o r 10 minutes), or sat through a s e s s i o n without e x e r c i s i n g . Observations of l a t e n c y to l i g h t a c i g a r e t t e , number of p u f f s taken, and smoking d u r a t i o n were made during a 60-minute p e r i o d immediately a f t e r the s e s s i o n s . Only smoking d u r a t i o n was a f f e c t e d and i t was s i g n i f i c a n t l y s h o r t e r f o r the f i r s t c i g a r e t t e a f t e r the s e s s i o n i n the high i n t e n s i t y e x e r c i s e c o n d i t i o n . Two aspects of M i k h a i l ' s procedure, however, may have attenuated smoking e f f e c t s . Subjects were requested not to smoke f o r 30 minutes p r i o r to the s e s s i o n i n order to st a n d a r d i z e the measurement of pul s e r a t e . These smokers were a l s o not pe r m i t t e d to smoke durin g the s e s s i o n , which may have r e s u l t e d i n i n c r e a s e d smoking immediately a f t e r w a r d . Secondly, 1 4 M i k h a i l examined the e f f e c t s on smoking of only a s i n g l e s e s s i o n of e x e r c i s e at each of the d i f f e r e n t i n t e n s i t i e s . As the author suggested, the topograpic e f f e c t s of e x e r c i s e on smoking may be enhanced through repeated s e s s i o n s . E f f e c t s Of E x e r c i s e And T h e i r P o t e n t i a l R e l a t i o n s h i p To C i g a r e t t e Smoking P h y s i o l o g i c a l i n c o m p a t i b i l i t y . As suggested e a r l i e r , behavior s u b s t i t u t i o n may be an e s p e c i a l l y e f f e c t i v e response r e d u c t i o n s t r a t e g y to the extent that the a l t e r n a t i v e behavior i s incompatable with smoking. There i s evidence sup p o r t i n g the n o t i o n of a b a s i c p h y s i o l o g i c a l i n c o m p a t i b i l i t y between a e r o b i c e x e r c i s e and c i g a r e t t e smoking in terms of the f u n c t i o n i n g of the c a r d i o v a s c u l a r and r e s p i r a t o r y systems. Montoye, Gayle, and H i g g i n s (1980) suggested that c h r o n i c smoking causes a decrease in the c a p a c i t y of the c i r c u l a t o r y and r e s p i r a t o r y systems f o r muscular work. F i r s t , carbon monoxide (CO) i n c i g a r e t t e smoke reduces the oxygen c a r r y i n g c a p a c i t y of the blood. Oxygen i s t r a n s p o r t e d i n the bloodstream v i a hemoglobin, yet hemoglobin has a g r e a t e r a f f i n i t y f o r CO. Consequently, l e s s hemoglobin i s a v a i l a b l e f o r the t r a n s p o r t of oxygen. Secondly, smoking causes a g r e a t e r workload on the c a r d i o v a s c u l a r system as a r e s u l t of i n c r e a s e d heart r a t e , blood p r e s s u r e , and p e r i p h e r a l r e s i s t a n c e . Decreased p e r i p h e r a l blood flow r e s t r i c t s the u t i l i z a t i o n of oxygen i n the t i s s u e s , thus l i m i t i n g the body's p h y s i c a l work c a p a c i t y . F i n a l l y , smoking d i r e c t l y impairs the r e s p i r a t o r y response and pulmonary d i f f u s i o n c a p a c i t y ( i . e . , the a b i l i t y of the lungs to remove oxygen from i n s p i r e d a i r and pass i t to the 15 b l o o d ) . I t i s c l e a r that these processes produced by smoking are c o n t r a r y to the p h y s i o l o g i c a l demands of a e r o b i c e x e r c i s e . T h i s i n c o m p a t i b i l i t y i s supported by evidence i n d i c a t i n g that smokers in comparison with non-smokers have a reduced e x e r c i s e t o l e r a n c e ( F r a y s e r , 1974; Leon, de Backer, Jacobs, & T a y l o r , 1976; McHenry F a r r i s , Jordan, & M o r r i s , 1977; Montoye, Gayle, & H i g g i n s , 1980), and that smoking impairs the p h y s i c a l c o n d i t i o n i n g response (Cooper, Gey, & Bottenberg, 1968; Rode & Shepard, 1971). Moreover, t h i s p h y s i o l o g i c a l i n c o m p a t i b i l i t y i s not n e c e s s a r i l y l i m i t e d to c h r o n i c c i g a r e t t e smokers s i n c e , i n non-smokers, smoking a s i n g l e c i g a r e t t e has been shown to a l t e r s i g n i f i c a n t l y the c a r d i o v a s c u l a r / r e s p i r a t o r y response to e x e r c i s e (Goldbarg, Krone, & Resnekov, 1971). If c i g a r e t t e smoking r e s u l t s i n changes i n c a r d i o -v a s c u l a r / r e s p i r a t o r y f u n c t i o n i n g i n a d i r e c t i o n opposite to that caused by a e r o b i c e x e r c i s e , i t might be hypothesized, c o n v e r s e l y , that e x e r c i s e f u n c t i o n s as a p r o p h y l a x i s f o r c i g a r e t t e consumption, s i n c e the body's need for oxygen may preclude the smoking d e s i r e . Smoking a c i g a r e t t e a f t e r or during v i g o r o u s e x e r c i s e may- be a s o m a t i c a l l y a v e r s i v e experience that attenuates subsequent d e s i r e and consumption. A l t e r n a t i v e l y , the p o s i t i v e p h y s i o l o g i c a l e f f e c t s of i n c r e a s e d a e r o b i c c a p a c i t y which a r i s e from engaging i n a e r o b i c e x e r c i s e and d e c r e a s i n g or q u i t t i n g smoking (Rode, Ross, & Shepard, 1972) may r e i n f o r c e non-smoking. Paxton and S c o t t (1981) found an i n v e r s e r e l a t i o n s h i p between measured changes i n lung f u n c t i o n i n g , which were communicated to s u b j e c t s f o l l o w i n g 16 smoking c e s s a t i o n , and s u b j e c t s ' tendency to r e l a p s e . These r e s u l t s , however, do not c o n f i r m a c a u s a l r e l a t i o n s h i p s i n c e i n t h e i r design s u c c e s s f u l q u i t t e r s may have been s e l f - s e l e c t e d , so that those with more e a s i l y r e v e r s i b l e lung impairment ( i . e . , those who had the g r e a t e s t changes i n lung f u n c t i o n ) were l e s s c h r o n i c a l l y a d d i c t e d to c i g a r e t t e s i n i t a l l y . P s y c h o l o g i c a l e f f e c t s . Smokers as a group are l e s s l i k e l y than non-smokers or ex-smokers to be concerned with t h r e a t s to t h e i r h e a l t h and s a f e t y ( E i s e n , Sutton, & Wober, 1979); are more l i k e l y to a v o i d exposure to i n f o r m a t i o n that makes s a l i e n t the h e a l t h r i s k a s s o c i a t e d with smoking ( T a g l i a c o z z o , 1981); are l e s s l i k e l y to p e r c e i v e themselves as v u l n e r a b l e to the adverse consequences of smoking (Weinberger, Greene, Mamlin, & J e r i n , 1981); and are l e s s l i k e l y to p e r c e i v e any non-smoking normative i n f l u e n c e (Loken, 1982). F u r t h e r , there i s some evidence that the s t r e n g t h of h e a l t h b e l i e f s i s r e l a t e d to the amount smoked (Loken, 1982). By engaging in e x e r c i s e , which i s p e r c e i v e d by smokers as health-enhancing (Mackie 1975), the s a l i e n c y of c i g a r e t t e smoking as a h e a l t h - t h r e a t e n i n g behavior or h e a l t h damaging behavior may be i n c r e a s e d . For smokers, the p e r c e p t i o n that one i s engaging in e x e r c i s e behavior to enhance h e a l t h may a l s o enhance t h e i r p e r c e p t i o n that engaging in smoking behavior d e t r a c t s from h e a l t h . Ledwidge (1980) has argued that a e r o b i c e x e r c i s e enhances se l f - e s t e e m and s e l f - c o n f i d e n c e through changes i n p h y s i c a l appearance and p h y s i c a l f u n c t i o n i n g , and through the r e l a t i v e l y more immediate sense of accomplishment in overcoming a d i f f i c u l t 17 p h y s i c a l and p s y c h o l o g i c a l c h a l l e n g e . To the extent that t h i s g e n e r a l i z e s to i n c r e a s e d c o n f i d e n c e i n one's a b i l i t y to change one's h e a l t h and to change one's smoking p a t t e r n s , a e r o b i c e x e r c i s e may f a c i l i t a t e smoking c e s s a t i o n . I t has a l r e a d y been demonstrated that measures of change i n smoking s e l f - e f f i c a c y ( C o l l e t t i , Supnick & Riz z o , 1981) p r e d i c t s u c c e s s f u l changes i n modifying smoking behavior. There are a l s o r e p o r t s that p a r t i c i p a t i o n i n e x e r c i s e programs enhances other h e a l t h - r e l a t e d behaviors_and encourages p o s i t i v e h e a l t h b e l i e f s (Durbeck et a l . 1972; Heinzleman & Bagley, 1970). Measures of h e a l t h locus of c o n t r o l and h e a l t h value have a l s o been used s u c c e s s f u l l y to p r e d i c t outcome i n smoking c e s s a t i o n programs (Kaplan & Cowles, 1978). T h e r f o r e , engaging i n p h y s i c a l a c t i v i t y i n order to improve h e a l t h and p h y s i c a l f u n c t i o n i n g may i n c r e a s e awareness of, sense of c o n t r o l over, and adherence to other h e a l t h -enhancing behaviors and enable smokers to decrease c i g a r e t t e consumpt i o n . E x e r c i s e as an a l t e r n a t i v e source of reinforcement. One important f a c t o r i n the maintenance of smoking i s the reinforcement provided by changes i n hedonic s t a t e produced by n i c o t i n e and other agents l i b e r a t e d d u r i n g smoking (Pomerleau, 1980). Le v e n t h a l and C l e a r y (1980) have suggested that smoking m o d i f i c a t i o n techniques need to 'r e p l a c e ' the r e i n f o r c i n g e f f e c t s p r o v i d e d by smoking. Smoking app a r e n t l y i n c r e a s e s under c o n d i t i o n s of e i t h e r s t r e s s (Ikard & Tomkins, 1973; Schachter, S i l v e r s t e i n , Kozlowski, Herman, & L i e b l i n g , 1977) or minimal s t i m u l a t i o n ( F u l l e r & F o r e s t , 1973). Smoking under s t r e s s f u l 18 c o n d i t i o n s may dampen a r o u s a l thus producing r e l a x i n g e f f e c t s while smoking under c o n d i t i o n s of m i l d sensory i s o l a t i o n may produce s t i m u l a t i o n (Golding & Mangan, 1982). These o b s e r v a t i o n s a l s o p a r a l l e l f a c t o r dimensions d e r i v e d from the Reasons For Smoking (RFS) Scale (Ikard, Horn, & Green, 1969). Subjec t s r e p o r t smoking to reduce unpleasant a f f e c t and produce r e l a x a t i o n , or f o r s t i m u l a t i o n , to p rovide something to manipulate, and heighten p o s i t i v e a f f e c t . Many of these d i f f e r e n t e f f e c t s have been a t t r i b u t e d to the p a r a d o x i c a l a c t i o n of n i c o t i n e , which appears to have both s t i m u l a t i n g and depressant e f f e c t s on the c e n t r a l nervous system (Golding & Mangan, 1982). The p a r a d o x i c a l a c t i o n of n i c o t i n e appears to be dose r e l a t e d (Ashton, Marsh, Millman, Rawlins, T e l f o r d , & Thompson, 1978). N i c o t i n e dose, in t u r n , i s a p p a r e n t l y mediated by changes i n v a r i o u s aspects of the smoking topography such as puff frequency and volume of i n h a l a t i o n (Ashton & Watson, 1970). P h y s i c a l e x e r c i s e r e s u l t s in s i m i l a r ' t r a n q u i l i z i n g ' and ' s t i m u l a t i n g ' changes in a f f e c t i v e tone (Martin & Dubbert, 1982). P o s i t i v e f e e l i n g and i n c r e a s e d energy have been r e p o r t e d a f t e r p a r t i c i p a t i n g in e x e r c i s e programs (Durbeck et a l . , 1972). Conversely, a few experimental i n v e s t i g a t i o n s have demonstrated s i g n i f i c a n t a n x i o l y t i c e f f e c t s due to e x e r c i s e . Sime (1977) compared t r e a d m i l l e x e r c i s e , r e l a x a t i o n m e d i t a t i o n , and placebo medication as treatments f o r t e s t - a n x i o u s s t u d e n t s . His r e s u l t s i n d i c a t e d that the 10 minutes of m i l d e x e r c i s e (maintained heart r a t e of 110 beats per minute) a f t e r a m i l d s t r e s s o r produced 19 s i g n i f i c a n t l y g r e a t e r decreases i n r e s t i n g heart r a t e (HR) and e l e c t r o d e r m a l response post-treatment than e i t h e r the me d i t a t i o n or the placebo group treatment. DeVries and Adams (1972) have demonstrated that 15 minutes of t r e a d m i l l e x e r c i s e s e s s i o n s were s u p e r i o r to a muscle r e l a x a n t (meprobamate) i n producing subsequent decreases i n muscle a c t i o n p o t e n t i a l . S i c o n o l f i , C a r e l t o n , and Elden (1982) eva l u a t e d the e f f e c t s of 30-minute s e s s i o n s of e x e r c i s e and r e l a x a t i o n on blood pressure i n e i g h t normotensive and e i g h t h y p e r t e n s i v e males. At 30 minutes post-e x e r c i s e , s i g n i f i c a n t decreases were found from b a s e l i n e i n s y s t o l i c blood pressure f o r both normotensive and hyp e r t e n s i v e groups, while no s i g n i f i c a n t e f f e c t s were found i n the r e l a x a t i o n c o n d i t i o n . While i t i s proposed here that a e r o b i c e x e r c i s e may be an e f f e c t i v e a l t e r n a t i v e because i t has some of the r e l a x i n g and s t i m u l a t i n g e f f e c t s provided by smoking, i t cannot be assumed that these e f f e c t s are e q u i v a l e n t to those produced by smoking. N i c o t i n e , f o r example, a c t s on the nervous system w i t h i n seconds ( J a r v i c k , 1977) producing almost immediate changes i n a r o u s a l . The immediacy of n i c o t i n e ' s a c t i o n not only make c i g a r e t t e s very r e i n f o r c i n g , but may be one of the more s i g n i f i c a n t reasons why smoking i s so i n t r a c t a b l e to m o d i f i c a t i o n . By c o n t r a s t , the e f f e c t of e x e r c i s e on p h y s i o l o g i c a l and s u b j e c t i v e i n d i c e s of a n x i e t y occurs l a t e r . Morgan and Horstman (1976) ch a r t e d changes i n s t a t e a n x i e t y (using a m o d i f i e d STAI) a f t e r p h y s i c a l e x e r c i s e i n a s e r i e s of s t u d i e s on a group of 177 male and 38 female a d u l t s . They found that a n x i e t y l e v e l s began to decrease 20 immediately f o l l o w i n g a high i n t e n s i t y e x e r c i s e c o n d i t i o n (at 80% of maximal oxygen uptake), but were not s i g n i f i c a n t l y lower than p r e - e x e r c i s e u n t i l the 10th minute afterward. Summary. There are a number of e f f e c t s a t t r i b u t e d to e x e r c i s e that support i t s use as a b e h a v i o r a l s u b s t i t u t e f o r smoking. P h y s i c a l a c t i v i t y i s an a t t r a c t i v e t h e r a p e u t i c a l t e r n a t i v e f o r modifying smoking s i n c e i t may be p h y s i o l o g i c a l l y incompatible with smoking, may heighten awareness and f e e l i n g s of c o n t r o l over h e a l t h , and may produce r e i n f o r c i n g changes in a f f e c t and a r o u s a l not u n l i k e smoking. The e f f e c t of repeated e x e r c i s e on c i g a r e t t e smoking, however, i s yet to be e x p e r i m e n t a l l y e s t a b l i s h e d . Overview And Hypotheses In view of the i n t e r p r e t i v e problems i n p r e v i o u s r e s e a r c h , a number of f e a t u r e s were i n c o r p o r a t e d i n t o the present study to provide a c o n t r o l l e d t e s t of the e f f e c t of e x e r c i s e on smoking. F i r s t , i n order to c o n t r o l f o r n o n - s p e c i f i c e f f e c t s of p a r t i c i p a t i n g in e x e r c i s e (such as the d i v e r s i o n or time-out from d a i l y a c t i v i t y ) , an a e r o b i c e x e r c i s e i n t e r v e n t i o n was c o n t r a s t e d , not only with a n o - e x e r c i s e c o n t r o l group, but a l s o with a non-aerobic e x e r c i s e i n t e r v e n t i o n of the same d u r a t i o n . Furthermore, i n order to c o n t r o l f o r any expectancies of change in smoking behaviour, only smokers unmotivated to q u i t smoking were c o n s i d e r e d f o r i n c l u s i o n i n the study and the nature of the study was d i s g u i s e d so that s u b j e c t s were unaware that smoking was the dependent v a r i a b l e . Since there i s evidence that s e l f -m o nitoring i s not r e a c t i v e i n smokers not motivated to q u i t 21 (Freeman & Brown, 1980), r e a c t i v i t y was not expected to e f f e c t t h i s sample. T h i r d l y , the i n t e n s i t y , type, and d u r a t i o n of e x e r c i s e and e x e r c i s e adherence have been o p e r a t i o n a l l y d e f i n e d and c o n t r o l l e d . I t was h y pothesized that d a i l y c i g a r e t t e consumption and smoking topography immediately a f t e r e x e r c i s e would be reduced i n the a e r o b i c e x e r c i s e group but not i n the non-aerobic or no-e x e r c i s e c o n t r o l groups. Repeated s e s s i o n s were expected to enhance the e f f e c t s of a e r o b i c e x e r c i s e on d a i l y c i g a r e t t e consumption and smoking topography. It was a l s o hypothesized t h a t , because of the a n x i o l y t i c e f f e c t s a t t r i b u t e d to a e r o b i c e x e r c i s e , g r e a t e r decrements i n s t a t e a n x i e t y , both w i t h i n and over s e s s i o n s , should occur i n the a e r o b i c group r e l a t i v e to the other two groups. While changes in blood pressure were expected to p a r a l l e l the e f f e c t s on s t a t e a n x i e t y , the magnitude of t h i s hypothesized e f f e c t was u n c e r t a i n s i n c e n i c o t i n e produces v a s o - c o n s t r i c t i o n and e l e v a t e d blood pressure (Stephens, 1977) which might counteract the e f f e c t s on blood pressure due to a e r o b i c e x e r c i s e . However, s i n c e smoking was expected to decrease, i t was expected that blood pressure would a l s o decrease. F i n a l l y , i t was hypothesized that repeated p a r t i c i p a t i o n i n a h e a l t h - r e l a t e d a c t i v i t y such as e x e r c i s e would r e s u l t i n g r e a t e r p e r c e i v e d c o n t r o l over h e a l t h . Thus, both e x e r c i s e groups were expected to show g r e a t e r changes in p e r c e i v e d c o n t r o l over h e a l t h and i n t e n t i o n to q u i t than the n o - e x e r c i s e group. 22 METHOD Subjects Subjects were r e c r u i t e d by advertisements, p l a c e d around the U n i v e r s i t y of B r i t i s h Columbia campus and Health Sciences Center, o f f e r i n g $60 to c i g a r e t t e smokers f o r p a r t i c i p a t i o n i n a study o s t e n s i b l y examining the r e l a t i o n s h i p between p h y s i c a l a c t i v i t y and smoking enjoyment. At the i n i t i a l phone c o n t a c t , s u b j e c t s were t o l d the study's purpose was to examine how d i f f e r e n t a c t i v i t e s e f f e c t smoking enjoyment and to examine d a i l y f l u c t u a t i o n s i n smokers' enjoyment of t h e i r c i g a r e t t e s . T h i s r a t i o n a l e (Appendix F) was employed to conceal the f a c t that smoking was the dependent measure. A f t e r a few b r i e f s c r e e n i n g q u e s t i o n s concerning smoking r a t e , smoking h i s t o r y , h e a l t h , c u r r e n t e x e r c i s e h a b i t s , age, i n t e n t i o n to q u i t , and a v a i l a b i l i t y , an appointment was scheduled f o r the i n i t i a l assessment. V o l u n t e e r s were s e l e c t e d only i f they had i n d i c a t e d : (a) that they smoked, on average, at l e a s t a pack of c i g a r e t t e s / d a y ; (b) that they smoked c i g a r e t t e s f o r at l e a s t 2 years; (c) that they were not attempting to reduce or stop smoking, and had made no attempts to q u i t i n the 6 months p r i o r to the study; (d) that they were not p r a c t i c i n g any formal r e l a x a t i o n or m e d i t a t i v e technique; (e) that they e x e r c i s e d l e s s than three 15-minute 23 sessions/week; (f ) that they were m e d i c a l l y e l i g i b l e to p a r t i c i p a t e i n p h y s i c a l e x e r c i s e by a lack of a f f i r m a t i v e responses on the P h y s i c a l A c t i v i t y Readiness Q u e s t i o n a i r e (PAR-Q) (Chisholm, C o l l i s , Kulak, Davenport, & Gruber, 1975); (g) that they were not on medication i n d i c a t e d by the Compendium of Pharmaceutical S p e c i a l t i e s (1982) to a f f e c t c a r d i o v a s c u l a r or r e s p i r a t o r y f u n c t i o n i n g ; and (h) that they were not s u f f e r i n g from c o l d s or illness., which would e f f e c t t h e i r smoking. Twenty-five women and t h i r t e e n men p a r t i c i p a t e d i n the study. S u b j e c t s ' mean age was 23.9 years ranging from 20 to 34 years. The mean repor t e d smoking r a t e was 22.8 c i g a r e t t e s / d a y ranging from 20 to 40 c i g a r e t t e s , while the mean number of years smoked was 8.4 ranging from 2 to 18 years. Brands of c i g a r e t t e s smoked by s u b j e c t s had a mean t a r content of 12 mgs ranging from 1 to 17 mgs and a mean n i c o t i n e content of 0.8 mgs ranging from 0.1 to 1.2 mgs ( B r i t i s h Columbia Lung A s s o c i a t i o n , 1982). Instruments Four s e l f - r e p o r t instruments were a l s o used: The Reasons fo r Smoking Scale (RFS) (Ikard, Green, & Horn, 1969), the S t a t e -T r a i t Anxiety Inventory (STAI) ( S p i e l b e r g e r , Gorsuch, & Lushene, 1970), the Hea l t h Locus of C o n t r o l Scale (HLC) (Wallston, W a l l s t o n , Kaplan, & Maides, 1976) and the PAR-Q. The RFS was used to assess i n d i v i d u a l reasons f o r smoking s i n c e d i f f e r e n t ' t y p o l o g i e s ' may be d i f f e r e n t i a l l y responsive to e x e r c i s e (O'Connor & S t r a v y n s k i , 1982). The RFS s c a l e c o n t a i n s f a c t o r -24 a n a l y t i c a l l y d e r i v e d subscales of s e l f - r e p o r t e d smoking m o t i v a t i o n . These subscales are A d d i c t i v e (ADD), Habit (HAB), S t i m u l a t i o n (STI), Sensory-motor M a n i p u l a t i o n (SMO), P l e a s u r e a b l e R e l a x a t i o n (PRE), and Negative A f f e c t Reduction (NAF). RFS f a c t o r s have been c o n s i s t e n t l y r e p l i c a t e d and shown to be s t a b l e over time (Costa, McCrae, & Bosse, 1980). Some of the RFS s c a l e s have been shown to c o r r e l a t e s i g n i f i c a n t l y with s e l f - m o n i t o r e d reasons f o r smoking ( J o f f e , Low, & F i s h e r , 1981) and scores on d i f f e r e n t s c a l e s have been used to i d e n t i f y smokers more l i k e l y to smoke under e x p e r i m e n t a l l y manipulated c o n d i t i o n s such as s t r e s s or p l e a s u r e (Ikard & Tomkins, 1973). The STAI measures two aspects of a n x i e t y : a s t a b l e i n d i v i d u a l d i f f e r e n c e or t r a i t aspect and a s i t u a t i o n a l or s t a t e aspect. The t r a i t a n x i e t y measure has been shown to be r e l a t i v e l y s t a b l e a c r o s s s i t u a t i o n s while the s t a t e measure has been shown to be s e n s i t i v e to a wide range of manipulations (Lamb, 1978) i n c l u d i n g e x e r c i s e (Morgan, 1979). The HLC s c a l e assesses the degree to which people b e l i e v e they have c o n t r o l over t h e i r h e a l t h . High s c o r e r s tend to seek more h e a l t h - r e l a t e d i n f o r m a t i o n i n experimental s i t u a t i o n s , tend to be more s a t i s f i e d with weight c o n t r o l programs, and tend to be more s u c c e s s f u l i n smoking c e s s a t i o n programs (Kaplan & Cowles, 1978; Wal l s t o n et a l . , 1976). L a s t l y , the PAR-Q i s a 7-item q u e s t i o n n a i r e that screens out i n d i v i d u a l s who may have medical c o n d i t i o n s that would c o n t r a i n d i c a t e e x e r c i s e without c l o s e medical s u p e r v i s i o n . In the development of the t e s t , items were chosen on the b a s i s of 25 t h e i r r e l a t i o n s h i p to e x e r c i s e - s p e c i f i c medical exams i n c l u d i n g v a l i d a t i o n with ECG and submaximal b i c y c l e ergometer t e s t s i n a sample of over 1200 a d u l t s (Chisholm et a l . , 1975). Procedure I n i t i a l assessment. At the i n i t i a l assessment, s u b j e c t s were given a w r i t t e n d e s c r i p t i o n of the study (Appendix G) which i n c l u d e d an o u t l i n e of the a c t i v i t i e s i n v o l v e d and the d e t a i l s of compensation f o r t h e i r p a r t i c i p a t i o n . S u b j e c t s then completed a consent form, a pre-experimental s c r e e n i n g q u e s t i o n n a i r e , the PAR-Q, the RFS, the STAI, and the HLC. The pre-experimental s c r e e n i n g q u e s t i o n n a i r e (Appendix H) contained items r e g a r d i n g smoking h i s t o r y and c u r r e n t involvement i n p h y s i c a l a c t i v i t y and formal r e l a x a t i o n technique's, as w e l l as items to assess expectancies regarding the experimental a c t i v i t i e s and a t t i t u d e s towards smoking and e x e r c i s e . The items on smoking and e x e r c i s e a t t i t u d e s were adapted from a survey by Mackie (1975). S y s t o l i c (stage 1) and d i a s t o l i c (stage IV) blood pressures'(American Heart A s s o c i a t i o n , 1967) were taken using a Ditmar stethoscope and an Accuson c u f f sphygonomonometer. Subje c t s were then matched i n blocks a c c o r d i n g to age and sex and randomly assi g n e d to one of the three groups: (a) an a e r o b i c e x e r c i s e c o n d i t i o n which c o n s i s t e d of continuous s t a t i o n a r y c y c l i n g at 60% of maximal heart r a t e ; (b) a non-aerobic e x e r c i s e c o n d i t i o n which c o n s i s t e d of d i s c o n t i n u o u s s t r e t c h i n g and i s o m e t r i c e x e r c i s e s ; (c) and a no-e x e r c i s e c o n t r o l c o n d i t i o n . Subjects were informed as to which a c t i v i t y they would be i n v o l v e d i n and requested not to engage 26 i n e x e r c i s e a c t i v i t i e s on t h e i r own f o r the 4-week d u r a t i o n of the study. I n d i v i d u a l schedules (Appendix I) o u t l i n i n g the e x e r c i s e a c t i v i t i e s and s e s s i o n times were prepared f o r s u b j e c t s while each completed the 5-minute step t e s t to determine an estimate of maximal oxygen uptake (MVG^). The procedure to determine MV0 2 estimates f o l l o w s an ada p t a t i o n of the Harvard Step Test as d e s c r i b e d by Sharkey (1979). F i r s t , a step beat was demonstrated by the experimenter a f t e r which the s u b j e c t s p r a c t i s e d stepping f o r 5 seconds. Then the s u b j e c t s stepped up and down on the standard s i z e d plywood boxes to a metronome set at 90 beats per minute, f o r 5 minutes. The boxes were 40 cm i n height f o r men and 33 cm i n height f o r women. Sub j e c t s then sat down and the c a r o t i d pulse was taken fo r 15 seconds, s t a r t i n g 15 seconds a f t e r the ste p e x e r c i s e . Pulse r a t e was ad j u s t e d f o r age and body weight a c c o r d i n g to Sharkey's (1979) t a b l e s , from which MV0 2 estimates were d e r i v e d . S e l f - m o n i t o r i n g . At the end of the i n i t i a l assessment, s u b j e c t s were given 14 x 5 cm r e c o r d i n g cards (and a c i g a r e t t e -s i z e d p e n c i l ) f o r the f i r s t week of r e c o r d i n g (Appendix J ) . Co n s i s t e n t with the r a t i o n a l e , s u b j e c t s were then d i r e c t e d i n re c o r d i n g t h e i r c i g a r e t t e enjoyment r a t i n g s . Subjects were i n s t r u c t e d : (a) to c a r r y the cards i n t h e i r c i g a r e t t e packages; (b) to note the time they took t h e i r f i r s t i n h a l a t i o n while l i g h t i n g the c i g a r e t t e ; (c) to r a t e the pl e a s u r e d e r i v e d from t h e i r f i r s t i n h a l a t i o n using a 7-point r a t i n g s c a l e , which ranged from very p l e a s a n t to very unpleasant, and which was p r i n t e d on the r e c o r d i n g c a r d s ; and (d) to record t h i s 27 in f o r m a t i o n on the cards immediately to avoid f o r g e t t i n g . By r a t i n g smoking p l e a s u r e f o r every c i g a r e t t e , s u b j e c t s i n d i r e c t l y monitored the frequency of c i g a r e t t e consumption d u r i n g t h e i r p a r t i c i p a t i o n the study. F i n a l l y , s u b j e c t s were asked not to change brands d u r i n g the study. In a d d i t i o n to these i n s t r u c t i o n s a bogus s a l i v a t e s t (Appendix C) was used to enhance accuracy and compliance i n r e c o r d i n g (Chambliss & Murray, 1979). Subjects were t o l d that the chemicals i n the s a l i v a vary a c c o r d i n g to the number of c i g a r e t t e s they smoke, and are used to c o n f i r m that there are r a t i n g s f o r every c i g a r e t t e smoked. Subjects p l a c e d a 35 mm co t t o n d e n t a l r o l l i n t h e i r mouths f o r between 20 to 30 seconds and then d e p o s i t e d i t i n a 150 ml p l a s t i c c o n t a i n e r l a b e l e d with t h e i r name and date. S a l i v a samples were taken on two other occasions d u r i n g the study to maintain s u b j e c t p e r c e p t i o n s that the number of recorded r a t i n g s was being v e r i f i e d . Subjects monitored t h e i r smoking on weekdays f o r 4 con s e c u t i v e weeks. At the s t a r t of each week s u b j e c t s were contacted by phone to remind them of t h e i r r e c o r d i n g and of any scheduled a c t i v i t i e s f o r that week. With the exception of the c o n t r o l group, e x e r c i s e s e s s i o n s were scheduled a c c o r d i n g to an A-B-B-A design f o r the 4 weeks of s e l f - m o n i t o r i n g . E x e r c i s e s e s s i o n s were conducted d u r i n g the middle 2 weeks, so s e l f -monitored data from the f i r s t week served as a b a s e l i n e and the l a s t week served as a r e t u r n to b a s e l i n e comparison f o r the ae r o b i c and non-aerobic groups. Experimental environment and s u b j e c t s c h e d u l i n g . 28 Experimental s e s s i o n s were conducted i n a w e l l - v e n t i l a t e d dance s t u d i o (15 x 30 meters i n s i z e ) i n the Armouries B u i l d i n g (Appendix M), on the U n i v e r s i t y of B r i t i s h Columbia campus. Change rooms and showers were a v a i l a b l e i n the b u i l d i n g . An area i n the middle of the s t u d i o was reserved f o r the non-a e r o b i c e x e r c i s e s , while the three s t a t i o n a r y b i c y c l e s used i n the a e r o b i c group were p o s i t i o n e d along the w a l l f a c i n g t h i s c e n t e r area. Along the w a l l adjacent to the b i c y c l e s , were three desks separated by p a r t i t i o n s p e r p e n d i c u l a r to the w a l l , where s u b j e c t s sat d u r i n g the o b s e r v a t i o n p e r i o d . The desks were arranged so that s u b j e c t s sat f a c i n g the p a r t i t i o n s . On the s i d e of the s t u d i o opposite the desks were 2 long t a b l e s c o n t a i n i n g experimental equipment where the experimental a s s i s t a n t s s a t , d i r e c t l y f a c i n g the p a r t i t i o n e d desks. A l l 'no smoking' sig n s had been removed from the s t u d i o , and a s h t r a y s were l o c a t e d on the s u b j e c t s ' desks. In a d d i t i o n , a s h t r a y s and a c i g a r e t t e package were p l a i n l y v i s i b l e on the a s s i s t a n t ' s t a b l e s at a l l s e s s i o n s and c u r r e n t magazines and newspapers were a v a i l a b l e f o r s u b j e c t s to read. S u b j e c t s ' schedules i n d i c a t e d the time, d u r a t i o n , type of a c t i v i t y , and necessary p r e p a r a t i o n . Subjects were requested not to smoke durin g the 20 minutes of e x e r c i s e or while s i t t i n g i f they were i n the c o n t r o l group. At the very f i r s t s e s s i o n f o r the e x e r c i s e groups, s u b j e c t s were given a standard r a t i o n a l e f o r the a c t i v i t y and i n s t r u c t e d in the b a s i c format of the s e s s i o n (Appendices A & B). Subjec t s were run i n groups of up to three at a time. 29 E x e r c i s e s e s s i o n s were conducted only on weekdays between 4:30 and 6:30 p.m. Subjects i n the ae r o b i c and non-aerobic group attended four d a i l y s e s s i o n s d u r i n g the second and t h i r d weeks. G e n e r a l l y , s e s s i o n s were h e l d Monday to Thursday. I f one s e s s i o n was missed or c o u l d not be accommodated i n a s u b j e c t ' s schedule, the f o u r t h s e s s i o n was h e l d on the F r i d a y of that week. Aerobic e x e r c i s e s e s s i o n s . The 20-minute s e s s i o n s c o n s i s t e d of 3 minutes of muscle s t r e t c h i n g to warm-up, 15 minutes continuous c y c l i n g (the l a s t 2 minutes g r a d u a l l y d e c r e a s i n g i n i n t e n s i t y ) and a 2 minute m u s c l e - s t r e t c h i n g warm-down (Appendix A). F o l l o w i n g an a d a p t a t i o n of p h y s i c a l work t e s t s d e s c r i b e d by Astrand (1977), s u b j e c t s p e d a l l e d on e i t h e r a computerized Dynavit b i c y c l e ergometer or one of two T u n t u r i b e l t - t e n s i o n s t a t i o n a r y b i c y c l e s to a metronome pacer of 100 beats per minute (or 50 c y c l i n g r e v o l u t i o n s per minute). S t a r t s were staggered so that pulse measures(pulse count f o r 10 seconds and the r e s u l t m u l t i p l i e d by 6) c o u l d be taken one subject at a time a f t e r 1,5,10, and 15 minutes of c y c l i n g , corresponding to measures at 4,8,13, and 18 minutes i n t o the s e s s i o n . Pulse r a t e was taken by counting the c a r o t i d or r a d i a l pulse f o r 10 seconds, while s u b j e c t s continued to c y c l e . A f t e r each p u l s e measure, c y c l i n g r e s i s t a n c e was adju s t e d i f necessary to maintain heart r a t e at approximately 60% of maximal heart r a t e . For these s u b j e c t s , 60% of maximal heart r a t e corresponds to approximately 140 bpm (Cooper,1977). Non-aerobic s e s s i o n s . Subjects were d i r e c t e d by one of two 30 a s s i s t a n t s i n a standard s e r i e s of minimal i n t e n s i t y i s o m e t r i c and s t r e t c h i n g e x e r c i s e s adapted from Verney (1980) f o r 20 minutes (Appendix B). Pulse was taken beforehand and at 4,8,13, and 18 minutes i n t o the s e s s i o n to correspond with pulse r a t e measures i n the a e r o b i c e x e r c i s e c o n d i t i o n . U n l i k e the continuous high i n t e n s i t y a c t i v i t y i n the a e r o b i c s e s s i o n s , these s e s s i o n s i n v o l v e d d i s c o n t i n u o u s minimal i n t e n s i t y a c t i v i t y . One of the a s s i s t a n t s demonstrated or d e s c r i b e d a s t r e t c h i n g movement and s u b j e c t s repeated the s t r e t c h slowly 5 to 10 times. Isometric e x e r c i s e s were i n t e r s p e r s e d with the s t r e t c h movements and fo l l o w e d the same procedure: the a s s i s t a n t would demonstrate or d e s c r i b e the e x e r c i s e and s u b j e c t s would tense ( f o r between 5 to 10 seconds) and r e l a x d i f f e r e n t muscle groups f o r two to f i v e r e p e t i t i o n s . Subjects were a l s o s t a r t e d at staggered times so that p u l s e measures co u l d be taken i n d i v i d u a l l y . The same sequence of e x e r c i s e s was used a c r o s s a l l s e s s i o n s . No-exercise C o n t r o l group s e s s i o n s . Subjects i n t h i s c o n d i t i o n monitored t h e i r smoking over the same 4 week p e r i o d as d i d the e x e r c i s e groups. During the second and t h i r d week of the study, c o n t r o l s u b j e c t s were seen as part of the assessment procedure. They sat and read q u i e t l y f o r 20 minutes, without smoking, d u r i n g which t h e i r pulse r a t e s were counted at the same i n t e r v a l s used i n the two e x e r c i s e c o n d i t i o n s . Assessment/observation procedure. On the f i r s t and l a s t e x e r c i s e s e s s i o n and the corresponding days i n the no-e x e r c i s e c o n t r o l c o n d i t i o n , s u b j e c t s waited f o r 30 minutes a f t e r the 31 s e s s i o n . They were t o l d that the purpose of the w a i t i n g p e r i o d was to assess t h e i r p h y s i o l o g i c a l recovery a f t e r e x e r c i s e . C o n t r o l s u b j e c t s were t o l d that they were p r o v i d i n g a comparison to the other groups on the same measures. Subjects were t o l d that they were f r e e to smoke i f they wished, and were requested to s i t i n separate c u b i c l e s and read q u i e t l y , without t a l k i n g . A l l assessment s e s s i o n s followed the same format. Subjects completed the s t a t e form of the STAI, and had t h e i r blood pressure and pulse taken, both before the s e s s i o n s t a r t e d and at the end of the r e s t p e r i o d . At the end of the assessment s e s s i o n , s a l i v a samples were taken, previous weeks' s e l f -m onitoring cards were c o l l e c t e d , and new cards s u p p l i e d . During the r e s t p e r i o d , s u r r e p t i t i o u s o b s e r v a t i o n s of s u b j e c t s ' smoking were made by two resea r c h a s s i s t a n t s , who were o s t e n s i b l y busy with equipment and working on data p r e p a r a t i o n . The a s s i s t a n t s noted the time each c i g a r e t t e was l i t , the number of p u f f s taken and the time each c i g a r e t t e was butted out. At the l a s t assessment s e s s i o n , s u b j e c t s completed an a c t i v i t y e v a l u a t i o n form (Appendix K) on which they r a t e d how the e x e r c i s e (or c o n t r o l s i t t i n g ) had e f f e c t e d them. A l s o at t h i s time, the HLC s c a l e was r e a d m i n i s t e r e d . Post-experimental i n t e r v i e w . A f t e r the f i n a l 5-day monitoring p e r i o d , an i n t e r v i e w was arranged at which s u b j e c t s returned t h e i r f i n a l weeks' s e l f - m o n i t o r i n g cards and completed a post experimental q u e s t i o n n a i r e . T h i s q u e s t i o n n a i r e i n c l u d e d q u e s t i o n s a s s e s s i n g s u b j e c t s ' knowledge of the purpose of the study, compliance to experimental r e s t r i c t i o n s and to c i g a r e t t e 32 r e c o r d i n g , and i n t e n t i o n to q u i t smoking (Appendix L ) . A f t e r completing the q u e s t i o n n a i r e , s u b j e c t s r e c e i v e d payment, were given feedback on t h e i r l e v e l of f i t n e s s , and d e b r i e f e d . A s s i s t a n t p r e p a r a t i o n and r e l i a b i l i t y checks. Two under-graduate psychology students, one male and one female, served as r e s e a r c h a s s i s t a n t s and were present at a l l s e s s i o n s with the exc e p t i o n of the i n i t i a l s c r e e n i n g and the post-experimental i n t e r v i e w . As a p r e c a u t i o n a r y measure, one of the a s s i s t a n t s was t r a i n e d i n b a s i c f i r s t a i d and cardiopulmonary r e s u s c i t a t i o n (CPR). Both were b l i n d to the a c t u a l hypotheses, and were t o l d i n s t e a d that the aim of the study was to p r e d i c t i n d i v i d u a l smoking responses to d i f f e r e n t p h y s i c a l a c t i v i t i e s . A s s i s t a n t s were a l s o t o l d t h a t they were being kept b l i n d to i n f o r m a t i o n on the smokers' typ o l o g y . The a s s i s t a n t s were a l s o unaware that the s a l i v a samples were not a c t u a l l y analyzed. The a s s i s t a n t s were given manuals d e s c r i b i n g the r a t i o n a l e s to be presented to s u b j e c t s and the experimental procedures (Appendices A & B). P i l o t s e s s i o n s were conducted to st a n d a r d i z e the assessment and e x e r c i s e s e s s i o n s and to ensure r e l i a b i l i t y i n the measurement. Before the study began, a s s i s t a n t s were t r a i n e d to c r i t e r i a of agreement of w i t h i n ± 1 puff taken and agreement of w i t h i n ± 3 seconds on the time measure had been achieved. To f a c i l i t a t e a c c u r a t e r e c o r d i n g , d i g i t a l stopwatches were used f o r a l l timing and data was recorded on s t a n d a r d i z e d sheets (Appendices D & E ) . F o l l o w i n g F r e d e r i c k s o n , M i l l e r , and Peterson (1977), p u f f s were d e f i n e d as each time the c i g a r e t t e ' f l a r e d ' or was drawn to the l i p s f o r an 33 i n h a l a t i o n and removed. I n i t i a l l i g h t i n g and i n h a l a t i o n d i d not c o n s t i t u t e a p u f f . Time of l i g h t i n g the c i g a r e t t e was d e f i n e d as when the flame makes con t a c t with the end of the c i g a r e t t e , and butt out was d e f i n e d as the f i r s t time the c i g a r e t t e was pushed i n t o the bottom of the a s h t r a y . Agreement on both s y s t o l i c and d i a s t o l i c blood pressure was achieved to w i t h i n ± 5 mm Hg and agreement on pulse was w i t h i n ± 6 beats per minute d u r i n g e x e r c i s e and at r e s t . T r a i n i n g in blood pressure measurement i n v o l v e d reading a d e s c r i p t i o n of the procedure, l i s t e n i n g to tape r e c o r d i n g s of Korotokoff sounds, and p r a c t i s e at p i l o t s e s s i o n s . F o l l o w i n g the American Heart A s s o c i a t i o n ' s (1967) recommendations, s y s t o l i c was d e f i n e d as the s t a r t of Phase I sounds ( c l e a r tapping) and d i a s t o l i c was d e f i n e d as the s t a r t of Phase IV sounds ( m u f f l i n g sounds). Pulse r a t e was taken by c o u n t i n g the beats i n the ' c a r o t i d or r a d i a l p u l s e f o r a 10 second p e r i o d and m u l t i p l y i n g t h i s r e s u l t by 6. R e l i a b i l i t y checks were taken on the o b s e r v a t i o n a l measures, pulse r a t e , and blood p r e s s u r e . P r i o r to the s t a r t of each assessment, each a s s i s t a n t was s e p a r a t e l y a l l o c a t e d two s u b j e c t s to observe, so that each a s s i s t a n t was b l i n d to which s u b j e c t s the other was o b s e r v i n g . Since no more than three s u b j e c t s were assessed a one time, t h i s meant that o b s e r v a t i o n s on at l e a s t one subject c o u l d serve as r e l i a b i l i t y check. Observations were recorded s e p a r a t e l y and the a s s i s t a n t s ' t a b l e was arranged so that the equipment on the t a b l e formed a p a r t i t i o n s e p a r a t i n g o b s e r v e r s . On those occasions where only two s u b j e c t s were being assessed both were doubly recorded and 34 one was randomly chosen as the r e l i a b i l i t y check. Blood p r e s s u r e r e l i a b i l i t y checks were taken by immediately r e t a k i n g the measure on the opposite arm, by the second a s s i s t a n t . Pulse r a t e r e l i a b i l i t y was determined by t a k i n g the c a r o t i d and r a d i a l p u l s e s s i m u l t a n e o u s l y . 35 RESULTS The r e s u l t s are presented i n three s e c t i o n s : (a) analyses of s u b j e c t v a r i a b l e s , (b) an a l y s e s of the manipulation checks and the r e l i a b i l i t y data, and (c) analyses of the dependent v a r i a b l e s . Data from one female and one male s u b j e c t were excluded because both became i l l d u r i n g the study. Subject C h a r a c t e r i s t i c s F i t n e s s and smoking data. A l l groups were comparable at the i n i t i a l i n t e r v i e w with r e s p e c t to s e l f - r a t i n g s of f i t n e s s and a c t i v i t y , estimated MV0 2, s e l f - r e p o r t e d c i g a r e t t e consumption, number of years smoked, and t a r and n i c o t i n e content of brands smoked. Table 1 pres e n t s means and standard d e v i a t i o n s f o r each group on each of these v a r i a b l e s . In each case a one-way a n a l y s i s of v a r i a n c e (ANOVA) was performed with Type I e r r o r c o n t r o l l e d by the B o n f e r r o n i c o r r e c t i o n i n which alpha i s d i v i d e d by the number of comparisons («*=.05/7 comparisons=.007) (Hays, 1973). B a r t l e t t - B o x F t e s t s , conducted c o n c u r r e n t l y with the ANOVAs, i n each case confirmed the assumption of homogeneous v a r i a n c e s . No s i g n i f i c a n t d i f f e r e n c e s were found f o r any of these v a r i a b l e s . The o v e r a l l mean s e l f - r a t i n g s of a c t i v i t y and f i t n e s s f o r a l l s u b j e c t s , were l o c a t e d midway between the 'average' and the ' i n a c t i v e ' or the ' u n f i t ' semantic anchors on the r e s p e c t i v e 5-p o i n t s c a l e s . S i m i l a r l y the mean MVO£ estimates f o r men (M=47.1, SD=5.6) and f o r women (M=40.5, SD=7.3) were i n the low average category a c c o r d i n g to norms pr o v i d e d by Sharkey (1979). 36 Table 1 - Mean Values f o r F i t n e s s and Smoking V a r i a b l e s at the I n i t i a l Assessment by Group Group Aerobic Non-Aerobic No-exercise Measures M (SD) M (SD) M (SD) F i t n e s s MV0 2(ml/kg/min) 24. ,3 (3. .4) 23. .7 (5. ,5) 23. .9 (4. .6) A c t i v i t y Rating 2. .5 (0. .8) 2. .8 (0. ,9) 2. .2 (0. .9) F i t n e s s Rating 2. .2 (0. .9) 2. .9 (0. ,5) 2, .4 (0. .8) loking Rate(cig/day) 25. .3 (6. .5) 22, .2 (3. .0) 23. .0 (3, .6) Years Smoked 9. .7 (3. .5) 7. .7 (5. .1 ) 7, .7 (4. ,8) Tar(mg) 12. .5 (2, .8) 1 1 . .0 (4. .6) 1 1 , .5 (4. .4) N i c o t i n e (mg) 0. .9 (0. . 1 ) 0, .8 (0. .3) 0, .9 (0. .3) Note. A c t i v i t y and F i t n e s s r a t i n g s are on a 5-point high scores i n d i c a t i n g g r e a t e r a c t i v i t y or f i t n e s s . s c a l e with 37 Ratings of both a c t i v i t y and f i t n e s s were s i g n i f i c a n t l y c o r r e l a t e d with MV02 estimates (£=.33, p < ' u 5 and £=.37, p_<.0l r e s p e c t i v e l y ) . Subjects were normotensive with an o v e r a l l mean blood p r e s s u r e of 116.1/76.4 mmHg. Mean weight was 71.0 kgs, SD=9.3 fo r males and was 60.0 kgs, SD=8.1 f o r females. The groups d i d not d i f f e r s i g n i f i c a n t l y with respect to blood pressure or weight. I n t e r e s t i n g l y , both weight and the f i t n e s s r a t i n g i n t h i s sample c o r r e l a t e d with r e p o r t e d d a i l y smoking r a t e (£=.33, p_<.02 and £=-.52, g<.00l r e s p e c t i v e l y ) . Smoking r a t e was not s i g n i f i c a n t l y d i f f e r e n t between sexes. Subject a t t i t u d e s and e x p e c t a n c i e s . F i f t e e n items from the pre-experimental q u e s t i o n a i r e ( f i v e concerning e x p e c t a t i o n s of the e f f e c t of e x e r c i s e and mood s t a t e s on smoking enjoyment, and ten, adapted from Mackie (1975), concerning a t t i t u d e s towards smoking and e x e r c i s e ) , were analyzed s e p a r a t e l y with a one-way ANOVA procedure using the B o n f e r r o n i c o r r e c t i o n (°<=.004). No s i g n i f i c a n t d i f f e r e n c e s were found between groups on any of the i terns. The o v e r a l l mean r a t i n g s of e x e r c i s e and smoking were i n the same d i r e c t i o n as those found i n Mackie's (1975) survey of 427 Canadian smokers. In g e n e r a l , e x e r c i s e was r a t e d n e u t r a l l y with respect to "convenient" and "enjoyable" and r a t e d p o s i t i v e l y with respect to " s o c i a l l y approved", "good", and "necessary". Smoking was r a t e d n e u t r a l l y with respect to "enjoyable", p o s i t i v e l y with r e s p e c t to "convenient", but was r a t e d toward the " s o c i a l l y disapproved", "bad", and 38 "unnecessary" poles on the respective 7-point scales. Psychoinetric data. Means and standard deviations of the nine test scores obtained at the i n i t i a l assessment are presented in Table 2. While concurrent Bartlett-Box F tests confirmed the assumption of homogeneous variances for each variable, one-way ANOVAs with alpha corrected (<x = .006) revealed no s i g n i f i c a n t between groups differences on any of these measures. The o v e r a l l mean STAI scores on both state and t r a i t anxiety for both sexes lay between the 55th and 65th percentiles according to norms provided by Speilberger, Gorsuch, and Lushene (1970) for undergraduates. The ov e r a l l mean HLC score was within half a standard deviation of the mean reported for undergraduate populations (Wallston, Wallston, Kaplan, & Maides, 1976). Manipulation And R e l i a b i l i t y Checks Awareness of experimental design. On the post-experimental questionnaire, none of the subjects correctly described the actual experimental hypotheses. The post-experimental interview revealed that no subject was aware that his or her smoking behavior had been observed by the research assistants. Pulse rate. Experimenter-monitored pulse was used as an index of the intensity of session a c t i v i t y . Figure 1 presents pulse rate data from a l l three groups at the f i r s t and last sessions. To assess group differences in intensity during sessions, pulse rates from both sessions were analyzed in a groups x repeated measures ANOVA design. Only the group effect 39 Table 2 - Mean Psychometric Scores at the I n i t i a l Assessment by Group Group Test Aerobic M (SD) Non-Aerobic M (SD) No-exerc i se M (SD) HLC RFS J State 32. .0 (6. .1) 32. ,8 (6, .6) 29. ,6 (6. ,9) 37. .8 (6. .2) 38. ,9 (4. .9) 36. . 1 (6. .2) T r a i t 45. .7 (9. .6) 40. ,9 (6. .7) 39. ,6 (9. .8) i A d d i c t ive 16. .8 (2. .7) 15. . 1 (3, .2) 15. .5 (4. .0) Habit 10. .3 (2. .6) 8. .8 (2. .2) 9. ,7 (2. . 1 ) St imulat ion 7. .8 (1 , .8) 7 . ,6 (2. .7) 7. .3 (1 . 7) Sensory-Motor 7, .8 (2. .5) 8. . 1 (3, .4) 6. .8 (2. .5) Relaxat ion 7, .3 (1 . 8) 7. .2 ( 1 . .6) 7. ,3 (1 . 3) Negative A f f e c t •18. .2 (3. .4) 16. .5 (3, .4) 16. .5 (3. .9) 40 was s i g n i f i c a n t , [F(2,33) = 56.1 2 , p_<.000l], as i l l u s t r a t e d i n Fi g u r e 1. Only the aer o b i c group c o n s i s t e n t l y maintained pulse r a t e above 60% of maximum (or approximately 140 bpm) f o r at l e a s t 10 minutes or, i n other words, was of s u f f i c i e n t i n t e n s i t y to meet the c r i t e r i a of a e o r b i c e x e r c i s e as d e f i n e d by Cl a r k e (1975). A c t i v i t y e v a l u a t i o n s . Each of the e i g h t items from the e v a l u a t i o n was analyzed with a one-way ANOVA with the B o n f e r r o n i c o r r e c t i o n a p p l i e d (°< = .006). As i n d i c a t e d i n Table 3, four items emerged s i g n i f i c a n t . Post-hoc Tukey t e s t s r e v e a l e d that s u b j e c t s i n both e x e r c i s e c o n d i t i o n s r a t e d the e x e r c i s e as having i n c r e a s e d f i t n e s s , muscle tone, and muscle f l e x i b i l i t y and as having decreased boredom i n comparison to c o n t r o l s u b j e c t s ' r a t i n g s of t h e i r e x perience. I t i s noteworthy that there 'was no d i f f e r e n c e i n the r a t i n g s between the e x e r c i s e groups on these four r a t i n g s d e s p i t e the l a r g e d i f f e r e n c e i n pulse rat e i n d i c a t e d i n Fi g u r e 1. R e l i a b i l i t y of o b s e r v a t i o n a l measures. I n t e r o b s e r v e r agreement was c a l c u l a t e d f o r smoking o b s e r v a t i o n s , pulse r a t e , and BP. The r e l i a b i l i t y of smoking topographic measures was c a l c u l a t e d f o r 37% of the 63 c i g a r e t t e s smoked du r i n g the obs e r v a t i o n p e r i o d s of the study by t a k i n g Pearson c o r r e l a t i o n s between the two experimental a s s i s t a n t s ' r e c o r d i n g s . C o r r e l a t i o n s were h i g h l y s i g n i f i c a n t f o r a l l measures of smoking topography (r= .99, .99, and .73, f o r l a t e n c y to smoke, d u r a t i o n , and p u f f s taken, r e s p e c t i v e l y , g<.00l). T h i r t y - n i n e percent of o b s e r v a t i o n s on p u f f s taken were i d e n t i c a l , 82% were 41 F i g u r e 1 - Pulse Rate During the F i r s t and La s t Session FIRST SESSION 155 LAST SESSION 1 3 5 1 15 PULSE RATE 95 r 7 5 L - J L PRE 3 8 13 • O 18 J :J_ • Aerobic • Non-Aerobic O No-Exercise • • O 50 PRE 3 TIME(MIN) 8 1 3 18 . J 50 42 Table 3 - A c t i v i t y E v a l u a t i o n Ratings Group Non- No-Aerobic Aerobic E x e r c i s e F p_ Item M (SD) M (SD) M (SD) F i t n e s s 3 .8(1 .3) 4 .2(1 .2) 1 .3(0. 9) 22. 61 <.0001 Muscle Tone 2 .7(1 .2) 3 .2(1 .3) 1 .3(0. 6) 10. 1 5 .0004 Muscle F l e x i b i l i t y 2 .2(1 . 1 ) 4 .0(1 .4) 1 .3(0. 6) 19. 45 <. 0001 Boredom 2 .0(1 . 1 ) 1 .8(0 .7) 3 .7(2. 1 ) 5. 94 .0062 Note. Ratings on a 1-7 s c a l e . Higher scores r e f l e c t higher r a t i n g s of the a t t r i b u t e . 43 ± 1 p u f f and 95% were ± 2 p u f f s . I n t e r - o b s e r v e r r e l i a b i l i t y f o r pulse r a t e , c a l c u l a t e d from 26% of 1,132 i n d i v i d u a l pulse rate r e c o r d i n g s , was highly, s i g n i f i c a n t (r=.95,£<.0001). I n t e r -observer r e l i a b i l i t y f o r blood p r e s s u r e , c a l c u l a t e d from one blood pressure sample from 22% of s u b j e c t s , was h i g h l y s i g n i f i c a n t f o r both s y s t o l i c and d i a s t o l i c blood pressure (r=.75 and .85, £<.001, r e s p e c t i v e l y ) . None of the blood pressure r e c o r d i n g s between observers was d i s c r e p a n t by more than ± 5 mmHg. Dependent Measures S e l f - m o n i t o r e d c i g a r e t t e consumption. Table 4 pre s e n t s the mean d a i l y recorded c i g a r e t t e consumption by group f o r each of the 4 weeks. A one-way ANOVA of b a s e l i n e smoking r a t e confirmed that the groups were comparable at b a s e l i n e [F(2,33)<1]. Mean d a i l y c i g a r e t t e consumption over the 2 middle 5-day p e r i o d s was analyzed in a groups x repeated measures ANOVA de s i g n . No s i g n i f i c a n t group, repeated measures, or i n t e r a c t i o n e f f e c t s were found. While no s i g n i f i c a n t group e f f e c t s were found, s e l f -monitored data from the e x e r c i s e groups i n d i c a t e d c o n s i d e r a b l e v a r i a b l i t y i n c i g a r e t t e consumption d u r i n g the 2 middle weeks. These changes ranged from a mean decrease from b a s e l i n e of 6 c i g a r e t t e s per day to mean i n c r e a s e of 2 c i g a r e t t e s per day. In order to assess whether t h i s v a r i a b i l i t y was r e l a t e d to i n d i v i d u a l d i f f e r e n c e s , data from both e x e r c i s e groups were pooled and d i v i d e d at the median i n t o two groups on each of the s e l f - r e p o r t measures taken at the i n i t i a l assessment and i n t o 44 high and low s c o r e r s on the STAI before and a f t e r e x e r c i s e . U n i v a r i a t e _ t - t e s t s , between high and low s c o r e r s i n mean d a i l y change in c i g a r e t t e consumption, however, f a i l e d to reach s i g n i f i c a n c e . Smoking Topography. For the purposes of data a n a l y s i s , i n d i v i d u a l s who d i d not smoke d u r i n g the o b s e r v a t i o n p e r i o d were given a l a t e n c y of 25 minutes, 0 sec of d u r a t i o n , and 0 p u f f s . Means and standard d e v i a t i o n s on these measures, f o r each group, are shown in Table 5. Because of the l a r g e v a r i a b i l i t y i n the topographic components, and because MVO2 and some of the RFS s c a l e s were c o r r e l a t e d with the topographic measures, a two-way (groups x assessments) m u l t i v a r i a t e a n a l y s i s of c o v a r i a n c e (MANCOVA) was performed with MV02 and the HAB, SMO, STI, and NAF s c a l e scores as c o v a r i a t e s . While the e f f e c t f o r repeated assessments was n o n - s i g n i f i c a n t , the main e f f e c t f o r groups reached s i g n i f i c a n c e [ F (1 , 61 ) =2 . 50 , p_<.05]. Concurrent u n i v a r i a t e a n a lyses of c o v a r i a n c e (ANCOVA) on the o b s e r v a t i o n a l measures, however, rev e a l e d only one s i g n i f i c a n t r e s u l t : a main e f f e c t f o r groups on number of p u f f s taken [ F ( 2 , 6 1 ) = 3.1 0 , p_<.05]. Post-hoc Tukey range t e s t s i n d i c a t e d a s i g n i f i c a n t d i f f e r e n c e between the non-aerobic group and the n o - e x e r c i s e c o n t r o l group. Neither group, however, was s i g n i f i c a n t l y d i f f e r e n t from the aerobic group. Puff r a t e was analyzed s e p a r a t e l y from the other v a r i a b l e s in the MANCOVA because i t i s a l i n e a r combination of p u f f s taken and d u r a t i o n . A groups x repeated measures ANCOVA was performed on puff r a t e with MVOg and HAB s c a l e scores used as c o v a r i a t e s , 45 Table 4 - Mean D a i l y C i g a r e t t e Consumption from Subject Recordings Group Aerobic Non-Aerobic No-Exercise Week M (SD) M (SD) M (SD) 1 22.4 (4.6) 21.7(3.3) 20.8 (4.4) 2 22.9(4.7) 21.2(2.5) 21.2(4.3) 3 22.2(4.3) 20.6(3.3) 21.4(3.9) 4 21.7(3.6) 21.4(3.2) 21.7(4.4) 4 6 Table 5 - Mean Values for Topographic Smoking Measures by Group and Assessment Group Measures Aerobic Non-Aerobic No-Exercise Assmt. M (SD) M (SD) M (SD) Latency(sec) Duration(sec) Puffs Puff rate 1 2 1 2 1 2 1 2 648 (669) 656 (609) 371 (289) 318 (236) 6.6 (7.1) 5.1 (3.9) .68 (.63) .73 (.51) 623 (596) 627 (682) 345 (236) 304 (244) 4.2 (2.8) 4.7 (4.1) .55 (.32) .67 (.70) 489 (555) 236 (416) 414 (269) 537 (328) 7.3 (5.0) 7.1 (4.0) 1.06 (.98) .94 (.91) 47 s i n c e both these scores c o r r e l a t e d with puff r a t e . Although the assessments and i n t e r a c t i o n e f f e c t s were not s i g n i f i c a n t , a s i g n i f i c a n t main e f f e c t f o r groups was found [F(2,64)=3.30, 2<.05]. C o n s i s t e n t with the MANCOVA r e s u l t s , post-hoc Tukey t e s t s r e v e a l e d that the non-aerobic e x e r c i s e group had a s i g n i f i c a n t l y lower puff rat e than the no- e x e r c i s e c o n t r o l s , while the a e r o b i c group was not s i g n i f i c a n t l y d i f f e r e n t from e i t h e r group. During the two o b s e r v a t i o n s , a t o t a l of 27.5% of s u b j e c t s i n both e x e r c i s e groups a b s t a i n e d from smoking compared to a t o t a l of 14.5% i n the no-e x e r c i s e c o n t r o l group. A c h i square a n a l y s i s , however, r e v e a l e d that the p r o p o r t i o n of a b s t a i n e r s i n the e x e r c i s e groups was not s i g n i f i c a n t l y d i f f e r e n t from c o n t r o l s at e i t h e r assessment. S i m i l a r l y , no s i g n i f i c a n t r e s u l t s were obtained i n a two-way ANOVA of the t o t a l number of c i g a r e t t e s smoked. The o b s e r v a t i o n a l measures were s i g n i f i c a n t l y i n t e r c o r r e l a t e d as Table 6 shows. Subjects who d i d not smoke were excluded from these c o r r e l a t i o n s . Those smokers who l i t up sooner a l s o tended to smoke longer and take more p u f f s . I t i s i n t e r e s t i n g to note that two of the c o r r e l a t i o n s i n c r e a s e d s u b s t a n t i a l l y and one decreased from the f i r s t to the second assessment. None of the c o r r e l a t i o n s between topographic measures at the f i r s t assessment and the same measures at the second assessment were s i g n i f i c a n t . S e l f - m o n i t o r e d l a t e n c i e s . S e l f - r e c o r d e d smoking times showed moderate agreement with observers' r e c o r d i n g s of l a t e n c y 48 Table 6 - C o r r e l a t i o n s Among the Topographic Measures Measures Assmt. Latency Durat ion P u f f s Duration 1 -.26 2 -.50** P u f f s 1 -.27 .42* 2 -.32* .61** Puff 1 -.05 -.30 .66** rate 2 -.04 -.31* .37* Note. N=27 f o r Assessment 1 and N=28 f o r Assessment 2. **<.005 *<.05 49 fo r the f i r s t c i g a r e t t e smoked durin g the o b s e r v a t i o n a l p e r i o d s . A Pearson c o r r e l a t i o n between the two measures was s i g n i f i c a n t (r_=.46, 2<.005). Of the 55 f i r s t c i g a r e t t e s smoked during the o b s e r v a t i o n a l p e r i o d s , only 2 were not recorded by s u b j e c t s , 42.4% were w i t h i n ± 5 minutes agreement with observers l a t e n c i e s , 77.2% were w i t h i n ± 10 minutes agreement and 96.9% were w i t h i n ± 20 minutes. Three s e l f - m o n i t o r e d l a t e n c y measures were analyzed with a groups x repeated measures MANOVA. These i n c l u d e d time ( i n minutes) of l a s t c i g a r e t t e before the s t a r t of the s e s s i o n , time ( i n minutes) of f i r s t c i g a r e t t e a f t e r the end of s e s s i o n (or s t a r t of the ' r e s t ' p e r i o d ) and time ( i n minutes) of the second c i g a r e t t e a f t e r the end of the s e s s i o n . Because 23% of the sub j e c t s d i d not smoke du r i n g the 25 minute o b s e r v a t i o n a l p e r i o d , the s e l f - m o n i t o r e d l a t e n c i e s f o r the f i r s t two c i g a r e t t e s a f t e r e x e r c i s e were analyzed. The two-way MANOVA rev e a l e d only a s i g n i f i c a n t group e f f e c t [F(6,62)=3.89, p_<.005]. U n i v a r i a t e analyses r e v e a l e d no d i f f e r e n c e between groups i n time of l a s t c i g a r e t t e before a s e s s i o n [F(2,33)<1], t h e r e f o r e , mean d i f f e r e n c e s i n l a t e n c i e s a f t e r s e s s i o n s c o u l d not be accounted f o r by d i f f e r e n c e s between groups i n time from l a s t c i g a r e t t e before the s e s s i o n . However, s i g n i f i c a n t main e f f e c t s for groups f o r both the f i r s t , [ F ( 2 , 33 ) =6. 80 , p_<.005], and the second c i g a r e t t e [F (2, 33) = 1 1 .01 , p_<.00l], were found on the u n i v a r i a t e a n a l y s e s of s e l f - m o n i t o r e d l a t e n c y data. These means are presented i n Table 7. C o n s i s t e n t with the e f f e c t s on puff r a t e , post-hoc Tukey comparisons r e v e a l e d a s i g n i f i c a n t l y longer 50 Table 7 - S e l f - M o n i t o r e d Smoking L a t e n c i e s i n Minutes by Group at each Assessment Group C i g a r e t t e Assmt Aerobic Non-Aerobic M (SD) M (SD) No-Exercise M (SD) Last c i g a r e t t e p r i o r to s e s s i o n 1 2 F i r s t c i g a r e t t e a f t e r end of s e s s i o n 1 2 Second c i g a r e t t e a f t e r end of s e s s i o n 1 2 35 (38) 27 (25) 16 (16) 13 (22) 54 (30) 66 (41) 35 (39) 27 (30) 24 (23) 37 (39) 92 (31 ) 115 (45) 26 (36) 28 (24) 3 (11) 10 (18) 46 (32) 62 (44) 51 l a t e n c y f o r the non-aerobic e x e r c i s e group compared to the no-e x e r c i s e c o n t r o l s f o r the f i r s t c i g a r e t t e a f t e r the s e s s i o n . Latency of the second c i g a r e t t e i n the non-aerobic e x e r c i s e group was s i g n i f i c a n t l y longer than both the a e r o b i c e x e r c i s e and n o - e x e r c i s e c o n t r o l s at both assessment s e s s i o n s . Smoking enjoyment r a t i n g s . Enjoyment r a t i n g s were analyzed in a two-way (groups x assessments) MANCOVA f o r d i f f e r e n c e s between groups on r a t i n g s of the l a s t c i g a r e t t e p r i o r to the s e s s i o n , the f i r s t c i g a r e t t e a f t e r the s e s s i o n , and the second c i g a r e t t e a f t e r the s e s s i o n . Since scores on the PRE s c a l e were h i g h l y c o r r e l a t e d with a l l these c i g a r e t t e r a t i n g s , PRE s c a l e scores were c o v a r i a t e s . None of the MANCOVA e f f e c t s reached s i g n i f i c a n c e . State a n x i e t y and blood pressure measures. Three i n d i c e s of t e n s i o n , the STAI s t a t e score, s y s t o l i c BP, and d i a s t o l i c BP were analyzed using a two-way (groups x repeated measures) MANOVA. Only the i n t e r a c t i o n e f f e c t reached s i g n i f i c a n c e [F(8,132)=3.53, p_= . 01 ], although the group e f f e c t approached s i g n i f i c a n c e [F(2,33)=2.02, p_<.07]. U n i v a r i a t e a n a l yses r e v e a l e d no e f f e c t s f o r the BP measures, but there was a s i g n i f i c a n t i n t e r a c t i o n e f f e c t on the STAI measure [F(8,33)=4.36, p_<. 01 ] , and the group e f f e c t approached s i g n i f i c a n c e [F(2,33)=1.93, £ = . 0 7 ] , F i g u r e 2 prese n t s mean STAI scores at the i n i t i a l assesment and before and a f t e r the f i r s t and l a s t s e s s i o n s . Although no s i g n i f i c a n t d i f f e r e n c e s were found at the i n i t i a l assessment, post-hoc Tukey t e s t s r e v e a l e d group d i f f e r e n c e s at both 52 F i g u r e 2 - Mean STAI S c o r e s A c r o s s A s s e s s m e n t s 46 r 44 r 42 40 STAI 38 STATE SCORE 36 34 32 30 O I N I T I A L ASSESSMENT F I R S T SESS ION • A e r o b i c • N o n - a e r o b i c O N c - E x e r c i s e O - - O LAST SESS ION PRE POST PRE POST 53 s e s s i o n s . P r i o r to the f i r s t s e s s i o n , s t a t e a n x i e t y i n both non-aerobic and ae r o b i c c o n d i t i o n s was s i g n i f i c a n t l y g r e a t e r than n o - e x e r c i s e c o n t r o l s while afterwards only the non a e r o b i c c o n d i t i o n was s i g n i f i c a n t l y g r e a t e r than the no- e x e r c i s e c o n t r o l s . P r i o r to the f i n a l assessment, the aer o b i c e x e r c i s e group had s i g n i f i c a n t l y g r e a t e r s t a t e a n x i e t y than e i t h e r non-ae r o b i c e x e r c i s e s u b j e c t s or no- e x e r c i s e c o n t r o l s while post-s e s s i o n STAI s t a t e scores f o r the a e r o b i c group were only s i g n i f i c a n t l y g r e a t e r than no-exercise c o n t r o l s . Post hoc Tukey analyses of simple main e f f e c t s a c r o s s groups r e v e a l e d a s i g n i f i c a n t decrease i n p r e - e x e r c i s e s t a t e a n x i e t y scores from the f i r s t to the l a s t s e s s i o n i n the non-aerobic group and a s i g n i f i c a n t i n c r e a s e from the f i r s t to the l a s t s e s s i o n . No change acr o s s assessments was found i n the no-e x e r c i s e c o n t r o l group. HLC and post-study a t t i t u d e s toward q u i t t i n g . The HLC scores were analyzed i n a group x repeated measures ANOVA. No s i g n i f i c a n t d i f f e r e n c e s were found. At the c o n c l u s i o n of the study, s u b j e c t s a l s o r a t e d (a) t h e i r l i k e l i h o o d of q u i t i n g c i g a r e t t e s , (b) the l i k e l i h o o d t h a t they would q u i t at 1 month a f t e r the study; and (c) the l i k e l i h o o d that they would q u i t w i t h i n 1 year a f t e r the study. These items were analyzed i n a one-way MANOVA which rev e a l e d a s i g n i f i c a n t o v e r a l l e f f e c t [F6,62)=3.87, p_<.005]. Mean values on these items are presented i n Table 8. M u l t i p l e comparisons on the one-way MANOVA procedure r e v e a l e d that the s u b j e c t s i n the ae r o b i c c o n d i t i o n r a t e d t h e i r l i k e l i h o o d of q u i t t i n g i n general and at 1 year 54 Table 8 - Post-Study Ratings of the Like.lihood of Q u i t t i n g Group Rated L i k e l i h o o d Aerobic Non-Aerobic No-Exercise of Q u i t t i n g M (SD) M (SD) M (SD) At one month(O-lOO) 38 (28) 33 (34) 37 (38) At one year(O-lOO) 82 (18) 53 (32) 47 (38) In general(1-7) 4.5 (1.8) 3.4 (2.0) 3.2 (2.4) Note. Higher r a t i n g s g r e a t e r s e l f - r a t e d l i k e l i h o o d of q u i t t i n g . 55 s i g n i f i c a n t l y higher than s u b j e c t s i n both of the other groups. Aerobic s u b j e c t s were not s i g n i f i c a n t l y d i f f e r e n t from the other groups on the r a t e d l i k e l i h o o d of q u i t t i n g at one month. Follow up. Since s u b j e c t s were i n i t i a l l y s e l e c t e d because they were not contemplating q u i t t i n g , the hig h scores on r a t e d l i k e l i h o o d of q u i t t i n g i n the a e r o b i c group were s u f f i c i e n t l y i n t e r e s t i n g to warrant a follow-up. S u b j e c t s were asked 4 months a f t e r the study to r a t e t h e i r l i k e l i h o o d of q u i t t i n g on the same three items. Reported mean d a i l y smoking r a t e s were a l s o obtained at t h i s time. Of the o r i g i n a l 36 s u b j e c t s 28 were conta c t e d , 11 i n the a e r o b i c group, 8 i n the non-aerobic group and 9 i n the c o n t r o l group. U n i v a r i a t e one-way ANOVAs, however, re v e a l e d no s i g n i f i c a n t d i f f e r e n c e s on any of the items or on mean d a i l y smoking r a t e . 56 DISCUSSION The r e s u l t s do not support the hypothesis that a e r o b i c e x e r c i s e reduces c i g a r e t t e smoking. They do i n d i c a t e , however, that even a s i n g l e s e s s i o n of non-aerobic, minimal i n t e n s i t y e x e r c i s e can a l t e r smoking topography inasmuch as the number of p u f f s taken and puff r a t e were s i g n i f i c a n t l y l e s s and the l a t e n c y to smoke the f i r s t two c i g a r e t t e s f o l l o w i n g e x e r c i s e was s i g n i f i c a n t l y g r e a t e r f o r s u b j e c t s i n t h i s c o n d i t i o n . Repeated e x e r c i s e over e i g h t s e s s i o n s d i d not s i g n i f i c a n t l y enhance the e f f e c t s of minimal i n t e n s i t y e x e r c i s e on smoking topography or s e l f - m o n i t o r e d d a i l y c i g a r e t t e consumption. By i n c l u d i n g i n the present study smokers not attempting to q u i t , only a very c o n s e r v a t i v e estimate of e x e r c i s e e f f e c t s on smoking, at best, i s to be expected. O'Leary and Borkovec (1978) p o i n t out that e f f e c t s produced in experimental designs that remove the e f f e c t s of n o n - s p e c i f i c f a c t o r s (such as expectancies) are l i k e l y to underestimate the c l i n i c a l e f f i c a c y of the procedure under i n v e s t i g a t i o n . I t remains to be determined whether a e r o b i c and non-aerobic e x e r c i s e i n t e r a c t with m o t i v a t i o n a l and expectancy s e t s in smokers attempting to q u i t smoking. The r e s u l t s d i d not r e p l i c a t e the e f f e c t s of h i g h i n t e n s i t y aerobic e x e r c i s e on c i g a r e t t e d u r a t i o n r e p o r t e d by M i k h a i l (1983). However, there were d i f f e r e n c e s between the s t u d i e s that may account f o r the d i s c r e p a n c y . A l l of M i k h a i l ' s s u b j e c t s were male and e x e r c i s e d , at one s e s s i o n , to a pulse r a t e of over 160 beats per minute. In t h i s i n v e s t i g a t i o n , t w o - t h i r d s of the 57 s u b j e c t s were female and the p r o t o c o l r e q u i r e d repeated s e s s i o n s of an e x e r c i s e i n t e n s i t y that was somewhat lower, at 140 beats per minute. D i f f e r e n c e s between these samples i n sex may be an important f a c t o r s i n c e s i g n i f i c a n t d i f f e r e n c e s on smoking topography between males and females have been repo r t e d ( E p s t e i n et a l . , 1982). F u r t h e r , the o b s e r v a t i o n a l p e r i o d was h a l f as long i n the present study, so that a smaller p r o p o r t i o n of s u b j e c t s smoked du r i n g o b s e r v a t i o n . L a s t l y , s u b j e c t s i n the present study were not asked to r e f r a i n from smoking p r i o r to e x e r c i s e as they were in M i k h a i l ' s study. T h e r e f o r e , v a r i a t i o n s in the parameters of e x e r c i s e or v a r i a t i o n s i n the o b s e r v a t i o n a l assessment of smoking behavior may subsequently r e v e a l e f f e c t s on smoking. For example, i n c r e a s e d e x e r c i s e d u r a t i o n , i n c r e a s e d number of e x e r c i s e s e s s i o n s , more f i n e - g r a i n e d a n a l y s i s of smoking behavior such as puff d u r a t i o n or volume i n h a l a t i o n ( c f . E p s t e i n et a l . , 1982), and longer p e r i o d s of o b s e r v a t i o n may r e v e a l e f f e c t s r e s u l t i n g from a e r o b i c a c t i v i t y . Inasmuch as there were no s i g n i f i c a n t repeated measures or i n t e r a c t i o n e f f e c t s on any measure of smoking topography, i t can be concluded that there was no cumulative e f f e c t of e i t h e r e x e r c i s e c o n d i t i o n on smoking topography. However, i t i s i n t e r e s t i n g to note t h a t , i n the absence of s i g n i f i c a n t repeated measures or i n t e r a c t i o n e f f e c t s , the magnitude of c o r r e l a t i o n s among the topographic measures changed over time u n l i k e the f i n d i n g s of p r e v i o u s r e p o r t s ( L i c h t e n s t e i n & Antonuccio, 1980). S t i l l , the l a c k of any cumulative e f f e c t s i n c l u d i n g the absence of s i g n i f i c a n t changes i n d a i l y c i g a r e t t e consumption ac r o s s the 58 4 weeks i s c o n s i s t e n t with other r e p o r t s (Freeman & Brown, 1980) that s e l f - m o n i t o r i n g of c i g a r e t t e smoking i s not r e a c t i v e i n smokers not attempting to q u i t . The q u e s t i o n must be r a i s e d as to whether the s t a t i s t i c a l l y s i g n i f i c a n t e f f e c t s of the non-aerobic e x e r c i s e on smoking topography are (a) simply a r t i f a c t and (b) whether these e f f e c t s are c l i n i c a l l y s i g n i f i c a n t . F i r s t , s i n c e there was no pre-e x e r c i s e o b s e r v a t i o n of smoking, i t i s p o s s i b l e that the groups may have d i f f e r e d i n the way they smoked. However, s i n c e the groups were randomly a s s i g n e d and were e q u i v a l e n t i n d a i l y smoking r a t e , years smoked, as w e l l as t a r and n i c o t i n e content of the c i g a r e t t s they smoked, t h i s i n t e r p r e t a t i o n seems l e s s l i k e l y . With regard to the c l i n i c a l s i g n i f i c a n c e of changes i n smoking topography, two s i n g l e s u b j e c t experiments i n which c i g a r e t t e d u r a t i o n , puff frequency, and puff d u r a t i o n were e x p e r i m e n t a l l y m o d i f i e d ( F r e d e r i k s e n & Simon, 1978(a); 1978(b)) have demonstrated c l i n i c a l l y s i g n i f i c a n t r e d u c t i o n s i n h e a l t h r i s k r e s u l t i n g from reduced carbon monoxide uptake duri n g smoking i n the absence of changes i n c i g a r e t t e consumption. These authors have a l s o demonstrated that the changes i n smoking topography can g e n e r a l i z e to the smokers' n a t u r a l environment. Changes i n smoking topography, such as those observed i n the present study, t h e r e f o r e , are c l i n i c a l l y r e l e v a n t . 59 E x e r c i s e And R e l a x a t i o n Previous reseach has demonstrated that a e r o b i c e x e r c i s e decreases s t a t e a n x i e t y as measured by the STAI (Morgan, 1979; Morgan & Hortsman, 1976). In the present study, s t a t e a n x i e t y scores decreased when measured before and a f t e r e x e r c i s e s e s s i o n s . However, i t was not expected on the b a s i s of pre v i o u s r e p o r t s that s t a t e a n x i e t y would be e l e v a t e d by the l a s t s e s s i o n i n a n t i c i p a t i o n of ae r o b i c e x e r c i s e . I t i s s u r p r i s i n g then, that no evidence of i n c r e a s e d smoking was found e i t h e r p r i o r to or a f t e r the a e r o b i c s e s s i o n s i n c e smoking a p p a r e n t l y i n c r e a s e s under c o n d i t i o n s of apprehension (Ikard & Tompkins,1973; Schachter et a l . , 1977). S e v e r a l s t u d i e s have demonstrated i n c r e a s e d r e l a x a t i o n f o l l o w i n g a s i n g l e s e s s i o n of a e r o b i c e x e r c i s e (e.g. Bahrke & Morgan, 1978; de V r i e s & Adams, 1972; Morgan & Horstman, 1976). Such assessments of pre- to p o s t - e x e r c i s e change i n s t a t e a n x i e t y s c o r e s , however, do not take i n t o account the observed i n c r e a s e i n the i n i t i a l measurement which appears to r e s u l t from a n t i c i p a t o r y a n x i e t y . T h i s suggests that there may, i n f a c t , be no net change i n s t a t e a n x i e t y as a r e s u l t of a e r o b i c e x e r c i s e . F u r t h e r , these data suggest that the a e r o b i c e x e r c i s e was somewhat unpleasant or a v e r s i v e f o r s u b j e c t s s i n c e p r e - s e s s i o n s t a t e a n x i e t y scores i n c r e a s e d s i g n i f i c a n t l y with the experience of engaging i n a e r o b i c e x e r c i s e . The r e d u c t i o n s i n smoking a f t e r the minimal non-aerobic e x e r c i s e were not expected s i n c e the non-aerobic e x e r c i s e group was i n c l u d e d to c o n t r o l f o r any n o n - s p e c i f i c e f f e c t s of e x e r c i s e 60 (Martin & Dubbert, 1982) such as time out from normal r o u t i n e or c o n t a c t with a s s i s t a n t s . With repeated non-aerobic e x e r c i s e , however, s e l f - r e p o r t e d a n x i e t y decreased, suggesting that e i t h e r the u n c e r t a i n t y about the " e x e r c i s e " was reduced or that the s t r e t c h i n g and i s o m e t r i c a c t i v i t y was p o s s i b l y more r e l a x i n g f o r smokers than the a e r o b i c a c t i v i t y . R e l a x a t i o n techniques have been shown to e f f e c t smoking topography in the same d i r e c t i o n as the non-aerobic group. . Dobbs, S t r i c k l e r , and Maxwell (1981) f i r s t exposed s u b j e c t s to manipulations designed to i n c r e a s e apprehension, then exposed them to a r e l a x a t i o n tape, employing c o g n i t i v e - i m a g i n a l s u g g e s t i o n s . The r e l a x a t i o n tape r e s u l t e d i n s i g n i f i c a n t l y g r e a t e r r e d u c t i o n i n smoking topography, as i n d i c a t e d by puff rate and c e n t i m e t r e s smoked, than exposure to a n e u t r a l tape or exposure to a s t r e s s enhancing tape. In t h e i r study, s t a t e a n x i e t y scores on the STAI decreased with r e l a x a t i o n i n s t r u c t i o n s but not s i g n i f i c a n t l y so. The minimal i n t e n s i t y e x e r c i s e may produce a n x i o l y t i c e f f e c t s f o r three reasons. F i r s t , Stoyva (1979) has o u t l i n e d mechanisms whereby s t r i a t e muscle r e l a x a t i o n i s hypothesized to e f f e c t autonomic r e a c t i v i t y and c o r t i c a l a r o u s a l . The i s o m e t r i c e x e r c i s e s i n the present study were not u n l i k e the muscle t e n s i n g and r e l e a s i n g component of p r o g r e s s i v e muscle r e l a x a t i o n ( B e r n s t e i n & Borkovec, 1973). A l s o the s t r e t c h i n g e x e r c i s e s were not u n l i k e a c t i v e yoga procedures which have been shown to produce r e d u c t i o n i n h y p e r t e n s i o n ( P a t e l & North, 1973). The major d i f f e r e n c e between the non-aerobic a c t i v i t y i n t h i s study and p r o g r e s s i v e muscle r e l a x a t i o n or yoga procedures i s that 61 these e x e r c i s e s were p e r c e i v e d and presented as e x e r c i s e . S p e c i f i c suggestions to expect r e l a x a t i o n and to a t t e n d to body s e n s a t i o n s of r e l a x a t i o n were not i n c l u d e d . Secondly, the non-a e r o b i c a c t i v i t y may have been r e l a x i n g because i t p r o v i d e d a d i v e r s i o n from d a i l y r o u t i n e that was not p h y s i c a l l y s t r e s s f u l i n comparison to the a e r o b i c a c t i v i t y which appears to have been more a n x i e t y a r o u s i n g . Bahrke and Morgan (1978) f o r example, found no d i f f e r e n c e s between an e x e r c i s e c o n d i t i o n , a m e d i t a t i o n c o n d i t i o n , and a w a i t i n g - c o n t r o l c o n d i t i o n i n producing r e d u c t i o n s i n s t a t e a n x i e t y . These authors suggest that p r o v i d i n g 'time-out' from d a i l y r o u t i n e i s r e l a x i n g . F i n a l l y , s i n c e the e x e r c i s e was not demanding or p h y s i c a l l y d i f f i c u l t , the p e r c e i v e d ease of performance may have c o n t r i b u t e d to a p e r s o n a l sense of c o n t r o l . In a r e l a t e d context, M a r l a t t and Marques (1978) have suggested that m e d i t a t i o n e f f e c t i v e l y reduces a l c o h o l abuse because i t p r o v i d e s an a l t e r n a t i v e to a l c o h o l f o r a c h i e v i n g a sense of c o n t r o l over s t r e s s . I f non-a e r o b i c e x e r c i s e r e s u l t s i n a s i m i l a r sense of c o n t r o l then i t may decrease the n e c e s s i t y of smoking to achieve a r e d u c t i o n i n s t r e s s . I n t e n t i o n s To Quit Smoking Although no changes i n the HLC were found as a r e s u l t of the e x e r c i s e a c t i v i t y or the s e l f m onitoring, p a r t i c i p a t i o n i n a e r o b i c e x e r c i s e may p r o v i d e temporary 'motivation' to q u i t . The a e r o b i c group r e p o r t e d s i g n i f i c a n t l y g r e a t e r l i k e l i h o o d of q u i t t i n g both ' i n g e n e r a l ' and at 1 year. Since the a e r o b i c a c t i v i t y was more p h y s i c a l l y demanding, perhaps the a v e r s i v e n e s s 62 of the a e r o b i c e x e r c i s e experience and the l i m i t a t i o n s of s u b j e c t s ' endurance and p h y s i c a l stamina were made more s a l i e n t to them in t h i s c o n d i t i o n i n comparison to the other groups ( c f . Pennebaker, 1982). The l i m i t e d e x e r c i s e a b i l i t y and any unpleasant s e n s a t i o n s a s s o c i a t e d with e x e r c i s e may have been a t t r i b u t e d d i r e c t l y to t h e i r c i g a r e t t e consumption. While smokers app a r e n t l y tend to a v o i d exposure to i n f o r m a t i o n on the h e a l t h hazards of smoking ( T a g l i a z z o , 1981), i t was d i f f i c u l t to a v o i d the unpleasant sens a t i o n s r e s u l t i n g from e x e r c i s e i n the a e r o b i c c o n d i t i o n . I f s u b j e c t s i n t h i s c o n d i t i o n b e l i e v e d that t h e i r a e r o b i c e x e r c i s e i n t o l e r a n c e r e s u l t e d from t h e i r smoking, then they might have r e s o l v e d to improve t h e i r p h y s i c a l s t a t e by a n t i c i p a t i n g q u i t t i n g i n the f u t u r e . That smokers reduce ' c o g n i t i v e dissonance' by a n t i c i p a t i n g that they w i l l q u i t sometime in the f u t u r e has been suggested elsewhere (Johnson, 1968). T h i s e f f e c t , however, was t r a n s i e n t s i n c e at follow-up the a e r o b i c group was not smoking any l e s s than the other groups and there were no longer any group d i f f e r e n c e s i n i n t e n t i o n to q u i t . C o n c l u s i o n s And D i r e c t i o n s For Future Research T h i s ' study i n d i c a t e s that minimal i n t e n s i t y non-aerobic e x e r c i s e reduces topographic measures of smoking and may be u s e f u l as a non-aversive b e h a v i o r a l adjunct to smoking m o d i f i c a t i o n . O'Connor and S t r a v y n s k i (1982) suggest that d i f f e r e n t s u b s t i t u t e behaviors fo r reducing smoking should be i n d i v i d u a l l y s e l e c t e d f o r each smoker. Future res e a r c h c o u l d be d i r e c t e d toward i d e n t i f y i n g smokers most l i k e l y to b e n e f i t from 63 an e x e r c i s e adjunct and i n d i v i d u a l l y t a i l o r i n g the type of e x e r c i s e to t h e i r needs. The study a l s o i n d i c a t e s t h a t , among smokers, s t a t e a n x i e t y in a n t i c i p a t i o n of a e r o b i c e x e r c i s e i n c r e a s e s with repeated p a r t i c i p a t i o n . Future r e s e a r c h should c o n t r o l f o r the e f f e c t s of a n t i c i p a t i o n i n demonstrating pre- to p o s t - e x e r c i s e changes on measures of a n x i e t y . F u r t h e r , s i n c e l e s s than h a l f of a l l i n d i v i d u a l s who s t a r t s t r u c t u r e d e x e r c i s e programs continue to p a r t i c i p a t e 3 months l a t e r (Martin & Dubbert, 1982), a n t i c i p a t o r y a n x i e t y may be a p o t e n t i a l c o n t r i b u t i n g f a c t o r to poor e x e r c i s e adherence. Conversely, non-aerobic e x e r c i s e may be u s e f u l i n i n i t i a l l y e s t a b l i s h i n g a p h y s i c a l a c t i v i t y p a t t e r n , s i n c e a n x i e t y l e v e l s i n a n t i c i p a t i o n of e x e r c i s e decrease with repeated p a r t i c i p a t i o n . Aerobic e x e r c i s e may, n e v e r t h e l e s s , be a u s e f u l treatment adjunct f o r those smokers unmotivated to q u i t because t h i s a c t i v i t y reduces the h e a l t h r i s k a s s o c i a t e d with smoking (Martin & Dubbert, 1982). Carbon monoxide and other smoke by-products have been i m p l i c a t e d i n a v a r i e t y of d y s f u n c t i o n a l c a r d i o v a s c u l a r c o n d i t i o n s ( F r e d r i k s e n & M a r t i n , 1979). Aerobic e x e r c i s e , however, reduces the r i s k of coronary heart d i s e a s e i n smokers (Stromme et a l . , 1982; Thomas, 1 9 8 1 ) a p p a r e n t l y , because i t a c c e l e r a t e s the v e n t i l a t i o n of CO (Kam, 1980; M a r t i n & Dubbert, 1982) v i a i n c r e a s e d oxygen exchange or v i a changes in smoking behavior. Despite the observed i n c r e a s e i n s t a t e a n x i e t y i n a n t i c i p a t i o n of s e s s i o n s , a e r o b i c e x e r c i s e may be u s e f u l i n 64 producing a g e n e r a l sense of w e l l - b e i n g at other times. Aerobic e x e r c i s e may a l s o be u s e f u l i n a l l a y i n g f e a r s a s s o c i a t e d with weight gain upon smoking c e s s a t i o n , s i n c e t h i s a c t i v i t y has shown promise as treatment component f o r weight c o n t r o l (Martin & Dubbert, 1982). F i n a l l y , a e r o b i c e x e r c i s e may be u s e f u l i n reducing the s t r e s s a s s o c i a t e d with q u i t t i n g and may a l l e v i a t e symptoms of s l e e p d i s t u r b a n c e and c o g n i t i v e impairment a s s o c i a t e d with withdrawal (Shiffman & J a r v i k , 1976). Adherence to e x e r c i s e , however, ^remains a major o b s t a c l e i n employing a e r o b i c e x e r c i s e as a smoking c e s s a t i o n treatment component. Since smokers have a poorer c a r d i o v a s c u l a r response to e x e r c i s e (Peterson & K e l l y , 1969; Cooper, Gey, & Bottenberg, 1969), a c t i v i t y of t h i s i n t e n s i t y may be a v e r s i v e . T h i s i s c o n s i s t e n t with r e p o r t s of a higher dropout r a t e from e x e r c i s e programs among smokers when compared to non-smokers (Massie & Shepard, 1971; O l d r i d g e , 1979). In view of the f i n d i n g s of the present study, some of the recommendations of other w r i t e r s (Hunt & Matarazzo, 1973; Pomerleau, 1979, 1980) may be o v e r s t a t e d s i n c e there i s not s u f f i c i e n t data to i n d i c a t e that a e r o b i c e x e r c i s e c o n t r i b u t e s to the m o d i f i c a t i o n of smoking behavior. 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P h y s i o l o g i c a l and p s y c h o l o g i c a l e f f e c t s of t r a i n i n g : A comparison of i n d i v i d u a l and gymnasium programs with a c h a r a c t e r i z a t i o n of the e x e r c i s e "drop-out". Medicine and Science i n  Spor t s, 3, 110-117. M c F a l l , R.M. (1978). Smoking-cessation r e s e a r c h . J o u r n a l of  C o n s u l t i n g and C l i n i c a l Psychology, 46, 703-712. McHenry, P.L., F a r i s , J.V., Jordan, J.W., & M o r r i s , S.N. (1977). Comparative study of c a r d i o v a s c u l a r f u n c t i o n and v e n t r i c u l a r premature complexes in smokers and nonsmokers durin g maximal t r e a d m i l l e x e r c i s e . The American J o u r n a l of  C a r d i o l o g y , 39, 493-498. M i k h a i l , C. (1983). The acute e f f e c t s of a e r o b i c e x e r c i s e on  c i g a r e t t e smoking. 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Salonen, J.T., Puska, P., & Tuomilehto, J . (1982). P h y s i c a l a c t i v i t y and r i s k of myocardial i n f a r c t i o n , c e r e b r a l s t r o k e , and death. American J o u r n a l of Epidemiology, 115, 526-537. Schachter, S., Kozlowski, L.T., & S i l v e r s t e i n , B. (1977). E f f e c t s of u r i n a r y pH on c i g a r e t t e smoking. J o u r n a l of  Experimental Psychology, 106, 13-19. Schachter, S., S i l v e r s t e i n , B, L e i b l i n g , B. (1977). smoking and u r i n a r y Psychology, 106, 24-30. Kozlowski, L.T., Herman, C P . , & E f f e c t s of s t r e s s on c i g a r e t t e pH. J o u r n a l of Experimental Sharkey, B.J. (1979. P h y s i o l o g y of F i t n e s s . Human K i n e t i c s P u b l i s h e r s . Champaign, 111.: Shepard, R.J., Corey, P., & Kavanagh, T. (1981). E x e r c i s e compliance and p r e v e n t i o n of a recurrence of myocardial i n f a r c t i o n . Medicine and Science i n Sports and E x e r c i s e , 13, 1-5. 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American J o u r n a l of  P u b l i c H e a l t h , 71, 1253-1255. 74 APPENDIX A - AEROBIC EXERCISE SESSIONS  Experimental Procedures and I n s t r u c t i o n s f o r Subjects "These e x e r c i s e s e s s i o n s are designed to 1) loosen and s t r e t c h the legs and lower body, 2) in c r e a s e c a r d i o v a s c u l a r endurance, and 3) increase s t r e n g t h i n the l e g muscles. In each of the eig h t s e s s i o n s , groups w i l l f o l l o w the same format: 1) l i g h t s t r e t c h i n g 2) c y c l i n g on the s t a t i o n a r y bikes and, 3) warm-down and l i g h t c y c l i n g and s t r e t c h i n g . Be sure you f e e l loose and s t r e t c h e d before s t a r t i n g . Do not over exert y o u r s e l f while c y c l i n g . Simply c y c l e to the beat of the metronome (one downward push with each c l i c k ) . Your heart r a t e w i l l be checked every few minutes and the te n s i o n a d j u s t e d to maintain a constant i n t e n s i t y of e x e r c i s e . " A l l i n t e r a c t i o n s with p a r t i c i p a n t s should be l i m i t e d as much as p o s s i b l e to the r a t i o n a l e and d e s c r i p t i o n of the i n d i v i d u a l e x e r c i s e s . T h i s i n f o r m a t i o n i s con t a i n e d above and on the f o l l o w i n g pages. 75 Procedural Steps 1. Take each person's p u l s e . 2. S t a r t each person 1 minute a p a r t . 3. Leg s t r e t c h i n g f o r 3 minutes i n c l u d i n g : S t r i d e S t r e t c h e r Lean forward on your hands, with your r i g h t l e g f l e x e d under your r i g h t chest and your l e f t l e g s t r e t c h e d out behind. With arms s t r a i g h t and your forward h e e l on the f l o o r , push your h i p s down toward f l o o r . Hold f o r three to f i v e seconds. Repeat the e x e r c i s e with the other l e g forward. S i t t i n g Hamstring S t r e t c h e r S i t on the f l o o r , knees extended, with your l e g s spread approximately at a 45 degree angle. Bend forward slowly at the waist. Reach out and grasp an ankle with both hands. Now s t r e t c h and t r y to touch your head to your knee u n t i l you f e e l s t r e t c h i n g i n the back of the l e g . Hold t h i s p o s i t i o n f o r two to three seconds, then r e t u r n to the s t a r t i n g p o s i t i o n . C r o t c h S t r e t c h Place f e e t s o l e to so l e and grasp ankles f i r m l y . Place your elbows on your knees and press the knees down towards the f l o o r as f a r as p o s s i b l e . Hold that p o s i t i o n f i v e seconds and r e l a x . Repeat a couple of times. 4. Set up the bike (adjust seat e t c .) 5. S t a r t metronome at 100 b.p.m. 6. Set workload at 300 kgm/min or e q u i v a l e n t to produce a heart rate of about 140 beats/minute. 76 7. Take pulse a f t e r each person has done 1,5, and 10 minutes of c y c l i n g . Adjust workload to maintain heart rate above 140 b.p.m. ( i f n e c e s s a r y ) . 8. A f t e r 13 minutes, reduce t e n s i o n g r a d u a l l y to zero and l e t the person warm-down. 9. Take p u l s e . 10. Repeat s t r e t c h i n g e x e r c i s e s from step 2 ( f o r 2 minutes) and i n c l u d e : Hamstring s t r e t c h e r Cross l e g s . Slowly bend forward from the waist, keeping your rear l e g s t r a i g h t (heel on f l o o r ) . Try to s t r e t c h u n t i l you f e e l s t r e t c h in the muscles of your rear l e g . Hold the p o s i t i o n three to four seconds and r e t u r n to the s t a r t i n g p o s i t i o n . S t r e t c h the other l e g i n a s i m i l a r manner. Repeat a few times. 77 APPENDIX B - NON-AEROBIC EXERCISE SESSIONS  Experimental Procedure and I n s t r u c t i o n s f o r Subjects "These e x e r c i s e s are designed to 1) loosen and limber up the j o i n t s , 2) make the body more supple and 3) f i r m up the muscles. In each of the e i g h t s e s s i o n s , groups w i l l f o l l ow the same gene r a l p r o g r e s s i o n : 1) general l o o s e n i n g and s t r e t c h i n g of the whole body, 2) s t r e t c h i n g and s t r e n g t h e n i n g upper body and arms, 3) s t r e t c h i n g and s t r e n g t h e n i n g m i d s e c t i o n and l e g s , 4) general warm-down of l i g h t s t r e t c h i n g . Be sure to take i t easy and do not f o r c e any movements to the p o i n t of p a i n . J o i n t f l e x i b i l i t y should be a t t a i n e d g r a d u a l l y , e s p e c i a l l y s i n c e some people's j o i n t s are l e s s f l e x i b l e than o t h e r s . Remember to s t r e t c h g e n t l y and g r a d u a l l y u n t i l a p o s i t i o n of maximum f l e x i s reached. A l s o , do not bob or bounce; f o r most of these e x e r c i s e s you can hold the p o s i t i o n f o r 5-10 seconds, then r e l a x the muscles and repeat. Your heart r a t e w i l l be checked every few minutes to maintain a constant i n t e n s i t y of e x e r c i s e . " A l l i n t e r a c t i o n s with p a r t i c i p a n t s should be l i m i t e d as much as p o s s i b l e to the r a t i o n a l e and d e s c r i p t i o n of i n d i v i d u a l e x e r c i s e s . T h i s i n f o r m a t i o n i s c o n t a i n e d above and i n the f o l l o w i n g pages. 78 1) General Loosening and S t r e t c h i n g 1. Side Bends ( L a t e r a l Bending) Stand e r e c t , f e e t comforably apart, hands at s i d e s . Bend trunk to l e f t and s l i d e hand down the t h i g h as f a r as i s comfortable. Return to u p r i g h t p o s i t i o n . Repeat on other s i d e . Note: Keep the back s t r a i g h t . R e p e t i t i o n s : 6 each s i d e . 2. Trunk Twists Stand e r e c t , f e e t comfortably apart, hands on h i p s . Twist a l t e r n a t e l y from si d e to s i d e . Note: Keep the back s t r a i g h t . At each t w i s t t r y to look as f a r over the shoulder as p o s s i b l e . R e p e t i t i o n s : 6 each s i d e . 3. Neck R o l l s Stand e r e c t , f e e t comfortably apart, hands on h i p s . Drop chin to your chest and then r o l l the head round, pushing the head back and r a i s i n g the c h i n . Repeat i n a continuous movement clo c k w i s e , then c o u n t e r c l o c k w i s e . Note: Stand e r e c t throughout and keep the stomach i n . R e p e t i t i o n s : 5 4. Trunk-Shoulder Stand e r e c t with one arm s t r a i g h t above head. Reach extended arm over your head, s t r e t c h i n g l a t e r a l trunk muscles. A l t e r n a t e arms. Note: Make t h i s a p u l l , not a h i p s h i f t . Opposite arm p u l l i n g a c r o s s body to i n c r e a s e involvement. R e p e t i t i o n s : 5 each s i d e . 2) S t r e t c h i n g and Strengthening Upper Body and Arms 5. Wing S t r e t c h e r s Stand e r e c t , f e e t comfortably apart, elbows at shoulder l e v e l with f i s t s clenched i n f r o n t of the body. Force the elbows back as f a r as they w i l l go, count to 2, then r e l a x . Note: The body must remain u p r i g h t throughout. Do not arch the back. Keep the head e r e c t . R e p e t i t i o n s : 10 6. Arm I s o m e t r i c s Stand e r e c t , with arms r a i s e d to shoulder l e v e l , elbows bent, hands l i g h t l y c l a s p i n g arms. Tig h t e n muscles and p u l l hands towards elbows. Keep head and shoulders back. Hold 6 seconds. 79 R e p e t i t i o n s : 5 of each. 7. Shoulder Isometric I Stand e r e c t , head up, trunk e r e c t , both arms overhead, elbows bent, r i g h t elbow in l e f t hand, l e f t elbow in r i g h t hand. P u l l out, hold f o r 6 seconds. R e p e t i t i o n s : 5 8. Shoulder Isometrics II Stand e r e c t , trunk e r e c t , arms overhead, f i n g e r s hooked, p u l l hands a p a r t . Hold 6 seconds. R e p e t i t i o n s : 5 9. Wrist Shakes Standing or s i t t i n g , h o l d arms out, l e t hands drop, then shake the w r i s t s and hands upwards, downwards and sideways. Note: Try to keep the forearm s t i l l . D u r a t i o n : 15-20 seconds. S t r e t c h i n g and Strengthening Lower Body and Legs 10. The Reach Stand e r e c t , f e e t comfortably a p a r t , hands l o o s e l y at the s i d e s . Breathe i n deeply and slowly bend backward, t h r u s t i n g out the p e l v i s . At the same time reach upward with the hands, f i n g e r s o u t s t r e t c h e d . Breathe out. Hold p o s i t i o n f o r 5 seconds before r e t u r n i n g to the u p r i g h t p o s i t i o n . Breathe i n deeply and repeat. R e p e t i t i o n s : 5 11. The Lunge (Sidways S p l i t s ) Stand e r e c t , f e e t comfortably apart, hands on h i p s . P i v o t f e e t outward and then take a s t r i d e • with the r i g h t foot and adopt a lunging p o s i t i o n as i n f e n c i n g . Keep pushing the l e f t l e g back and keep i t s t r a i g h t , while at the same time p r e s s i n g the body toward the f l o o r . Hold f o r a count of 5 seconds, r e l a x . Repeat on the other s i d e . Note: The back should remain s t r a i g h t throughout and the forward l e g v e r t i c a l . 12. C a l f S t r e t c h e s Stand at arm's length away from a w a l l with f e e t together and hands to u c h i n g . Then lean forward, bending the arms and keeping the f e e t f l a t on the f l o o r . S t r a i g h t e n , r e l a x . Note: The purpose of t h i s e x e r c i s e i s to s t r e t c h the c a l f muscles, so i t i s e s s e n t i a l to keep the fe e t f l a t on the f l o o r and the back s t r a i g h t . . 80 You can a l s o use t h i s e x e r c i s e to strengthen the f i n g e r s by pushing the body upri g h t again with f i n g e r s alone. R e p e t i t i o n s : 5 13. Wall S i t Using the w a l l as a brace, assume a s i t t i n g p o s i t i o n and hold f o r 30 seconds. F l o o r E x e r c i s e s 14. Foot S t r e t c h In a s i t t i n g p o s i t i o n , f l e x and extend your f e e t . R e p e t i t i o n s : 10 each f o o t . 15. A l t e r n a t e Toe Touches S i t t i n g down, fe e t comfortably a p a r t , arms r a i s e d . Reach and touch r i g h t hand to l e f t toe, r e t u r n to the s i t t i n g p o s i t i o n with back s t r a i g h t , then touch l e f t hand to r i g h t toe. Note: Keep legs as s t r a i g h t as p o s s i b l e and do not r o t a t e the h i p s . Return to the s i t t i n g p o s i t i o n with the back s t r a i g h t a f t e r each movement. If you cannot reach a l l the way down to the toes, reach as f a r down the l e g as i s c o m f o r t a b l e . A f t e r a while the back w i l l become more supple and you w i l l f i n d that you can reach f u r t h e r and f u r t h e r toward the opposite f e e t . R e p e t i t i o n s : 5 each s i d e . 16. Crotch S t r e t c h Place f e e t sole to s o l e and grasp ankles firmly.. Place your elbows on your knees and press the knees down toward the f l o o r as f a r as p o s s i b l e . Hold that p o s i t i o n f i v e seconds and r e l a x . R e p e t i t i o n s : 5 17. Inner Thighs (Isometric) S i t with knees f l e x e d , inner edge of f e e t together, brace forearm (heel of hand to elbow) between knees. Push knees together as hard as p o s s i b l e . Hold 6 seconds. R e p e t i t i o n s : 5 times 18. Trunk Lean Assume a kn e e l i n g p o s i t i o n , trunk e r e c t , hands behind lower back. Lean back slowly keeping trunk and head in s t r a i g h t l i n e , r e t u r n to v e r t i c a l p o s i t i o n . There should be a b s o l u t e l y no arch i n the lower back and no side-ward bend from the h i p s . Hold 10 seconds. R e p e t i t i o n s : 3 81 19. Knee P u l l s (Knee Hug/Knee L i f t ) L y i n g f l a t on the ground, p u l l each knee a l t e r n a t e l y in to the c h e s t . Hold f o r count of 5, then r e t u r n l e g to f l o o r . The head may e i t h e r remain on the f l o o r or be hunched forward. R e p e t i t i o n s : 5 each l e g . General S t r e t c h i n g Warm-down 20. Hurdles ( S i t t i n g S t r e t c h ) S i t on f l o o r , with r i g h t l e g o u t s t r e t c h e d and l e f t l e g at a r i g h t angle, bent back. Place hands at top of r i g h t l e g and s l i d e them down toward the f o o t , bending the body, neck and head as c l o s e to the knee as p o s s i b l e . Relax. Repeat a number of times, then change l e g s . Note: At f i r s t you may not be able to reach very fa r down the extended l e g , but t h i s w i l l improve with p r a c t i c e . Do not o v e r s t r e t c h , and do not bounce. Apply a steady pressure and then r e l a x . Try to keep the extended l e g c l o s e to the f l o o r . R e p e t i t i o n s : 5 each l e g . 21. Shoulder Shrugs Stand e r e c t , f e e t comfortably a p a r t , arms hanging l o o s e l y at the s i d e s . Raise shoulders up to the ears, then r e l a x and push them as f a r down as p o s s i b l e . R e p e t i t i o n s : 10 22. Legs, Trunk, Arms Assume we l l - b a l a n c e d e r e c t standing p o s i t i o n . F l ex forward from h i p s , keeping back s t r a i g h t and arms extended i n l i n e with trunk. Continue to move slowly as f a r down as p o s s i b l e , m a i n t a i n i n g s t r a i g h t back, arms, and l e g s . Be sure to keep your head in l i n e with your spine. 23. Trunk Bender Stand with your f e e t f i v e to s i x inches apart and p a r a l l e l to each other. Bend forward from the waist, a l l o w i n g your arms, trunk and head to hang f r e e l y . Reach to touch the f l o o r , then t w i s t the trunk and reach f o r the o u t s i d e of one shoe. Hold t h i s p o s i t i o n f o r two seconds. Return to an u p r i g h t p o s i t i o n by coming up from the s i d e . Again bend forward from the waist and a l t e r n a t e your movement to the other s i d e . Repeat the e x e r c i s e . Normally, your knees should be h e l d s t r a i g h t ; however, a s l i g h t bend does not hinder the e f f e c t i v e n e s s of the e x e r c i s e as long as you f e e l a s t r e t c h s t r e t c h 82 i n y o u r r e a r l e g m u s c l e s . R e p e t i t i o n s : 5 83 APPENDIX C - EXPERIMENTER'S INSTRUCTIONS FOR THE SAMPLING OF  SALIVA FOR THIOCYANATE ESTIMATIONS 1. The best time to o b t a i n a sample i s i n the afternoon as l e v e l s are somewhat higher i n the AM. 2. Each subject to be sampled i s pro v i d e d with: i ) a 2" d e n t a l r o l l . i i ) a 150 ml empty p l a s t i c c o n t a i n e r . 3. The subject p l a c e s the d e n t a l r o l l a g a i n s t the cheek i n the mouth f o r about one-half minute which i s generaly s u f f i c i e n t time to s a t u r a t e the r o l l . Mouthing or g e n t l y chewing the r o l l may he l p . 4. The su b j e c t removes the r o l l , p l a c e s i t i n t o the 150 ml p l a s t i c c o n t a i n e r . 5. The c o n t a i n e r i s a p p r o p r i a t e l y l a b e l l e d p r i o r to shipment. 6. Samples w i l l be analyzed w i t h i n 48 hours of r e c e i p t . 84 APPENDIX D - DATA RECORDING SHEET Date: Experimenter: Time: A c t i v i t y : S u b j e c t s : B i k e s : p r e - s e s s i o n pulse 1 minute 5 minute 10 minute 15 minute end of s e s s i o n pulse STAI pre post(check) Blood Pressure pre post S a l i v a sample(check) Pulse (Last s e s s i o n only) HLC(check) A c t i v i t y E v a l u a t i o n (check) Comments: 85 APPENDIX E - OBSERVATION SESSION RECORDING SHEET Experimenter: Date: A c t i v i t y : Time: C u b i c l e : C u b i c l e : S u b j e c t : Subject: 1st C i g a r e t t e : l i g h t up: p u f f s : butt out: 2nd C i g a r e t t e : l i g h t up: p u f f s : butt out: Brand Smoked Comments: 86 APPENDIX F - INITIAL PHONE CONTACT Ra t i o n a l e "The study i s l o o k i n g at smoking p l e a s u r e , an o f t e n n e g l e c t e d aspect of smoking r e s e a r c h . D i f f e r e n t types of a c t i v i t y , such as jogging, c y c l i n g , and yoga, have been shown to e f f e c t emotions, p h y s i c a l awareness, and degree of r e l a x a t i o n . T h i s study w i l l examine whether the e f f e c t s ( a s s o c i a t e d with d i f f e r e n t kinds of a c t i v i t y ) enhance or d e t r a c t from smoking p l e a s u r e . For example, c e r t a i n p h y s i o l o g i c a l and emotional s t a t e s may enhance smoking enjoyment by h e i g h t e n i n g s e n s i t i v i t y to the s t i m u l a t i n g and r e l a x i n g e f f e c t s of tobacco or may d e t r a c t from smoking enjoyment because of heightened s e n s i t i v i t y to the i r r i t a t i n g and unpleasant p r o p e r t i e s of tobacco. In a d d i t i o n , the study w i l l a l s o examine d a i l y f l u c t u a t i o n s i n people's smoking enjoyment. We hope to see i f these f l u c t u a t i o n s p a r a l l e l known d a i l y p h y s i o l o g i c a l c y c l e s . " S e l e c t i o n Questions and S e l e c t i o n C r i t e r i a Answers 1) Can you be a v a i l a b l e f o r 1/2 hour between the hours of 4:30 to 6:30 p.m. Monday to Thursday on the UBC campus. (Yes) 2) Are you c u r r e n t l y attempting to q u i t smoking or have you attempted to q u i t i n the l a s t 6 months? (No) 3) How o l d are you? (between 20-40 years) 4) How much do you smoke? (at l e a s t 20/day) 5) How long have you smoked? (at l e a s t 2 years) 6) Any medical reason you c ouldn't e x e r c i s e ? (No to a l l PAR-Q items) 7) How much e x e r c i s e do you do? ( l e s s than 3 x 15 minute sessions/week) 8) Do you c u r r e n t l y p r a c t i c e any formal r e l a x a t i o n technique such as yoga or meditation? (No) 87 APPENDIX G - SMOKING ENJOYMENT STUDY DESCRIPTION T h i s study i s being undertaken as part of a master's t h e s i s in C l i n i c a l Psychology by Ken Reesor under the s u p e r v i s i o n of Dr. David Lawson. The purpose of t h i s study i s to examine the e f f e c t s of d i f f e r e n t p h y s i c a l a c t i v i t i e s on smoking enjoyment and to examine d a i l y f l u c t u a t i o n s i n smoking s a t i s f a c t i o n and enjoyment. P a r t i c i p a n t Involvement: For t h i s study we would ask you t o : 1) Complete a couple of q u e s t i o n n a i r e s , and perform a 5 minute e x e r c i s e t e s t . 2) Keep tra c k of the p l e a s u r e you d e r i v e from each c i g a r e t t e you smoke for four 5-day p e r i o d s . We'll give you some s p e c i a l l y designed cards to r e c o r d t h i s i n f o r m a t i o n . 3) Have your blood pressure taken, provide a s a l i v a sample and complete a b r i e f q u e s t i o n n a i r e on 4 separate o c c a s i o n s . P h y s i c a l A c t i v i t i e s : We may a l s o r e q u i r e you to come to the e x e r c i s e s t u d i o ( i n gym s t r i p ) f o r a t o t a l of 8 prearranged 20 minute s e s s i o n s that w i l l i n v o l v e e i t h e r f l o o r e x e r c i s e s to improve muscle tone and f l e x i b i l i t y or c y c l i n g on a s t a t i o n a r y bike to improve muscular endurance. I t i s p o s s i b l e that you may experience some f a t i g u e and muscles soreness as a r e s u l t of your p a r t i c i p a t i o n . We w i l l however, keep the i n t e n s i t y of the e x e r c i s e at a l e v e l s u i t a b l e f o r beginners and i n c l u d e warm-up s t r e t c h i n g e x e r c i s e s to minimize the chances of developing temporary muscle s t i f f n e s s . At the f i r s t and l a s t s e s s i o n , we'd l i k e you to stay f o r an e x t r a 25 minutes so we can take a blood pressure reading, a s a l i v a sample and have you f i l l out a b r i e f q u e s t i o n n a i r e . Even i f you aren't i n v o l v e d i n the e x e r c i s e part of t h i s study w e ' l l ask you to come in twice to get the same i n f o r m a t i o n . Time Committment: A l t o g e t h e r , these s e s s i o n s take between 3 1/2 to 4 1/2 hours of your time. The s e s s i o n s w i l l be h e l d i n l a t e a fternoon and e a r l y evenings over two 4-consecutive weekday p e r i o d s (e.g. Monday to Thursday) at the e x e r c i s e s t u d i o s i n the Armory B u i l d i n g . Keeping tr a c k of your smoking enjoyment over the 20 days w i l l take an e x t r a hour. We'll give you a schedule d e s c r i b i n g the a c t i v i t i e s r e q u i r e d i n t h i s study. Compensation: F i n a l l y , at the post study meeting to be arranged at your convenience, you w i l l be p a i d $60 f o r p a r t i c i p a t i n g . In a d d i t i o n , we w i l l g i v e you feedback on a l l the p h y s i o l o g i c a l measures taken and w e ' l l give you r e s u l t s from the p h y s i c a l 88 assessments undertaken. If you are unclear about any of the procedures i n v o l v e d , we w i l l be more than happy to answer your q u e s t i o n s . Since your p a r t i c i p a t i o n i s s t r i c t l y v o l u n t a r y , you are f r e e to withdraw at anytime from the study. Thank you very much f o r your i n t e r e s t in t h i s p r o j e c t . If you have decided to p a r t i c i p a t e , and have read and understood t h i s l e t t e r , p l e a s e sig n the form which accompanies t h i s l e t t e r g i v i n g your consent to p a r t i c i p a t e and acknowledging your r e c e i p t of t h i s l e t t e r . 89 APPENDIX H - PRE-EXPERIMENTAL QUESTIONNAIRE Name: Age: Sex: Address: Phone Number: Best time to c a l l : Occupation: A. Do you e x e r c i s e r e g u l a r l y ? Yes No If yes, d e s c r i b e your e x e r c i s e h a b i t s . Please c i r c l e a l l of the p h y s i c a l a c t i v i t i e s i n the f o l l o w i n g l i s t i n which you have engaged duri n g the past 4 weeks: a e r i a l t e n n i s , badminton, b a s k e t b a l l , boxing, c a l i s t h e n i c s , c u r l i n g , b i c y c l i n g , s t a t i o n a r y c y c l i n g , dancing (please s p e c i f y step below), f e n c i n g , f o o t b a l l , g o l f , h a n d b a l l , hockey, karate, kung-fu, l a c r o s s e , r a c q u e t b a l l , r o p e - s k i p p i n g , rowing, running ( s t a t i o n a r y ) , running/jogging, s k a t i n g , s k i i n g , squash, swimming, t e n n i s , v o l l e y b a l l , walking w r e s t l i n g , other sports not mentioned above. Enter the a c t i v i t y ( i e s ) you have c i r c l e d in the a p p r o p r i a t e space(s) below and provide as accurate an estimate as you can of each of the f o l l o w i n g q u a n t i t y or d i s t a n c e t r a v e l l e d on each occasion (e.g., m i l e s , yards, s e t s ) , time i n minutes to complete the a c t i v i t y , and average number of times you engaged i n the a c t i v i t y each week. A c t i v i t y Q u a n t i t y / D i s t a n c e Time Frequency 90 B. C i r c l e a number below to i n d i c a t e : 1. How p h y s i c a l l y a c t i v e you c o n s i d e r y o u r s e l f to be now. 1 2 3 4 5 very a c t i v e average i n a c t i v e very a c t i v e i n a c t i v e 2. Your c u r r e n t l e v e l of p h y s i c a l f i t n e s s . 1 2 3 4 5 very f i t average u n f i t very f i t u n f i t C. Do you p r a c t i s e any formal r e l a x a t i o n or meditative' techniques (e.g., TM, p r o g r e s s i v e r e l a x a t i o n ) ? Yes No If yes, d e s c r i b e the technique. During the past 4 weeks, how many times on the average have you p r a c t i s e d t h i s technique each week? times each week. During the past 4 weeks, how long on the average d i d you p r a c t i c e t h i s technique on each occasion? minutes on each o c c a s i o n . D. How many c i g a r e t t e s per day do you smoke on the average weekday? c i g a r e t t e s . How long have you been smoking? y e a r s . Have you made any attempts to q u i t smoking i n the l a s t 6 months? Yes No If yes, when and f o r how long? Are you p r e s e n t l y attempting to cut down or stop smoking? Yes No If yes, d e s c r i b e what you are doing to cut down or stop. 91 E. Please r a t e the extent to which the f o l l o w i n g a c t i v i t i e s or s t a t e s would a f f e c t your smoking enjoyment and s a t i s f a c t i o n by c i r c l i n g the a p p r o p r i a t e number: s t r o n g l y no enhance enhance e f f e c t 1 2 3 Vigorous p h y s i c a l e x e r c i s e L i g h t p h y s i c a l e x e r c i s e M e d i t a t i o n Yoga P o s i t i v e Mood Negative Mood S t r e s s s t r o n g l y d e t r a c t d e t r a c t 4 2 2 2 2 2 2 2 3 3 3 3 3 3 3 5 4 4 4 4 4 4 4 5 5 5 5 5 5 5 Please irate the f o l l o w i n g by p l a c i n g an 'X' along the l i n e . 1) To what extent do you f i n d e x e r c i s e . . . ? inconvenient convenient l i i i i i i enjoyable unenjoyable soc i a l l y soc i a l l y J I L d i sapproved approved j i i i i good bad J I unnecessary necessary 92 2) To what extent do you f i n d m e ditation...? inconvenient convenient i i i i i i i enjoyable unenjoyable j i i soc i a l l y soc i a l l y j i L j disapproved approved l i i i i i i good bad j i unnecessary _i L necessary j i i 3) To what extent do you f i n d smoking...? inconvenient convenient l I l l l l I en j oyable I I L unenjoyable j i i soc i a l l y soc i a l l y j i i L d i sapproved approved j I I I : I good bad J I I I I I unnecessary necessary 93 F . A r e y o u p r e s e n t l y on m e d i c a t i o n ? Y e s No I f y e s , p l e a s e s p e c i f y t y p e , d o s a g e , a n d f r e q u e n c y : G . What b r a n d o f c i g a r e t t e s do y o u smoke? Do y o u c h a n g e b r a n d s o f t e n ? Y e s No I f y e s , d e s c r i b e t h e c h a n g e s y o u ' v e made i n t h e l a s t 6 m o n t h s . 94 APPENDIX I - SCHEDULE FORM FOR SUBJECTS SMOKING ENJOYMENT STUDY: SCHEDULE AND PROCEDURE 1. RECORD the smoking pl e a s u r e you d e r i v e from each c i g a r e t t e from to on weekdays only (Monday to F r i d a y ) . 2. Carry the r a t i n g cards i n your c i g a r e t t e package. Note the TIME you take the f i r s t i n h a l a t i o n from each c i g a r e t t e and RATE the p l e a s u r e d e r i v e d from that i n h a l a t i o n using the 0 to 6 s c a l e . Use one s i d e f o r each day. 3. Br i n g completed cards to the f o l l o w i n g scheduled SESSIONS at room 203 i n the Armories. DATE TIME ACTIVITY DURATION 4. If you are i n one of the e x e r c i s e groups, come dressed i n comfortable GYM CLOTHING. 5. If f o r some reason, you are UNABLE TO MAKE A SESSION - CALL Ken Reesor at 324-6943 (home) or 228-5581 ( o f f i c e ) as soon as 95 p o s s i b l e so we can arrange an a l t e r n a t i v e s e s s i o n that week. 6. A FINAL MEETING w i l l be arranged on at so you can turn i n any a d d i t i o n a l s e l f -r a t i n g cards, r e c e i v e $60 and get feedback on a l l the p h y s i c a l measures taken. 96 APPENDIX J - SELF-MONITORING CARD AND COMPLIANCE RATIONALE  Self-Monitoring Card (example): Name Date 6-V. Pleasant 5-M. Pleasant 4-S. Pleasant 3-Neutral 2-S. Unpleasant 1-M. Unpleasant 0-V. Unpleasant Compliance rationale: "Please record a l l the information on the cards immediately to avoid forgetfulness and make your recordings as accurate as possible, since your results w i l l be c a r e f u l l y analyzed for dai l y fluctuations. We w i l l be analyzing your s a l i v a in order to obtain biochemical data which varies according to the number of cigarettes you smoke. It i s , therefore, especially important that there are ratings for every cigarette, since we can only use your ratings i f the biochemical measures agree with the number of ratings you've reported." 97 APPENDIX K - ACTIVITY EVALUATION P r i o r to t h i s assessment, you were i n v o l v e d i n some a c t i v i t y f o r 20 minutes while your heart r a t e was taken. Please r a t e the a c t i v i t y a c c o r d i n g to how i t has a f f e c t e d you i n t h i s study, i n terms of the f o l l o w i n g : 1 . f i t n e s s : somewhat improved no change b e n e f i c i a l f i t n e s s I I I I I I I 2. f a t i g u e : somewhat very no change t i r e d t i r e d I I I i I I I 3. muscle tone: somewhat very no change t i g h t f i r m 4. muscle f l e x i b i l i t y : somewhat very no change loose f l e x i b l e 5. boredom: somewhat very no change bored bored 98 6 . body awareness: somewhat i n c r e a s e d l 1 7. t e n s i o n : somewhat i n c r e a s e d 8. time usage: good use of time no change i somewhat dec r e a s e d no somewhat change decre a s e d I I I I waste of time Have you engaged i n any a d d i t i o n a l p h y s i c a l or m e d i t a t i v e a c t i v i t i e s o u t s i d e t h i s study s i n c e you s t a r t e d keeping your smoking . r a t i n g s ? Yes No I f y e s , p l e a s e d e s c r i b e t h e s e : 99 APPENDIX L - POST-STUDY QUESTIONNAIRE 1 . What was the purpose of the study? 2. Did you make any d e l i b e r a t e attempts dur i n g the study to a l t e r your smoking behaviour? Yes No I f so, please s p e c i f y what you d i d and whether you b e l i e v e i t d i d i n f a c t a f f e c t your smoking. 3. D i d you expect at any time that p a r t i c i p a t i o n i n the study would have an e f f e c t on your smoking? Yes No If yes, what aspect of the procedure d i d you b e l i e v e would a f f e c t your smoking? How d i d you expect your smoking would be a f f e c t e d ? When d i d you expect your smoking to be a f f e c t e d ? 100 4. Did you p a r t i c i p a t e in p h y s i c a l a c t i v i t i e s o u t s i d e t h i s study d u r i n g the p e r i o d s you recorded smoking plea s u r e ? Yes No I f yes, l i s t what a c t i v i t i e s you engaged i n , when you engaged i n these a c t i v i t i e s , and s t a t e how o f t e n you engaged in these a c t i v i t i e s . 5. At t h i s p o i n t i n time, how l i k e l y i s i t that you would q u i t smoking? not somewhat very l i k e l y l i k e l y l i k e l y I I L I I I I What are the chances that you'd q u i t i n the next month? 0% 20% 40% 60% 80% 100% l i i i i i i i i i i What are the chances that you'd q u i t i n the next year? 0% 20% 40% 60% 80% 100% I l I I I l I I I I I 6. Were you able to provide a r a t i n g for every c i g a r e t t e smoked d u r i n g the study? Yes No If no, how many c i g a r e t t e s do you t h i n k you missed r e c o r d i n g ? Please d e s c r i b e when and under what circumstances your missed -> r a t i n g s occured? 101 you were going to q u i t smoking, how would you do i t ? 1 02 APPENDIX M - EXPER IMENTAL ENVIRONMENT s t a t i o n a r y b i c y c l e s DC4> s u b j e c t s a a D 

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