HoptoStop: Development and feasibility of a novel intervention to promote active ageing and smoking cessation in inactive smokers

Smokers are less physically active than the general population which puts them at greater risk of infectious disease and early death. Encouraging individuals who smoke to lead smoke-free and active lives is therefore a priority. Stop-smoking services operating out of pharmacies, supermarkets and GP surgeries in local neighbourhoods provide a unique opportunity to engage smokers in physical activity in addition to smoking cessation.

Some studies have explored this approach. Physical activity has been used as an aid for smoking cessation because it can reduce the desire to smoke, help weight-loss and improve confidence, which are common barriers to smoking cessation. At the moment, we cannot be certain that physical activity improves smoking quit-rates, because it is difficult to keep people interested and involved with the intensity of activity necessary for change. A 12-week supervised vigorous exercise programme has facilitated long-term quit rates when used in combination with a smoking cessation programme so it is possible. However, supervised exercise programmes like this are beyond the scope of most stop-smoking services and are unlikely to be maintained by individuals in the long-term. This is especially true for smokers who cite lack of time as a common barrier to maintaining regular physical activity.

High-impact physical activity such as jumping and hopping has the potential to be used as a coping strategy for reducing the desire to smoke because it involves short bouts of intense activity with time for sufficient recovery. It also has the potential to be used for improving quit rates because it can be carried out at home and is easily integrated into every-day routine, allowing for a greater chance of uptake and maintenance for public-health impact. In inactive adults, we have shown that short bouts of regular high impact physical activity produced more than 91% adherence rates over a 12-month period. Implementing high impact physical activity into stop-smoking services has intuitive appeal because it could provide opportunity to assist stop-smoking treatment with improving quit rates. Improvements in physical fitness and musculoskeletal health could also provide an important extra stimulus to stop smoking. However this has never been tried, so we know nothing about the feasibility, acceptability or views of users towards such an idea. Without this crucial information and some knowledge of the potential barriers, it would be difficult to proceed.

This project would investigate the feasibility and acceptability of implementing high-impact physical activity into a local stop-smoking service (Quit51) and explore the views and attitudes relevant to the intervention in order to develop and refine it. We would do this by first developing the approach with input from current and ex-smokers, Operations Managers (Quit51) and Public Health Leads and secondly by assessing how many people volunteered for the study, whether they carried out the activity and how effectively procedures were delivered. Thirdly, we would explore the views of smokers who did and who did not volunteer for the study to find out why, and the views of those who did and did not complete the activity to find out what they liked/disliked about it. Finally we smoking-cessation advisors would give us their views on the delivery of the activity and thoughts how such an approach might be improved for future work.

Smoking and physical inactivity are leading causes of preventable death both in the UK and worldwide. Stop-smoking services operating in local communities offer a prime opportunity to target these two very important health behaviours. Physical activity (PA) has been shown to regulate withdrawal symptoms and cigarette cravings, but when used as an adjunct to smoking-cessation treatment, few trials have identified an effect of PA on rates of smoking abstinence. A recent Cochrane review reported insufficient PA intensity and poor compliance to PA as limitations of the previous trials. Our innovative solution is to implement a brief and simple high impact PA intervention into smoking-cessation services and evaluate PA adherence by accelerometers specific to impact loading. No definitive trials have been conducted as of yet so it is important to carry out early phase research to guide continued intervention development. This project will therefore involve operations managers (Quit51), Public health Leads and a Smokers Panel in design workshops to address perceived logistical difficulties with initial intervention application. After refinement, the first early-phase study will then assess the acceptability and feasibility of accelerometer-guided high-impact PA among smokers (n=30) accessing smoking cessation support from their local service in Surrey (Quit51). We will use mixed-methods to assess recruitment and retention rates, demographic differences, adherence to PA, protocol efficacy and likely effect size. The second early-phase study will use interviews to explore thoughts to the PA intervention among three distinct users (1) those who declined to take part (n=15) (2) trial participants who did and did not adherence to the intervention (n=30) and (3) smoking-cessation advisors (n=15). The results of this research will inform the design of a future clustered, randomised trial of the intervention for clinical and cost effectiveness.