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= '''Cardiovascular Effects of Smoking''' =
<div class="editorbox">
'''Original Editors '''- [[User:Lance Ramos|Lance Ramos]]


Aerobic exercise challenges the body's ability to supply and handle oxygen. For example, when performing high-intensity aerobic exercise, mitochondrial reactive oxygen species' (ROS) grow in number. ROS, if left unchecked, have the ability to cause genetic mutations. However, several enzymes -- including superoxide dismutase -- are present to handle this oxidative stress caused by ROS.The body responds to chronic aerobic exercise by enhancing its ability to cope with ROS. <ref>Vollaard, NB, Shearman, JP, Cooper, CE. Exercise-induced oxidative stress. Sports Med 2005;35:1045-62.</ref>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}
</div>
== Introduction  ==
[[File:Smoking-1026556 960 720-2.jpg|right|frameless]]
Smoking causes both immediate and long-standing effects on [[Therapeutic Exercise|exercise]] and [[Physical Activity|physical activity]] (PA). Smokers’ increased risks for [[Oncology|cancer]] and heart and respiratory diseases are well known. In terms of exercise and physical activity, smokers also have:
* Less endurance
* Poorer physical performance
* Increased rates of injury and complications<ref name=":0">Cleveland Clinic [https://my.clevelandclinic.org/health/articles/10643-smoking-and-physical-activity Smoking and PA] Available from:https://my.clevelandclinic.org/health/articles/10643-smoking-and-physical-activity (accessed 8.4.2021)</ref>.
To achieve peak performance, the heart, lungs and muscles need oxygen-rich blood. When you inhale tobacco smoke, carbon monoxide (just one of the 4,000-plus chemicals found in tobacco, more than 50 of which are known to cause cancer) binds to red blood cells. Oxygen is displaced, preventing delivery to the muscles and other body tissues. This causes an increase in lactic acid i.e. the substance that causes muscle “burning,” fatigue, heavier breathing, and increased soreness after exercise.


Smoking also induces an oxidative stress; however, smoking-induced oxidative stress also inhibits the body's abiltiy to cope by suppressing the genes responsible for antioxidant production.<ref>Garbin U, Pasini AF, Stranieri C, Cominacini M, Pasini A, Manfro S, et al. Cigarette smoking blocks the protective expression of Nrf2/ARE pathway in peripheral mononuclear cells of young heavy smokers favouring inflammation. PLoS ONE 2009;4:1-12.</ref>&nbsp; The net result of smoking-induced oxidative stress is vascular and arteriolar inflammation -- further impairing the oxygen-delivering capabilties of the body. By limiting oxygen delivery, cigarette smoking impairs the ability to generate energy through the oxidative energy system. The literature also suggests that smoking impairs anaerobic energy provision by altering contractile proteins, creatine kinase, and other glycolytic enzymes.<ref>Barreiro E, Peinado VI, Galdiz JB, Ferrer E, Marin-Corral J, Sanchez F, et al. Cigarette smoking-induced oxidative stress: A role in chronic obstructive pulmonary disease skeletal muscle dysfunction. Am J Resp Crit Care Med 2010;182:477-88.</ref>&nbsp;Moderate and heavy smokers have also shown to have a decreased VO2max. There tends to be a stronger correlation in men, and the decrease in VO2max becomes more significant with age <ref>Bernaards, C, Twisk, J, Mechelen, W, Snel, J, Kemper, H. A longitudinal study on smoking in relationship to fitness and heart rate response. Medicine & Science in Sports & Exercise 2003;35:793-800.</ref>. With this in mind, therapists should be weary of setting unrealistic goals for patients who are smokers.
This decrease in oxygen will reduce physical endurance e.g. It makes it harder to do everyday things, too, like walking up stairs. Decrease in oxygenation also causes a smoker’s resting heart rate to be higher than a nonsmoker’s, as the heart must work harder to deliver enough oxygen to the body.<ref name=":0" />


Smoking is a huge risk factor for coronary artery disease and many other complications such as myocardial infarction and sudden death. <ref name="Fernhall" />Smoking is one of the biggest causes of death in the world.&nbsp;It is also associated with increased blood pressure, systemic vascular resistance, and heart rate.<ref name="Fernhall">Fernhall B, Mendonca G, Pereira F. Effects of cigarette smoking on cardiac autonomic function during dynamic exercise. Journal of Sports Science 2011;29:879-86</ref> &nbsp;Nicotine is one factor that stimulates epinephrine and norepinephrine release from the sympathetic nerve terminals and adrenal glands, which explains that acute cardiovascular effects may be due to adrenergic stimulation at the peripheral levels. <ref name="Fernhall" />Acute cigarette smoking is associated with a significant decrease in vagal cardiac modulations which may increase the risk of complications during daily exercise or intense physical activity. <ref name="Fernhall" />Acute smoking affects the cardiorespiratory responses to both submaximal and maximal exercise, which can result in an increase of sympathetic dominance at lower levels of submaimal work. <ref name="Fernhall" />&nbsp; Furthermore, smoking just prior to exercise results in less oxygen availability at the tissue level. <ref>Hansen JE, Hirsch GL, Robinson TE, Sue DY, Wasserman K. Immediate effects of smoking on cardiorespiratory responses to exercise. Journal of Applied Physiology. 1985;58:1975-81.</ref> Clinicians should be considerate of all options and treatment plans for patients who are avid smokers.  
== Cardiorespiratory Effects  ==
[[File:Heart Attack.png|right|frameless]]
Due to the effects of smoking on the cardiovascular system, the heart is not capable of pumping sufficient blood to supply adequate oxygen. Due to insufficient supply of oxygen, the ability of smokers to exercise and perform daily physical activities are also hampered and this ultimately increases the risk of strokes and heart attacks.


Smoking has not only been shown to be associated with an increase in resting heart rate (HR), but also with a significantly diminished increase in HR during exercise (known as chronotropic incompetence).<ref>Benowitz NL. Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment. Prog Cardiovasc Dis. 2003;46:91-111.</ref><ref>Srivastava R, Blackstone EH, Lauer MS. Association of smoking with abnormal exercise heart rate responses and long-term prognosis in a healthy, population-based cohort. Am J Med. 2000;109:20-6.</ref>&nbsp; Chronotropic incompetence (CI) prevents the heart from being able to keep up with increased demand during activity and therefore reach the age-appropriate maximal HR.&nbsp; Since an increase in HR is key to performing exercise for any significant amount of time, CI leads to progressive deterioration in exercise tolerance.&nbsp; As CI worsens through habitual smoking over time, it can move beyond exercise tolerance to affect basic functional activities of daily living. CI caused by smoking has traditionally been observed in middle-aged and older adults, however a more recent study of male and female young adults (20-29 yrs) found that smokers had a significantly lower maximal HR and a significantly slower HR&nbsp;increase during exercise testing when compared to non-smokers.<ref>Papathanasiou G, Georgakopoulos D, Papageorgiou E, Zerva E, Michalis L, Kalfakakou V, et al. Effects of smoking on heart rate at rest and during exercise, and on heart rate recovery, in young adults. Hellenic J Cardiol 2013;54:168-77.</ref><br>
Inhaling the smoke of tobacco can cause different responses instantly in the heart and blood vessels. The effects of smoking on the cardiovascular system begin immediately after its consumption.  
* Within one minute of smoking, heart rate starts increasing and it may increase up to 30% in the first ten minutes of smoking.  
* Nicotine present in the tobacco releases adrenaline that makes the heart beat faster and increases the flow of blood, thereby pressuring the heart to work faster and harder.
* The carbon monoxide present in the tobacco smoke puts your heart at risk of harmful effects by decreasing the ability of blood to carry oxygen to the organs.  
Specific Changes and or Increased risk of:[[File:Atherosclerosis diagram.png|right|frameless|281x281px]]


= '''Musculoskeletal Effects of Smoking''' =
# [[Atherosclerosis]]
# Low [[Blood]] Oxygen
# [[Coronary Artery Disease (CAD)|Coronary Heart Disease]]: Smoking is a huge risk factor for coronary artery disease and many other complications e.g. myocardial infarction and sudden death<ref name="Fernhall">Fernhall B, Mendonca G, Pereira F. [https://www.tandfonline.com/doi/abs/10.1080/02640414.2011.572991 Effects of cigarette smoking on cardiac autonomic function during dynamic exercise]. J Sport Sci 2011;29:879-86</ref>. It is also associated with increased blood pressure, systemic vascular resistance, and heart rate<ref name="Fernhall" />.&nbsp; Nicotine is one factor that stimulates epinephrine and norepinephrine release from the sympathetic nerve terminals and adrenal glands,<ref name="Fernhall" />. Acute cigarette smoking is associated with a significant decrease in vagal cardiac modulations which may increase the risk of complications during daily exercise or intense physical activity<ref name="Fernhall" />. Acute smoking affects the cardiorespiratory responses to both submaximal and maximal exercise, which can result in an increase of sympathetic dominance at lower levels of submaximal work<ref name="Fernhall" />.
# [[Deep Vein Thrombosis|Blood Clots]]: The smokers are more vulnerable to strokes and heart attacks because due to smoking there is less room for blood to flow to the brains and heart through the blood vessels, due to hypertension Also the level of fibrinogen increases in smokers. This increases the risk of formation of blood clots in the blood vessels<ref>painassist Effects of smoking Available from:https://www.epainassist.com/chest-pain/heart/7-effects-of-smoking-on-the-cardiovascular-system (accessed 8.4.2021)</ref>. [[File:Stroke 2.jpg|right|frameless|196x196px]]
# [[Stroke]]
# Thromboangiitis Obliterans or Buerger’s Disease: rare type of peripheral arterial disease that usually affects the medium and small arteries, veins of legs and arms. Buerger’s Disease is another effect of smoking on the cardiovascular system and in some studies it is discovered that passive smokers are also at risk of developing such diseases. This disease mainly occurs in young smokers that age between 20 and 45.
# [[Peripheral Arterial Disease]]: one of the common effects of smoking on the cardiovascular system.
# Hyperlipidaemia.


Smoking has also been found to have a negative effect on bone mineral density which is directly related to osteporotic fracture. <ref name="krall">Krall, E. A. and Dawson-Hughes, B. (1999), Smoking Increases Bone Loss and Decreases Intestinal Calcium Absorption. J Bone Miner Res, 14: 215–220. doi: 10.1359/jbmr.1999.14.2.215</ref>&nbsp;Smokers do not absorb supplemental or dietary calcium as well as non-smokers. Studies show that smokers on average have 20mg/day less&nbsp;calcium available&nbsp;than non-smokers. The full reason in which calcium absorption is decreased is still unclear, but one explanation is that smoking damages intestinal villi which is a major component in digestion and absorption of nutrients. <ref name="krall" />&nbsp;The decreased ability to absorb calcium leading to decreased bone mineral density increases the risk of osteoporotic fracture with exercise.  
== Effects of Smoking on the Respiratory System ==
[[File:Coughing.jpeg|right|frameless]]
Some of the most commonly known effects of smoking are those related to the respiratory system.  


The use of cigarettes and other tobacco products has also been found to be a contributing factor to age-related muscle atrophy, which is known as sarcopenia. Studies have found that when compared to non-smokers of similar backgrounds those who did smoke had evidence of increased muscle tissue deterioriation. <ref>Rom, O., Kaisari, S., Aizenbud, D., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Reznick, A. (2012). Identification of possible cigarette smoke constituents responsible for muscle catabolism. Journal of Muscle Research and Cell Motility, 33(3), 199-208. doi:10.1007/s10974-012-9299-4</ref> Type I fibers are specifically affected which would limit muscular endurance.&nbsp;<ref name="typeI" /> Some research has also found that the use of these products can cause excessive amounts of adipose tissue catabolism during and after exercise. This can also lead to muscle tissue wasting in those who are nutritionally deficient. Researchers believe that this is a cause for a condition known as cachexia, a syndrome in which the patient loses muscle mass uncharacteristic to aging. This metabolic condition is usually seen in patients with cancer or other issues such as congestive heart failure. <ref name="typeI">Ide H, Tabira K. Changes in sympathetic nervous system activity in male smokers after moderate-intensity exercise. Respiratory Care 2013; 58:1892-98</ref>
The chemicals in tobacco smoke can damage the respiratory system in many ways.  


This loss of muscle mass can lead to less productivity during exercise in regards to energy output and respiration efficiency. Upper extremity muscles also serve as muscles of respiration, which should be taken into consideration while working to condition patients who are heavy smokers. A controlled trial used upper body resistance exercises to study their effects on breathing among a sample of sedentary male smokers. There was, in fact, a significant effect on forced expiration and forced vital capacity within the exercise group <ref>Singh, V. P., Jani, H., John, V., Singh, P., &amp;amp;amp;amp;amp;amp;amp;amp; Joseley, T. (2011). Effects of upper body resistance training on pulmonary functions in sedentary male smokers. Lung India : Official Organ of Indian Chest Society, 28(3), 169–173. doi: 10.4103/0970-2113.83971</ref>. Clearly, smoking impacts multiple systems of the body. It is important to be aware of the interconnectedness to make improvements, such as strengthening upper extremity muscles that have been weakened due to smoking. As a result, controlled respiration can also be improved thus increasing rehabilitation productivity, exercise tolerance, and overall health.<br>  
Examples:
* Tar is a sticky substance that coats your lungs like soot in a chimney.
* Phenols paralyse and kill the hair-like cells in your airways. These cells sweep clean the lining of your airways and protect them against infections.
* Tiny particles in tobacco smoke irritate your throat and lungs and cause ‘smoker’s cough’. This increases production of mucus and damages lung tissue.
* Ammonia and formaldehyde irritate your eyes, nose and throat.
* Cancer-causing chemicals make your cells grow too fast or abnormally and can result in cancer cells.<ref>Aust Gov. Smoking effects Available from:https://www.health.gov.au/health-topics/smoking-and-tobacco/about-smoking-and-tobacco/what-are-the-effects-of-smoking-and-tobacco (accessed 8.4.2021)</ref>
* Research looking at direct exposure to smoking has shown that moderate and heavy smokers have a decreased VO2max. There tends to be a stronger correlation in men, and the decrease in VO2max caused by smoking becomes more significant with age<ref name="Bernaards et al">Bernaards CM, Twisk JW, Van Mechelen W, Snel J, Kemper HC. [https://scholar.google.com/scholar_url?url=https://psycnet.apa.org/record/2003-00653-002&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=16282103726194542725&ei=NuSuY5qeA86vywS1g6foAw&scisig=AAGBfm27Zm2jzvYwEjC6OlPfYngkgMLXnA A longitudinal study on smoking in relationship to fitness and heart rate response.] Medicine & Science in Sports & Exercise. 2003 May. </ref>. Furthermore, smoking just prior to exercise results in less oxygen availability at the tissue level<ref name="Hansen et al">Hirsch GL, Sue DY, Wasserman KA, Robinson TE, Hansen JE. [https://scholar.google.com/scholar_url?url=https://journals.physiology.org/doi/abs/10.1152/jappl.1985.58.6.1975&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=2401442079248795554&ei=U-SuY5yFEZCXywSwqaaIDw&scisig=AAGBfm26lwR8zeFIR2PyhDhB5lYLkJEsQQ Immediate effects of cigarette smoking on cardiorespiratory responses to exercise]. Journal of Applied Physiology. 1985 Jun 1;58(6):1975-81.</ref>.


Smoking is an overall unhealthy habit and causes many of the physiological effects described above that can hinder exercise performance, but it can also decrease the amount a person exercises. In a study done by Loprinzi and Walker, the variables of nicotine dependence and the amount of exercise per day were compared. They further&nbsp;divided the participants to account for other variables including age, gender, race, and several others. Through data analyses, this study found that there was a positive correlation between higher levels of nicotine dependence and sedentary behavior in participants 50 years of age or older. The study also found that older participants were more dependent on nicotine. <ref>Loprinzi, P. D., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Walker, J. F. (2015). Nicotine dependence, physical activity, and sedentary behavior among adult smokers. North American Journal of Medical Sciences, 7(3), 94-99. doi: 10.4103/1947-2714.153920</ref> This information shows us that individuals who smoke may exercise less and may&nbsp;require more motivation&nbsp;to participate in a more active lifestyle.
== Musculoskeletal Effects  ==


= '''Alternative Sources of Nicotine and Their Effects on Exercise''' =
=== Bone Density ===
Smoking has also been found to have a negative effect on bone mineral density which is directly related to [https://www.physio-pedia.com/Osteoporosis osteoporotic] fracture<ref name="krall">Krall EA, Dawson-Hughes B. [https://scholar.google.com/scholar_url?url=https://asbmr.onlinelibrary.wiley.com/doi/abs/10.1359/jbmr.1999.14.2.215&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=5535149142029664252&ei=eeSuY5mlFMSYywTZh5fgCg&scisig=AAGBfm2jHppZnA0rktspFPjfKUlRYuwEcA Smoking increases bone loss and decreases intestinal calcium absorption]. J Bone Miner Res 1999;14:215–20. doi: 10.1359/jbmr.1999.14.2.215</ref>. Smokers do not absorb supplemental or dietary calcium as well as non-smokers. Studies show that smokers on average have 20mg/day less&nbsp;calcium available&nbsp;than non-smokers. The full reason in which calcium absorption is decreased is still unclear, but one explanation is that smoking damages intestinal villi which is a major component in digestion and absorption of nutrients<ref name="krall" />. The decreased ability to absorb calcium leading to decreased bone mineral density increases the risk of osteoporotic fracture with exercise.


While smoking can create adverse health issues for individuals, an athlete may be prone to the use of smokeless forms of nicotine to help with exercise performance. <ref name="Pesta">Pesta D.H., Angadi, S. S., Burtscher, M., &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Roberts, C. K. The effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance. Nutrition &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Metabolism. 2013;10(71).</ref> Through smokeless forms of nicotine use, an individual may be able to obtain a greater concentration of nicotine, while being able to avoid the inhalation of harmful smoke. <ref name="Pesta" /> It has been shown that nicotine has the ability to increase blood flow in muscles, as well as increase the breakdown of lipids during exercise. <ref name="Weber">Weber F, Anlauf M, Muller RD. Changes in muscle blood flow after smoking a cigarette determined by a new noninvasive method. European journal of clinical pharmacology. 1989;37(5):517-20.</ref><ref name="Andersson">Andersson K, Arner P. Systemic nicotine stimulates human adipose tissue lipolysis through local cholinergic and catecholaminergic receptors. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. 2001;25(8):1225-32.</ref> This is due to "enhanced circulating levels of norepinephrine and epinephrine as well as direct action on nicotinic cholinergic receptors in adipose tissue." <ref name="Andersson" /> In addition, studies have shown that nicotine use can improve cognitive function, such as "learning and memory, reaction time, and fine motor abilities." <ref name="Pesta" /> Nicotine has also been found to aid in pain tolerance, which athletes could find beneficial if they participate in contact sports. <ref name="Jamner">Jamner LD, Girdler SS, Shapiro D, Jarvik ME. Pain inhibition, nicotine, and gender. Experimental and clinical psychopharmacology. 1998;6(1):96-106.</ref> While nicotine has been shown to provide an ergogenic effect on exercise performance,&nbsp;it is still a highly addictive drug which can result in withdrawal symptoms affecting motor skills for individuals that abstain from nicotine for a short period of time. <ref name="Pesta" />
=== Sarcopenia ===
* The use of cigarettes and other tobacco products has also been found to be a contributing factor to age-related muscle atrophy, which is known as [https://www.physio-pedia.com/Sarcopenia sarcopenia]. When compared to non-smokers of similar backgrounds those who did smoke had evidence of increased muscle tissue deterioration<ref>Rom O, Kaisari S, Aizenbud D, Reznick A. [https://scholar.google.com/scholar_url?url=https://link.springer.com/article/10.1007/s10974-013-9355-8&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=18285817331106422852&ei=p-SuY-b7Bc6vywS1g6foAw&scisig=AAGBfm10QAxcMWhjEA_llZwk3OhUUF_hDA Identification of possible cigarette smoke constituents responsible for muscle catabolism.] J Muscle R and Cell Motility 2012;33(3):199-208. doi:10.1007/s10974-012-9299-4</ref>. Type I fibers are specifically affected which would limit muscular endurance<ref name="typeI">Ide H, Tabira K. [https://scholar.google.com/scholar_url?url=http://rc.rcjournal.com/content/58/11/1892.short&hl=en&sa=T&oi=gsb&ct=res&cd=0&d=7366803437012240499&ei=weSuY7q3AtKxywSLm5agCA&scisig=AAGBfm3lloWEkoBaTup_En9VmM74SW6kDQ Changes in sympathetic nervous system activity in male smokers after moderate-intensity exercise]. Respiratory Care 2013; 58:1892-98</ref>. The use of tobacco products can also cause excessive amounts of adipose tissue catabolism during and after exercise. This can also lead to muscle tissue wasting in those who are nutritionally deficient. Researchers believe that this is a cause for a condition known as cachexia, condition usually seen in patients with cancer or congestive heart failure<ref name="typeI" /> in which the patient loses muscle mass to aging.
* This loss of muscle mass can lead to less productivity during exercise in regards to energy output and respiration efficiency. Upper extremity muscles also serve as muscles of respiration, which should be taken into consideration while working to condition patients who are heavy smokers. A controlled trial used upper body resistance exercises to study their effects on breathing among a sample of sedentary male smokers. There was, in fact, a significant effect on forced expiration and forced vital capacity within the exercise group <ref>Singh VP, Jani H, John V, Singh P, Joseley T. [https://scholar.google.com/scholar_url?url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009654/&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=18433077998069176310&ei=2eSuY7fVL8SYywTZh5fgCg&scisig=AAGBfm3S1Y9p_6Lknn9ndxyBVrv7qzJQPA Effects of upper body resistance training on pulmonary functions in sedentary male smokers]. Lung India : Official Organ of Indian Chest Society 2011:28(3);169–73. doi: 10.4103/0970-2113.83971</ref>.


Individuals seeking nicotine without the added chemicals found in tobacco may turn to electronic cigarettes (ECIGS). ECIGS&nbsp;have become&nbsp;a popular alternative to traditional tobacco cigarettes since 2007. While most research regarding the long-term effects of ECIGS is still in infancy, several studies address ECIGS as a viable step in smoking cessation and note the reduction in negative health effects. A longitudinal study conducted over the duration of a year by Etter (2014) reported on two groups, those who just use ECIGS (vape) and those who vape and smoke traditional cigarettes. Use among the vape only group did not increase over time, while almost half of the dual users were able to quit smoking traditional cigarettes. While ECIGS may be a safer alternative to traditional cigarettes, it is important to note the specific differences and similarities between the two as they relate to exercise. <ref name="Etter">Etter. A longitudinal study of electronic cigarette users. Addictive behaviors. 2014;39(2):491.</ref> A study by Yan (2015) investigated nicotine intake and the acute effects of ECIGS on heart rate and blood pressure, in direct comparison to traditional tobacco use. They found that participants using ECIGS had significantly lower blood plasma levels after 30 minutes of controlled use, followed by one hour of free use. The ECIG users showed consistent levels of exhaled CO levels, heart rate, and blood pressure versus the magnified levels displayed by smokers. <ref name="Yan">Yan. Effects of using electronic cigarettes on nicotine delivery and cardiovascular function in comparison with regular cigarettes. Regulatory toxicology and pharmacology. 2015;71(1):24.</ref>&nbsp;These findings suggest ECIG users do not need to receive the same precautions as traditional smokers in regards to exercise prescription.
== Smokers Exercise Less  ==


Exercise has been shown to reduce cravings to smoke. Roberts et al. (2015) found that vigorous exercise can drastically reduce the cravings for nicotine. The researchers believe this is due to the realease of noradrenaline and cortisol. However, it is important to note that light to moderate exercise does not appear to reduce cravings for nicotine.&nbsp;<ref name="Roberts et al. (2015)">Roberts, V., Gant, N., Sollers, JJ., Bullen, C., Jiang, Y., &amp;amp;amp;amp;amp;amp;amp;amp;amp; Maddison, R. (2015). Effects of exercise on the desire to smoke and physiological responses to temporary smoking abstinence: a crossover trial. Psychopharmacology, 232(6), 1071-1081. doi: 10.1007/s00213-014-3742-8</ref>&nbsp;While exercise does not completely get rid of the desire to smoke, it can be a healthy and more affordable alternative to the use of other products that also help people quit smoking. A therapist should encourage patients to adopt an exercise regimen if they mention that they are trying to quit smoking. Additionally, a therapist should be able to provide the patient with an exercise plan if they request one.&nbsp;
Smoking can also decrease the amount a person exercises.
* In a study done by Loprinzi and Walker, the variables of nicotine dependence and the amount of exercise per day were compared. They further&nbsp;divided the participants to account for other variables including age, gender, race, and several others. Through data analyses, this study found that there was a positive correlation between higher levels of nicotine dependence and sedentary behavior in participants 50 years of age or older. The study also found that older participants were more dependent on nicotine. <ref>Loprinzi PD, Walker JF. [https://scholar.google.com/scholar_url?url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731864/&hl=en&sa=T&oi=gsb-ggp&ct=res&cd=0&d=18432143262973270087&ei=_eSuY7KRDZCXywSwqaaIDw&scisig=AAGBfm2H1Ipee3913y47FN6kGBHO_qNcSA Nicotine dependence, physical activity, and sedentary behavior among adult smokers.] North American Journal of Medical Sciences 2015:7(3);94-9. doi: 10.4103/1947-2714.153920</ref>&nbsp;Individuals who smoke may exercise less and may&nbsp;require more motivation&nbsp;to participate in a more active lifestyle.


= References  =
== References  ==


<references /><br>
<references /><br>  
[[Category:Physical Activity]]
[[Category:Chronic Respiratory Disease - Conditions]]

Latest revision as of 15:05, 30 December 2022

Original Editors - Lance Ramos

Top Contributors - Trevor McKay, Brandi Kindiger, Christopher Ahrens, Allee Tatum, Vidya Acharya, James Williams, Emily North, Ryan Staebell, Lucinda hampton, Alyxandria Davis, Burgundy Cribbs, Robert Long, Lance Ramos, Kim Jackson, Maddisen Coleman, Alan Tran, Chelsea Mclene, Kyle Covey, Devyn Redford, Kelly Fossard, Michelle Lee, Taylor Ledford and Josh Williams

Introduction[edit | edit source]

Smoking-1026556 960 720-2.jpg

Smoking causes both immediate and long-standing effects on exercise and physical activity (PA). Smokers’ increased risks for cancer and heart and respiratory diseases are well known. In terms of exercise and physical activity, smokers also have:

  • Less endurance
  • Poorer physical performance
  • Increased rates of injury and complications[1].

To achieve peak performance, the heart, lungs and muscles need oxygen-rich blood. When you inhale tobacco smoke, carbon monoxide (just one of the 4,000-plus chemicals found in tobacco, more than 50 of which are known to cause cancer) binds to red blood cells. Oxygen is displaced, preventing delivery to the muscles and other body tissues. This causes an increase in lactic acid i.e. the substance that causes muscle “burning,” fatigue, heavier breathing, and increased soreness after exercise.

This decrease in oxygen will reduce physical endurance e.g. It makes it harder to do everyday things, too, like walking up stairs. Decrease in oxygenation also causes a smoker’s resting heart rate to be higher than a nonsmoker’s, as the heart must work harder to deliver enough oxygen to the body.[1]

Cardiorespiratory Effects[edit | edit source]

Heart Attack.png

Due to the effects of smoking on the cardiovascular system, the heart is not capable of pumping sufficient blood to supply adequate oxygen. Due to insufficient supply of oxygen, the ability of smokers to exercise and perform daily physical activities are also hampered and this ultimately increases the risk of strokes and heart attacks.

Inhaling the smoke of tobacco can cause different responses instantly in the heart and blood vessels. The effects of smoking on the cardiovascular system begin immediately after its consumption.

  • Within one minute of smoking, heart rate starts increasing and it may increase up to 30% in the first ten minutes of smoking.
  • Nicotine present in the tobacco releases adrenaline that makes the heart beat faster and increases the flow of blood, thereby pressuring the heart to work faster and harder.
  • The carbon monoxide present in the tobacco smoke puts your heart at risk of harmful effects by decreasing the ability of blood to carry oxygen to the organs.

Specific Changes and or Increased risk of:

Atherosclerosis diagram.png
  1. Atherosclerosis
  2. Low Blood Oxygen
  3. Coronary Heart Disease: Smoking is a huge risk factor for coronary artery disease and many other complications e.g. myocardial infarction and sudden death[2]. It is also associated with increased blood pressure, systemic vascular resistance, and heart rate[2].  Nicotine is one factor that stimulates epinephrine and norepinephrine release from the sympathetic nerve terminals and adrenal glands,[2]. Acute cigarette smoking is associated with a significant decrease in vagal cardiac modulations which may increase the risk of complications during daily exercise or intense physical activity[2]. Acute smoking affects the cardiorespiratory responses to both submaximal and maximal exercise, which can result in an increase of sympathetic dominance at lower levels of submaximal work[2].
  4. Blood Clots: The smokers are more vulnerable to strokes and heart attacks because due to smoking there is less room for blood to flow to the brains and heart through the blood vessels, due to hypertension Also the level of fibrinogen increases in smokers. This increases the risk of formation of blood clots in the blood vessels[3].
    Stroke 2.jpg
  5. Stroke
  6. Thromboangiitis Obliterans or Buerger’s Disease: rare type of peripheral arterial disease that usually affects the medium and small arteries, veins of legs and arms. Buerger’s Disease is another effect of smoking on the cardiovascular system and in some studies it is discovered that passive smokers are also at risk of developing such diseases. This disease mainly occurs in young smokers that age between 20 and 45.
  7. Peripheral Arterial Disease: one of the common effects of smoking on the cardiovascular system.
  8. Hyperlipidaemia.

Effects of Smoking on the Respiratory System[edit | edit source]

Coughing.jpeg

Some of the most commonly known effects of smoking are those related to the respiratory system.

The chemicals in tobacco smoke can damage the respiratory system in many ways.

Examples:

  • Tar is a sticky substance that coats your lungs like soot in a chimney.
  • Phenols paralyse and kill the hair-like cells in your airways. These cells sweep clean the lining of your airways and protect them against infections.
  • Tiny particles in tobacco smoke irritate your throat and lungs and cause ‘smoker’s cough’. This increases production of mucus and damages lung tissue.
  • Ammonia and formaldehyde irritate your eyes, nose and throat.
  • Cancer-causing chemicals make your cells grow too fast or abnormally and can result in cancer cells.[4]
  • Research looking at direct exposure to smoking has shown that moderate and heavy smokers have a decreased VO2max. There tends to be a stronger correlation in men, and the decrease in VO2max caused by smoking becomes more significant with age[5]. Furthermore, smoking just prior to exercise results in less oxygen availability at the tissue level[6].

Musculoskeletal Effects[edit | edit source]

Bone Density[edit | edit source]

Smoking has also been found to have a negative effect on bone mineral density which is directly related to osteoporotic fracture[7]. Smokers do not absorb supplemental or dietary calcium as well as non-smokers. Studies show that smokers on average have 20mg/day less calcium available than non-smokers. The full reason in which calcium absorption is decreased is still unclear, but one explanation is that smoking damages intestinal villi which is a major component in digestion and absorption of nutrients[7]. The decreased ability to absorb calcium leading to decreased bone mineral density increases the risk of osteoporotic fracture with exercise.

Sarcopenia[edit | edit source]

  • The use of cigarettes and other tobacco products has also been found to be a contributing factor to age-related muscle atrophy, which is known as sarcopenia. When compared to non-smokers of similar backgrounds those who did smoke had evidence of increased muscle tissue deterioration[8]. Type I fibers are specifically affected which would limit muscular endurance[9]. The use of tobacco products can also cause excessive amounts of adipose tissue catabolism during and after exercise. This can also lead to muscle tissue wasting in those who are nutritionally deficient. Researchers believe that this is a cause for a condition known as cachexia, condition usually seen in patients with cancer or congestive heart failure[9] in which the patient loses muscle mass to aging.
  • This loss of muscle mass can lead to less productivity during exercise in regards to energy output and respiration efficiency. Upper extremity muscles also serve as muscles of respiration, which should be taken into consideration while working to condition patients who are heavy smokers. A controlled trial used upper body resistance exercises to study their effects on breathing among a sample of sedentary male smokers. There was, in fact, a significant effect on forced expiration and forced vital capacity within the exercise group [10].

Smokers Exercise Less[edit | edit source]

Smoking can also decrease the amount a person exercises.

  • In a study done by Loprinzi and Walker, the variables of nicotine dependence and the amount of exercise per day were compared. They further divided the participants to account for other variables including age, gender, race, and several others. Through data analyses, this study found that there was a positive correlation between higher levels of nicotine dependence and sedentary behavior in participants 50 years of age or older. The study also found that older participants were more dependent on nicotine. [11] Individuals who smoke may exercise less and may require more motivation to participate in a more active lifestyle.

References[edit | edit source]

  1. ↑ 1.0 1.1 Cleveland Clinic Smoking and PA Available from:https://my.clevelandclinic.org/health/articles/10643-smoking-and-physical-activity (accessed 8.4.2021)
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Fernhall B, Mendonca G, Pereira F. Effects of cigarette smoking on cardiac autonomic function during dynamic exercise. J Sport Sci 2011;29:879-86
  3. ↑ painassist Effects of smoking Available from:https://www.epainassist.com/chest-pain/heart/7-effects-of-smoking-on-the-cardiovascular-system (accessed 8.4.2021)
  4. ↑ Aust Gov. Smoking effects Available from:https://www.health.gov.au/health-topics/smoking-and-tobacco/about-smoking-and-tobacco/what-are-the-effects-of-smoking-and-tobacco (accessed 8.4.2021)
  5. ↑ Bernaards CM, Twisk JW, Van Mechelen W, Snel J, Kemper HC. A longitudinal study on smoking in relationship to fitness and heart rate response. Medicine & Science in Sports & Exercise. 2003 May.
  6. ↑ Hirsch GL, Sue DY, Wasserman KA, Robinson TE, Hansen JE. Immediate effects of cigarette smoking on cardiorespiratory responses to exercise. Journal of Applied Physiology. 1985 Jun 1;58(6):1975-81.
  7. ↑ 7.0 7.1 Krall EA, Dawson-Hughes B. Smoking increases bone loss and decreases intestinal calcium absorption. J Bone Miner Res 1999;14:215–20. doi: 10.1359/jbmr.1999.14.2.215
  8. ↑ Rom O, Kaisari S, Aizenbud D, Reznick A. Identification of possible cigarette smoke constituents responsible for muscle catabolism. J Muscle R and Cell Motility 2012;33(3):199-208. doi:10.1007/s10974-012-9299-4
  9. ↑ 9.0 9.1 Ide H, Tabira K. Changes in sympathetic nervous system activity in male smokers after moderate-intensity exercise. Respiratory Care 2013; 58:1892-98
  10. ↑ Singh VP, Jani H, John V, Singh P, Joseley T. Effects of upper body resistance training on pulmonary functions in sedentary male smokers. Lung India : Official Organ of Indian Chest Society 2011:28(3);169–73. doi: 10.4103/0970-2113.83971
  11. ↑ Loprinzi PD, Walker JF. Nicotine dependence, physical activity, and sedentary behavior among adult smokers. North American Journal of Medical Sciences 2015:7(3);94-9. doi: 10.4103/1947-2714.153920


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