A telephone-based intervention to promote physical activity during smoking cessation: a randomized controlled proof-of-concept study

Abstract

Smoking and physical inactivity contribute to disproportionate disease burden among underserved adults. Telephone-based interventions (quitlines) are becoming the standard care for addressing smoking. There is increasing interest to determine whether quitlines can be utilized to administer interventions for other unhealthy behaviors. This study aims to examine the proof-of-concept and potential efficacy of a telephone-based behavioral counseling intervention to boost daily low-to-moderate physical activity among low-income, physically inactive smokers. Participants (N = 101) were randomized to receive 4 weeks of counseling prior to their smoking quit day that included either standard smoking cessation counseling (control) or the Step-up to Quit (SUTQ) intervention. SUTQ promoted daily walking to foster physical activity as a primary smoking urge management strategy and facilitate incremental increases in daily steps with the goal of achieving 7500 steps/day by the quit day in week 4. Exploratory structural equation modeling tested SUTQ effects on six measures of low-to-moderate physical activity (primary outcome) and smoking cue reactivity (secondary outcome) simultaneously in a single multivariate model with controlling variables. The sample was 51 % female and 77 % African-American, with a mean age of 42.1 years (SD = 10.9). Compared to the control condition, SUTQ intervention was associated with greater physical activity at week 4 (b = 0.51, z = 1.71, p = 0.08), with between-group differences sustained at follow-up. At week 4, the SUTQ group had higher 7-day mean steps/day (M = 7,207.25, SD = 4,276.03) than controls (M = 3,947.03, SD = 3,655.03) (t = 3.35; p < .01); and had more participants reach the >7500 steps/day goal (49% vs. 11 %, c2 = 10.78; p < .01), a difference that was sustained at 1-month follow-up (X2 = 9.04, p < .01) Effects of SUTQ treatment on cue reactivity were in the hypothesized direction but not significant (b = -0.29; z = -1.09, p = 0.27). To our knowledge, this is the first study to promote physical activity using telephone counseling in an underserved population of smokers known to have greater challenges with physical activity adoption and smoking cessation. The SUTQ approach suggests that integration of physical activity advice and support within the context of smoking cessation treatment has the potential to promote physical activity among smokers intending to quit.

Trial registration: ClinicalTrials.gov NCT02220465.

Keywords: Low-income smokers; Physical activity; Smoking cue reactivity; Telephone-based counseling.

Fig. 1

Participant flow. 1 Reasons for ineligibility: not meeting criteria for physical inactivity (n = 134), mental health diagnosis (n = 70), smoking history (n = 40), age (n = 31), not owning a phone (n = 24), drug/alcohol use (n = 30), disability (n = 5), pregnancy (n = 2), exclusive e-cig use (n = 2). 2 Seven participants were ineligible after completion of baseline (prior to being randomized); reasons included mental health diagnosis (n = 3), smoking <5 cigarettes per day (n = 2), and not meeting the criteria for physical inactivity (n = 1). 3 Reasons for withdrawal post-randomization included reported use of psychotropic medications, drug and alcohol use, and misreporting physical activity levels during screening, and moving outside service area. 4 One-week and 1-month assessments were only completed for participants who completed their quit day session