This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Overcoming tobacco use and nicotine dependence, one of the main cardiovascular risk factors, appears to be more difficult for women than for men, mainly because 1) women may be more sensitive to the effects of nicotine than men; 2) negative affectivity that is associated with continued tobacco use is more common among women than men; and 3) women have more concerns about weight as a reason for continuing smoking and not attempting to quit. The combination of an exercise intervention with nicotine replacement therapy (NRT) should provide a particularly efficacious and cost-effective treatment for female smokers. In our ongoing study, we have found that aerobic exercise, held in a supervised hospital setting, and used as an adjust to NRT, has produced higher quit rates than standard care with NRT. However, relapse was still very rapid and adherence to the exercise regimen was less than optimal. Exercise adherence was particularly poor among those who had higher body mass index, higher nicotine dependence, and depression prior to quitting, i.e., those with high cardiovascular risk index. Increasing the adherence to the exercise might result in improved cessation rates, concurrently reducing cardiovascular risk factors and, in turn, female morbidity and mortality. The proposed study will investigate if cognitive-behavioral exercise adherence counseling (CBC) added to an exercise prescription (ERX), used effectively in many patient-populations, increases engagement in physical exercise among female smokers attempting to quit compared to an ERX alone condition. We will examine if increased exercise adherence results in higher cessation rates, and whether prescribed exercise that is home-based (HB) would result in the same cessation effects as an exercise program that is facility-based (FB).
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