Ussher Michael, Lewis Sarah, Aveyard Paul, Manyonda Isaac, West Robert, Lewis Beth, Marcus Bess, Riaz Muhammad, Taylor Adrian, Daley Amanda, Coleman Tim
Population Health Research Institute, St George's University of London, London SW17 ORE, UK
Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK.
BMJ. 2015 May 14;350:h2145. doi: 10.1136/bmj.h2145.
To determine the effectiveness of a physical activity intervention for smoking cessation during pregnancy.
Parallel group, randomised controlled, multicentre trial.
13 hospitals in England, April 2009 to January 2014.
789 pregnant smokers, aged 16-50 years and at 10-24 weeks' gestation, who smoked at least one cigarette daily and were prepared to quit smoking one week after enrollment were randomised (1:1); 785 were included in the intention to treat analyses, with 392 assigned to the physical activity group.
Interventions began one week before a target quit date. Participants were randomised to six weekly sessions of behavioural support for smoking cessation (control) or to this support plus 14 sessions combining supervised treadmill exercise and physical activity consultations.
The primary outcome was continuous smoking abstinence from the target quit date until end of pregnancy, validated by exhaled carbon monoxide or salivary cotinine levels. To assess adherence, levels of moderate-vigorous intensity physical activity were self reported and in a 11.5% (n=90) random subsample of participants, physical activity was objectively measured by an accelerometer.
No significant difference was found in rates of smoking abstinence at end of pregnancy between the physical activity and control groups (8% v 6%; odds ratio 1.21, 95% confidence interval 0.70 to 2.10). For the physical activity group compared with the control group, there was a 40% (95% confidence interval 13% to 73%), 34% (6% to 69%), and 46% (12% to 91%) greater increase in self reported minutes carrying out physical activity per week from baseline to one week, four weeks, and six weeks post-quit day, respectively. According to the accelerometer data there was no significant difference in physical activity levels between the groups. Participants attended a median of four treatment sessions in the intervention group and three in the control group. Adverse events and birth outcomes were similar between the two groups, except for significantly more caesarean births in the control group than in the physical activity group (29% v 21%, P=0.023).
Adding a physical activity intervention to behavioural smoking cessation support for pregnant women did not increase cessation rates at end of pregnancy. During pregnancy, physical activity is not recommended for smoking cessation but remains indicated for general health benefits. Trial registration Current Controlled Trials ISRCTN48600346.
确定孕期体育活动干预对戒烟的有效性。
平行组、随机对照、多中心试验。
2009年4月至2014年1月期间英格兰的13家医院。
789名年龄在16 - 50岁、孕期为10 - 24周的孕妇吸烟者，她们每天至少吸一支烟且在入组一周后准备戒烟，被随机分组（1:1）；785名被纳入意向性分析，其中392名被分配到体育活动组。
干预在目标戒烟日期前一周开始。参与者被随机分配接受为期六周的戒烟行为支持（对照组），或接受这种支持并加上14节结合有监督的跑步机运动和体育活动咨询的课程。
主要结局是从目标戒烟日期到孕期结束持续戒烟，通过呼出一氧化碳或唾液可替宁水平进行验证。为评估依从性，自我报告中等强度到高强度体育活动的水平，并在11.5%（n = 90）的随机子样本参与者中，通过加速度计客观测量体育活动情况。
体育活动组和对照组在孕期结束时的戒烟率没有显著差异（8%对6%；优势比1.21，95%置信区间0.70至2.10）。与对照组相比，体育活动组从基线到戒烟后一周、四周和六周，自我报告的每周进行体育活动的分钟数分别增加了40%（95%置信区间13%至73%）、34%（6%至69%）和46%（12%至91%）。根据加速度计数据，两组之间的体育活动水平没有显著差异。干预组参与者参加治疗课程的中位数为4节，对照组为3节。两组之间的不良事件和分娩结局相似，但对照组的剖宫产率显著高于体育活动组（29%对21%，P = 0.023）。
在孕妇戒烟行为支持中增加体育活动干预并未提高孕期结束时的戒烟率。孕期不建议将体育活动用于戒烟，但基于对总体健康有益，仍建议进行体育活动。试验注册 现行对照试验ISRCTN48600346
