Urge Coping Mediates the Relationship Between Physical Activity and Smoking Outcomes in a Sample of Premenopausal Women Intending to Quit Smoking

Introduction: Physical activity (PA), urge coping, and menstrual phase may all influence combustible cigarette smoking cessation yet have never been examined concurrently. Therefore, we examined the effects of PA and urge coping on smoking outcomes among women who were randomly assigned to quit smoking based on their menstrual phase. Aims and Methods: Participants were randomized to quit smoking during the follicular menstrual phase (FP; quit date set 6–8 days post onset of menses) or to standard-of-care condition (SC; no menstrual timing of quit date). Smoking-related outcomes at the end of treatment (EOT; ie, 7-day abstinence and cigarettes/day) were regressed on baseline levels of PA stratified by randomization. Mediation analysis examined whether urge coping mediated the relationship between PA and smoking outcomes. Results: Participants (FP: n = 58, SC: n = 60) were, on average, 33.4 years old and smoked 13.8 cigarettes/day at baseline. Total volume of PA was significantly associated with better urge coping (β = .09, 95% CI [0.001, 0.18], p = .05). Urge coping was associated with fewer cigarettes/day at EOT (β = −.37, 95% CI [−0.57, −0.18], p < .001) and greater likelihood of smoking abstinence (β = .28, 95% CI [0.13, 0.42], p < .001). When PA was analyzed by intensity, vigorous PA, but not walking or moderate PA, significantly predicted better urge coping (β = .28, 95% CI [0.06, 0.49], p = .01) and, in turn, greater likelihood of smoking abstinence (β = .50, 95% CI [0.13, 0.87], p = .01). Conclusions: Vigorous PA may be an effective strategy to support urge coping and smoking cessation in premenopausal women. Implications: This study provides evidence that vigorous-intensity PA, but not walking or moderate PA, may play a significant role in improving urge coping, reducing smoking, and improving the likelihood of successful smoking cessation among women of reproductive age, regardless of menstrual timing. Findings did not vary between those who were randomized to quit smoking during the FP versus those who quit regardless of menstrual cycle timing. Findings suggest that incorporating PA in smoking cessation programs in a sequential behavioral change approach (ie, focusing on adopting vigorous PA before setting a quit day) may be beneficial.