Figure 5.—Percent distribution of 130 brands of cigarettes and 25 brands of little
cigars by nicotine content.

 

 

 

 

 

 

 

 

 

50
Cigarettes
45 | Little cigars -——4
o
a “OT 4
= 35+ J
5 30} iy
° 4
@ >] g
44
g 20} 4
@ 15+ 4
10} Z |
iY
5 1 4
0 Vi ZI A Zl mm |
42 ££ 8 § 2 eR eB,
@ = toe | m= = A WN 3
Ry
ag eg 22 48 2288
< Oo oO o o + a 4 oo N A
v
* g2 4% © an oO 2 8 + 4© 8 6
é w ” + ” 9 q a 0 a
m
oe ° © © & @ G@ go °
ge = 2 XN + s s a + o 4g
Go
&
ro
Vv

SOURCE: U.S. Department of Health, Education, and Welfare (97) and Federal Trade Com-
mission (34).

226
TasLe 37.—Shipment of small and large cigars destined for domestic
consumption (1970, 1971, 1972)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year 1970 1971 1972
Small cigars

January__._______.____- 58, 328, 520 85, 753, 780 123, 477, 550
February._._-...__--___- 63, 431, 580 72, 092, 205 179, 817, 839
March. ___.-___.-___-__- 85, 881, 860 46, 542, 800 198, 165, 593
April____- 22 101, 613, 500 59, 059, 920 125, 335, 740
May..---_._-----_ ee 81, 093, 180 93, 237, 473 159, 334, 565
June__.--- 2-2. 82, 471, 120 94, 560, 140 180, 582, 243

Subtotal__________ 472, 819, 760 451, 246, 318 966, 713, 530
July. 22-222 eee 62, 143, 140 70, 332, 500 127, 713, 320
August_.._-__._________ 68, 220, 365 127, 709, 310 670, 936, 869
September_.._____._____ 79, 101, 045 95, 027, 340 422, 534, 705
October. ...-_---.-_-_- 90, 752, 880 109, 567, 900 708, 116, 830
November_______-______ 64, 290, 600 106, 666, 107 551, 326, 888
December__._..__.____- 63, 806, 010 123, 809, 553 485, 587, 014

Subtotal___.______ 428, 314, 040 633, 112, 710 2, 966, 215, 626

Yearly total__._.__ 901, 133,800 1, 084, 359,028 = 3, 932, 929, 156

Large cigars

January.-.-.---2_-___. 581, 742, 001 573, 039, 120 534, 565, 488
February.__._...._.___- 595, 249, 522 586, 810, 844 562, 414, 577
March_______. 222-28 629, 977, 375 665, 998, 099 654, 827, 796
April__...--_------____- 652, 800, 200 655, 850, 213 554, 242, 048
May..._.--_- ee 748, 040, 796 670, 064, 933 719, 489, 529
June____--- 2-2 644, 539, 031 692, 436, 529 578, 501, 068

Subtotal___.__-____ 852, 348,925 3, 844, 199, 738 3, 604, 040, 506
July. 2222-2 ee 647, 397, 547 619, 838, 386 520, 873, 339
August... 222 673, 082, 971 662, 970, 148 682, 331, 630
September___.__._______ 721, 561, 449 680, 476, 418 594, 843, 957
October. ._--. 2-2. 797, 601, 253 679, 420, 968 693, 150, 668
November_._.__-__-____ 696, 526, 464 742, 948, 802 650, 746, 540
December. .____-______- 596, 244, 159 516, 879, 415 437, 429, 996

Subtotal__________ 4, 132, 413, 843 3, 902, 534,137 3, 579, 356, 130

Yearly total______ 8, 084, 762, 768 7, 746, 733, 875 7, 183, 396, 636

 

Source: U.S. Department of the Treasury (101).

227
TABLE 38.—Selected compounds in mainstream smoke

 

 

Smoke compound Cigarette A Cigarette B Little Little Small
(onfilter) (filter) cigar A cigar B elgar C

“Tar”, milligram per cigarette... 36. 1 20. 3 17. 4 31.8 40. 6
Nicotine, milligram per cigarette _ 2.7 14 .6 1.8 3. 1
Carbon monoxide, volume per-

cent. _-.--.----------- ieee 4.6 4.5 5.3 111 7.7
Carbon dioxide, volume percent__ 9. 4 9. 6 8.5 13. 2 12.7
Reducing sugars, percent of

tobacco weight______________ 9.3 7.9 1.5 2.9 2.7
Hydrogen cyanide, microgram

per cigarette____._-_-_.._._.- 5386.0 361.0 381.0 697.0 1,029.0
Acetaldehyde, microgram per

cigarette.__..._._-___-_-_._- 770.0 774.0 630.0 1,238.0 1, 150.0
Acrolein, microgram per cigar-

ette__----_------- eee eee. 105. 0 71.0 41.0 54. 0 66. 0
Total pyridines, micrograms per

cigarette-_.__.______.__-_-_. 82.8 27. 3 58. 0 85. 3 80. 3
Phenol, microgram per cigarette_. 124. 2 33. 0 35. 1 63. 4 94, 1
Benz(a)anthracene, nanogram

per cigarette_______.______-- 74,0 31.0 34. 0 25. 0 39. 0
Benzo(a)pyrene, nanogram per

cigarette__......--_._----___- 47.0 20. 0 18. 0 22. 0 30. 0

 

Source: Hoffmann, D., Wynder, E. L. (44).

TABLE 39.— The pH of the mainstream smoke of selected tobacco products
[Numbers in parentheses indicate number of last puff.]

 

 

Average pH Cigarette A Cigarette B Little Little Small Cigar D
(nonfilter) (filter) cigar A cigar B cigar C
3d puff__._- 6. 19 6.15 6. 44 6. 55 6. 53 6. 47
5th puff.__. 6.14 6. 12 6. 34 6. 46 649 9 _LLL eee
7th puff__._ 6. 09 6. 01 7. 03 6. 51 656 = ___-uuee
9th puff._.. 6. 02 §.83 _l_ eee 6. 98 6. 59 6. 27
13th puff... 2 eee Lee eee Lee ee eee eee eee 6. 39
18th puff... 2 Lee eee eee eee eee eee eee 6. 41
Q3d puff... ee ee eee eee eee eee 6. 81
28th puff_.. _.------ eee eee eee eee eee eee eee eee 7. 22
33d puff_--8 8 eee eee eee 7.53
38th puff... 28 eee eee eee eee 7.78

Last puff___ 5.96(11) 5. 76(10) 7.73 (8) 7.25(10) 7.11(11) 7. 96(43)

 

Source: Hoffmann, D., Wynder, E. L. (44).

228
Conclusions

Pipe and cigar smokers in the United States as a group experience
overall mortality rates that are slightly higher than those of nonsmok-
ers, but these rates are substantially lower than those of cigarette
smokers. This appears to be due to the fact that the total exposure to
smoke that a pipe or cigar smoker receives from these products is
relatively low. The typical cigar smoker smokes fewer than five cigars
a day and the typical pipe smoker smokes less than 20 pipefuls a day.
Most pipe and cigar smokers report that they do not inhale the smoke.
Those who do inhale, inhale infrequently and only slightly. As a
result, the harmful effects of cigar and pipe smoking appear to be
largely limited to increased death rates from cancer at those sites which
are exposed to the smoke of these products. Mortality rates from
cancer of the oral cavity. intrinsic and extrinsic larynx, pharynx, and
esophagus are approximately equal in users of cigars, pipes, and ciga-
rettes. Inhalation is evidently not necessary to expose these sites to
tobacco smoke. Although these are serious forms of cancer, they account
for only about 5 percent of the cancer mortality among men.

Coronary heart disease, lung cancer, emphysema, chronic bronchitis,
cancer of the pancreas, and cancer of the urinary bladder are diseases
which are clearly associated with cigarette smoking, but for cigar and
pipe smokers death rates from these diseases are not greatly elevated
above the rates of nonsmokers. These diseases seem to depend on mod-
erate to deep inhalation to bring the smoke into direct. contact with
the issue at risk or to allow certain constituents, such as carbon mon-
oxide, to be systematically absorbed through the lungs or to affect the
temporal patterns of absorption of other constituents such as nicotine
that can be absorbed either through the oral mucosa or through the
lungs. Evidence from countries where smokers tend to consume more
cigars and inhale them to a greater degree than in the United States
indicates that rates of ling cancer become elevated to levels approach-
ing those of cigarette smokers.

Available data on the chemical constituents of cigar, pipe, and
cigarette smoke suggest that there are marked similarities in the com-
position of these products. Pipe and cigar smoke, however, tends to
be more alkaline than cigarette smoke, and fermented tobaccos com-
monly used in pipes and cigars contain less reducing sugars than the
rapidly dried varieties commonly used in cigarettes.

Experimental evidence suggests that little difference exists between
the tumorigenic activities of tars obtained from clgar or cigarette

229
tobaccos. Malignant skin tumors appear somewhat more rapidly and
in larger numbers in animals whose skin has been painted with cigar
tars than in those animals painted with cigarette tars.

One must conclude that some risk exists from smoking cigars and
pipes as they are currently used in the United States, but. for most
diseases this is small compared to the risk of smoking cigarettes as they
are commonly used. Nevertheless, changes in patterns of usage that
would bring about increased exposure either through increased indi-
vidual use of cigars and pipes or increased inhalation of pipe and cigar
smoke have the potential of producing risks not unlike those now
incurred by cigarette smokers. Mechanical or chemical modifications
of pipe tobacco and cigars that would result in a smoke more compat-
ible with inhalation could have this effect.

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CHAPTER 7

 

Exercise Performance
Contents

Page
Introduction_____..._-.---_----------------------------- 241
Studies of Smokers_._.___._-_--------------------------- 241
Studies Comparing Smokers to Nonsmokers:
Athletie Performance -- -- - wee ee eee eee eee eee 243
Bicycle Ergometer Performance. _--.-------------------- 244
Treadmill Performance___..--------------------------- 245
Performance in Other Tests of Fitness....--------------- 245
Discussion__.______...-----_----_-_--------------------- 246
Biomechanisms_______.__.------------------------------ 246
Summary____._._.__--_-------------------------------- 247
References____.__._.__-___.--__-__--------------------- 248

239
Introduction

Although it has long been held by athletes and coaches that cigarette
smoking is associated with “shortness of wind” and impaired perform-
ance, until recently there has been little scientific evidence to support
this view. In the past few years, a variety of studies have appeared
dealing with the effect of cigarette smoking on the response of man
to exercise. The following is a review of these studies.

Age, sex, training, health, weight, and other factors are known to
influence exercise performance. Because most of the investigations
were carried out in healthy, young male volunteers, the groups were
quite comparable with regard to age, sex, and health; however, weight,
training, and other factors were often inadequately controlled.
Furthermore, problems in study design and statistical analysis limit
the value of several of these studies.

Many forms of exercise were performed in these experiments, in-
cluding : pedaling a bicycle ergometer, running on a treadmill, running
on a track, swimming, step climbing, gripping a hand dynamometer,
and doing several different exercise activities as part of a battery of
tests. Small to maximum amounts of work were carried out in the
various studies revewed.

Studies of Smokers

Most of the studies of habitual cigarette smokers followed a similar
format with respect to smoking: (a) The subjects refrained from
smoking for a few hours prior to testing, and (6) two test runs were
performed, one without smoking and one in which smoking imme-
diately preceded the exercise or was incorporated with the exercise
protocol.

Several investigators (/, 15, 28) studied the effect of smoking on
maximum grip strength. Willgoose (28) reported a greater mean per-
cent recovery of grip strength after the nonsmoking trial than after
the smoking trial. Kay and Karpovich (75) and Anderson and Brown
(1) all followed a protocol similar to that of Willgoose except that
they randomized the smoking and nonsmoking trials, and substituted

241
a “placebo” cigarette for the nonsmoking trial. In neither of these
studies were statistically significant differences observed between the
grip scores for the smoking and nonsmoking trials.

Reeves and Morehouse (24) administered a battery of tests to 15
colleges students. The tests were: A tapping test, a strength test, a
jumping test, and the short form of the Harvard step test. No statis-
tically significant differences in performance were noted under con-
ditions of smoking or nonsmoking.

A total of 32 college students from intermediate swimming classes
abstained from smoking for 15 minutes, 2 hours, and 12 hours in a study
conducted by Pleasants, et al. (23). Following the abstinence, they
swam distances of 100 and 200 yards. Although actual swimming times
were not published, the authors reported no statistically significant
differences between the mean swimming times after the different
periods of abstinence for either distance.

In 1946, Juurup and Muido (13) carried out several experiments
in which three young cigarette smokers exercised on a Krogh’s bi-
cycle ergometer. Smoking was found to increase the pulse rate at
rest as well as during exercise. Although the effect was less con-
sistent than on the heart rate, smoking was also associated with
elevated blood pressure. Smoking had no effect on oxygen consump-
tion. Henry and Fitzhenry (/2), in 1949, using the bicycle ergometer,
also found that smoking exerted no effect on oxygen consumption.
In the same year, Karpovich and Hale (14) studied bicycle ergometer
performance in eight young men. In all subjects, the average riding
time was better in nonsmoking tests than in smoking tests; how-
ever, the results were statistically significant for only three of the
eight subjects.

Kerrigan, et al. (16) more recently measured direct arterial blood
pressure, heart rate, and cardiac output in 25 habitual smokers at
rest and after exercise. Smoking two cigarettes produced statistically
significant (P<0.01) increases in cardiac index, heart rate, and arter-
ial mean pressure compared to the immediately preceding control
period. Exercise after smoking resulted in an increase in cardiac in-
dex over either the resting period or the exercise period which fol-
lowed abstinence; the resultant cardiac index appeared to be approxi-
mately the sum of the exercise and smoking effects. Exercise tests
preceded by smoking were also associated wtih significantly higher
(P<0.01) and more prolonged elevations of blood pressure than those
not preceded by smoking.

In the study by Goldbarg, et al. (17) of nine habitual smokers
performing submaximal exercise on a bicycle ergometer, cardiovas-
cular responses were measured via pulmonary and subclavian artery
catheters. At rest, after smoking, the mean cardiac index and mean
heart rate increased. During successively increasing levels of exercise,
the heart rate was greater and stroke index lower than values for

242
comparable work before smoking. The net effect of smoking was to
decrease the effiicency of the heart during exercise in the upright
position by causing a smaller stroke volume and a higher heart
rate.

Rode and Shephard (26) investigated near maximal treadmill exer-
cise performance in six habitual smokers. A 1-day abstinence from
cigarette smoking was associated with a 13- to 79-percent decrease in
the oxygen cost of breathing. Abstinence was also followed by a slow-
ing of the heart rate and a decrease in expiratory minute volume after
exercise.

The study of Krumholz, et al. (78) is different from those cited pre-
viously in that bicycle ergometer exercise performance was measured
in habitual smokers both before and after 3 to 6 weeks of abstinence.
Among the 10 subjects who abstained from smoking for 3 weeks, there
was a statistically significant (P<0.05) decrease in heart rate, oxygen
debt, and ratio of oxygen debt to total increase in oxygen uptake pro-
duced by the 5 minutes of exercise.

Using a “double 9-inch progressive step test” Rode and Shephard
(25) studied several hundred participants of a smoking withdrawal
clinic at the time of entry and at a 1-year followup. Among those
who returned for the followup and who gave up smoking, absolute
aerobic power increased insignificantly ; however, the relative aerobic
power diminished in both sexes among those who quit smoking because
of the weight gain experienced.

Studies Comparing Smokers to Nonsmokers

Athletic Performance

In 1968 Cooper, et al. (6) evaluated 419 airmen during their initial
6 weeks on active duty in the USAF. A 12-minute maximum running
test was performed at least. 1 hour after cigarette smoking. The mean
distance covered in 12 minutes by the nonsmokers was significantly
greater (P<0.05) than that covered by the smokers at the beginning,
the middle, and the end of training. All categories of smokers and non-
smokers improved their performance at the end of training; however,
the maximum change in performance of those smoking 10 to 30 cig-
arettes per day was significantly (P<0.001) less than that of non-
smokers.

David (7) administered a battery of tests to 88 military personnel,
aged 19 to 39 years. A 1-mile run was included in the testing. and cig-
arette smoking was associated with a significant decrease in perform-
ance in this event.

243
Some 45 special forces soldiers were investigated at sea level and
13,000 feet above sea level by Fine (8). The subjects were randomly
assigned to a placebo group or an acetazolamide treated group. Cig-
arette smoking was positively correlated to decrements in 600-yard
running performance from sea level to altitude in both groups.

Pleasants (22) studied 106 students from intermediate university
swimming classes. Swimming times were measured for 100- and 200-
yard distances before and after training and for 800-yard distances
after training. The mean swimming times of nonsmokers were less
than those of smokers in six of seven listed categories, but these dif-
ferences were not statistically significant.

Bicycle Ergometer Performance

Chevalier, et al. (5) investigated cardiovascular parameters in 32
young physicians after a standard 5-minute ergometer test. Oxygen
debt accumulation among smokers was significantly (P<0.01) greater
than among nonsmokers. The heart rate at rest and 3 minutes after
exercise was significantly (P<0.02) faster in smokers than in non-
smokers.

Using a 5-minute ergometer test, 18 housestaff physicians, half of
whom smoked, were investigated by Krumholz, et al. (77). They noted
the following: Oxygen debt accumulation after exercise was signifi-
cantly (P<0.02) greater in smokers than non-smokers, the ratio of the
oxygen debt to total increased oxygen uptake during exercise was sig-
nificantly (P<0.001) greater in smokers than in nonsmokers, and
the diffusing capacity at rest and with exercise was significantly
(P<0.05) decreased in smokers compared to nonsmokers.

Kerrigan, et al. (16) studied cardiovascular parameters in smokers
and nonsmokers at rest, during, and after a 5-minute bicycle ergometer
ride. Cardiac index and blood pressure values obtained during exercise
performed immediately after smoking were greater than those found
in nonsmokers performing the same exercise. Similarly, heart rate and
blood pressure remained elevated for longer periods in those who
exercised immediately after smoking than in nonsmokers performing
the same task.

Aerobic capacity scores were examined in 60 university student vol-
unteers by Peterson and Kelley (20). Subjects worked at submaximal
levels on a bicycle ergometer before, during, and after a training
program. At all of these intervals, nonsmokers had significantly
(P<0.05) higher mean aerobic capacity scores than smokers. Both
groups increased their aerobic capacity during training but non-
smokers consistently performed better throughout training.

244
Treadmill Performance

In 1960 Blackburn, et al. (4) carried out several measurements of
cardiovascular function after different amounts of treadmill exercise
were performed by 233 professional men, 159 university students, and
414 railroad workers. The differences between the smokers and non-
smokers were of small magnitude. Basal oxygen consumption was
slightly higher in smokers than in nonsmokers. Also, resting pulse
rates were higher in smokers of most groups.

Cooper, et al. (6) studied 47 out of 419 airmen with treadmill test-
ing. Cardiopulmonary indices measured on the treadmill, including
maximum indices, were comparable in smokers and nonsmokers ex-
cept for a significant (P<0.01) reduction in the maximum minute
volume among the smokers.

A total of 277 prospective Canadian firemen performed the Balke-
Ware test of work capacity in treadmill studies carried out by Glass-
ford and Howell (70). The mean performance scores of nonsmokers
were significantly (P<0.01) greater than those of smokers.

The effect of vitamin C supplementation on treadmill exercise per-
formance was investigated in 40 male volunteers by Bailey, et al. (2).
Significant differences in oxygen utilization and ventilatory function
between smokers and nonsmokers were noted in only two of the 24
separate analyses of variance performed.

Maximal oxygen intake during treadmill exercise was examined by
McDonough, et al. (79) in 86 healthy, middle-aged male volunteers.
Cigarette smoking was one of six variables which together provided
a multiple correlation coefficient of 0.73.

Performance in Other Tests of Fitness

When physical fitness tests were administered to 88 military per-
sonnel by David (7), cigarette smoking was found to be associated
with a significant (P<0.001) decrease in performance in the dodge
and jump test, and a significant (P<0.02) decrease in performance in
the crawling test.

Using a step test, a breath holding test, and an ergometer test,
Franks (9) examined 58 middle-aged men. Nonsmokers were able to
hold their breath longer and had greater vital capacity residual after
the step test than the smokers.

In 1971, Wysokinski (29) studied 200 young Polish soldiers using
Letunov’s test which included 20 knee-bending exercises, a fast run for
20 seconds, and a run for 3 minutes. Cigarette smoking was associated
with a significant (P<0.01) reduction in the vital capacity and a

245
marked rise in the pulse rate at rest and after exercise. Intense exer-
cise also caused a greater rise in the systolic blood pressure in smokers
than in nonsmokers.

Discussion

Most of the studies in habitual cigarette smokers compared exercise
performance in “smoking” and “nonsmoking” runs after only a few
hours of abstinence. In some studies, smoking adversely affected per-
formance (11, 13, 14, 16, 18, 26, 28), while in others it did not (7, 72,
15, 23, 24). Some of these apparently discrepant results are due to dif- ~
ferences in methodology and in amounts and types of work performed.
In all of the more recent studies of habitual smokers in which moderate
to near maximal amounts of work were performed and sophisticated
measurements of oxygen transport and cardiopulmonary function
were made, impairment of function during smoking trials was found
(11, 16, 18,26).

The data of Krumholz, et al. (78) also raise the question of whether
residual effects of cigarette smoking influence “nonsmoking” trials per-
formed after a few hours of abstinence; they found statistically sig-
nificant decreases in heart rate and oxygen debt produced by exercise
after 3 weeks of cessation.

The work of Rode and Shephard (25) suggests that physical fitness
improves with cessation, but this improvement may be negated if the
subject gains a substantial amount of weight after giving up smoking.

Several investigators compared exercise performance or postexer- -
cise cardiopulmonary function of smokers to nonsmokers. Although
only minor differences between smokers and nonsmokers were found -
in a few of these studies (3, 4, 22), in most of them (4, 6, 7, 8, 10, 16,
17, 20, 29) the performance or function of the nonsmokers was better
than that of the smokers. Both nonsmokers and smokers improved .
their performance with training, but nonsmokers maintained their ad-
vantage throughout training (6. 20).

Biomechanisms

The cited studies indicate that cigarette smoking exerts its adverse
effect on exercise performance through several mechanisms. Cigarette
smoking appears to impair cardiac performance during exercise by
increasing the heart rate and exerting a variable effect on cardiac

246
output (5, 11, 13, 16, 18, 26, 29). Cigarette smoking is associated with
an increased oxygen debt after exercise (5, 18). Also, one study indi-
cated that the oxygen cost of hyperventilation was greater among
smokers than among nonsmokers (26).

Some of these adverse effects of smoking on oxidative metabolism
are mediated by the elevated carboxyhemoglobin levels found in
smokers, CO exerts these effects through one or more of the following
mechanisms: (a) Reduction of the amount of hemoglobin available for
oxygen transport, (6) shift of the oxygen-hemoglobin dissociation
curve to the left with consequent interference in oxygen release at
the tissue level, (c) induction of arterial hypoxemia, and (d@) possible
interference with the homeostatic mechanism by which 2,3,DPG
controls the affinity of hemoglobin for oxygen (27). Because carboxy-
hemoglobin has a half life in the body of at least 3 to 4 hours, its influ-
ence may still be measurable several hours after abstinence from
smoking (27).

A recent investigation of maximal muscular exercise during CO in-
toxication in five male volunteers demonstrated reduced maximal O:
consumption in spite of a much higher heart rate and a relative hyper-
ventilation (27).

Astrand and Rodahl (2) commented recently on the adverse effect
of cigarette smoking on oxygen transport: “All other factors being
equal, a reduction in the oxygen-transporting capacity is associated
with a corresponding reduction in physical performance capacity dur-
ing heavy or maximal work * * *. Because a regular physical train-
ing program only increases the maximal oxygen uptake by some 10 to
20 percent, a 5- to 10-percent reduction in maximal aerobic power due
to smoking may play a significant role in many types of athletic events
and in very heavy work.”

Other studies cited in this review document the adverse effect of
smoking on pulmonary diffusing capacity (78) and on pulmonary
function with exercise (6,29).

Summary

Clinical studies in healthy, young men have shown that cigarette
smoking impairs exercise performance, especially for many types of
athletic events and activities involving maximal work capacity. Some
of these effects are mediated by reduced oxygen transport and reduced
cardiac and pulmonary function.

247
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248

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