We are all well aware of the fact that smoking is considered a serious public health issue with high incidence worldwide, leading to high costs to the health system due to tobacco-related diseases. Moreover, it is important to emphasize that smoking affects many systems in the human body such as the respiratory, cardiovascular, musculoskeletal, and neurological systems. Furthermore, the consequence of persistent smoking; is lung cancer shares similarities with symptoms of SARS-CoV-2 infection, such as constant cough, low oxygen levels, and breathlessness.

The COVID-19 pandemic could have been an excellent opportunity to significantly reduce global smoking rates, with the help of concerted advertising campaigns, enhanced social support, and utilization of efficient digital technologies. But, conversely, that was not the case. Based on a survey conducted by ASH (Action on Smoking and Health), it is seen that quit numbers had increased in the UK in the early months of the pandemic, but the number of smokers has also increased tremendously in 2021.

The motivations behind this proliferation are presumably multifactorial, but the influences of multiple lockdowns and the related stress, boredom, and isolation could have played a pivotal role. Therefore, it is absolutely imperative that necessary actions are put into place and smokers regain control and quit overuse of a substance. 

Each year, more than a third of people who are addicted to smoking try to quit the habit. But stress, anxiety, depression, pressure, and especially the addictive property of nicotine often get the worse of these people. This is why to break such an addictive unhealthy habit you need help. Physical therapy or physiotherapy is a mainstay of treatment for substance use disorders and can help people get their nicotine addiction under control. There is evidence that suggests proper exercising and other physiotherapy interventions that stimulate endorphin release can significantly help mitigate symptoms of nicotine withdrawal.

Role of the Physical Therapists in Smoking Intervention 

There is no doubt that the destructive consequences of smoking cigarettes extend to various systems of the human organism, such as musculoskeletal, respiratory cardiovascular, neurological, and can interfere in the clinical practice of physical therapists. Thus smoking detection is paramount in physical therapy patients to facilitate counseling and suitable intervention.

The experts doing physiotherapy in Caledonia play a fundamental role in the multidisciplinary clinical team. In practice, they provide secondary and tertiary prevention and can present actions for mental fitness by associating health guidance with increasing levels of physical activity. The multifarious outcomes of smoking on cardiopulmonary, vascular, musculoskeletal, neuromuscular, and integumentary impairments undoubtedly demonstrate a critical obligation for physiotherapists to undertake a more significant role in tobacco cessation to improve treatment.

How Can Physiotherapy Help Smokers In Tackling Their Smoking Addiction 

Physiotherapists have adopted a variety of three-step brief intervention models that are capable of helping patients in smoking cessation. The three-step model, known as the AAR model recommends that physiotherapists: 

• Initially ask patients about their tobacco use
• Provide advice for tobacco users on how to quit and the reasons to quit
• Refer patients to an external healthcare system for assistance and also perform follow-up

As the model recommends, physical therapists must enquire about a patient’s current and past smoking behavior; counsel by presenting details on the consequences of smoking and tobacco addiction; and act by providing possibilities for later or additional support and the stop-smoking medications that are currently available. 

Step 1 – Ask

A physiotherapist will enquire about a patient’s smoking status and constantly record it in their documents. If the patient conveys that he/she is an ex-smoker, physiotherapists will also ask when they ceased the addiction because if it was within six months, they may still require assistance in maintaining their quit attempt so that they can completely prevent a relapse.

In any of the three-step brief intervention models, physiotherapists find it unnecessary to question how much a patient smokes, as underreporting is typical among patients for fear of stigma or disapproval by a health professional.

Also, it is suggested that patients should be asked about their smoking status and improvement of their cessation attempts only during subsequent physiotherapist-patient consultations. It is not advised to enquire every day of an inpatient stay, as it may adversely impact the physiotherapist-patient relationship and discourage a quit attempt.

Step 2- Advice

Once the physiotherapist has taken the necessary steps to inquire about and understand the patient’s smoking status, the physiotherapist will then move on to advising the patient to quit. To be more relevant, the physiotherapist will personalize the guidance and construct an intricate connection between the benefits of quitting and the consequences of not quitting. 

For example:

• The guidance provided by physiotherapists to patients with tobacco-related diseases, such as Chronic Obstructive Pulmonary Disease (COPD), lung cancer, and cardiovascular disease, could connect the advantages of smoking cessation to enhanced lung function; lowered repetition of cardiovascular events or cancer; and better effectiveness of radiotherapy and chemotherapy. 
• In the domain of surgery, the physiotherapist’s preoperative and post-operative guidance could connect the advantages of quitting tobacco to the decline of pulmonary complications, delayed wound recovery, and joint infections. 
• In chronic pain, quitting smoking addiction could lead to reduced pain, as persistent smoking hinders the effectiveness of pain medication and sometimes even worsen the pain. 
• In critical musculoskeletal damages, the advantages of quitting can be connected to optimizing bone and connective tissue recovery.
• In women’s health and pediatrics, physiotherapists will provide various relevant data that can emphasize the significance of quitting smoking to decrease the threat smoking causes the fetus, the chance of having a preterm birth, and the damaging consequences of second-hand smoke on the child’s health and well-being. 

Step 2- Help

The physiotherapist will then be able to guide the patient to evidence-based smoking cessation methods. They do this by a range of different methods, including: 

• Physiotherapy exercises and respiratory physiotherapy.
• Arrange a referral to a free cessation service
• Encourage the usage of behavioral support techniques
• Encourage the use of pharmacotherapy. For example, nicotine replacement therapy
• Encourage the use of prescription-only pharmacotherapy

Deep breathing techniques to improve lung efficiency

Physiotherapists can help perform a set of deep breathing exercises that are beneficial for smokers who quit smoking to cleanse their lungs and significantly overcome smoking withdrawal symptoms such as cigarette cravings. Deep breathing techniques can improve the efficiency of the lungs and have been widely employed by pulmonary rehabilitation centers to strengthen the diaphragm. It is also a standard treatment method for patients with smoking-related illnesses such as COPD.

Exercise to fight cravings

Smokers often experience shortness of breath while performing physical activities. This itself shows proof of the influence of smoking on their lungs. With physiotherapy exercises, patients who are addicted to smoking will have a better chance to quit, especially once they notice that it’s becoming easier to exercise. That is because their lung function becomes better and oxygen flow increases when they are not smoking.

Physiotherapists will routinely examine if the patients are properly abiding with the new exercise methods because some patients may find it difficult to stick to an exercise routine as boredom often settles in after a while. But with the help of a physiotherapist, they can learn new exercise methods frequently so that they do not have to follow the same old methods over and over again. 

Conclusion

By keeping yourself engaged through physiotherapy exercises and increased physical activity, you will be able to overcome cravings, unfavorable transitions in mood, and withdrawal symptoms as an aid to cessation. Moreover, improved physical activity may help reduce insomnia, which is another major reason why most people depend on cigarettes at night. Physiotherapy can help reduce this dependency on cigarettes and act as a replacement activity or diversion for those individuals who are adamant about quitting their addiction.