We all know that smoking is bad for your health. I think we have driven that message home over the last couple of decades with all of the information out there regarding smoking and cancer rates. But smoking is also a risk factor for a whole host of other chronic conditions such as heart disease, diabetes, multiple sclerosis, and stroke.
As a physiotherapist, I am also aware that often, rehab for a person who smokes will be LONGER than for someone who doesn’t …
So, what exactly happens? It all comes down to that dreaded word inflammation. The more we learn, the more we realize that this is the mechanism behind almost all of the chronic issues we have in rehab and medicine! Smoking is no different.
Smoking increases the amount of inflammation travelling through your body. From a heart perspective, this causes plaques to form around the arteries of your heart. This is how heart attacks often happen. When those plaques get to a certain level in your body, they can block an important artery around the heart. This blockage causes a heart attack or if caught soon enough, send people into bypass surgery. Persons who smoke have higher blood pressure in general and this all works together to make your heart less healthy.
But inflammation isn’t “site-specific”. That means that it can impact a bunch of different areas. What shows up as an issue is essentially what breaks down first. If these plaques come into the legs, it’s called peripheral vascular disease (PVD). The brain? A stroke. The heart? A heart attack.
The chemicals in smoke literally affect the air we breathe. We know this because we can smell it. But did you know that the smoke BINDS to your oxygen in your body. It means less oxygen is getting to your cells and tissues. We NEED that oxygen for so many things we do every day (not to mention keeping us alive!). These issues which over time lead to COPD (chronic obstructive pulmonary disease) and chronic bronchitis. This means that people can have trouble breathing. Their fitness level goes down. The amount that they can accomplish in a day isn’t the same.
As we begin to learn more, we see that smoking can have huge impacts on the brain as well. Nicotine (the addictive substance in cigarettes) can easily pass the barrier that protects the brain. That means that nicotine is literally IN the brain. It is what causes the addiction.
People who smoke in the middle of their life are more like to get dementia or Alzheimer’s Disease. This is likely related to that inflammation argument I was making earlier. We are starting to see that many dementias can be related to how our body breaks down sugar and break down of some of our blood vessels. It can lead to neurodegenerative conditions! Persons who smoked 20-40 cigarettes a day (a pack roughly/day) are more than 2x as likely to develop MS. You’re also more likely to have ALS (amyotrophic lateral sclerosis).
All of the information presented above gives your physiotherapist a general idea of your health based on your smoking history. We know all of these things are going on. But how does it directly affect rehab?
Smokers have less blood flow to injured areas in their body. We need that blood flow to bring the chemicals that help your injuries heal. Because that isn’t happening, healing takes longer. Our body needs to wait for the right material to get there so that healing can happen.
Smoking also impacts the bones. It causes them to break down faster potentially causing osteoporosis or osteopenia. This means, especially in older persons and women in particular, that you can be at a bigger risk for a broken bone. A fall can be even more devastating if a broken bone lands you in hospital.
People who smoke (again because of that darn inflammation) are more likely to have rheumatoid arthritis and lupus. Both of these have generally been considered genetic autoimmune conditions but that doesn’t seem to be the whole truth.
Functionally for some of my older clients, smokers just aren’t doing as well physically. The longer the history the worse you are doing as well. Older women had less strength, worse balance and lower physical performance scores than their non-smoking peers! Just like medications that have side effects throughout the body, smoke is no different. It affects everything!
As a physiotherapist, I do talk with my clients who smoke about quitting. That being said, I am not in the driver seat. YOU ARE. I can be your accountability. Your healthcare team is there to help you! Going to the gym and working out can help clear your mind when you are having cravings. We can support you.
But the decision to quit is yours alone.
When you’re ready, set a quit date. Keep it close to your decision to quit.
Tell people so that you have some support and accountability.
Pignataro, R. M., Ohtake, P. J., Swisher, A., & Dino, G. (2012). The role of physical therapists in smoking cessation: Opportunities for improving treatment outcomes. Physical Therapy, 92(5), 757-766.