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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 1  |  Issue : 2  |  Page : 52-56

A preliminary study of smokeless tobacco on cardio-respiratory fitness


1 Department of Physiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh, India
2 Department of Physiology, Basaveshwara Medical College, Chitradurga, Karnataka, India
3 Department of Anesthesiology, Basaveshwara Medical College, Chitradurga, Karnataka, India

Date of Web Publication21-Sep-2013

Correspondence Address:
Amrith Pakkala
40, SM Road 1st Cross Jalahalli Cross T. Dasarahalli, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-449x.118583

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  Abstract 

Background: Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risk and needs to be discouraged. Although previous reports have described long-term harmful effects of smokeless tobacco on various body parameters, little is known about short-term effects of smokeless tobacco on cardio-respiratory parameters. Very few studies have been undertaken on the effect of short-term use of smokeless tobacco in India on cardio-respiratory parameters of youngsters. This aspect of use of smokeless tobacco needs to be attended to. Material and Methods: The present study has been undertaken to study the effect of smokeless tobacco on cardio-respiratory fitness tests in young healthy tobacco chewers compared to age- and sex-matched nontobacco chewing healthy controls. Various cardio-respiratory parameters like resting HR, delta HR, MVV, VE max, VO 2 max were studied by using treadmill exercise testing and computerized spirometry. Results: In the present study no statistically significant difference was found in any parameter studied that can be attributed to the residual effect of short-term use of smokeless tobacco. Conclusion: This is the reason enough to discourage smokeless tobacco from this unhealthy habit at this early stage itself before permanent residual effects on health is seen.

Keywords: Cardio-respiratory, delta HR, MVV, resting HR, smokeless tobacco, VE max, VO 2 max


How to cite this article:
Pakkala A, Ganashree CP, Raghavendra T. A preliminary study of smokeless tobacco on cardio-respiratory fitness. Heart India 2013;1:52-6

How to cite this URL:
Pakkala A, Ganashree CP, Raghavendra T. A preliminary study of smokeless tobacco on cardio-respiratory fitness. Heart India [serial online] 2013 [cited 2020 Jul 13];1:52-6. Available from: http://www.heartindia.net/text.asp?2013/1/2/52/118583


  Introduction Top


Tobacco and traces of nicotine were discovered in human remains as early as the prehistoric era. During the 16 th and 17 th centuries, tobacco gained widespread popularity, especially in the form of snuffing tobacco. Snuff was considered a luxury; as tobacco became more readily available. Tobacco became even more popular and more affordable in the 19 th century. The consumption of cigarettes had surpassed other forms, such as chew or snuff. Chewing is another mode of tobacco consumption, which is still widely used worldwide.

There has been resurgence of smokeless tobacco use since 1970; [1] its use is common in various parts of the world, including India and central Asia. An increase in consumption of smokeless tobacco has been noticed among high school, college students, and sportspersons. [2],[3],[4] Use of smokeless tobacco indeed represents a health concern of growing magnitude among these groups. As a consequence of its addictive qualities, the consumption of smokeless tobacco often becomes a lifelong habit with cumulative and deleterious effects on health. [5],[6] Despite the known health consequences of tobacco, "chewing" is not viewed by users as particularly dangerous and is considered less of a "social evil" than smoking by much of the public. [7],[8] Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risk and needs to be discouraged. Although previous reports have described long-term harmful effects of smokeless tobacco on various body parameters, little is known about short-term effects of smokeless tobacco on cardio-respiratory parameters. [9] The effect of tobacco smoking on aerobic capacity and their predisposition to various unfavorable risk factors for disease is well studied. Very few studies have been undertaken on the effect of short-term use of smokeless tobacco in India on cardio-respiratory parameters of youngsters. This aspect of use of smokeless tobacco needs to be attended to.


  Aims and Objectives Top


The present study has been undertaken to study the effect of smokeless tobacco on cardio-respiratory fitness tests in young healthy users of smokeless tobacco compared to age- and sex-matched nonuser controls.


  Material and Methods Top


The present study was conducted in the Exercise Physiology lab of PES IMSR. Thirty apparently healthy sedentary male smokeless tobacco users of age group 18-31 years were taken as subjects and equal number of age- and sex-matched healthy nonsmokeless tobacco chewers were taken as controls. Ethical clearance was obtained from the institution ethical committee.

The subjects for the study were selected based on the following criteria:

Inclusion criteria:

  • Males between 18 and 31 years of age.
  • Leading sedentary life.
  • Smokeless tobacco users of 2- to 5-year duration of five or more packets per day.


Exclusion criteria:

  • Age more than 31 years.
  • Leading physically active lifestyle.
  • Suffering from cardio-respiratory or systemic illness like diabetes, hypertension.
  • Involved in any sports or exercise regimen.
  • Addicted (dependence) to any drugs.


The subjects for the control group were selected based on the following criteria:

Inclusion criteria:

  • Males between 18 and 31 years of age.
  • Leading sedentary life.
  • Not chewed even a single packet of smokeless tobacco up to the time of study.


Exclusion criteria:

  • Age more than 31 years.
  • Leading physically active lifestyle.
  • Suffering from cardio-respiratory or systemic illness like diabetes, hypertension.
  • Involved in any sports or exercise regimen.
  • Addicted (dependence) to any drugs.


Before starting the actual study subjects were briefed about the protocol and informed consent was obtained. Thorough history regarding suitability as per the above inclusion and exclusion criteria was elicited. Basic clinical examination was done to rule out any cardio-respiratory or other illness. Subjects were instructed to come to the lab after 2-3 hours of abstinence from tobacco chewing. Both controls and chewers were advised to refrain from consumption of coffee, tea, and heavy meals at least 2 hours prior to the recordings.

I. Resting heart rate:

Resting heart rate was measured in both study and control groups, with the help of a Cardiart 108T-mk-VI; ECG machine manufactured by BPL India Ltd. which is a single-channel, 12-lead selection electrocardiograph, designed to record electrocardiograms.

Measurement was carried out only after the subjects were thoroughly acquainted with working of the corresponding instrument and the prescribed maneuver.

Special instructions:

  • The subject was made to rest for 15 minutes after the attachment of leads.
  • He was instructed to remain in sitting posture and completely relaxed.


The calibration (1 mv = 10 mm deflection height) and paper speed (25 mm/s) were checked. Lead selection was switched to LEAD-II and E.C.G. was taken. The resting heart rate was calculated and results were expressed as beats per minute.



II. Maximal voluntary ventilation (MVV)

MVV was measured in both the nonathlete and the athlete group with the help of a computerized spirolyzer.

Spirolyzer:

In this study, the instrument used to measure respiratory parameters was the spirolyzer model Spl-95 manufactured by the FIM Company, which is an electronic spirometer.

The instrument has facility for calibration, and gives reliable values of tests, which are displayed on the screen along with its graphical interpretation. The instrument is standardized. It has an in-built printer, which prints on special thermal paper. It also has memory for two to three tests; hence best of the three tests can be chosen.

Recording of MVV:

The sensor was placed on the stand and then MVV key was pressed. The subject was instructed to keep the disposable mouthpiece attached to the pneumotachograph half way in the mouth above the tongue. The nose clip was applied and the start button was pressed. The subject was asked to breathe as deeply and as quickly as possible for 12 seconds, at the end of which the test terminates automatically. Now the sensor is replaced back on the stand. The screen displays the values of MVV along with its graph. This test has no memory. The print key was pressed to obtain a print.

III. Maximal oxygen consumption (VO 2 max)

VO 2 max was indirectly assessed by the astrand-astrand nomogram method from submaximal exercise data obtained while running on a treadmill.

In this study, the treadmill used was a model GM1300 motorized treadmill manufactured by the Clifton company, with assembling size: 146 (L) × 66 (w) × 143 (H) cm and running surface of 360 × 1150 mm. It is driven by a 1.25 H.P. DC motor capable of 4000 r.p.m. The treadmill has a speed range of 1-11 km/h with three levels of preset elevations which can be selected. The three possible elevations are 1° (1.75% grade), 3° (5.23% grade), and 7° (12.28% grade). This tread mill has a polyster-backed belt and waxed deck for silent operation and eight elastomer cushions for a low impact running surface.

The LCD monitor of the above treadmill has a five-window display and displays time, distance traveled, speed, pulse rate, and calories consumed. It also has an ear pulse sensor, magnetic safety key for emergency stop, ON/OFF and FAST/SLOW switches. In addition there are switches for mode, set, and reset.

Sub maximal exercise testing:

Subject preparation:


  • Subjects had to appear for the test only after 2-3 hours have lapsed after the last meal.
  • Contra-indications to testing are ruled out.
  • A detailed explanation of the testing procedure was given outlining risks and possible complications. The subject was told how to perform the exercise test and the testing procedure was demonstrated.
  • All safety measures for the exercise testing were undertaken.


The treadmill was set to the elevation of 7°. The safety key was put in place and the mains switched ON. The subject was made to stand on the belt and support his arms by the side in the arm support provided. ECG limb leads were connected and the cables were securely tied to the legs. The ear pulse sensor was connected.

The "ON" switch is pressed to start the motor. The "FAST" switch is pressed to increase the speed gradually up to 5 km/h and the subject is instructed to run at this speed. The running is continued till a heart rate between 125 and 170 beats per minute is obtained as shown on the LCD display. A steady heart rate for a given work load is indicated by a variation of not move than five beats per minute. On attaining this heart rate, the speed is gradually brought down by pressing the slow switch and the machine is switched OFF.

Lead II is selected in the E.C.G. machine and E.C.G. is recorded for a few complexes and the submaximal heart rate is calculated.

The distance traveled and time taken is noted down from the LCD display.

The power reached is calculated as follows:

X = sin α × B

where X = vertical distance traveled, α = elevation in degrees, B = distance traveled on treadmill (in km), work done = weight of subject x (X), power = work done/time.

The astrand nomogram is used. The heart rate and the power reached are connected in the nomogram. VO 2 max (in l/min) is read from the VO 2 scale.

The corresponding values of VO 2 max in terms of body weight, height, and surface area are calculated.

Since the subjects in this study did not exceed 25 years of age, the age correction factor was not applied.

Maximal exercise testing:

This is done after a rest period of 10 minutes. The L.C.D. display of the treadmill is reset to zero values.

The spirolyzer is switched ON, the subject's details entered, and the VC key is pressed and kept ready. The ECG limb leads are connected and the cables secured as before. The subject was suitably instructed about the test maneuver. Elevation was continued at 7°. The subject was asked to run till exhaustion and to stop only when he felt that he could no longer run.

With the subject on the belt, the treadmill was switched ON and the FAST key pressed. The speed was gradually raised to 10 km/h. When the subject could no longer continue running, the speed was gradually brought down and the treadmill switched OFF.

Lead II is selected in the E.C.G. machine and E.C.G. is recorded for a few complexes and maximal heart rate is calculated.

IV. Maximal heart rate:

Simultaneously, the nose clip is applied; the disposable mouth piece on the pneumotachograph of the ready spirolyzer is placed on the subject'smouth over the tongue. The start switch is pressed in the VC mode to record the respiration at VO 2 max work load. After 50 seconds the test terminates automatically. The sensor is placed back in its place. A print is obtained.

V. Delta heart rate (α HR).

The α HR was the calculated difference between the maximal HR and the resting HR.

VI. Minute volume at VO 2 max ( VE max) is calculated from the respiratory rate and the tidal volume recorded.

VII. Breathing reserve (BR) at VO 2 max is calculated using the formula

BR at VO2max = MVV - VE max.

VIII. Dyspeic index (DI) at VO 2 max is calculated using the formula

DI at VO2max = BR at VO2max /MVV.

IX. Recovery heart rate: This is recorded after a period of 1 minute from the cessation of maximal exercise. Lead II is selected in the E.C.G. machine and E.C.G. is recorded for 15 seconds.

Recovery heart rate is obtained by using the formula

Recovery HR = 15 - sec HR × 4.

X. Maximum oxygen pulse

This is calculated by using the formula



All these sets of recordings were done on both the nonathlete as well as the athlete groups.

Statistical analysis was done by using an unpaired Student's test.


  Results Top


The results are shown in [Tables 1] , [Tables 2] , [Tables 3] , [Tables 4] and [Tables 5].
Table 1: Anthropometric data of controls and smokeless tobacco users (mean±SD)


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Table 2: Various heart rates of controls and smokeless tobacco users (mean±SD)


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Table 3: Comparison of the differences between Maximum heart rate and recovery heart rate (MHR-RHR), Maximum heart rate and resting heart rate ( δ HR), Maximum oxygen pulse of controls and smokeless tobacco users


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Table 4: Comparison of maximal oxygen consumption (VO2 max) of controls and smokeless tobacco users


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Table 5: Comparison of the differences between. Maximum voluntary ventilation (MVV), Maximum minute ventilation (VE max), Dyspeic index (DI) of controls and smokeless tobacco users


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  Discussion Top


The greatest concern for nicotine-related effects is acceleration or aggravation of cardiovascular disease. [10] In a study of the cardiovascular effects of daily smokeless tobacco use, the prominent effects of nicotine use, namely heart rate acceleration and increased urinary catecholamine excretion were similar throughout the day in people smoking cigarettes and those using smokeless tobacco. [9]

In the present study no statistically significant difference was found in any parameter studied that can be attributed to the residual effect of short-term use of smokeless tobacco users. This is the reason enough to discourage smokeless tobacco from this unhealthy habit at this early stage itself before permanent residual effects on health is seen.

 
  References Top

1.Gupta R, Gurm H, Bartholomew JR. Smokeless tobacco and cardiovascular risk. Arch Intern Med 2004;164:1845-9.  Back to cited text no. 1
    
2.Sankaranarayanan R, Duffy SW, Padmakumary G, Dey NE, Padmanabhan TK. Tobacco chewing, alcohol and nasal snuff in cancer of the gingival in Kerala, India. Br J Cancer 1989;60:638-43.  Back to cited text no. 2
    
3.Jones. Use of smokeless tobacco in the 1986 world series. N Engl J Med 1987;316:952.  Back to cited text no. 3
    
4.Hunter SM, Croft JB, Burke GL, Parker FC, Webber LS, Berenson GS. Longitudinal pattern of cigarette smoking and smokeless tobacco use in youth. The Bogalusa Heart study. Am J Public Health 1986;76:193-5.   Back to cited text no. 4
    
5.Schroeder KL, Chen MS Jr. Smokeless tobacco and blood pressure. N Engl J Med 1985;312:919.  Back to cited text no. 5
    
6.Tomar SL, Giovino GA. Incidence and predictors of smokeless tobacco use among US youth. Am J Public Health 1998;88:20-6.  Back to cited text no. 6
    
7.Rothman KJ. Tobacco Habits. Am J Public Health 1986;76:133.  Back to cited text no. 7
    
8.Marty PJ, McDermott RJ, Williams T. Patterns of smokeless tobacco use in a population of high school students. Am J Public Health 1986;76:190-2.  Back to cited text no. 8
    
9.Siegel D, Benowitz NL, Ernster VL, Grady DG, Hauck WW. Smokeless tobacco, cardiovascular risk factors and nicotine levels in professional baseball players. Am J Public Health 1992;82:417-21.  Back to cited text no. 9
    
10.Benowitz NL. Systemic absorption and effects of nicotine from smokeless tobacco. Adv Dent Res 1997;2:336-41.  Back to cited text no. 10
    



 
 
    Tables

  [Tables 1], [Tables 2], [Tables 3], [Tables 4], [Tables 5]



 

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  In this article
Abstract
Introduction
Aims and Objectives
Material and Methods
Results
Discussion
References
Article Tables

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