People who switch from smoking to vapes or heated tobacco products can improve their fitness levels in as little as four weeks, a new study has found. Besides being beneficial in itself, the researchers say this could be a persuasive motivation for younger people, especially, to swap cigarettes for safer nicotine options.
The study, published in the Scientific Reports journal and titled “Improved aerobic capacity in a randomized controlled trial of noncombustible nicotine and tobacco products,” was conducted by researchers at the Center of Excellence for the acceleration of Harm Reduction (CoEHAR) of the University of Catania, Italy. It looked at a measure known as V̇O₂ max—the top rate of oxygen consumption a person can achieve during physical exercise, which the paper described as “the gold standard measure of cardiorespiratory fitness.”
This was the first time research had examined the specific impact on V̇O₂ max of using e-cigarettes (EC) or heated tobacco products (HTP) versus smoking. The study was a secondary analysis of CoEHAR’s CEASEFIRE trial, which followed a group of 220 people who didn’t intend to quit smoking, and used the Chester Step Test to measure aerobic performance after four and 12 weeks.
Smoking reduces aerobic capacity. But the study found that people who quit smoking, or even just reduced it, showed significant increases in V̇O₂ max, with the researchers noting that “these gains were observed equally in users of ECs and HTPs.”
“These gains in aerobic performance can be viewed as a collateral benefit of switching, reinforcing the potential of smoke-free alternatives as effective harm reduction tools.”
One of the authors was Riccardo Polosa, professor of internal medicine at the University of Catania and founder of CoEHAR. “In our trial, participants who completely switched to combustion-free nicotine products exhibited meaningful increases in V̇O₂ max,” he told Filter. “These improvements were comparable to those reported in prior studies involving individuals who achieved complete smoking abstinence—defined as quitting all tobacco use without substituting with alternative nicotine products.”
According to Dr. Polosa, participants who used safer nicotine products to reduce their cigarette use achieved V̇O₂ max improvements of about 3 percent and 4.5 percent at four and 12 weeks, respectively. Those who switched entirely saw improvements of about 5.5 percent and 6 percent at those points.
“These gains in aerobic performance can be viewed as a collateral benefit of switching, reinforcing the potential of smoke-free alternatives as effective harm reduction tools,” he said.
Polosa didn’t find the broad results surprising, as they aligned with what he has previously witnessed. But he did find the speed and consistency of V̇O₂ max gains after just four weeks “remarkable.”
“These improvements exceeded the minimum clinically important difference, indicating that the changes were not only statistically significant but also clinically meaningful,” he said. “This reinforces the idea that removing combustion-related toxicants, particularly carbon monoxide, can rapidly enhance oxygen transport and cardiovascular efficiency.”
HTP have proved popular alternatives to cigarettes in a number of countries, including Japan, where cigarette sales have halved following their introduction. But the benefits of switching to these devices, which heat tobacco sticks to produce vapor without combustion, are probably less well documented than the benefits of switching to vapes, so it’s a particularly valuable addition to that evidence base.
“Indeed, in our study, we found no significant difference in V̇O₂ max gains between users of ECs and HTPs,” Polosa said. “Both groups demonstrated clinically meaningful improvements.”
To younger people who smoke, “the prospect of improved fitness and better athletic performance speaks directly to their lifestyle and aspirations.”
This, too, broadly matched his expectations when the two options are conceptually similar in eliminating combustion from nicotine use; it would, he said, have been surprising to observe major differences.
The researchers anticipate that the biggest practical impact from communicating their findings may be among younger people. To young people who smoke, cancer or heart disease may feel like distant threats, “but the prospect of improved fitness and better athletic performance speaks directly to their lifestyle and aspirations,” Polosa said.
“More research, particularly long-term studies, is needed, but our findings suggest that both ECs and HTPs can be effective tools for enhancing cardiovascular fitness when switching from smoking is complete,” he concluded.
Photograph by Magda Ehlers via Pexels
Both CoEHAR and The Influence Foundation, which operates Filter, have received grants from Global Action to End Smoking. Filter‘s Editorial Independence Policy applies.