Research Article| Volume 240, ISSUE 2, P472-476, June 2015

Acute vascular effects of waterpipe smoking: Importance of physical activity and fitness status


      • Smoking WP for 30 min resulted in immediate reduction of vascular and venous functions.
      • These changes were most apparent in individuals with lower physical fitness and activity levels.
      • These results that might be helpful in offsetting the adverse effect of waterpipe smoking.
      • The study is advocating physical conditioning as an effective complementary component of smoking cessation plans.



      While new forms of tobacco, including waterpipe (WP) smoking, continue to gain popularity, limited literature has examined the vascular health consequences. The purpose of the current study was to examine: (i) the acute WP-induced changes in vascular function; (ii) whether acute changes in vascular function are modified by lifestyle behaviors (habitual physical activity, physical fitness).


      Fifty three (22.7 y, 36% F, 23.4 kg/m2) otherwise healthy WP smokers were recruited. Strain-gauge plethysmography was used to measure forearm blood flow, vascular resistance, venous capacitance, and venous outflow at rest and following occlusion. Habitual physical activity was determined using the Arabic version of short-form international physical activity questionnaire, while physical fitness was assessed using the 6 min walk test and handgrip strength. Partial correlations were used to examine the relationships between post-smoking vascular function and lifestyle behaviors, controlling for pre-smoking vascular measures.


      (i) WP had a small effect on forearm post-occlusion blood flow (d = −0.19), a moderate effect on venous outflow (d = 0.30), and a moderate effect on post-occlusion vascular resistance (d = 0.32). (ii) Total habitual physical activity strongly correlated with resting blood flow (r = 0.50) and moderately with vascular resistance (r = −0.40). Handgrip strength moderately correlated with venous capacitance (r = 0.30) and post-occlusion blood flow (r = 0.30), while 6 min walked distance moderately correlated with resting venous capacitance (r = 0.30).


      Waterpipe smoking is associated with immediate changes in vascular function, which are exacerbated in individuals with low habitual physical activity and physical fitness levels in young otherwise healthy individuals.


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