Inclusion Criteria:

• Healthy sedentary smokers (> 4 per day for at least one year)
• Ages 18 to 65 years
• Must be able to give informed consent
• Must live in the area for the next 3 months
• Willing to use the nicotine patch to attempt smoking cessation
• Must receive consent to participate from primary care physician

Exclusion Criteria:

• Cannot read or write fluently in the English language
• Pregnancy or plans to attempt pregnancy
• 60 minutes or more per week of moderate or vigorous physical activity
• Smokes cigars, pipes, or uses smokeless tobacco at least once per week
• Currently in a quit smoking program
• Currently using NRT of any kind or using any other quit smoking method or treatment
• Never had an adverse reaction to the nicotine patch resulting in discontinuation of use
• Poor willingness or inability to comply with protocol requirements
• An employee of the Centers for Behavioral and Preventive Medicine
• Previous participant in Commit to Quit or Fit to Quit smoking cessation studies
• Another member of the household is or has been enrolled in this study
• Currently taking a medication that might impact heart rate response, including but not limited to:

Acebutolol Atenolol Carvedilol Metoprolol Nadolol Pindolol Propranolol Timolol

Medical problems:

• Cardiac disease of any kind such as angina, a history of myocardial infarction or valve disease including mitral valve prolapse. Anyone with an interventional procedure such as a stent
• Pain, discomfort (or other anginal equivalent) in the chest, neck, jaw, arms or other areas that may be due to ischemia
• Cerebrovasular disease such as stroke or history of transient ischemic attacks
• Peripheral vascular disease (such as claudication)
• Diabetes (both Type I and II)
• Chronic infectious disease (HIV, hepatitis) (hepatitis A is okay)
• Liver disease
• Cystic fibrosis (CF)
• Chronic obstructive pulmonary disease (COPD) (see asthma and bronchitis under questionable)
• Interstitial lung disease
• Emphysema
• Chronic Bronchitis
• Orthopnea (difficulty breathing except in the upright position) or paroxysmal nocturnal dyspnea (sudden shortness of breath at night typically triggered by lying down)
• Current diagnosis of Chronic Fatigue Syndrome
• Current diagnosis of Fibromyalgia
• Abnormal exercise stress test
• Hypertension (anyone currently being followed and/or treated for hypertension)
• Cancer treatment (other than skin cancer) within the past 6 months
• Musculoskeletal problems such as osteoarthritis, gout, osteoporosis or back, hip or knee pain that can interfere with physical activity (i.e., walking at a brisk pace - about 3-mph)
• Any other serious medical condition that might make exercise unsafe or unwise

Psychiatric Problems

• Hospitalization for a psychiatric disorder in the last 6 months
• Currently suicidal or psychotic, (or suicidal/psychotic in last 6 months)
• Self-report of more than three alcoholic drinks per day on 5 or more days; 5 or more alcoholic drinks on 3 or more days
• Taking these specific medications for psychiatric problems: Mood stabilizer (Lithium, Depakote, Neurontin), Antipsychotics (Haldol, Clozaril, Risperdal)
• Must be on other current psychiatric medications for at least three months

REQUIRES MD CONSENT FOR THE SPECIFIC CONDITION

• Lightheadedness, dizziness, vertigo, or fainting
• Last electrocardiogram (EKG) performed was abnormal
• Anemia
• Previous ETT for medical reason with normal results
• Irregular heart beats or palpitations in the past two years
• Heart murmurs in the past two years - the person will need physician's consent and an echocardiogram showing no evidence of significant heart disease