Medical Student University of Ottawa Mississauga, Ontario, Canada
Background: Despite the increasing popularity of e-cigarettes, their long-term effects remain less well understood compared to traditional tobacco cigarettes. In particular, the effect of regular e-cigarette usage, or ‘vaping”, on cardiorespiratory fitness and physical activity remains unclear. Understanding this information is critical for both tobacco smokers considering harm reduction and young adults engaging in recreational vaping. This review systematically evaluates the impact of regular vaping on markers of cardiorespiratory performance and physical activity.
METHODS AND RESULTS: A systematic search following PRISMA guidelines was conducted in October 2024 across PubMed/Medline, Cochrane Library, and Embase. The review was also registered on PROSPERO (ID# CRD420250589685). Studies assessing cardiorespiratory fitness (e.g., VO₂ max, six-minute walk distance (6MWD)) and physical activity levels (e.g. weekly minutes of moderate-to-vigorous physical activity, sport participation) in e-cigarette users versus non-users were included. Two reviewers performed article screening, data extraction, and risk of bias assessment using the Newcastle-Ottawa Scale. Out of a total of 1,502 studies screened, six studies were included which evaluated cardiorespiratory fitness parameters in vape users. Measured outcomes of fitness were variable and included VO₂ max, 6MWD, 2-mile run time, and peak metabolic equivalents (METs) during treadmill stress testing. In all four studies that evaluated exercise performance in e-cigarette users compared to never users (non-vapers and non-smokers), cardiorespiratory fitness tended to be lower in e-cigarette users. Two studies looked at the effects of substituting e-cigarettes in place of cigarettes in regular smokers, with both demonstrating an improvement in cardiorespiratory fitness over time after switching. Physical activity levels in regular e-cigarette users varied, with some studies reporting an increased frequency of physical activity, and others reporting a decreased frequency compared to non-users. Findings of lower physical activity tended to be more evident in adult e-cigarette users, compared to adolescent populations.
Conclusion: Vaping negatively affects cardiorespiratory performance, raising concerns about its potential long-term impact on overall health and fitness. There is some preliminary evidence to support possible amelioration of the negative cardiorespiratory impacts of cigarette use by switching to e-cigarettes, but more research on this topic is required. The adverse effects of e-cigarettes on exercise performance may contribute to broader cardiovascular risks, emphasizing the need for further research to clarify these associations and inform public health policies.
