Combining counseling with physical activity is a more effective way for teenagers to stop smoking, a new U.S. study indicates.

A team at the West Virginia Prevention Center began the study in October 2009. The findings are to be published in the October issue of Pediatrics.

The study involved 233 teens aged 14 to 19 from West Virginia, which has one of the highest smoking rates in the country, at more than 22 percent. Those who participated in a smoking cessation program combined with exercise were on average up to three times more likely to quit smoking than those who were provided only minimal stop-smoking counseling.

The researchers randomly assigned teens from different schools to one of three groups: counseling, counseling plus physical activity and a group that was given a brief intervention. The brief intervention group was given about 15 minutes of smoking cessation advice. The counseling group was given a brief session at the start of the study and then offered a group session once a week. The physical activity group had all of the above plus a log book and a pedometer to record their daily steps.

At six months, almost 16 percent of the teens in the brief intervention group said they weren't smoking. More than 21 percent of the teens in the counseling group reported quitting, and 31 percent of the teens in the counseling plus physical activity group were still not smoking.

However, the effect didn't hold for the girls. More girls in the counseling alone program quit smoking after three months than those getting smoking and exercise counseling.

We're wondering if perhaps girls have more barriers to overcome in getting more physically active, said Kimberly Horn, a professor of community medicine at West Virginia University and lead author of the paper.

The results still suggest that exercise might help motivate at least some teens to quit smoking.