To the Editor.
—Among the women over 65 years of age studied by Dr Nelson and her colleagues,1 those who smoked were weaker, had poorer balance, and had impaired neuromuscular performance compared with those who had never smoked. A dose-response effect was observed. The authors speculate that these observations might be explained by toxic effects of tobacco smoke on the cerebrovascular and peripheral vascular systems as well as on the global state of poorer health expected among those who smoke. Another possibility is that the observed differences might be caused by pharmacologic effects of nicotine directly affecting neuromuscular activity.Bahrke et al2 described decrements in physical performance related to smoking similar to those reported by Nelson et al, but in a young male population.Smoking is a risk factor for low back pain. In a prospective study of 3000 industrial workers aged 21 to 67 years,3 those
Slade J. Smoking, Alcohol, and Neuromuscular Function in Older Women. JAMA. 1995;273(17):1333-1334. doi:10.1001/jama.1995.03520410027017