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Over time the same mechanisms increase cardiovascular disease risk, which undercuts the long game for fitness. VO2 max and endurance dip Smokers show lower maximal oxygen uptake and poorer cardiorespiratory responses even in healthy adults

Many tobacco users continued to use smokeless tobacco, such as chewing tobacco, possibly due to the lack of areas to smoke

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A conclusion of a recent National Academy of Science Report on e-cigarettes read e-cigarettes cannot be simply categorized as either beneficial or harmful to health. And a recent review in the British Medical Journal of the respiratory effects of e-cigarettes noted they have measurable adverse biologic effects on organ and cellular health in humans

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