Obese females face a number of health challenges, including infertility. Obese females are three times more likely to present with infertility compared to normal weight females. Exercise improves infertility by interacting with hormones specific to reproduction. The hormones leptin and kisspeptin (KiSS) are crucial for reproduction. Research suggests leptin may increase production and secretion of KiSS. KiSS subsequently increases gonadotropin-releasing hormone, activating the menstrual cycle and reproduction. Interestingly, circulating levels of leptin and KiSS are altered in the obese state. Leptin levels significantly increase, whereas KiSS levels decrease. Studies demonstrate increases in leptin cause leptin resistances, which is followed by a decrease in KiSS mRNA concentrations. Exercise is associated with decreases in circulating leptin and infertility, however there is no research examining the changes in KiSS after an exercise intervention. Therefore the purpose of this research was to examine the effects of an exercise intervention on circulating KiSS and leptin levels in obese females. Ten obese females were randomized to an exercise intervention (n=5) or a non-exercise control group (n=5). The exercise intervention group completed a 12-week supervised, progressive, aerobic exercise program that involved walking a treadmill between 65 – 75% of their predicated maximum heart rate. The non-exercise control group maintained their current lifestyle habits. All participants had blood drawn at three different time points; baseline, mid-point and end-point; and KiSS and leptin levels were analyzed. The exercise group had a significant decrease in %BF (p<0.01) compared to the control group from baseline to end-point testing, whereas there was a significant increase in weight (p<0.01) and BMI (p<0.01) in the control group from baseline to mid-point testing. A group main effect for circulating leptin levels was found (p<0.01), however a pairwise comparison between the exercise and control group was not significant (p=0.81). For KiSS there was a main effect of time (p<0.05). Test of Within-Subjects Contrasts indicated that there was a significant decrease in KiSS between baseline and end-point testing (p=0.05). Individual participant data was also graphically represented for weight, leptin and KiSS level. Trends in the data suggest leptin levels in the exercise group corresponded with changes in weight; as weight decreased from baseline to mid-point testing, so did leptin levels. When individual participant KiSS levels were looked at in conjunction with leptin changes over the intervention potential trends did appear. All exercise participants experienced decreases in leptin from baseline to mid-point testing and all but one exercise participant saw increases in KiSS levels during the same time frame. Overall, results support a decrease in %BF in the exercise group compared to the control group. However, there was no evidence to support that an exercise intervention for obese females statistically significantly decreased circulating leptin levels and increases KiSS levels. Although there was a trend for hormone levels to be associated with body fat levels, the small sample size was problematic. A definitive study with increased numbers is now required to elucidate whether the trends become significant.

The aim of this thesis was to determine the synergistic effect of milk and exercise to: promote fat loss while maintaining protein balance and muscle; improve cardiovascular fitness and strength; and to evaluate the short-term adaptations of the inflammatory system and metabolic risk factors in overweight adolescents (boys ages 11-15 years, girls ages 9 to 13 years). A 7-day dietary intervention with 1-h intense exercise was used with randomization to milk (MILK: n=26, 8 male, 18 female) or carbohydrate beverage (CONT; n=29, 12 male, 17 female) post exercise. Both groups received a diet based on their resting energy expenditure. To determine whole body protein balance (WBPB), participants consumed 15N-glycine. Subjects performed a maximal cycling test to determine changes in power and 1-repetition maximum testing to determine changes in strength. Blood was taken to evaluate glucose and insulin; tumour necrosis factor-alpha (TNF-α), interleukin-6 and c-reactive protein ; and blood pressure was measured pre and post intervention. Although body weights did not change, the MILK group maintained more muscle (-0.2 ± 0.6 vs. -0.7 ± 0.8 kg, p<0.01) and had a greater loss in body fat (-0.4 ± 1 vs. 0.5 ± 1.0 %, p<0.006). The changes in body composition were supported by a greater WBPB after training in the MILK group (1.64 ± 1.1 vs. 0.84 ± 0.6, p<0.001). Power increased only in the MILK group with an increase of 0.13 watts/kg (p<0.05) with an increase in V02max that approached significance (p=0.06). Improvements in strength and the blood risk factors were not different between the groups. There was a greater decline in mean arterial pressure in the MILK group (-3 ± 6 mmHg vs. 2 ± 7 mmHg, p< 0.04). The exercise intervention led to an increase in TNF-α in both groups (0.3 ± 0.7 pg/ml vs. 0.5 ± 0.7 pg/ml, p<0.001). These data support the consumption of milk after exercise in the early stages of pediatric obesity treatment. / Thesis / Doctor of Philosophy (PhD) / The aim of this thesis was to determine if milk and exercise work together to: promote body fat loss while maintaining protein balance and muscle in overweight adolescents; increase fitness and strength; and assess changes in inflammatory markers and disease risk factors. A 7-day diet with 1-hour exercise sessions was performed with milk or a carbohydrate drink. Protein balance was measured by a urine marker. Pre and post the following measures were used: cycling test for power; weight lifting test for strength; blood for disease markers; and blood pressure. After the week, the milk group were in a more positive protein balance, maintained more muscle, had a greater loss in body fat, greater increase in power and lower blood pressure compared to the carbohydrate group. Some of the inflammatory markers increased in both groups. Exercise combined with the nutrients from milk can have a positive effect on adolescent health.

Introduction: Obesity during pregnancy is linked to many negative health effects for mothers and offspring. The majority of interventions with obese pregnant women based on physical activity have had limited success suggesting alternative approaches are needed. Sedentary behaviour is defined as waking activities that expend very low energy, 1.5 metabolic equivalents or below, while reclining, lying or sitting. Spending too much time sedentary has been identified as a risk factor for health, regardless of physical activity levels. We hypothesised that targeting sedentary behaviour may be a suitable alternative to reduce health risks during gestation among pregnant women who are morbidly obese (defined as body mass index, BMI > 40 Kg/m²). Aim and objectives: The aim was to explore sedentary behaviour among obese pregnant women and to propose an intervention to reduce the time obese pregnant women spend sedentary, through an active sitting exercise intervention. To conduct a systematic review of the literature to determine the proportion of time spent in sedentary behaviour among pregnant women, and the association of sedentary behaviour with pregnancy outcomes in mothers and offspring. To estimate total energy expenditure, and energy expended in sedentary activities in morbidly obese and lean pregnant women. To assess the feasibility of an active sitting exercise intervention for morbidly obese pregnant women, designed using a patient involvement in research method. Systematic Review: A systematic review of the literature reporting sedentary behaviour during pregnancy and its effects on pregnancy outcomes was conducted. Twenty six publications were included in the systematic review up until October 2015, and a further 18 were identified in the update completed in April 2018. Pregnant women spent at least 50% of their time in sedentary activities. Associations between increased time sedentary and higher risk of macrosomia, higher risk of pre-eclampsia, higher risk of developing gestational diabetes mellitus, and larger new-born abdominal circumference were observed, as the main findings. Most of included studies scored an intermediate quality, only two of the 44 studies scored a good quality. Cross-sectional study. A cross-sectional study was conducted, using the Pregnancy Physical Activity Questionnaire (PPAQ), and the Actical accelerometer, to assess energy expenditure, and energy expended in sedentary behaviour. Based on the PPAQ, women who were morbidly obese expended significantly more energy per day, as total expenditure, than lean pregnant women, which was confirmed by the Actical. During sedentary behaviour lean pregnant women expended significantly less energy than morbidly obese pregnant women, based on the PPAQ. No differences were observed between lean and morbidly obese pregnant women in the proportion of time spent in sedentary activities, nor in time sedentary. Exercise Intervention Design A patient involvement in research approach was used to design an active sitting exercise intervention for morbidly obese pregnant women. Twenty three women took part in the design of the intervention, enabling design of a final protocol including six exercises, to be performed in two sets of 10 repetitions. Active sitting exercise intervention An intervention based on active sitting exercises for morbidly obese pregnant women to reduce sedentary time was conducted to assess the feasibility. Thirty morbidly obese pregnant women were recruited of whom 20% completed the exercise intervention. The main reason not to complete the intervention was lack of time. Conclusion: A better understanding of sedentary behaviour is needed for the design of effective interventions to help to reduce the adverse effects of morbid obesity on pregnancy, especially as prevalence is growing. More time spent in light intensity activities rather than in sedentary behaviour may play a role as contributing to reduce those risks associated with obesity during pregnancy, and to reduce time spent sedentary. Participants have shown real interest in helping to design an effective exercise intervention. Involving and empowering participants in how to take care of themselves as part of the intervention helps to increase their commitment. Giving participants the tools to take care of their own health and their babies' should be considered as part of the intervention with very obese pregnant women. Providing the information in how and why exercise might help, and basing the intervention in giving participants easy and realistic tasks that they could do on their own and around their own environment, will help to increase their commitment. This appears to be a feasible and effective strategy.

Thesis (Ph.D.)--Virginia Commonwealth University, 2009. / Prepared for: Dept. of Health and Human Performance. Title from resource description page. Includes bibliographical references.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Thesis (MScSportSc)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: There are extensive literature on the PEH response after acute and chronic aerobic and resistance exercise, as well as a few studies on concurrent and water exercise. However, there is comparatively little evidence that high intensity interval training (HIIT) elicits similar post exercise blood pressure reductions (PEH) compared to other types of exercise. Furthermore, it is difficult to quantify the magnitude of the hypotensive response following these exercises, due to variations in exercise protocols in terms of intensity and duration. Both these training variables are considered important determinants of the magnitude and duration of the PEH response. The current study determined the magnitude of the PEH response after an acute bout and six sessions of HIIT, and the effects after two weeks of detraining in overweight/obese young women. Twenty young women (aged 21 ± 2 years) volunteered for the study. All the subjects were normotensive (SBP: 119.2 ± 5.6 mmHg and DBP: 78.8 ± 4.1 mmHg). Subjects performed six sessions of HIIT within two weeks and detrained for two weeks. SBP, DBP, MAP and HR were monitored during seated recovery after exercise for 60 min to determine the change from resting values. The overall outcome showed that an acute HIIT session resulted in a reduction of 2.9 mmHg in SBP which approached near clinical significance, while six sessions of HIIT caused a clinically significant reduction of 5.3 mmHg; this response was almost totally reversed after detraining. There were no clinically significant reductions in DBP after the acute or six sessions of HIIT (1.7 and 2.7 mmHg, respectively). However, a clinically significant hypotensive response of 3.9 mmHg was sustained after detraining following the maximal exercise capacity test. MAP also reduced by a magnitude of 2.3 and 5.6 mmHg, respectively, after the acute bout and six sessions of HIIT, and detraining values were still 2.9 mmHg lower than resting values and approached near clinical significance. The results indicate that both an acute bout and six sessions of HIIT elicited a meaningful PEH response. However, the six sessions of HIIT caused a clinically significant reduction which was approximately twice the acute session. Likewise, detraining showed clinically significant effects in DBP and MAP, but SBP returned to near baseline values. This suggests that in only two weeks, the accumulated effects of six sessions of HIIT elicited a greater hypotensive response than after an acute session of HIIT. / AFRIKAANSE OPSOMMING: Daar is omvattende literatuur oor die post-oefening hipotensie (POH) na afloop van akute en kroniese aërobiese en weerstandsoefeninge, asook enkele studies oor gelyktydige krag- en uithouvermoë- en wateroefeninge. Daar is egter relatief min bewyse dat hoë intensiteit interval oefening (HIIO) soortgelyke post-oefening afnames in bloeddruk (POH) in vergelyking met ander tipes oefening veroorsaak. Voorts is dit moeilik om die omvang van die hipotensiewe respons na afloop van oefening te kwantifiseer, hoofsaaklik as gevolg van die variasies in oefeningprotokolle in terme van intensiteit en tydsduur. Beide hierdie inoefeningveranderlikes word as belangrike determinante van die omvang en die tydsduur van die POH respons beskou. Die huidige studie het die omvang van die POH respons na ʼn akute sessie en ses sessies HIIO, en die gevolge na afloop van twee weke se nie-inoefening (“detraining”) by oorgewig/vetsugtige jong dames, bepaal. Twintig jong dames (ouderdom 21 ± 2 jaar) het vrywillig ingestem om aan die studie deel te neem. Al die deelnemers was normotensief (SBD: 119.2 ± 5.6 mmHg en DBD: 78.8 ± 4.1 mmHg). Die deelnemers het ses sessies HIIO binne twee weke voltooi en het daarna vir twee weke geen inoefeningsessies gehad nie. SBD, DBD, GAD en HS is tydens ʼn sittende herstelfase vir 60 minute gemonitor om die verandering vanaf rustende waardes te bepaal. Die algehele uitkoms toon dat ʼn akute HIIO sessie ʼn afname van 2.9 mmHg in SBD tot gevolg gehad het wat aan kliniese betekenisvolheid grens, terwyl ses sessies van HIIO ʼn klinies betekenisvolle afname van 5.3 mmHg veroorsaak het; hierdie respons wat bykans volledige omgekeerd na die twee weke met geen inoefening. DBD het geen kliniese betekenisvolle afname na afloop van die akute of ses sessies van HIIO getoon nie (1.7 en 2.7 mmHg, respektiewelik). ʼn Klinies betekenisvolle hipotensiewe respons van 3.9 mmHg is egter gevind na die geen inoefeningsperiodes. GAD het ook met ʼn omvang van 2.3 en 5.6 mmHg, respektiewelik, verminder na afloop van die akute sessie en ses sessies van HIIO. Die geen inoefening waardes was steeds 2.9 mmHg laer as die rustende waardes en het aan kliniese betekenisvolheid gegrens. Die resultate toon dat beide ʼn akute sessie en ses sessies van HIIO ʼn betekenisvolle POH respons ontlok het. Ses sessies van HIIO het egter ʼn klinies betekenisvolle afname, wat ongeveer twee keer soveel as die afname van die akute sessie was, veroorsaak. In dieselde lig het ʼn twee weke geen inoefeningsperiode steeds klinies betekenisvolle veranderinge in DBD en GAD getoon, maar SBD het tot naby aan die basislyn waardes teruggekeer. Hierdie resultate suggereer dat in slegs twee weke die geakkumuleerde effekte van ses sessies van HIIO ʼn groter hipotensiewe respons as na ʼn akute sessie van HIIO ontlok het.

Made available in DSpace on 2014-12-17T15:16:20Z (GMT). No. of bitstreams: 1 NicoleSOC_DISSERT.pdf: 1342792 bytes, checksum: c040154e5911aeafa634f51d3ef0bb57 (MD5) Previous issue date: 2013-11-29 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / obesity affects rightly functional capacity diminishing the cardiovascular system efficiency and oxygen uptake (VO2). Field tests, such as, Incremental Shuttle Walking Test (ISWT) and Six Minute Walk Test (6MWT) has been employed as alternative of Cardiopulmonary Exercise Test (CPX), to functional assessing for conditions which transport of oxygen to peripheral is diminished. Nevertheless, the knowing about metabolic variables response in real time and it comparing among different maximal and submaximal tests in obese is absent. Aim: to compare cardiopulmonary, metabolic response during CPX, ISWT and 6MWT and to analyse it influence of adiposity markers in obese. Material e Method: crosssectional, prospective study. Obese included if: (BMI>30Kg/m2; FVC>80%), were assessed as clinical, anthropometric (BMI, body adiposity index-BAI, waist-WC, hip- HC and neck-NC circumferences) and spirometry (forced vital capacity-FVC, Forced expiratory volume-1?second-FEV1, maximal voluntary ventilation-MVV) variables. Obese performed the sequence of tests: CPX, ISWT and 6MWT. Throughout tests was assessed breath-by-breath by telemetry system (Cortex-Biophysik-Metamax3B) variables; oxygen uptake on peak of activity (VO2peak); carbon dioxide production (VCO2); Volume Expiratory (VE); ventilatory equivalents for VO2 (VE/VO2) and CO2 (VE/VCO2); respiratory exchange rate (RER) and perceived effort-Borg6-20). Results: 15 obese (10women) 39.4+10.1years, normal spirometry (%CVF=93.7+9.7) finished all test. They have BMI (43.5+6.6kg/m2) and different as %adiposity (BAI=50.0+10.5% and 48.8+16.9% respectively women and men). Difference of VO2ml/kg/min and %VO2 were finding between CPX (18.6+4.0) and 6MWT (13.2+2.5) but not between ISWT (15.4+2.9). Agreement was found for ISWT and CPX on VO2Peak (3.2ml/kg/min; 95%; IC-3.0 9.4) and %VO2 (16.4%). VCO2(l/min) confirms similarity in production for CPX (2.3+1.0) and ISWT (1.7+0.7) and difference for 6MWT (1.4+0.6). WC explains more the response of CPX and ISWT than other adiposity markers. Adiposity diminishes 3.2% duration of CPX. Conclusion: ISWT promotes similar metabolic and cardiovascular response than CPX in obese. It suggesting that ISWT could be useful and reliable to assess oxygen uptake and functional capacity in obese / a obesidade afeta diretamente a capacidade funcional diminuindo a efici?ncia do sistema cardiovascular e o consumo de oxig?nio (VO2). Testes de campo, tais como, Incremental Shuttle Walking Test (ISWT) e Teste de Caminhada de 6 minutos (TC6M) tem sido empregados como alternativa ao Teste de Esfor?o Cardiopulmonar (TECP), para avalia??o funcional de patologias que levam a diminui??o da transfer?ncia de oxig?nio ? periferia, entretanto, pouco ? conhecido da respostas fisiol?gicas de vari?veis metab?licas e ventilat?rias em obesos durante teste incremental de exerc?cio. Objetivo: analisar e comparar as respostas cardiopulmonares, metab?licas (VO2pico-consumo de oxig?nio-pico e VCO2-produ??o de di?xido de carbono) e de esfor?o percebido nos testes subm?ximos de esfor?o (ISWT e TC6M) com o TECP. Materiais e M?todo: estudo transversal, prospectivo, onde foi avaliada a concord?ncia de dois diferentes testes de campo (TC6M e ISWT) com o TECP. Crit?rios de Inclus?o (IMC > 30Kg/m2; CVF > 80%). Os participantes realizaram avalia??o cl?nica, antropom?trica (IMC, IAC-?ndice de adiposidade corporal, RCQ-rela??o cintura-quadril, CQ-circunfer?ncia quadril, CC-circunfer?ncia cintura, CP-circunfer?ncia pesco?o) e espirom?trica (CVF-capacidade vital for?ada, VEF1-volume expirat?rio for?ado no 1? segundo, VVM-ventila??o volunt?ria m?xima). Obesos realizaram em momentos distintos a sequ?ncia de testes (TECP, TC6M e ISWT). Medidas ventilat?rias (VE-ventila??o por minuto, VE/VO2-equivalente ventilat?rio de oxig?nio, VE/VCO2-equivalente ventilat?rio de di?xido de carbono, RER-raz?o de troca gasosa) e metab?licas (VO2 e VCO2) dos gases expirados (breath-by-breath) com sistema de telemetria (Cortex-Biophysik-Metamax3B), al?m das vari?veis de percep??o de esfor?o (fadiga e dispneia-Borg6-20) foram tomadas. Resultados: os participantes eram adultos jovens (39.4+10.1 anos), com altos percentuais de adiposidade corporal (IAC=50.0+10.5%-mulheres; IAC=48.8+16.9%- homens) e IMC=43.5+6.6. Observou-se que IMC e CC justificaram isoladamente 56% e 48% da vari?ncia da dura??o do TECP. Diferen?as de VO2ml/kg/min e %VO2 nos obesos foram encontradas apenas entre TECP e TC6M (%VO2 p=0.008 em mulheres e p=0.01 nos homens), sendo os valores de VO2PICO de 18.6+4.0ml/kg/min no TECP; 15.4+2.9 no ISWT e 13.2+2.5 no TC6M. O Bland-Altman evidenciou concord?ncia entre TECP e o ISWT no VO2PICO (3.2ml/kg/min; 95%; IC -3.0 9.4) e no %VO2 (16.4%; 95%; -23.6 56.4). A an?lise da produ??o de CO2(l/min) xiv confirmou uma maior produ??o ao final do TECP (2.3+1.0), seguido do ISWT (1.7+0.7) e TC6M (1.4+0.6), por?m com diferen?as apenas entre o TECP e TC6M (p<0.01). Conclus?o: apesar de considerado um teste de esfor?o subm?ximo, o ISWT promove respostas metab?licas e cardiovasculares semelhantes ao TECP na popula??o obesa, sugerindo que o ISWT pode ser uma boa op??o para avaliar a capacidade funcional de obesos