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Rationale: The prevalence of obesity among individuals with chronic obstructive pulmonary disease (COPD) is increasing, which contributes to further ventilatory limitations, and compromised exercise capacity, and health-related quality of life (HRQOL) compared to COPD alone. Objective: To conduct a systematic review to evaluate the effects of exercise interventions on walking capacity, ventilatory parameters, anthropometrics and HRQOL in individuals with COPD and elevated weight. Methods: A search was conducted on March 16, 2018 of Embase, Medline, CINAHL, AMED and PsycINFO for controlled trials of exercise interventions, involving adults with any stage of severity and stability of COPD with concurrent obesity or overweight. Overall effects were determined with standardized (SMD) and weighted (WMD) mean difference, using Review Manager 5.3. Results: Nineteen studies with 1716 participants (BMI mean ± SD 28.2 ± 5.1 kg/m2) were included. Exercise interventions were effective in improving walking capacity measured by the 6-Minute Walk Test (6MWT), Endurance Shuttle Walk Test and Incremental Shuttle walk Test (12 studies, 1215 participants, SMD 0.25 (95% CI [0.06, 0.43]); p=0.01), fat-free mass index (2 studies, 285 participants, WMD 0.33 kg/m2 (95% CI [0.21, 0.46]); p<0.00001), St. George Respiratory Questionnaire (6 studies, 648 participants, WMD -7.49 points (95% CI [-13.01, -1.98]); p=0.008) and Chronic Respiratory Disease Questionnaire Dyspnea (5 studies, 478 participants, WMD 0.51 points (95% CI [0.00, 1.02]); p=0.05), Emotion (4 studies, 404 participants, WMD 0.28 points, 95% CI [0.03, 0.54]); p=0.03), and Mastery domains (4 studies, 404 participants, WMD 0.31 points (95% CI [0.02, 0.59]); p=0.03). There were no effects on ventilatory parameters or anthropometric measures. Conclusions: Exercise interventions were effective in improving walking capacity and HRQOL in individuals with COPD and elevated weight. There is an important opportunity to establish effective interventions to minimize the functional and health effects in this subset of the COPD population. / Thesis / Master of Health Sciences (MSc)

Obesity in the United States has increased dramatically during the past 40 years. Women are more at risk than men to be obese; and, a lesbian sexual identity further increases a woman's likelihood of being overweight or obese. This dissertation includes the following components: 1) a review of factors influencing overweight and obesity in lesbians, 2) an ethnographic inquiry examining how lesbian culture and a lesbian sexual identity contribute to a woman's body weight, and 3) the development of a lesbian-specific tool based on factors identified during the ethnography that predicts eating, physical activity, and weight status. The literature review, informed by the Social Ecological Model, investigated potentially contributing factors of overweight and obesity in lesbians. This review revealed a small body of literature dedicated to lesbians' physical activity and eating behaviors; additionally, weight-influencing social-cultural elements of lesbian communities were identified. This body of literature suggests that specific personal, social, and environmental factors negatively influence lesbians' weight, although there is not much known about this community's PA and eating behaviors, as overall behavior-specific findings, were equivocal. However, the following gaps in the literature were identified: lesbians' self-efficacy in PA and healthy eating, and effects on these behaviors as determined by their membership in lesbian subcultures. An ethnographic inquiry examined how a lesbian sexual identity contributes to body weight, attempted to fill a need in the current literature, and was driven by the following questions: 1) How does this lesbian social community serve as a context for its lesbian members to understand body weight? 2) What is the relationship between women's lesbian identities and their body weight? 3) What sub-cultural customs exist that permit or prohibit healthy eating and physical activity by women in this lesbian community? Participant observation, the primary method of data collection, uncovered the following themes: 1) Valuing Weight, 2) Coping and Socializing Behavior, and 3) Living within an Inconsistent Environment. Social Cognitive Theory assisted in interpreting how and why lesbians create innovative ways to appreciate diverse body weights and provided directives for measurement domains when investigating overweight in this community. Informed by the previous projects, the Lesbian Overweight and Obesity Questionnaire (The LOOQ) was developed as a tool to measure potential influences on PA, fat intake, and dietary consumption, which assist in predicting body mass index (BMI) within the lesbian community. Internal consistency, test-retest reliability, and predictive validity demonstrated encouraging results; all but two (i.e., 2/27) subscales demonstrated adequate to high internal consistency (Cronbach's Alphas= 0.61-0.97) and reliable test-retest scores (r=0.61-0.92). The LOOQ displayed predictive validity with subscale scores predicting outcome behaviors, which predicted BMI scores. / Ph. D.

Overweight and obesity have been increasing dramatically in the United States. Certain ethnic and sociodemographic subsets of the population, including Latino children, tend to suffer proportionally higher rates of overweight. The first body figure scale was published in 1983 by Stunkard, Sørensen, and Schulsinger, researchers delineating the influence of genetics. Body figure scales consist of a series of similar figures, ranging in appearance from emaciated to obese. Respondents circle the figure that resembles the person or ideal of interest. Currently no figure scale targets multi-ethnic or minority pre-adolescent populations. This study sought to discern the favored design parameters, including format and stance, for the creation of an evidence-based body figure scale for use with mixed populations of youth. Eighty-nine fourth and fifth-grade students from four ethnically diverse elementary schools in northern Virginia were surveyed using novel and standard body figure scales, and assessed for anthropometric measures. Approximately 37% of subjects were at-risk of overweight or overweight; levels varied between and within ethnic groups. Subjects identified best with photographic format scales with figures shown in a three-quarters stance with their arms at their sides. The choice of a "self" figure on both the novel and Collins (1991) figure scales was related to BMI-for-age percentile and body image. The novel scale allowed differentiation of mean self-identified figure choices between ethnic groups. There is hope that body figure scales will one day provide rapid, inexpensive assessment of overweight and obesity. / Master of Science

Thesis (Ph.D.)--McMaster University, 2003. / Includes bibliographical references (leaves 268-302). Also available via World Wide Web.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2007 / Thesis submitted in partial fulfillment for the degree of Master of Social Work. Includes bibliographical references (leaves 55-57).

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2008. / Typescript. Includes bibliographical references (leaves 50-56).

Thesis (Ph.D.)--Bowling Green State University, 2009. / Document formatted into pages; contains v, 130 p. Includes bibliographical references.

Thesis (Ph. D.)--State University of New York at Binghamton, Department of Anthropology, 2009. / Includes bibliographical references.

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