The aim of this thesis was to evaluate the effect of exercise training and inspiratory muscle training and to describe pulmonary function, respiratory muscle strength, physical performance and health-related quality of life (HRQoL) following lung cancer surgery. Study I was a randomised controlled trial including 78 patients radically operated for lung cancer. The intervention group received 10 sessions of supervised exercise training in addition to home-based exercise; the control group was instructed on home-exercise alone. Supervised compared to non-supervised exercise training did not result in differences between groups in HRQoL, except for the SF-36 bodily pain domain four months after the surgery. No effects of supervised training were found for any outcome after one year. Study II was descriptive and was based on the study I sample. We evaluated the course of recovery of HRQoL and physical performance up to one year following surgery. All patients improved HRQoL and physical performance one year after the surgery, reaching values comparable to a reference healthy population. The walked distance was positively associated with the SF-36 domain for physical functioning. Study III was descriptive, included 81 patients and evaluated the influence of surgery on respiratory muscle strength, lung function and physical performance two weeks and six months after surgery. We found that respiratory muscle strength was not affected after the second postoperative week and that muscle-sparring thoracotomy did not deteriorate respiratory muscle strength, compared to video-assisted thoracic surgery. Compared to preoperative values, physical performance was recovered, whereas lung function remained reduced six months postoperatively. Study IV was a randomised controlled trial including 68 patients at high risk of developing postoperative pulmonary complications (PPC). This study evaluated the effects of two weeks of postoperative inspiratory muscle training in addition to breathing exercises and early mobilisation on respiratory muscle strength and the incidence of PPC. Additional inspiratory muscle training did not increase respiratory muscle strength, but improved postoperative oxygenation. Respiratory muscle strength was recovered in both groups two weeks postoperatively.

Respiratory muscle training (RMT) has been shown to improve exercise tolerance during a wide range of exercise modalities and durations of activity (McConnell & Romer, 2004b). However, there is a limited amount of research characterising the influence of RMT in specific athletic populations, or examining any sport-specific factors that may influence the benefits of RMT. Hence, the purpose of this dissertation was to evaluate the application of RMT in competitive rowers and to explore methods of optimising this to rowing. Results: Inspiratory muscle training (IMT) increased inspiratory muscle strength (~20-29%; p < 0.05) and attenuated inspiratory muscle fatigue (~8-28%; p < 0.05) during time trial performance in club-level and elite rowers. However, only in the club-level oarsmen was IMT associated with a measurable improvement in rowing performance (2.7% increase in mean power; p < 0.05). Expiratory muscle training (EMT) provided no ergogenic effect, and concurrent EMT and IMT did not enhance performance above that seen with IMT alone. IMT loads performed at 60-70% of maximal inspiratory mouth pressure (PImax) were equivalent to the widely used 30 repetition maximum, which is higher than reported for non-rowers (Caine & McConnell, 1998a); further, a load of 60% PImax was sufficient to activate the inspiratory muscle metaboreflex, as evidenced by a time-dependent rise in heart rate (70.1 ± 13.2 to 98.0 ± 22.8 bpm; p < 0.05) and mean arterial blood pressure (92.4 ± 8.5 to 99.7 ± 10.1 mmHg; p < 0.05). Higher and lower inspiratory loads did not activate the metaboreflex. Assessments of flow, pressure and volume in rowing relevant postures revealed no significant impairments, but optimal function occurred in the most upright postures. Conclusions: These data support the application of IMT, but not EMT, in elite and sub-elite rowers, and suggest that a load of 60-70% of PImax provides metaboreflex activation during loading. Further, the data do not support a requirement to undertake IMT in rowing relevant postures.

Introdução. Pacientes portadores de diabetes mellitus tipo 2 (DM2) podem apresentar fraqueza da musculatura inspiratória. O efeito do treinamento muscular inspiratório (TMI) nesses pacientes ainda é desconhecido. Objetivos. Avaliar os efeitos do TMI sobre a força muscular inspiratória, a função pulmonar, a capacidade funcional e a modulação autonômica em pacientes com DM2 com fraqueza da musculatura inspiratória. Métodos. A pressão inspiratória máxima (PImáx) foi avaliada em uma amostra de 148 pacientes com DM2 da qual 25 pacientes com PImáx < 70% do previsto foram randomizados para um programa de 8 semanas de TMI diário (n=12) ou TMI-placebo (n=13). A PImáx, a função pulmonar, o consumo máximo de oxigênio e a variabilidade da freqüência cardíaca foram avaliados antes e após o TMI. Resultados. Do total de pacientes avaliados, 29,05% (43 pacientes) apresentaram fraqueza muscular inspiratória. O TMI aumentou significativamente a PImáx (118%) e a resistência muscular inspiratória (320%), sem alterar a função pulmonar, a capacidade funcional e a modulação autonômica. Conclusões. O TMI, em pacientes com DM2 e fraqueza dos músculos inspiratórios, aumentou significativamente a PImáx sem modificar a função pulmonar, a capacidade funcional e a modulação autonômica. / Introduction. Subject with type 2 diabetes mellitus (DM2) can present weakness of the inspiratory muscle. The effect of the inspiratory muscle training (IMT) in these patients still is unknown. Objectives. To evaluate the effect of the IMT on the inspiratory muscle force, the pulmonary function, the functional capacity and the autonômica modulation in patients DM2 with weakness of the inspiratory muscle. Methods. The maximum inspiratory pressure (PImáx) was evaluated in a sample of 148 patients with DM2 of which 25 patients with PImáx < 70% of the foreseen one had been randomizeds for a program of 8 weeks of daily IMT (n=12) or IMT-placebo (n=13). The PImáx, the function pulmonary, the VO2 and the variability of the cardiac frequency had been evaluated before and after the IMT. Results. Of the total of evaluated patients, 29.05% (43 patients) had presented inspiratory muscle weakness. The IMT significantly increased the PImáx (118%) and the inspiratory muscle resistance (320%), without modifying the function pulmonary, the exercise capacity and the modulation autonomic. Conclusions. The IMT in patients with DM2 and weakness of the inspiratory muscles increased the PImáx without modifying the function pulmonary, the exercise capacity and the modulation autonomic significantly.

Introdução. Pacientes portadores de diabetes mellitus tipo 2 (DM2) podem apresentar fraqueza da musculatura inspiratória. O efeito do treinamento muscular inspiratório (TMI) nesses pacientes ainda é desconhecido. Objetivos. Avaliar os efeitos do TMI sobre a força muscular inspiratória, a função pulmonar, a capacidade funcional e a modulação autonômica em pacientes com DM2 com fraqueza da musculatura inspiratória. Métodos. A pressão inspiratória máxima (PImáx) foi avaliada em uma amostra de 148 pacientes com DM2 da qual 25 pacientes com PImáx < 70% do previsto foram randomizados para um programa de 8 semanas de TMI diário (n=12) ou TMI-placebo (n=13). A PImáx, a função pulmonar, o consumo máximo de oxigênio e a variabilidade da freqüência cardíaca foram avaliados antes e após o TMI. Resultados. Do total de pacientes avaliados, 29,05% (43 pacientes) apresentaram fraqueza muscular inspiratória. O TMI aumentou significativamente a PImáx (118%) e a resistência muscular inspiratória (320%), sem alterar a função pulmonar, a capacidade funcional e a modulação autonômica. Conclusões. O TMI, em pacientes com DM2 e fraqueza dos músculos inspiratórios, aumentou significativamente a PImáx sem modificar a função pulmonar, a capacidade funcional e a modulação autonômica. / Introduction. Subject with type 2 diabetes mellitus (DM2) can present weakness of the inspiratory muscle. The effect of the inspiratory muscle training (IMT) in these patients still is unknown. Objectives. To evaluate the effect of the IMT on the inspiratory muscle force, the pulmonary function, the functional capacity and the autonômica modulation in patients DM2 with weakness of the inspiratory muscle. Methods. The maximum inspiratory pressure (PImáx) was evaluated in a sample of 148 patients with DM2 of which 25 patients with PImáx < 70% of the foreseen one had been randomizeds for a program of 8 weeks of daily IMT (n=12) or IMT-placebo (n=13). The PImáx, the function pulmonary, the VO2 and the variability of the cardiac frequency had been evaluated before and after the IMT. Results. Of the total of evaluated patients, 29.05% (43 patients) had presented inspiratory muscle weakness. The IMT significantly increased the PImáx (118%) and the inspiratory muscle resistance (320%), without modifying the function pulmonary, the exercise capacity and the modulation autonomic. Conclusions. The IMT in patients with DM2 and weakness of the inspiratory muscles increased the PImáx without modifying the function pulmonary, the exercise capacity and the modulation autonomic significantly.

Introdução. Pacientes portadores de diabetes mellitus tipo 2 (DM2) podem apresentar fraqueza da musculatura inspiratória. O efeito do treinamento muscular inspiratório (TMI) nesses pacientes ainda é desconhecido. Objetivos. Avaliar os efeitos do TMI sobre a força muscular inspiratória, a função pulmonar, a capacidade funcional e a modulação autonômica em pacientes com DM2 com fraqueza da musculatura inspiratória. Métodos. A pressão inspiratória máxima (PImáx) foi avaliada em uma amostra de 148 pacientes com DM2 da qual 25 pacientes com PImáx < 70% do previsto foram randomizados para um programa de 8 semanas de TMI diário (n=12) ou TMI-placebo (n=13). A PImáx, a função pulmonar, o consumo máximo de oxigênio e a variabilidade da freqüência cardíaca foram avaliados antes e após o TMI. Resultados. Do total de pacientes avaliados, 29,05% (43 pacientes) apresentaram fraqueza muscular inspiratória. O TMI aumentou significativamente a PImáx (118%) e a resistência muscular inspiratória (320%), sem alterar a função pulmonar, a capacidade funcional e a modulação autonômica. Conclusões. O TMI, em pacientes com DM2 e fraqueza dos músculos inspiratórios, aumentou significativamente a PImáx sem modificar a função pulmonar, a capacidade funcional e a modulação autonômica. / Introduction. Subject with type 2 diabetes mellitus (DM2) can present weakness of the inspiratory muscle. The effect of the inspiratory muscle training (IMT) in these patients still is unknown. Objectives. To evaluate the effect of the IMT on the inspiratory muscle force, the pulmonary function, the functional capacity and the autonômica modulation in patients DM2 with weakness of the inspiratory muscle. Methods. The maximum inspiratory pressure (PImáx) was evaluated in a sample of 148 patients with DM2 of which 25 patients with PImáx < 70% of the foreseen one had been randomizeds for a program of 8 weeks of daily IMT (n=12) or IMT-placebo (n=13). The PImáx, the function pulmonary, the VO2 and the variability of the cardiac frequency had been evaluated before and after the IMT. Results. Of the total of evaluated patients, 29.05% (43 patients) had presented inspiratory muscle weakness. The IMT significantly increased the PImáx (118%) and the inspiratory muscle resistance (320%), without modifying the function pulmonary, the exercise capacity and the modulation autonomic. Conclusions. The IMT in patients with DM2 and weakness of the inspiratory muscles increased the PImáx without modifying the function pulmonary, the exercise capacity and the modulation autonomic significantly.

Introdução: A respiração é um importante processo fisiológico, onde a musculatura inspiratória tem papel fundamental no desempenho de atletas nadadores. O aumento da resistência e força muscular inspiratória, adquiridos a partir do treinamento, tem sido associado a um melhor desempenho em diversas modalidades esportivas. Sendo assim, os objetivos deste estudo foram: descrever parâmetros de função pulmonar, teste de desempenho, espessura do diafragma e metaborreflexo muscular, suas correlações entre os nadadores de elite e suas especificidades nas modalidades de natação e analisar o efeito de um programa de doze semanas de treinamento muscular inspiratório(TMI), avaliando parâmetros de função pulmonar, espessura do diafragma e teste de desempenho em nadadores de elite. Desenho dos Estudos: Estudo transversal e quase experimento Métodos: 24 nadadores de elite, 16 homens e 8 mulheres, com idade (18±2 anos) entre velocistas, meio-fundistas e fundistas foram selecionados para mensuração de pressões inspiratórias, espessura de diafragma por ultrassonografia, testes de funções pulmonares, metaborreflexo inspiratório e número de respirações durante o teste. Os dados foram comparados entre os diferentes tipos de nadadores e suas diferentes provas natatórias. Para avaliar o efeito do Treinamento muscular inspiratório(TMI), foram recrutados 12 nadadores de elite. Os nadadores realizaram o TMI durante 12 semanas e foram repetidos os testes após TMI, a fim de averiguar as possíveis diminuição nos tempos nas provas de 50m e 200m, na espessura do diafragma e nos testes de função pulmonar. Resultados: O metaboreflexo muscular inspiratório não foi ativado durante 60% da pressão inspiratória máxima nos atletas. Os nadadores apresentaram força do volume expirado no 1s (VEF1s) e capacidade vital observada (CVF) superiores às estimativas de indivíduos não treinados; e as pressões respiratórias máximas (PI e PE) se correlacionaram com VEF1s e CVF destes atletas. Além disso, foi observado que, no teste de 50 metros, o menor número de respirações estava associado a uma maior pressão inspiratória, maior CVF e uma maior espessura diafragmática na posição deitada. Os velocistas apresentavam uma capacidade vital e a espessura do diafragma maior quando comparados a meio-fundistas e fundistas. Diferenças significativas foram observadas na avaliação após o TMI: aumento da capacidade funcional (p ≤0,005); aumento do VEF1s (p =0,019); e aumento do volume corrente (p ≤0,004). O TMI não alterou significativamente a espessura do diafragma. Também foi observada diminuição no número de respirações durante o teste de 50m após o TMI (p≤ 0,002). Já na avaliação do tempo de prova, não foram observadas diferenças após o treinamento. Conclusão: O TMI parece melhorar parâmetros de função pulmonar, o que foi evidenciado pelo menor número de respirações durante o teste de desempenho na prova de 50m de atletas submetidos ao TMI. A fadiga inspiratória (metaborreflexo inspiratório) não foi ativada durante 60% da carga da PIMáx dos nadadores. Nossos achados sugerem que o diafragma e os músculos inspiratórios acessórios podem ser relacionados com a melhora de desempenho de nadadores. Portanto, o treinamento muscular inspiratório poderia ser um recurso ergogênico útil a ser usado em modalidades esportivas, como parte importante a ser acrescentada no treinamento de atletas de elite em períodos pré-competitivos. / Introduction: Breathing is an important physiological process, where the inspiratory muscles has a fundamental role in the performance of swimmers. Increased endurance and muscle strength, acquired from training, has been associated with better performance in several sports. Thus, the objectives of this study were to describe pulmonary function parameters, performance testing, and thickness of the diaphragm muscle metaboreflex, their correlations among elite swimmers and their specificities in terms of swimming and analyze the effect of a twelve-week program inspiratory muscle training (IMT) evaluated pulmonary function parameters, thickness of the diaphragm and test performance in elite swimmers. Study Design: Cross-sectional study and experiment almost. Methods: 24 elite swimmers, 16 men and 8 women, aged (18 ± 2 years), between sprinters and distance runners, and runners were selected for measurement of airway pressures, diaphragm thickness by ultrasound, pulmonary function tests, inspiratory metaboreflex and number of breaths during the test. Data were compared between the different types of swimming, and different their swim tests. To evaluate the effect of inspiratory muscle training (IMT), 12 elite swimmers were recruited. The swimmers performed IMT for 12 weeks and the tests were repeated after TMI, to ascertain the possible decrease in time in the 50m and 200m evidence, the thickness of the diaphragm and lung function tests. Results: The inspiratory muscle metaboreflex was not activated for 60% of maximal inspiratory pressure in athletes. The swimmers showed strength of expiratory volume in 1s (VEF1s) and higher observed vital capacity (FVC) estimates of untrained subjects; and maximal respiratory pressures (PI and PE) correlated with FVC and VEF1s these athletes. Furthermore, it was observed that in the 50-meter test, the minimum number of breaths were associated with a higher inspiratory pressure and higher FVC increased diaphragm thickness in the lying position. The sprinters had a vital capacity and increased diaphragm thickness as compared to the middle and bottom runners. Significant differences were observed in the evaluation after the TMI: increased functional capacity (p ≤0,005); VEF1s increased (p = 0.019); and increased tidal volume (p ≤0,004). The IMT did not significantly alter the thickness of the diaphragm. Was also observed decrease in the number of breaths during the test 50m after IMT (p ≤ 0.002). Already at the time of trial, no differences were observed after training. Conclusion: The TMI seems to improve pulmonary function parameters, which was evidenced by the lower number of breaths during the performance test in the test of 50m of athletes submitted to TMI. The inspiratory fatigue (inspiratory metaboreflex) was not activated for 60% of the burden of MIP swimmers. Our findings suggest that diaphragm and accessory inspiratory muscles may be related to the improved performance of swimmers. Therefore, inspiratory muscle training, could be a useful ergogenic aid to be used in sports as important to be added in elite athletes training at periods of pre-competitive.

Introdução: A respiração é um importante processo fisiológico, onde a musculatura inspiratória tem papel fundamental no desempenho de atletas nadadores. O aumento da resistência e força muscular inspiratória, adquiridos a partir do treinamento, tem sido associado a um melhor desempenho em diversas modalidades esportivas. Sendo assim, os objetivos deste estudo foram: descrever parâmetros de função pulmonar, teste de desempenho, espessura do diafragma e metaborreflexo muscular, suas correlações entre os nadadores de elite e suas especificidades nas modalidades de natação e analisar o efeito de um programa de doze semanas de treinamento muscular inspiratório(TMI), avaliando parâmetros de função pulmonar, espessura do diafragma e teste de desempenho em nadadores de elite. Desenho dos Estudos: Estudo transversal e quase experimento Métodos: 24 nadadores de elite, 16 homens e 8 mulheres, com idade (18±2 anos) entre velocistas, meio-fundistas e fundistas foram selecionados para mensuração de pressões inspiratórias, espessura de diafragma por ultrassonografia, testes de funções pulmonares, metaborreflexo inspiratório e número de respirações durante o teste. Os dados foram comparados entre os diferentes tipos de nadadores e suas diferentes provas natatórias. Para avaliar o efeito do Treinamento muscular inspiratório(TMI), foram recrutados 12 nadadores de elite. Os nadadores realizaram o TMI durante 12 semanas e foram repetidos os testes após TMI, a fim de averiguar as possíveis diminuição nos tempos nas provas de 50m e 200m, na espessura do diafragma e nos testes de função pulmonar. Resultados: O metaboreflexo muscular inspiratório não foi ativado durante 60% da pressão inspiratória máxima nos atletas. Os nadadores apresentaram força do volume expirado no 1s (VEF1s) e capacidade vital observada (CVF) superiores às estimativas de indivíduos não treinados; e as pressões respiratórias máximas (PI e PE) se correlacionaram com VEF1s e CVF destes atletas. Além disso, foi observado que, no teste de 50 metros, o menor número de respirações estava associado a uma maior pressão inspiratória, maior CVF e uma maior espessura diafragmática na posição deitada. Os velocistas apresentavam uma capacidade vital e a espessura do diafragma maior quando comparados a meio-fundistas e fundistas. Diferenças significativas foram observadas na avaliação após o TMI: aumento da capacidade funcional (p ≤0,005); aumento do VEF1s (p =0,019); e aumento do volume corrente (p ≤0,004). O TMI não alterou significativamente a espessura do diafragma. Também foi observada diminuição no número de respirações durante o teste de 50m após o TMI (p≤ 0,002). Já na avaliação do tempo de prova, não foram observadas diferenças após o treinamento. Conclusão: O TMI parece melhorar parâmetros de função pulmonar, o que foi evidenciado pelo menor número de respirações durante o teste de desempenho na prova de 50m de atletas submetidos ao TMI. A fadiga inspiratória (metaborreflexo inspiratório) não foi ativada durante 60% da carga da PIMáx dos nadadores. Nossos achados sugerem que o diafragma e os músculos inspiratórios acessórios podem ser relacionados com a melhora de desempenho de nadadores. Portanto, o treinamento muscular inspiratório poderia ser um recurso ergogênico útil a ser usado em modalidades esportivas, como parte importante a ser acrescentada no treinamento de atletas de elite em períodos pré-competitivos. / Introduction: Breathing is an important physiological process, where the inspiratory muscles has a fundamental role in the performance of swimmers. Increased endurance and muscle strength, acquired from training, has been associated with better performance in several sports. Thus, the objectives of this study were to describe pulmonary function parameters, performance testing, and thickness of the diaphragm muscle metaboreflex, their correlations among elite swimmers and their specificities in terms of swimming and analyze the effect of a twelve-week program inspiratory muscle training (IMT) evaluated pulmonary function parameters, thickness of the diaphragm and test performance in elite swimmers. Study Design: Cross-sectional study and experiment almost. Methods: 24 elite swimmers, 16 men and 8 women, aged (18 ± 2 years), between sprinters and distance runners, and runners were selected for measurement of airway pressures, diaphragm thickness by ultrasound, pulmonary function tests, inspiratory metaboreflex and number of breaths during the test. Data were compared between the different types of swimming, and different their swim tests. To evaluate the effect of inspiratory muscle training (IMT), 12 elite swimmers were recruited. The swimmers performed IMT for 12 weeks and the tests were repeated after TMI, to ascertain the possible decrease in time in the 50m and 200m evidence, the thickness of the diaphragm and lung function tests. Results: The inspiratory muscle metaboreflex was not activated for 60% of maximal inspiratory pressure in athletes. The swimmers showed strength of expiratory volume in 1s (VEF1s) and higher observed vital capacity (FVC) estimates of untrained subjects; and maximal respiratory pressures (PI and PE) correlated with FVC and VEF1s these athletes. Furthermore, it was observed that in the 50-meter test, the minimum number of breaths were associated with a higher inspiratory pressure and higher FVC increased diaphragm thickness in the lying position. The sprinters had a vital capacity and increased diaphragm thickness as compared to the middle and bottom runners. Significant differences were observed in the evaluation after the TMI: increased functional capacity (p ≤0,005); VEF1s increased (p = 0.019); and increased tidal volume (p ≤0,004). The IMT did not significantly alter the thickness of the diaphragm. Was also observed decrease in the number of breaths during the test 50m after IMT (p ≤ 0.002). Already at the time of trial, no differences were observed after training. Conclusion: The TMI seems to improve pulmonary function parameters, which was evidenced by the lower number of breaths during the performance test in the test of 50m of athletes submitted to TMI. The inspiratory fatigue (inspiratory metaboreflex) was not activated for 60% of the burden of MIP swimmers. Our findings suggest that diaphragm and accessory inspiratory muscles may be related to the improved performance of swimmers. Therefore, inspiratory muscle training, could be a useful ergogenic aid to be used in sports as important to be added in elite athletes training at periods of pre-competitive.

Introdução: A respiração é um importante processo fisiológico, onde a musculatura inspiratória tem papel fundamental no desempenho de atletas nadadores. O aumento da resistência e força muscular inspiratória, adquiridos a partir do treinamento, tem sido associado a um melhor desempenho em diversas modalidades esportivas. Sendo assim, os objetivos deste estudo foram: descrever parâmetros de função pulmonar, teste de desempenho, espessura do diafragma e metaborreflexo muscular, suas correlações entre os nadadores de elite e suas especificidades nas modalidades de natação e analisar o efeito de um programa de doze semanas de treinamento muscular inspiratório(TMI), avaliando parâmetros de função pulmonar, espessura do diafragma e teste de desempenho em nadadores de elite. Desenho dos Estudos: Estudo transversal e quase experimento Métodos: 24 nadadores de elite, 16 homens e 8 mulheres, com idade (18±2 anos) entre velocistas, meio-fundistas e fundistas foram selecionados para mensuração de pressões inspiratórias, espessura de diafragma por ultrassonografia, testes de funções pulmonares, metaborreflexo inspiratório e número de respirações durante o teste. Os dados foram comparados entre os diferentes tipos de nadadores e suas diferentes provas natatórias. Para avaliar o efeito do Treinamento muscular inspiratório(TMI), foram recrutados 12 nadadores de elite. Os nadadores realizaram o TMI durante 12 semanas e foram repetidos os testes após TMI, a fim de averiguar as possíveis diminuição nos tempos nas provas de 50m e 200m, na espessura do diafragma e nos testes de função pulmonar. Resultados: O metaboreflexo muscular inspiratório não foi ativado durante 60% da pressão inspiratória máxima nos atletas. Os nadadores apresentaram força do volume expirado no 1s (VEF1s) e capacidade vital observada (CVF) superiores às estimativas de indivíduos não treinados; e as pressões respiratórias máximas (PI e PE) se correlacionaram com VEF1s e CVF destes atletas. Além disso, foi observado que, no teste de 50 metros, o menor número de respirações estava associado a uma maior pressão inspiratória, maior CVF e uma maior espessura diafragmática na posição deitada. Os velocistas apresentavam uma capacidade vital e a espessura do diafragma maior quando comparados a meio-fundistas e fundistas. Diferenças significativas foram observadas na avaliação após o TMI: aumento da capacidade funcional (p ≤0,005); aumento do VEF1s (p =0,019); e aumento do volume corrente (p ≤0,004). O TMI não alterou significativamente a espessura do diafragma. Também foi observada diminuição no número de respirações durante o teste de 50m após o TMI (p≤ 0,002). Já na avaliação do tempo de prova, não foram observadas diferenças após o treinamento. Conclusão: O TMI parece melhorar parâmetros de função pulmonar, o que foi evidenciado pelo menor número de respirações durante o teste de desempenho na prova de 50m de atletas submetidos ao TMI. A fadiga inspiratória (metaborreflexo inspiratório) não foi ativada durante 60% da carga da PIMáx dos nadadores. Nossos achados sugerem que o diafragma e os músculos inspiratórios acessórios podem ser relacionados com a melhora de desempenho de nadadores. Portanto, o treinamento muscular inspiratório poderia ser um recurso ergogênico útil a ser usado em modalidades esportivas, como parte importante a ser acrescentada no treinamento de atletas de elite em períodos pré-competitivos. / Introduction: Breathing is an important physiological process, where the inspiratory muscles has a fundamental role in the performance of swimmers. Increased endurance and muscle strength, acquired from training, has been associated with better performance in several sports. Thus, the objectives of this study were to describe pulmonary function parameters, performance testing, and thickness of the diaphragm muscle metaboreflex, their correlations among elite swimmers and their specificities in terms of swimming and analyze the effect of a twelve-week program inspiratory muscle training (IMT) evaluated pulmonary function parameters, thickness of the diaphragm and test performance in elite swimmers. Study Design: Cross-sectional study and experiment almost. Methods: 24 elite swimmers, 16 men and 8 women, aged (18 ± 2 years), between sprinters and distance runners, and runners were selected for measurement of airway pressures, diaphragm thickness by ultrasound, pulmonary function tests, inspiratory metaboreflex and number of breaths during the test. Data were compared between the different types of swimming, and different their swim tests. To evaluate the effect of inspiratory muscle training (IMT), 12 elite swimmers were recruited. The swimmers performed IMT for 12 weeks and the tests were repeated after TMI, to ascertain the possible decrease in time in the 50m and 200m evidence, the thickness of the diaphragm and lung function tests. Results: The inspiratory muscle metaboreflex was not activated for 60% of maximal inspiratory pressure in athletes. The swimmers showed strength of expiratory volume in 1s (VEF1s) and higher observed vital capacity (FVC) estimates of untrained subjects; and maximal respiratory pressures (PI and PE) correlated with FVC and VEF1s these athletes. Furthermore, it was observed that in the 50-meter test, the minimum number of breaths were associated with a higher inspiratory pressure and higher FVC increased diaphragm thickness in the lying position. The sprinters had a vital capacity and increased diaphragm thickness as compared to the middle and bottom runners. Significant differences were observed in the evaluation after the TMI: increased functional capacity (p ≤0,005); VEF1s increased (p = 0.019); and increased tidal volume (p ≤0,004). The IMT did not significantly alter the thickness of the diaphragm. Was also observed decrease in the number of breaths during the test 50m after IMT (p ≤ 0.002). Already at the time of trial, no differences were observed after training. Conclusion: The TMI seems to improve pulmonary function parameters, which was evidenced by the lower number of breaths during the performance test in the test of 50m of athletes submitted to TMI. The inspiratory fatigue (inspiratory metaboreflex) was not activated for 60% of the burden of MIP swimmers. Our findings suggest that diaphragm and accessory inspiratory muscles may be related to the improved performance of swimmers. Therefore, inspiratory muscle training, could be a useful ergogenic aid to be used in sports as important to be added in elite athletes training at periods of pre-competitive.

Background: Progressive respiratory muscle weakness and ineffective cough contributes to pulmonary morbidity and mortality in children with neuromuscular disease. Inspiratory muscle training aims to preserve or improve respiratory muscle strength, reduce respiratory complications and improve health-related quality of life. Objectives: To describe South African physiotherapists' knowledge and respiratory management strategies and determine the safety, viability, acceptability and efficacy of inspiratory muscle training for children 5-18 years with neuromuscular disease. Methods: Four studies were conducted: i) a quantitative descriptive survey; ii) a systematic review using Cochrane methodology; iii) a prospective, pre-experimental observational study and iv) a prospective, cross-over randomised controlled trial using a standardised 12-week inspiratory muscle training intervention. Results: i) South African physiotherapists (n=64) reported being aware of international clinical practice recommendations, however they favoured manual airway clearance techniques. The use of inspiratory muscle training in chronic management was well supported by South African physiotherapists. ii) Results of the systematic review (seven included studies; n=168) suggested that inspiratory muscle training may be effective in improving inspiratory muscle strength. There was insufficient evidence for an effect on patient morbidity or health-related quality of life. iii) The pre-experimental, pilot study (n=8) suggested that a six-week inspiratory muscle training programme was safe, viable, acceptable and associated with a significant increase in inspiratory muscle strength. iv) The cross-over randomised controlled trial (n=23) did not show evidence of a difference in the primary outcome measures (number of hospitalisations and respiratory tract infections) between intervention and control periods. There were no adverse events related to inspiratory muscle training. Inspiratory muscle strength (Pimax) and peak expiratory cough flow increased by 14.57 (±15.67)cmH2O and 32.27 (±36.60)L/min respectively during the intervention period compared to a change of 3.04 (±11.93)cmH2O (p=0.01) and -16.59 (±48.29)L/min (p=0.0005) during the control period. There was no evidence of change in spirometry, functional ability or total health-related quality of life scores following the intervention. Overall participant satisfaction with inspiratory muscle training was high and adherence was good. Conclusions: Inspiratory muscle training in children with neuromuscular disease is well tolerated, appears to be safe and is associated with significant improvements in inspiratory muscle strength and cough efficacy.

Bakgrund: Vid idiopatisk lungfibros (IPF) är dyspné det dominerande symtomet, vilket påverkar gångsträckan. Andra patientkategorier har ökat gångsträckan och minskat dyspnén efter inspirationsmuskelträning (IMT). Endast två studier angående IMT för personer med IPF har hittats och ingen av dessa studier har IMT som enda studieintervention.   Syfte: Syftet var att undersöka om IMT ökar andningsmuskelstyrkan (MIP), om gångsträcka och dyspné förändras efter träningen samt om det finns ett samband mellan MIP och gångsträcka, MIP och dyspné samt gångsträcka och dyspné.   Metod: Single-subject experimentell design användes. Sex personer med IPF deltog. IMT genomfördes under åtta veckor. Under baslinje, intervention och cirka sex veckor efter interventionsslutet mättes MIP med Micro RPM® och gångsträcka med sex-minuters gångtest. Dyspnén skattades med Borg CR-10-skala och University of California San Diego Shortness of Breath Questionnaire (UCSD SOBQ).   Resultat: Resultatet varierade mellan studiedeltagarna. Fyra deltagare ökade MIP. Fem studiedeltagare hade en kliniskt relevant ökning av gångsträcka. Fyra deltagare hade en kliniskt relevant minskad dyspné vid skattning med Borg CR-10 i vila eller UCSD SOBQ. Korrelationen mellan MIP och gångsträcka var signifikant för två studiedeltagare med rs 0,88 respektive 0,99.   Konklusion: IMT kan öka MIP och ge kliniskt relevanta förbättringar av gångsträcka och dyspné. Alla studiedeltagare drar ej nytta av träningen. Fortsatta studier behövs för att undersöka vilka som har nytta av IMT och vilken träningsmängd som behövs för att uppnå förbättring. / Introduction: In idiopathic pulmonary fibrosis (IPF), dyspnoea is the predominant symptom that affects walking distance. In other patient categories, walking distance has been increased and dyspnoea has been reduced after inspiratory muscle training (IMT). Only two studies on IMT for people with IPF have been found and none of these studies have IMT as the sole study intervention. Purpose: The purpose was to investigate whether IMT increases respiratory muscle strength (MIP), if walking distance and dyspnoea alter after practice, and if there is a relation between MIP and walking distance, MIP and dyspnoea and walking distance and dyspnoea. Method: Single-subject experimental design was used. Six people with IPF participated. IMT was carried out in eight weeks. During baseline, intervention and about six weeks after the intervention, MIP was measured with Micro RPM® and walking distance with a six-minute walk test. Dyspnoea was estimated with Borg CR 10-scale and the University of California, San Diego Shortness of Breath Questionnaire (UCSD SOBQ). Results: The results varied among the study participants. For four participants, the MIP increased. Five study participants had a clinically relevant increase in walking distance. Four participants had a clinically relevant reduction in dyspnoea on measuring with Borg CR 10 at rest or UCSD SOBQ. The correlation between MIP and walking distance was significant for two study participants with rs 0.88 and 0.99, respectively. Conclusion: IMT can increase MIP and provide clinically relevant improvements in walking distance and dyspnoea. All study participants do not benefit from exercise. Further studies are needed to determine which ones have the advantage of IMT and the amount of exercise needed to achieve improvement.