Thoracic loads (i.e., a heavy backpack) commonly used in occupational and recreational settings significantly challenge human physiological systems and increase the work of breathing, which may promote respiratory muscle fatigue and negatively impacts whole body performance during physical tasks. Accordingly this thesis: (Chapter number: II) designed a laboratory based protocol that closely reflects occupational demands and (III) assessed the effect that load carriage (LC) has upon physiological and respiratory muscle function. Consequently the thesis addressed (IV) acute, (V) chronic and (VI) functional inspiratory muscle loading strategies to assess the limitations and trainability of the respiratory muscles to load carriage performance. The novel laboratory protocol, performed wearing a 25 kg backpack load, combined submaximal load carriage (LC; 60 min treadmill march at 6.5 km·h-1) and self-paced time trial exercise (LCTT; 2.4 km) to better reflect the physiological demands of occupational performance (between trials mean difference -0.34 ± 0.89 min, coefficient of variation 10.5%). Following LC, maximal inspiratory muscle pressure (PImax) and maximal expiratory muscle pressure (P¬Emax) were reduced by 11% and 13% respectively (P<0.05), and further by 5% and 6%, respectively (P< 0.05), after LCTT. Acute inspiratory loading (2 × 30 forced inspiratory efforts 40% PImax) following an active warm-up (10 min lactate turnpoint) failed to improve LCTT despite a transient increase in PImax of ~7% (P<0.05). Chronic inspiratory loading (6 wk, 50% PImax, 30 breaths twice daily) increased PImax (31%, p<0.05) reduced HR and perceptual responses post-LC, and improved LCTT (8%, P< 0.05) with no change in a placebo control. Combining IMT with functional core muscle exercises improved PImax and LCTT by 7% and 4% respectively (P< 0.05), which was greater than traditional IMT alone. Acute, chronic and functional inspiratory muscle loading strategies did not protect against respiratory muscle or locomotor muscle fatigue during LC and LCTT.

Cross-sectional studies have shown that well trained endurance athletes frequently have a lower peripheral and central chemoreceptor response (pRc and cRc) and a lower minute ventilation (Ve) during exercise compared to untrained individuals. Some recent prospective studies support these observations. We speculated that the reductions in chemoreceptor response and Ve may be the specific result of the high rates of ventilation occurring during endurance training. To test this idea, subjects performed voluntary eucapnic hyperpnea to simulate exercise hyperpnea while avoiding the metabolic consequences of physical exercise. We therefore examined the effects of respiratory muscle training (RMT: 20x30min sessions of voluntary eucapnic hyperpnea) on the pRc, cR, cycling performance, and Ve. Twenty endurance trained cyclists were randomized into RMT or control-groups. To indicate cRc both the hypercapnic ventilatory response at rest (HCVRr) and during light exercise (HCVRex) were measured in a background of 50% O2. The pRc was assessed by measuring the ventilatory response to a modified Dejours O2 test (4-6 trials of 10-12 breaths of 100% O2) during light exercise. Endurance performance and Ve were measured during a fixed-rate cycling endurance test, performed at 85% of the maximal workload until exhaustion. The RMT-group's cycling endurance improved significantly compared to controls (+3.26±4.98min versus -1.46±3.67min. p=0.027) but Ve was unchanged at all times analyzed. The pRc was significantly reduced in the RMT-group but unchanged in controls (-5.8±6.0% versus +O.1±4.6%, p=O.032). The cRc, both at rest and during exercise, was not significantly altered following RMT in either group. However, the X-intercept of HCVRex exhibited a significant shift to the left (-5.83±10.68mmHg, +O.38±2.48mmHg, p=O.047, RMT-group and controls respectively). The importance of this leftward shift and the reduced pRc, though statistically significant, is unclear because there were no significant changes in Ve during any test nor were there correlations between Ve or performance or the altered chemoreceptor responses. We conclude that exercise hyperpnea, as simulated by RMT in this study, is accompanied by a reduction in pRc and a leftward shift in the HCVRex, and improves cycling endurance; however, the altered chemoreceptor responses had little impact on Ve suggesting that their role in the control of ventilation during exercise is minor.

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.

Background: Urinary incontinence (UI) is a public health issue from which many women suffer. There are different forms of UI and various causes of why the problem occurs, but the common factor is that UI contributes to shame and has a negative impact on women's quality of life (QoL). Aim: To find out if women find pelvic floor muscle training (PFMT) effective on UI-symptoms, and whether the effect differs depending on whether it is performed with or without aids: or as group versus individual training. The aim was also to illustrate the impact of PFMT on women's quality of life. Method: A literature review based on 15 scientific original articles with quantitative studies. The search was conducted in the databases PubMed and Cochrane Library. Results: The studies show that PFMT is an effective method to reduce symptoms of UI, both in combination with aids and without. Individual training proved more effective in strengthening the pelvic floor muscles (PFM) and in reducing urinary leakage, compared with group training. All articles that studied the relationship between PFMT and QoL showed that women's QoL increased when the symptoms of UI decreased. Four themes were identified regarding PFMT and UI in the study. Themes consisted of; effect, aid, training arrangements and QoL. Conclusion: All forms of PFMT showed positive results on symptoms of UI in women. PFMT reduced leakage, increased PFM strength and improved QoL. Intravaginal aids combined to PFMT proved to be the most effective method in reducing symptoms of UI. Keywords: Urinary incontinence, Pelvic floor muscle training, Women / Bakgrund: Urininkontinens är ett folkhälsoproblem som många kvinnor lider av. Det finns olika former av urininkontinens och olika orsaker till varför problemet uppstår. Den gemensamma faktorn är att urininkontinens bidrar till skam och har en negativ inverkan på kvinnors livskvalitet. Syfte: Att ta reda på om kvinnor finner bäckenbottenträning verksamt avseende urininkontinenssymtom, samt om verkan av bäckenbottenträning skiljer sig beroende på om den utförs med eller utan hjälpmedel, eller som grupp- kontra individuell träning. Syftet var även att belysa vilken inverkan bäckenbottenträningen har på kvinnors livskvalitet. Metod: En litteraturöversikt baserad på 15 vetenskapliga originalartiklar med kvantitativa studier. Sökningen genomfördes i databaserna PubMed och Cochrane Library. Resultat: Studierna visar att bäckenbottenträning är en verksam metod för att minska urininkontinenssymtom, både i kombination med hjälpmedel och utan. Individuell träning visade sig vara effektivare i att stärka bäckenbottenmusklerna och minska urinläckage, i jämförelse med gruppträning. Alla artiklar som studerade sambandet mellan bäckenbottenträning och livskvalitet visade att kvinnors livskvalitet ökade när symtomen av urininkontinens minskade. Fyra teman identifierades avseende bäckenbottenträning och urininkontinens i studien; verkan, hjälpmedel, träningsupplägg och livskvalitet. Slutsats: Samtliga former av bäckenbottenträning visade positiva resultat på symtom av urininkontinens hos kvinnor. Bäckenbottenträning minskade läckage, ökade bäckenbottenmuskelstyrka och förbättrade livskvalitén. Intravaginala hjälpmedel kombinerat med bäckenbottenträning visade sig vara den mest effektiva metoden för att minska symtom av urininkontinens. Nyckelord: Urininkontinens, Bäckenbottenträning, Kvinnor

No description available.

The purpose of this thesis was to explore the relationships between pregnancy, childbirth and incontinence (both urinary and faecal) and the effect of preventive activities during pregnancy on continence. Two papers comprise this thesis. The first paper, a scoping review, focused on examination of how pregnancy and childbirth affect continence in nulliparous women. Several key considerations were identified from the published literature that we suggest are crucial to understanding these relationships. The second paper, a systematic review, is focused on the effect of preventive measures during pregnancy on continence. Pelvic floor muscle training was found to be effective in reducing the incidence of incontinence at 3 months postpartum. Few studies met our inclusion criteria thus limiting analysis of data. Based on these two papers, further prospective research is suggested. The final chapter of this thesis outlines a developing PhD project that addresses gaps identified through the scoping and systematic reviews.

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.