Introdução: Atualmente, a primeira linha de tratamento para bexiga hiperativa (BH), incontinência urinária de urgência (IUU) e incontinência urinária mista (IUM), envolve medicação, treinamento da musculatura do assoalho pélvico (TMAP) e terapia comportamental. Outra abordagem que vem apresentando resultados positivos no tratamento dessas disfunções é a eletroestimulação do nervo tibial (ENT). Objetivo: Comparar a efetividade das técnicas de ENT e TMAP no tratamento da BH, IUU e IUM, e validar um equipamento portátil para aplicação domiciliar de ENT. Métodos: O estudo apresenta delineamento de Ensaio Clínico Randomizado tipo cross-over. A amostra foi composta por 40 mulheres acima de 18 anos com diagnóstico de BH, IUU e IUM. As participantes foram randomizadas em dois grupos: grupo ENT, iniciou a pesquisa realizando eletroestimulação, e o grupo TMAP, iniciou a pesquisa realizando exercícios pélvicos padronizados, ambos de forma domiciliar. Após 8 semanas, as participantes trocaram suas abordagens terapêuticas, totalizando 16 semanas. Todas foram submetidas a uma anamnese e avaliadas em três momentos por meio dos questionários Índice da Severidade da Incontinência (ISI), King´s Health Questionnarie (KHQ) e dados do diário miccional (DM). Resultados: Para todas as variáveis, o grupo ENT apresentou resultados estatisticamente significativos após a intervenção quando comparado ao grupo TMAP (p<0,05). Conclusão: Os dados apresentados indicam maior efetividade da ENT quando comparados ao TMAP após intervenção domiciliar. Com isto, acredita-se que o aparelho desenvolvido pelo Serviço de Engenharia Biomédica do Hospital de Clínicas de Porto Alegre (SEB/HCPA) possa ser uma alternativa de tratamento da BH, IUU e IUM, validando o equipamento para uso clínico. / Introduction: The first-line therapy in overactive bladder (OAB), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI) presently involves drug treatment, pelvic floor muscle training (PFMT) and behavioral intervention (BI). An approach that has shown positive results in the treatment of these dysfunctions is the electrical stimulation of the tibial nerve (TNES). Objective: To compare the effectiveness of TNES and PFMT for treatment of OAB, UUI and MUI, and validate a portable TNES unit designed for home use. Methods: Randomized, crossover clinical trial. The sample consisted of 40 women older than 18 with OAB, UUI and MUI. Participants were randomly assigned to two groups: TNES group, which started the experiment undergoing electrical stimulation, and PFMT group, which started the experiment doing standardized pelvic exercises, both at home. After 8 weeks, the groups exchanged their initial therapeutic approach for the other, thus totalizing 16 weeks of treatment. All the subjects underwent anamnesis and assessment in three different moments with the use of Incontinence Severity Index (ISI), King´s Health Questionnaire (KHQ) and data from a voiding diary (VD). Results: For all the variables, TNES group presented statistically significant results after intervention in comparison to PFMT group (p<0.05). Conclusion: Data have evidenced greater effectiveness of TNES as compared with PFMT after intervention. The device designed by the Department of Biomedical Engineering of Hospital de Clinicas de Porto Alegre (SEB/HCPA) may be an alternative for the treatment of OAB, UUI and MUI, and could have its validation established for clinical practice.

Syfte: Urininkontinens är ett folkhälsoproblem som berör åtminstone 500 000 svenskar.  Studiens syfte var att kartlägga sjukgymnastisk behandling med bäckenbottenträning, vid urininkontinens hos kvinnor, på primärvårdsnivå i Uppsala län. Metod: Studien hade en kvantitativ och deskriptiv design. Data samlades in via en webbenkät som skickades till alla sjukgymnaster på primärvårdsnivå i Uppsala, både offentligt anställda och privata sjukgymnaster med landstingsavtal. Resultat: 96 sjukgymnaster tillfrågades om deltagande i studien varav 65 besvarade enkäten (68 %). Drygt hälften av respondenterna behandlade med bäckenbottenträning. Antalet patienter som behandlades var lågt. Det var få patienter som remitterades från andra vårdgivare. Den vanligaste kontaktvägen var att patienten besökte sjukgymnast av andra orsaker och själv påtalade eller tillfrågades om urininkontinens. Det sjukgymnastiska omhändertagandet omfattade anamnes, information om bäckenbotten och knipteknik, praktisk träning samt muntlig utvärdering. Nära hälften av respondenterna önskade mer utbildning inom området.   Konklusion: Resultatet från studien visade att sjukgymnaster på primärvårdsnivå var en underutnyttjad resurs i behandlingen av urininkontinens hos kvinnor. I framtiden skulle ett utökat samarbete mellan sjukgymnaster och andra vårdgivare på primärvårdsnivå kunna ge effektivare patientflöden, så att fler kvinnor kan erbjudas behandling. För att möjliggöra detta behöver sjukgymnasterna själva informera lokalt om sin kompetens till berörda vårdgivare. Det behövs också utbildningsinsatser för att fler ska känna sig säkra i att behandla med BBT. / Objectives:  Urinary incontinence is a public health problem affecting at least 500 000 Swedes. The aim of this study was to conduct a survey examining physiotherapy treatment of pelvic floor muscle training, for urinary incontinence in women, at the primary care level in the county of Uppsala. Method:  The study had a quantitative and descriptive design. Data were collected with an online questionnaire that was sent to all physiotherapists with public contracts working at the primary care level in the county of Uppsala. Results:  96 physiotherapists were asked to participate in the study and 65 of them answered the questionnaire (68 %). More than half of the respondents gave treatment consisting of pelvic floor muscle training. The number of patients who received treatment was low. Few patients were referred by other health-care workers. The most common way for the patients to receive treatment was that they visited the physiotherapist because of other health problems and the subject of urinary incontinence came up. The treatment usually included medical history, information about the pelvic floor muscles, instructions on appropriate muscle contraction, practical training and verbal evaluation. Almost half of the respondents requested more education within the field. Conclusion:  The results from this study showed that physiotherapists at the primary care level were an underutilized resource in the treatment of women with urinary incontinence. In the future, improved cooperation between physiotherapists and other health-care workers at the primary care level would increase the number of women receiving treatment. To facilitate this outcome, physiotherapists need to engage in outreach activities to inform other health-care workers regarding their competence in this field. In addition, further education is required in order to help physiotherapists feel more confident in providing pelvic floor muscle training.

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness.The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. Results: Statistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness.The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. Results: Statistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.

Bakgrund: Bäckenbottendysfunktion innebär onormal funktion i bäckenbottenmuskulaturen som orsakas av ökad eller minskad muskeltonus och nedsatt koordination av bäckenbottenmusklerna.  Det innefattar flera olika funktionella problem och delas upp i urologiska, gynekologiska eller kolorektala. Biofeedback är en apparat som kan användas som ett tillägg till vanlig bäckenbottenträning. Den är till för att lära sig använda rätt teknik och kontrollera och identifiera rätt muskler. Man kan använda biofeedback till att träna styrka, uthållighet, koordination samt avslappning. Syfte: Undersöka effekten av bäckenbottenträning med biofeedback på blås- och tarmtömningsbesvär (utöver urin- och fekalinkontinens), livskvalitet och sexuell funktion jämfört med bäckenbottenträning utan biofeedback/sedvanlig behandling/ingen träning alls. Metod: Systematisk litteraturstudie med databaserna PubMed och Web of Science. Studiernas kvalitet granskades med PEDro och resultatets tillförlitlighet granskades enligt Uppsala Universitets Fysioterapeutsprograms bedömningsmall för systematiska översikter.  Resultat: Sju randomiserade kontrollerade studier inkluderades. Alla studier visade signifikant förbättring hos interventionsgrupperna. Fyra studier undersökte tömningssvårigheter, tre undersökte livskvalitet och två studier undersökte sexuell dysfunktion. Fem studier undersökte biverkningar av biofeedback utan fynd. Alla studier hade god kvalitet enligt PEDro, men samtliga visade på mycket låg tillförlitlighet (+) enligt Uppsala Universitets Fysioterapeutsprograms bedömningsmall för systematiska översikter. Konklusion: Det tyder på att bäckenbottenträning med biofeedback har positiv effekter på blås- och tarmtömningssvårigheter, livskvalitet och sexuell funktion hos personer med bäckenbottendysfunktion. Inga fynd av biverkningar av bäckenbottenträning med biofeedback hittades. Studierna hade god kvalitet enligt PEDro och dess sammanvägda resultat hade mycket låg tillförlitlighet (+). Resultatet bör därför tas med försiktighet och fler randomiserade kontrollerade studier behövs för att kunna dra några slutsatser. / Background: Pelvic floor dysfunction means abnormal function of the pelvic floor muscles caused by increased or decreased muscle tone and reduced coordination of the pelvic floor muscles. It includes several different functional problems such as urological, gynecological or colorectal. Biofeedback is a device that can be used as an addition to regular pelvic floor training. It helps people to use the right technique and to control and identify the right muscles. Biofeedback can be used to train strength, endurance, coordination and relaxation. Objective: Investigate the effect of pelvic floor training with biofeedback on bladder- and bowel voiding difficulties (except for urinary- and fecal incontinence), quality of life and sexual function compared to pelvic floor training without biofeedback/usual care/no training. Method: Systematic literature study which used the databases PubMed and Web of Science. The quality of the studies was reviewed using PEDro and the reliability of the results were reviewed according to Uppsala University's Physiotherapy program assessment template for systematic reviews. Results: Seven randomized controlled trials were included in this study. All studies showed significant improvement in the intervention groups. Four studies examined voiding difficulties, three examined quality of life and two studies examined sexual dysfunction. Five studies investigated side effects of biofeedback with no findings. All studies had good quality according to PEDro, however all showed very low reliability (+) according to Uppsala University's Physiotherapy program assessment template for systematic reviews. Conclusion: It indicates that pelvic floor training with biofeedback has positive effects on bladder- and bowel voiding difficulties, quality of life and sexual function in people with pelvic floor dysfunction. There are no findings of side effects of pelvic floor training with biofeedback. The studies were of good quality according to PEDro and their combined results had very low reliability (+). The result should therefore be taken with caution and more randomized controlled trials are needed to reach more reliable conclusions.

Thesis (PhD (Sport Science))--Stellenbosch University, 2008. / The aims of this study were (1) to determine the effect of concurrent respiratory muscle training (RMT) on respiratory muscle (RM) function and aerobic exercise performance in women competitive field hockey players, (2) to determine the effect and time duration of RM detraining on RM function in those who underwent RMT, and (3) to determine the predictors of RM strength and endurance in an athletic population. Twenty two women hockey players underwent a series of kinanthropometric and respiratory muscle function measurements, and were then randomly assigned to an experimental group (EXP, n = 15) who underwent concurrent RMT, and a control group (CON, n = 7) who underwent sham training. Twenty subjects took part in the RM detraining study. Significant improvements in pulmonary function and RM endurance (5 – 9%) were found in both groups after the HT-RMT and HT-ST interventions, while EXP also showed a significant improvement in RM strength variables (13% in MIP, 9% in MEP). MEF50% was the only variable that showed a significant difference in the changes over time after 20 weeks of DT between EXP and CON. RM strength in both groups remained relatively unchanged over the DT period. RM endurance in both groups remained unchanged after 9 weeks of DT, but decreased significantly after 20 weeks of DT in EXP. It was concluded that the intensity and duration of both the HT-RMT and HT-ST programmes were adequate to elicit training adaptations in the RM. In both groups there was a complete reversal in lung volumes after 9 weeks and a tendency of a reversal in RM endurance after 20 weeks of DT. It is suggested that a RMT programme should be incorporated every 9 weeks in the training schedule of field hockey players, to maintain improved RM function.

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.

Base teórica A incontinência urinária (IU) é um sintoma comum, afetando mulheres em todas as idades, com prevalência estimada em 30%. A incontinência urinária aos esforços (IUE) pode representar cerca de metade dos casos. O treinamento da musculatura do assoalho pélvico (TMAP), associado a medidas comportamentais e reeducação vesical constitui a primeira linha de tratamento. Apesar dos bons resultados em curto e médio prazo, pode haver perda de motivação e adesão ao tratamento em longo prazo. Técnicas complementares como o biofeedback (BIO) podem auxiliar no treinamento inicial e contribuir para melhores resultados, mas permanece indefinido o perfil de casos que pode realmente se beneficiar desta abordagem. Novos estudos e a implementação de dispositivos facilitadores do tratamento são necessários, pois a adesão é etapa fundamental para manutenção dos resultados. Objetivo Determinar o efeito do TMAP associado ao BIO comparados ao treinamento vesical (TV), considerando resultados com questionários de sintomas, qualidade de vida (QV) e função sexual (FS). Investigação adicional a partir de dados do diário miccional (DM), avaliação da funcionalidade dos músculos do assoalho pélvico por meio de palpação manual e perineométrica do assoalho, gerando informações adicionais sobre o efeito de ambos os tratamentos. Métodos Ensaio clínico randomizado, paralelo, aberto, incluindo mulheres acima de 18 anos com IUE na ausência de prolapso genital. Recrutamento de casos de forma consecutiva em ambulatório de uroginecologia, com alocação aleatória para TV ou BIO, sendo comparadas a resposta aos sintomas, força muscular, escores de QV e FS ao final de 3 meses de tratamento supervisionado com fisioterapeuta. Para o cálculo amostral foi considerada a detecção de uma diferença de 42 pontos percentuais entre os grupos e estimadas 26 pacientes em cada grupo para um α=0,05 e β-80%. Resultados Ao final do estudo, das 53 pacientes inicialmente recrutadas, 28 pacientes foram analisadas, 14 em cada grupo. Ambos os grupos apresentaram melhores resultados em número de perdas diárias (P<0.001), micções noturnas (P<0.002) e no questionário de sintomas (p<0.001). Na FS, não houve diferença individual e entre os grupos. Alguns domínios do questionário de qualidade de vida foram significativamente melhores nas pacientes que fizeram o treinamento vesical (TV), mas a percepção geral de saúde não se modificou de forma significativa ao longo do tempo e entre os grupos TV (P=0.157) e BIO (P=0.795). Apesar de ter havido melhora subjetiva da contração perineal, esse achado não se correlacionou com aumento de força muscular (rs=0.428 P=0.144). Conclusão No presente estudo, os resultados em ambos os grupos foram equivalentes em termos de melhora clínica, nas ferramentas de medida utilizadas, não sendo possível demonstrar um efeito significativo do biofeedback. O desenvolvimento de tecnologias para melhorar a adesão e motivação dos pacientes para o tratamento conservador segue sendo um desafio atual. / Objective: To compare the effect of pelvic exercises combined with biofeedback, against bladder training, using questionnaires on symptoms, quality of life, and sexual function. Methods: Randomized clinical trial. Women over the age of 18 with stress urinary incontinence, but without genital prolapse, were recruited at a urogynecology clinic and assigned to bladder training or pelvic floor restoration at home with biofeedback. Results for muscle strength and symptoms, quality of life, and sexual function questionnaires were compared after 3 months of physiotherapist-supervised treatment. Results: Fourteen patients in each group were analyzed at the end of the study. Both groups exhibited improved results for number of daily leakages (P<0.001), nighttime micturitions (P<0.002) and symptoms (P<0.001). For sexual function, there were no individual or intragroup differences. Some quality of life domains were significantly better in the bladder training patients, but perceived general health did not change significantly and did not differ between the BT (P=0.157) and BIO (P=0.795) groups. Improvements in perineal contraction were not correlated with increased muscle strength (rs=0.428 P=0.144). Conclusion: The two methods had equivalent results, but larger patient samples could change certain findings. It remains a challenge to develop technologies to improve patients’ motivation and adherence to conservative treatment. Registration: Plataforma ReBec (Brazilian Clinical Trials Register - http://www.ensaiosclinicos.gov.br/). Reference code REQ:7854.

INTRODUÇÃO: Treinamento muscular inspiratório (TMI) tem se mostrado capaz de aumentar a espessura diafragmática. Sabe-se que o diafragma crural age como um esfincter externo do esfíncter inferior do esôfago (EIE), mas é desconhecido se pacientes com hipotonia do EIE se beneficiariam do TMI, a fim de aumentarem a pressão respiratória média (PRM), consequentemente havendo melhora dos sintomas de refluxo gastroesofágico. OBJETIVO: Determinar o resultado dos efeitos do TMI nas pressões respiratória média nos pacientes com doença do refluxo gastroesofágico e seu efeito no tônus do esfíncter inferior do esôfago e compará-los com o grupo controle. MÉTODOS: Vinte pacientes foram incluídos no grupo caso e nove no grupo controle. Todos pacientes tinham a pressão expiratória máxima (PEM) entre cinco e 10mmHg e foram submetidos à manometria esofágica e teste de função pulmonar antes e após oito semanas de treinamento utilizando o threshold IMT (Respironics, Cedar Grove, NJ) duas vezes ao dia. A medida da pressão inspiratória máxima (Pimax) foi aferida a cada duas semanas. O grupo caso teve o threshold IMT ajustado progressivamente, a cada quinze dias, sempre a 30% da nova Pimax. O grupo controle realizou o treinamento com o mesmo aparelho, sob uma pressão constante de 7cmH2O. O nível de significância estatística foi estabelecido a 5% (p £ 0,05). RESULTADOS: A média de idade do grupo caso foi 50,1 ± 18 e no grupo controle de 51,3± 11 anos. Após oito semanas de treinamento utilizando o threshold IMT houve uma melhora na PRM em 15 (75%) pacientes, representando um ganho médio de 46,6% (p<0,01), enquanto no grupo controle, seis (66%) pacientes obtiveram um aumento médio de 26,2% (p<0,01). Não houve diferença estatisticamente significante entre os grupos (p= 0,507). A PEM também aumentou quando comparada com a inicial (p<0,01), mas não diferiu entre os grupos (p= 0,727). Observou-se uma melhora na Pimax no grupo 1 (40% versus 19,6%). Houve um aumento na pressão expiratória máxima (Pemax) em ambos os grupos após as oito semanas de IMT (p< 0,05). CONCLUSÕES: O treinamento muscular inspiratório aumentou as pressões respiratória média e expiratória máxima ao longo das oito semanas em ambos os grupos. Não houve diferença com significância estatística entre os grupos sugerindo que o aumento na pressão do esfíncter inferior do esôfago ocorre independentemente da resistência aplicada ao threshold IMT. Mais estudos são necessários para determinar o impacto clínico desse aumento pressórico e confirmar ou afastar a manutenção dessas pressões a longo prazo / INTRODUCTION: Inspiratory muscle training (IMT) has been shown to increase diaphragm thickness. It is known that the diaphragmatic crural fibers act as an external LES, but it is unknown if patients with hypotensive lower esophageal sphincter (LES) would benefit from IMT increasing the mid-respiratory pressure (MRP), and as such relieving gastroesophageal reflux symptoms. AIM: Evaluate the effect of inspiratory muscle training on MRP in patients with gastroesophageal reflux disease and hypotensive LES and compare it with the control group. PATIENTS AND METHODS: Twenty consecutive patients (progressive loading group) and 9 controls (sham group) were included. All of them had end expiratory pressure (EEP) between 5 and 10mmHg and underwent esophageal manometry and pulmonary function tests before and after 8 weeks of training using a threshold IMT (Respironics, Cedar Grove, NJ) twice daily. The maximal inspiratory pressure (Pimax) measurement was repeated each 2 weeks. The progressive loading group had their threshold IMT set at 30% of their new Pimax. Sham-treated patients (same device but minimal resistance to the air flow) had their threshold set at 7cmH2O and it was maintained constant during the period. The significance level was set at 5% (p £ 0.05). RESULTS: The mean age of progressive loading group was 50.1 ± 11.3 years and sham group was 51.3± 6.3. Following eight weeks of training using a threshold IMT there was an increase in MRP in 15 (75%) patients, representing an average gain of 46.6% (p<0.01), while in the sham group, six (66%) patients had their MRP raised with mean increase of 26.2% (p< 0.01). There was no significant difference between the groups (p= 0.507). EEP also increased when compared with before measured (p<0.01), but did not differ between groups (p= 0.727). It has also been observed an improvement in the Pimax in progressive loading group (40% versus 19.6%). It was observed a gain in the maximal expiratory pressure (Pemax) as well in both groups after the 8-week program of IMT (p< 0.05). CONCLUSION: Inspiratory muscle training increased MRP and EEP in patients of active and sham-treated group after an 8-week program. There was no significant statistical difference between groups suggesting that the increase in pressure at LES occurs regardless to the resistance loading of threshold IMT. Extended follow-up is necessary to document the long-term benefits of such improvements

Title: Options affect muscle hypertrophy in men age 20 25 years in the fitness centre. Method: Laboratory evaluation of body composition (bioelectric Impedance Analysis) and anthropometric measurement of muscle mass. Results: H1 Volumetric training significantly increased body weight, H2, passing the volume of training significantly increased muscle groups of districts reporting, H3 After completing training, the volume change of FM and FFM in the same order of magnitude ratio - 2:1. H4 After completing the training volume ratio of ECM:BCM linear placements the same as during the initial measurement). The proposed program increased the total weight of 8.9 kg. Similarly, the districts reporting increased body parts. Expected FM:FFM was higher than expected. H1, H2 and H4 is confirmed. Keywords: Volume training, 20 men 25 years, bioimpedences, body composition, fitness centre, hypertrophy Objective: The aim of this work is to create individual training macrocycles. Theme on volume training in the fitness centre. This volume training plan aims to increase the growth of active muscle mass and muscle mass.