O Diabetes Mellitus tipo 2 (DM-2) é uma doença crônica degenerativa com alta prevalência, e considerada um grande problema de Saúde Pública que tem como complicações o déficit funcional de membros inferiores e as quedas que podem interferir na manutenção do equilíbrio, além de reduzir a qualidade de vida (QV). Assim, o objetivo foi analisar a qualidade de vida, o equilíbrio postural estático e as respostas neuromusculares de DM-2, após o treinamento sensório-motor supervisionado e domiciliar. O ensaio clínico randomizado cego foi conduzido com oitenta DM-2, faixa etária entre 45 a 64 anos, de ambos os sexos, foram randomizados em três grupos: GC - Grupo Controle (n=27), GT-D - Grupo Treinamento Domiciliar (n=27) e GT-S - Grupo Treinamento Supervisionado (n=26). A intervenção foi realizada por 12 semanas, 2 vezes por semana, sendo dividida em três fases: aquecimento, treinamento sensório-motor e desaquecimento, com monitoramento da pressão arterial e glicemia. A variável primária foi o equilíbrio estático e as secundárias foram as medidas de sensibilidade tátil,sinais e sintomas de polineuropatia diabética, qualidade de vida, as variáveis eletromiográficas e isocinéticas de flexo-extensores de joelhos. Foi aplicado o teste de Wilcoxon para as comparações entre os tempos pré e pós-intervenção e Kruskal-Wallis, seguido de post hoc Dunn, para as comparações intergrupos, ambos com nível de significância de 5% e o coeficiente d de Cohen para descrição do tamanho do efeito da intervenção. Os resultados da avaliação inicial, demonstraram uma adesão ao tratamento acima de 90%. A sensibilidade tátil e vibratória, demonstraram ausência de sintomas de neuropatia periférica nos pacientes diabéticos. Nas comparações entre os tempos, houve aumento significativo da classificação sem sintomas de polineuropatia distal diabética nos grupos GT-D e GT-S (p<0,05) bem como apresentaram melhor desempenho para a amplitude de deslocamento médio-lateral com olhos abertos, nos grupos GT-D e GT-S (p<0,05), bem como a área elíptica com olhos abertos no GT-S (p<0,05). As avaliações isocinéticas e eletromiográficas não apresentaram diferença significativa, seja intra ou intergrupo. A conclusão é que o protocolo de intervenção influenciou positivamente apenas no equilíbrio postural estático no eixo médio-lateral nos DM-2 tratados em domicílio e supervisionado, mas não influenciou na Qualidade de Vida, houve excelente adesão e melhora da sintomatologia referida pelos voluntários dos grupos tratados / Type-2 Diabetes Mellitus (DM-2) is a highly prevalent degenerative disease, considered an important public health problem associated with complications such as lower-limb functional impairment and falls, which may impact balance and quality of life (QoL). This study\'s objective was to analyze the quality of life, static postural balance, and neuromuscular response of DM-2 patients after supervised sensory motor training and training at home. A blind randomized clinical trial was conducted with 80 patients, aged between 45 and 64 years old, both sexes, randomized into three groups: CG - Control group (n=27), TG-H-Training Group at Home (n=27), and TG-S-Supervised Training Group (n=26). The intervention lasted 12 weeks and was implemented twice a week following three steps: warming up, sensory motor training, and cooling down, including blood pressure and blood glucose monitoring. The primary variable was semi-static balance and secondary variables were measures of tactile sensitivity, signs and symptoms of diabetic polyneuropathy, quality of life, electromyography and isokinetic variables of knee flexor-extensors. The Wilcoxon\'s test was applied to compare pre- and postintervention while Kruskal-Wallis, followed by post hoc Dunn, was used for intergroup comparisons, both at a 5% significance level, and Cohen\'s d to describe the size of the intervention effect. The results from the initial assessment reveal adherence to treatment above 90%. The tactile and vibratory sensitivity, the patients showed an absence of peripheral neuropathy symptoms. Comparison pre- and post-intervention reveals that TG-H and TG-S experienced significant improvement, presenting no symptoms of diabetic distal polyneuropathy and improved performance in terms of open-eye mid-lateral displacement amplitude (p<0.05); the TG-S also improved performance in the assessment of the elliptical area with open eyes (p<0.05). The electromyography and isokinetic assessments did not show significant intra- or inter-groups differences. The conclusion was that the intervention protocol positively influenced only the static posture balance in the mid-lateral axis in DM-2 treated at home and supervised, but did not influence the Quality of Life, presented excellent adherence and experienced improved symptomatology

O objetivo do trabalho foi avaliar clinicamente os possíveis efeitos dos exercícios fisioterapêuticos propostos em comparação com o acompanhamento observacional dos pacientes com DLCP. Foi um estudo prospectivo controlado incluindo 20 pacientes com DLCP unilateral, divididos em dois grupos: grupo A, acompanhamento observacional e grupo B, acompanhamento fisioterapêutico. Foram avaliados os parâmetros: amplitude de movimento articular (ADM), o grau de força muscular e o grau de disfunção articular e o quadro radiográfico, pré e pós-tratamento. Houve no grupo B uma melhora significativa da ADM do quadril, enquanto no grupo A ocorreu uma piora. A força muscular também melhorou no grupo B, enquanto no grupo A não houve alteração. O grau de disfunção articular apresentou, uma melhora significativa no grupo B e uma piora no grupo A. O tratamento fisioterapêutico empregado no grupo B foi eficaz para os pacientes com DLCP. / The purpose of the present study was to clinically evaluate possible effects of the proposed physiotherapeutic exercises compared to observational follow-up in LCPD patients. A prospective follow-up study with control group was conducted with 20 unilateral LCPD patients divided into two groups: group A (observational follow-up) and group B (physiotherapeutic follow-up). The following parameters were assessed: articular range of motion (ROM), level of muscular strength, level of articular dysfunction, and radiographic status, both before and after the treatment. Group B showed significant ROM improvement of the hip, while in group A worsening occurred. Muscular strength also improved in group B, while group A showed no changes. The level of articular dysfunction showed significant improvement in Group B and worsening in group. The physiotherapeutic treatment (group B) was efficient for patients with LCPD.

INTRODUÇÃO: Anualmente nos E.U. A, estima-se mais de 250.000 mil casos de lesão do ligamento cruzado anterior, o que torna a reconstrução cirúrgica um procedimento comum na pratica da medicina esportiva. Ainda não existe consenso sobre o quanto de atividade promove uma reabilitação adequada sem prejudicar o enxerto ou produzir uma frouxidão anterior anormal, com consequente dano ao menisco e a cartilagem articular. OBJETIVO: Analisar e comparar o efeito de um protocolo de fisioterapia acelerado na estabilidade anterior e evolução clínica dos indivíduos submetidos à reconstrução do ligamento cruzado anterior. MÉTODOS: Foram incluídos 29 indivíduos no estudo que apresentaram ruptura total do LCA confirmada por RM e submetidos à reconstrução ligamentar com Tendão patelar. Aleatoriamente foram alocados em dois grupos com intervalos de reabilitação diferentes: Grupo Acelerado (4 meses) ou Grupo Convencional (6 meses). No pré-operatório, sexto e no quarto mês de pós-operatório um avaliador cego registrou: a lassidão anterior através do KT1000, Força muscular (CYBEX) e a função do joelho acometido através do IKDC (2000) e o Hop Test. RESULTADOS: os grupos foram semelhantes em relação aos dados demográficos. Não foi encontrada diferença estatística na lassidão anterior no quarto mês 0,92mm versus 1,33mm e no sexto mês 0,50mm versus 1,67mm sendo Grupo Convencional versus Grupo Acelerado respectivamente. No quarto mês o Grupo Acelerado apresentou uma melhora significativa (P< 0,001) na evolução clínica do IKDC (2000) 79,50 versus 60,61 do Grupo Convencional, essa diferença não se repetiu no sexto mês. A força muscular e o Hop Test, o Grupo Acelerado apresentou maiores valores, mas não de forma significativa nos dois momentos de avaliação (P> 0.05). CONCLUSÃO: Com base nos resultados obtidos, o protocolo acelerado quando comparado ao Convencional, não se diferiu quanto à estabilidade anterior do joelho e foi suficiente para demonstrar uma melhora significativa precoce na evolução clínica do joelho / BACKGROUND: Each year in the US, it is estimated more than 250 million cases of anterior cruciate ligament injury, which makes surgical reconstruction a common procedure in the practice of sports medicine. There is still no consensus on how much activity to promote adequate rehabilitation without damaging the graft or produce an abnormal anterior laxity, with consequent damage to the meniscus and articular cartilage. PURPOSE: To analyze and compare the effect of an accelerated physiotherapy protocol in the anterior-stability and clinical outcome of patients undergoing reconstruction of the anterior cruciate ligament. METHODS: We included 29 subjects in the study who had total ACL rupture confirmed by MRI and underwent ligament reconstruction with patellar tendon. Patients were randomly allocated in two groups with different rehabilitation intervals: Accelerated Group (4 months) or Conventional Group (6 months). Preoperatively, six and four months postoperatively a blind evaluator recorded: anterior laxity by KT1000, Brawn (CYBEX) and knee function affected by IKDC (2000) and the Hop Test. RESULTS: the groups were similar relative to demographic data. There was no statistical difference in anterior laxity in the fourth month 0,92mm versus 1.33mm and 0.50mm in the sixth month versus 1,67mm being conventional group versus accelerated group respectively. In the fourth month the accelerated group showed a significant improvement (P <0.001) in the clinical evolution of the IKDC (2000) 79.50 versus 60.61 in the conventional group, this difference was not repeated in the sixth month. Muscle strength and the Hop Test, the fast group had higher values, but not significantly in both time points (P> 0.05). CONCLUSION: Based on these results, the Accelerated protocol when compared to conventional, do not differ as the anterior knee stability and was sufficient to establish an early significant improvement in the clinical outcome of the knee

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-07T12:38:31Z No. of bitstreams: 1 Julianne Quinellato Louro.pdf: 3594581 bytes, checksum: 773d90a7f78e9d690e9646c39b81213c (MD5) / Made available in DSpace on 2015-12-07T12:38:31Z (GMT). No. of bitstreams: 1 Julianne Quinellato Louro.pdf: 3594581 bytes, checksum: 773d90a7f78e9d690e9646c39b81213c (MD5) Previous issue date: 2014 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Introdução: O equilíbrio, assim como os demais componentes da capacidade física é treinável com a pratica de exercícios físicos, no entanto, há uma falta de padronização do treinamento de equilíbrio. Objetivo: Avaliar a influência de um protocolo específico de exercícios voltados a melhora do equilíbrio em um programa global de atividade física para idosos sobre as variáveis: equilíbrio corporal e força de membros inferiores. Metodologia: Pesquisa do tipo experimental, com a duração de 3 meses. Fizeram parte deste estudo 39 mulheres idosas, sendo 21 no G-Equi e 18 no G-Cont. Para a avaliação foram utilizados questionários para a identificação de possíveis fatores de risco a saúde, variáveis socioeconômicas, nível de atividade física, histórico de quedas, como também, o questionário Mini mental, como exames físicos e testes motores; foram realizadas reavaliações ao final dos 3 meses. Resultados: Após os 3 meses pode-se perceber que o G-Equi apresentou uma diferença significativa entre os resultados dos testes TAFA, o TAFLD, o TAFLE, o TLA e o TC, no entanto, não apresentou para o TU apesar de uma tendência a um melhor desempenho. O G-CONT apresentou diferença significativa para o TLA, tendo as medianas muito próximas para os testes de alcance e TU. Em relação ao resultado da interação entre os grupos pode-se observar que o grupo que realizou a intervenção obteve melhores resultados, tendo diferenças significativas para os testes TAFA, o TAFLD, o TAFLE, e o TC, não apresentando para o TLA e o TU apesar de apresentar melhores resultados nos testes. Para os dados estabilométricos houve uma redução significativa do deslocamento total e da velocidade bidirecional, para o G-Equi com olhos abertos e fechados, e um aumento do deslocamento total e uma redução da velocidade bidirecional para o G-Cont com olhos abertos. Discussão: Os achados revelaram que o treinamento de equilíbrio auxilia na melhora do desempenho do controle postural em idosas, corroborando com a literatura. Conclusão: Os efeitos do treinamento de equilíbrio adicionado em um programa global de exercícios físicos para idosas apresentaram efeitos positivos no equilíbrio corporal e força de membros inferiores, além de evidenciar novas inquietações a respeito da afirmação que uma menor área e oscilação é o que representa maior estabilidade. / Introduction: The balance, as well as other components of physical ability is trainable with the practice of physical activity, however, there is a lack of standardization of balance training. Objective: To evaluate the influence of a specific protocol of exercises aimed at improving balance in a comprehensive physical activity program for seniors on variables: body balance and lower limb strength. Methodology: Survey of experimental type, with a duration of 3 months. This study included 39 elderly women, with 21 in G- Equi and the G- 18 Cont. For the evaluation questionnaires to identify possible risk factors to health, socioeconomic variables, physical activity level, history of falls, as were also used, the Mini Mental questionnaire such as physical exams and testing engines; revaluations were carried out at the end of 3 months. Results: After 3 months it can be seen that the G-Equi showed a significant difference between the results of the tests TAFA the TAFLD the TAFLE, TLA and TC, however, not presented to the TU despite a tendency to better performance. The G- Cont significant difference to TLA, and very close to the testing range and TU medians. Regarding the result of the interaction between the groups can be seen that the group that performed the intervention achieved better results, with significant differences for TAFA tests, TAFLD the TAFLE, and TC, for not presenting the TLA and the TU despite provide better test results. For stabilometric data there was a significant reduction in the total displacement and bidirectional speed for the G- Equi with eyes open and closed, and an increase in total displacement and reduction of bidirectional speed for the G-Cont with open eyes. Discussion: The findings showed that the Balance training helps in improving the performance of postural control in elderly, corroborating with literature. Conclusion: The effects of balance added an overall exercise program for older training had positive effects on body balance and lower limb strength, besides highlighting new concerns regarding the assumption that a shorter swing and is what is most stability.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Obesity is a health problem worldwide and projections of the World Health Organizations provide significant improves in rates for the coming years. Together with health problems related to obesity there are significant evidence that postural balance is also affected, which can lead limitations on activities of daily living. Purpose: Dissertation was divided in two research papers, each with different purposes: 1) To verify the influence of obesity on postural balance; and 2) To verify the influence of a treatment for weight reducing on obese individual s postural balance. Material and Method: The first paper s sample were composed by 48 overweight and obese individuals with mean age of 49,04 ± 8,59 years, mean height of 163,28 ± 5,58 cm and mean weight of 92,97 ± 16,49 kg. Fifteen women of that sample performed treatment for weight loss, composed by aerobic and anaerobic exercises three times a week and dietary guidelines once a week, during 12 weeks. They composed the second paper s sample and had mean age of 48,93 ± 7,04 years, mean height of 161,63 ± 4,57 cm and mean weight of 85,51 ± 10,58 kg. Were collected anthropometric data related to obesity level, like body mass, height, body mass index and waist circumference, and data related to postural balance with a force platform AMTI (Advanced Mechanical Technologies, Inc.) and foam-laser dynamic posturography, before and after proposed training. Results: Study results showed that the anthropometric variables did not change and only one postural balance variable significantly improved after treatment in a situation with closed eyes. After division in groups according body mass index (overweight group = GSP; obesity I group = GO I; obesity II group = GO II; obesity III group = GO III) was found better postural balance for GO III and worse postural balance for GO II. Was found significant moderate associations between postural balance values and obesity indicators, when removed GO III of analysis, denoting better postural balance for individuals with smaller obesity levels. Conclusions: Training performed improved only one of analyzed balance variables and individuals with higher body mass index have better postural balance than other individuals. There are a negative linear association between postural balance and obesity in individuals that composed groups GSP, GO I and GO II. / A obesidade é um problema de saúde em escala mundial e projeções da Organização Mundial da Saúde preveem aumentos significativos dos índices para os próximos anos. Juntamente com problemas de saúde relacionados à obesidade existem indícios significativos que o equilíbrio postural também é afetado, o que pode trazer limitações para atividades de vida diárias. Objetivo: A dissertação foi dividida em dois artigos de pesquisa, cada um com objetivos diferentes: 1) Verificar a influência da obesidade sobre o equilíbrio postural; e 2) Verificar a influência de um tratamento para redução de peso no equilíbrio postural de indivíduos obesos. Materiais e método: O grupo de estudo do primeiro artigo foi composto por 48 indivíduos com sobrepeso e obesos com idade média de 49,04 ± 8,59 anos, estatura corporal média de 163,28 ± 5,58 cm e massa corporal média de 92,97 ± 16,49 kg. Quinze mulheres deste grupo realizaram um tratamento para redução de peso, composto por exercícios aeróbicos e anaeróbicos três vezes na semana e orientações nutricionais por uma vez semanal, durante 12 semanas. Estas compuseram o grupo de estudo do segundo artigo e tinham idade média de 48,93 ± 7,04 anos, estatura corporal média de 161,63 ± 4,57 cm e massa corporal média de 85,51 ± 10,58 kg. Foram coletados dados antropométricos relacionados ao nível de obesidade, como massa corporal, estatura, índice de massa corporal e circunferência da cintura, e dados referentes ao equilíbrio postural com uma plataforma de força AMTI (Advanced Mechanical Technologies, Inc.) e posturografia dinâmica foam-laser, antes e depois do tratamento proposto. Resultados: Os resultados do estudo revelaram que as variáveis antropométricas não sofreram alterações e apenas uma variável de equilíbrio postural apresentou melhora significativa após o tratamento, em uma situação com olhos fechados. Após a divisão em grupos de acordo com o índice de massa corporal (grupo com sobrepeso = GSP; grupo obesidade I = GO I; grupo obesidade II = GO II; grupo obesidade III = GO III) foi encontrado melhor equilíbrio postural para GO III e pior equilíbrio postural para GO II. Foram encontradas associações moderadas e significativas entre valores de equilíbrio postural e indicadores de obesidade, quando retirada da análise o GO III, denotando melhor equilíbrio postural para indivíduos com menores níveis de obesidade. Conclusões: O tratamento realizado melhorou apenas uma das variáveis de equilíbrio avaliadas e indivíduos com maior índice de massa corporal têm melhor equilíbrio postural que os demais indivíduos. Existe uma associação linear negativa entre equilíbrio e obesidade entre indivíduos que compuseram os grupos GSP, GO I e GO II.

Primary ciliary dyskinesia is a rare hereditary disorder with impairment of cilia characterized by chronic cough with sputum, bronchiectasis or pneumonia. Regular exercise training should affect pulmonary function, promote mucociliary clearance and improve quality of life. The aim of this thesis is to compare the aerobic fitness of patients with PCD with a control group.

M.A. / As compared with psychoanalytic and other psychotherapies, behaviour therapy appears to have three distinct advantages. First of all, the treatment approach is precise. The target behaviours to be modified are specified, the methods to be used are clearly delineated, and the results can be readily evaluated (Marks, 1982). Second, the use of explicit learning principles is a sound basis for effective interventions as a result of their demonstrated scientific validity (Kazdin & Wilson, 1978). Third, the economy of time and costs is quite good. Not surprisingly, then, the overall outcomes achieved with behaviour therapy compare favourably with those of other approaches (Smith, Glass & Miller, 1980). Behaviour therapy usually achieves results in a short period of time because it is generally directed to specific symptoms, leading to faster relief of an individual's distress and to lower financial costs. In addition, more people can be treated by a given therapist.

End-stage conditions such as chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have shown some of the most dramatic increases in mortality in the developed world over the past 40 years. Both are therefore leading causes of morbidity and mortality worldwide and should be considered as a major economic and social burden that is both substantial and increasing. In these conditions, exercise therapy should play an integral part in maintaining the patient’s maximal level of independence and functioning, as well as slowing or possibly even stopping the progression of the condition. In this context the main objectives of these doctoral theses are: a. Proving the safety of different exercise modalities. b. Identifying the most effective exercise interventions in regards to clinical parameters. c. Proving the feasibility of outpatient rehabilitation programmes for these high risk populations. This work, therefore, combines three studies looking into the effects of non-pharmaceutical interventions – predominantly different exercise regimes in the two major conditions in the mortality statistics of CHF and COPD - both with a very poor prognosis. In conclusion it can be said that the results and experience of all three studies demonstrate the safe feasibility of different outpatient exercise interventions and suggest specific positive adaptations in patients with heart failure and COPD which also led to a lower hospitalisation rate. There are clear hints that the therapy spectrum could be supplemented significantly by specific training interventions. The financial implications for any health care system are also highly relevant.

Problem Statement A lack of fundamental movement skill (FMS) proficiency in children can contribute to decreased physical activity (PA) levels, increased adiposity and poor acquisition of specialised sport specific movement skills. To prevent the latter, the identification of FMS status in early and middle childhood years is needed for targeted and specific interventions. Against the backdrop of physical education being omitted from the South African school curriculum, the presence of a patriarchal society, gender sporting stereotyping, high levels of unemployment and low education levels; the assessment of FMS status is particularly warranted. Aim of Study The primary aim of this study was to assess the FMS proficiency of girls aged 9-to-12 years from previously disadvantaged communities within Nelson Mandela Bay. Methodology A descriptive-exploratory-contextual study design, employing quantitative assessment techniques, was utilized. The sample comprised of 227 girls. Convenience sampling was employed. Testing consisted of FMS proficiency tests in the 20m and 40m sprint, standing long jump, throwing for distance, catching, static balance and throwing for accuracy. FMS process scores were assessed with the body component (BC) and Test of Gross Motor Development II (TGMD II) approaches. Anthropometric measurements of the standing and seated height, mass, arm span and leg length were additionally measured. Microsoft Excel® and Statistica® were used for descriptive and inferential statistical analysis. In the case of significant ANOVA results, the Scheffe post hoc test was used for pairwise comparisons. Statistical significance was set at p<.05 and practical significance (Cohen’s d) was set at d>.2. Pearson Correlation Coefficient identified statistical and practical correlations between two variables and chi square was applied to indicate differences in frequency distribution tables. Cramer’s V values were applied to determine practical significance in the case where statistical significant differences were identified between sets of frequency distributions The BC approach indicated that most participants could not proficiently perform the run for speed (94.71 percent), standing long jump (96.9 percent) or throw for distance (83.56 percent). Only the catch was performed proficiently (91.19 percent). TGMD II results for the present study indicated that participants’ run for speed (100 percent) and catch (96.92 percent) were performed proficiently and their standing long jump (93.78 percent) and throw for distance (83.56 percent) process scores were performed least proficiently. Only the catch composite BC scores had a statistically (df=1.31; f=3.24; p=.024) and practically significant (d=0.82) improvement in the BC scores between the age groups 9 and 12 years. Only the standing long jump, throw for distance and throw for accuracy product scores improved statically and practically significantly with aging (p<.05; d>.2). Hence the further participants jumped, the faster they ran. Standing and seated height, weight and arm span improved statistically and practically significantly with age (p<.05; d>.2). All anthropometric variables, except for leg length, had a positive medium correlation (r=.335 to r=.439) with balance errors and this was only in 12 year olds. The throw for distance product scores had a medium correlation to seated height (r=.32) and arm span (r=.33). The run for speed had a medium correlation (r=.313) with mass. According to the IOTF classifications 24.67 percent of children were overweight and 7.49 percent of children were obese. Statistically significant differences were found for the run for speed (df=224; f=27.07; p=2.9E-11) and standing long jump (df=224; f=15.68; p=4.2E-07) when comparing product scores to normal weight, overweight and obese participants. These differences were furthermore found to be of medium to large practical significance between the normal and obese participants for the run for speed (d=0.61 to d=1.77) and Standing Long Jump (d=0.40 to d=1.33). On average 50 percent and 55 percent of participants partook 60 minutes or more of PA after school on week days and on weekend’s respectively. This PA consisted mostly of running and ball games. Only 10 percent of participants had commenced with menarche Conclusion Findings have highlighted the need for specifically targeted FMS interventions at an early age in female learners from previously disadvantaged communities. Both a product and process FMS assessment is warranted as this facilitates deductions about movement proficiency levels. A FMS proficiency assessment protocol is needed for South African children which is internationally comparable. Childhood overweight and obesity impacts FMS proficiency and should be addressed in future research. Cultural norms, gender stereotypes and sport management structures at primary school level seem to be affecting FMS proficiency and should be addressed in future research

INTRODUÇÃO: A incontinência urinária de esforço (IUE) é definida como a queixa de perda involuntária de urina em situações de esforço ou esforço físico, espirros ou tosse. O fortalecimento dos músculos do assoalho pélvico (MAPs) tem nível A de evidência científica no tratamento da IUE, mas não há respostas sobre o efeito de uma intervenção envolvendo o sinergismo muscular entre os MAPs e os músculos do quadril. OBJETIVOS: Avaliar se o fortalecimento dos MAPs associado ao fortalecimento dos músculos adutores de quadril, glúteo máximo e glúteo médio é mais eficaz do que o fortalecimento isolado dos MAPs, em relação à frequência de perda urinária, força do assoalho pélvico, perineometria e qualidade de vida. METODOLOGIA: Ensaio clínico randomizado e cego, com 43 mulheres (média de idade 50,09 ± 8,35) com diagnóstico de IUE. Após a avaliação inicial, as pacientes foram randomizadas para o grupo que realizava somente exercícios para fortalecimento dos músculos do assoalho pélvico (AP, n= 21) ou para o grupo de exercícios para fortalecimento dos músculos do assoalho pélvico, adutores de quadril, glúteo máximo e médio (APQ, n= 22). Como medida primária foi considerada a frequência de perda urinária avaliada pelo diário miccional de três dias e pela ficha de acompanhamento por sessão. As medidas secundárias foram: avaliação bidigital da força dos MAPs, a perineometria, e a avaliação da qualidade de vida realizada pelo International Consultation on Incontinence Questionnarie - Short Form (ICIQ-SF) e pelo King\'s Health Questionnaire (KHQ). As avaliações foram realizadas antes e após 20 sessões de fisioterapia. RESULTADOS: Na análise do diário miccional, entre o início e fim do tratamento, somente o grupo APQ teve redução significante da frequência de perda urinária, porém sem diferença estatisticamente significante entre os grupos no final do tratamento. A frequência diária de perda urinária obtida pela ficha de acompanhamento por sessão, constatou que somente o grupo APQ teve redução significativa da perda urinária ao longo do tratamento (efeito do fator tempo) (p-valor 0,0048), sendo que na comparação entre os grupos, o APQ resultou em maior redução da frequência diária de perda em relação ao grupo AP. Ambos os grupos tiveram aumento significativo da força e endurance dos MAPs, porém sem diferença estatisticamente significante entre os grupos. Não foi detectada diferença significativa na perineometria pré/ pós-tratamento, assim como na comparação entre os grupos. Na análise da qualidade de vida, ambos os grupos tiveram melhora significativa nos escores do ICIQ-SF, porém não apresentaram diferença significativa na comparação entre os grupos. Dos nove domínios do KHQ, seis apresentaram redução estatisticamente significativa no grupo APQ e quatro no grupo AP, porém os escores dos nove domínios não apresentaram diferença significativa entre os grupos no final do tratamento. CONCLUSÕES: Para o tratamento da incontinência urinária de esforço, os exercícios de fortalecimento do assoalho pélvico acrescidos do fortalecimento de músculos como os adutores de quadril, o glúteo máximo e glúteo médio apresentam melhor resultado ao longo do tratamento para a redução da perda urinária do que somente o fortalecimento perineal, ainda que não haja diferença significativa entre os tratamentos em relação à força e perineometria dos músculos do assoalho pélvico e na qualidade de vida / BACKGROUND: Stress urinary incontinence (SUI) is defined as the complaint of involuntary leakage of urine in situations of stress or physical exertion, sneezing or coughing. Strengthening the pelvic floor muscles (PFM) have the level A of scientific evidence in the treatment of SUI, but there are no findings on the effect of an intervention involving muscle synergism between PFM and hip muscles. OBJECTIVES: To evaluate whether the strengthening of PFM associated with the strengthening of the hip adductor muscles, gluteus medius and gluteus maximus is more effective than isolated strengthening of PFM, regarding the frequency of urine loss, strength of pelvic floor perineometry and quality of life. METHODS: This is a blind randomized clinical trial with 43 women (mean age 50.09 ± 8.35) diagnosed with SUI. After initial evaluation, patients were allocated to the group that performed only exercises to strengthen the pelvic floor (PF, n = 21) or to the group of exercises to strengthen the muscles of the pelvic floor, hip adductors, gluteus maximus and gluteus medius (PFH, n = 22). As a primary measure, the frequency of urinary incontinence was considered as assessed by a three-day voiding diary and the accompanying sheet, per session. Secondary measures were: bidigital assessment of the strength of PFM, perineometry, and the assessment of quality of life conducted by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the King\'s Health Questionnaire (KHQ). Evaluations were performed before and after 20 sessions of physiotherapy. RESULTS: In the analysis of the voiding diary, between the beginning and end of treatment, only the PFH group had a significant reduction in the frequency of urinary leakage, although there was no statistically significant difference between groups at the end of treatment. The daily frequency of urinary leakage obtained by the accompanying sheet per session, showed that only the PFH group had significantly reduced urinary loss throughout the treatment (time effect factor) (p-value 0.0048), and in that comparison between groups, the PFH group resulted in greater reduction in daily frequency of loss of urine in relation to the PF group. Both groups had a significant increase in strength and endurance of PFMs, although there was no statistically significant difference between groups. There was no significant difference in perineometry pre / post-treatment, as well as in the comparison between groups. In analyzing the quality of life, both groups had significant improvement in the scores of the ICIQ-SF, but did not show a significant difference between groups. Of the nine KHQ domains, six showed a statistically significant reduction in PFH group and four in the PF group, but the scores of the nine domains showed no significant difference between groups at the end of treatment. CONCLUSIONS: For the treatment of stress urinary incontinence, exercises to strengthen the pelvic floor muscles plus the strengthening of muscles like the hip adductors, gluteus maximus and gluteus medius have a better outcome during treatment for the reduction of urine loss than only the perineal strengthening, although there is no significant difference between treatments with respect to strength and perineometry of pelvic floor muscles, and the quality of life