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To assess cardiopulmonary capacity, autonomic heart function, and oxygen recovery kinetics during exercise testing before and after bariatric surgery. This is a prospective cohort study. Symptom-limited cardiopulmonary exercise testing was performed with 24 patients, 1 week before and 4 months after bariatric surgery. The main variables were maximum oxygen uptake (VO2 max), the time elapsed until the appearance of the first ventilatory threshold (TLV1), and VO2 oxygen kinetics during recovery with a 50% reduction in peak oxygen uptake in the recovery period after exercise (50%VO2RP). The study demonstrated that the peak VO2\kg increased significantly after bariatric surgery. When analyzed without adjusting for weight, the peak VO2 paradoxically and significantly decreased after the surgical procedure (p = 0.007). The exercise time until the anaerobic threshold was longer after surgical procedure than before it (p = 0.001). Regarding post-exercise oxygen recovery kinetics, there was a faster reduction in the peak oxygen uptake after bariatric surgery than before the procedure (p

Purpose: Evaluating the effects of interdialytic daily inspiratory muscle training (IMT) on respiratory muscle strength, chest wall regional volumes, diaphragmatic mobility and thickness, pulmonary...

Background Whole body vibration (WBV) training improves maximum voluntary isometric contraction (MVIC) of knee extensors, postural balance, functional capacity, and quality of life (QOL) in several diseases. The objective was to assess the efficacy of WBV training in patients with chronic kidney disease (CKD) on hemodialysis (HD) in the interdialytic period. Method A randomized, controlled trial study with concealed allocation, intention-to-treat analysis, and triple blinding. Sixteen patients with CKD of both genders aged over 40 years were allocated in two groups, the WBV group or the sham group, training 2 times a week for 12 weeks. The primary outcome was knee extensor muscle strength, and the secondary outcomes were quadriceps thickness, distance walked, balance, and QOL. Results The WBV group improved MVIC of knee extensors with a difference between groups in improvement of 117.29 N (95% CI, 32.25-202.24) at the end of training. The other outcomes were not different between groups. Practical applications: The WBV program has shown to be effective and may be able to help in prescribing the appropriate training program for CKD. Conclusion WBV training improves MVIC of knee extensors in patients with CKD on HD in the interdialytic period. WBV training could be considered in the management of patients with CKD.

The aim of this study was to assess the diaphragm kinetics, respiratory function, and serum dosage of leptin and inflammatory cytokines (IL-6 and TNF-α) in three clinical groups: obese, asthmatic, and healthy.This is a clinical exploratory study performed on 73 youths (12-24 years of age, 42.5% male) allocated into three groups: obesity (OG, n=33), body mass index (BMIz-score) ≥ +2, asthmatic (AG, n=26) controlled mild asthmatics, classified by GINA, and Healthy Control Group (CG, n=14). The participants were subjected to diaphragmatic ultrasound, spirometry, maximal respiratory pressure, serum leptin levels, and IL-6 and TNF-α whole blood cell culture levels.Diaphragm thickness was higher in OG in comparison to AG and CG (2.0±0.4 vs 1.7±0.5 and 1.6±0.2, both with p0.05). Maximal voluntary ventilation (MVV) was significantly lower in OG and AG in relation to the CG (82.8±21.4 and 72.5±21.2 vs 102.8±27.3, both with p0.05). OG has the highest leptin rate among the groups (with the other two groups had p0.05). All groups had similar TNF-α and IL-6 levels.The muscular hypertrophy found in the diaphragm of the obese individuals can be justified by the increase in respiratory work imposed by the chronic condition of the disease. Such increase in thickness did not occur in controlled mild asthmatics. The IL-6 and TNF-α markers detected no evidence of muscle inflammation, even though leptin was expected to be altered in obese individuals. Both obese and asthmatic patients had lower pulmonary resistance than the healthy ones.O objetivo deste estudo foi avaliar a cinética diafragmática, a função respiratória e a dosagem sérica de leptina e citocinas inflamatórias (IL-6 e TNF-α) em três grupos clínicos: obeso, asmático e saudável.Estudo clínico-exploratório realizado com 73 jovens (12-24 anos, sendo 42,5% do sexo masculino) alocados em três grupos: obesidade (GO, n = 33), índice de massa corporal (IMC z-score) ≥ + 2 e asmáticos leves controlados (GA, n = 26), classificados pela GINA, e grupo controle saudável (GC, n = 14). Os participantes foram submetidos à ultrassonografia diafragmática, espirometria, pressão respiratória máxima, níveis séricos de leptina e níveis de IL-6 e TNF-α em hemocultura total.A espessura do diafragma foi maior no GO em comparação ao GA e GC (2,0 ± 0,4 vs 1,7 ± 0,5 e 1,6 ± 0,2, respectivamente, com p0,05). A ventilação voluntária máxima (VVM) foi significativamente menor no GO e GA em relação ao GC (82,8 ± 21,4 e 72,5 ± 21,2 vs 102,8 ± 27,3, respectivamente, com p0,05). O GO tem a maior taxa de leptina entre todos os grupos (com os outros dois grupos, p0,05). Os três grupos tinham níveis semelhantes de TNF-α e IL-6.A hipertrofia muscular encontrada no diafragma de indivíduos obesos pode ser justificada pelo aumento do trabalho respiratório imposto pela condição crônica da doença. Esse aumento de espessura não ocorreu em asmáticos leves controlados. Os marcadores IL-6 e TNF-α não detectaram evidências de inflamação muscular, embora fosse esperado que a leptina estivesse alterada em indivíduos obesos. Pacientes obesos e asmáticos apresentaram menor resistência pulmonar do que os saudáveis.

The aim of this study was to evaluate the effectiveness of inspiratory muscle training (IMT) on sleep and functional capacity to exercise in subjects with obstructive sleep apnea (OSA). This is a controlled, randomized, double-blind study conducted in 16 OSA patients divided into two groups: training (IMT: n = 8) and placebo-IMT (P-IMT: n = 8). IMT was conducted during 12 weeks with a moderate load (50–60% of maximal inspiratory pressure—MIP), while P-IMT used a load 0.05) and respiratory muscle strength (p > 0.05). Maximal oxygen uptake (VO2Max) was not significantly different between IMT and P-IMT group (mean difference − 1.76, confidence interval (CI) − 7.93 to 4.41, p = 0.71). The same was observed for the other ventilatory and cardiometabolic variables measured (p > 0.05). A significant improvement in sleep quality was found when Pittsburgh Sleep Quality Index (PSQI) values of IMT and P-IMT group after training were compared (mean difference: 3.7, confidence interval 95% (CI95%) 0.6 to 6.9, p = 0.02) but no significant changes were seen in daytime sleepiness between both groups after the intervention (mean difference: 3.4, CI 95%: − 3.3 to 10.0; p = 0.29). According to these results, 12 weeks of moderate load IMT resulted in improved sleep quality, but there were no significant repercussions on functional capacity to exercise or excessive daytime sleepiness.

This study evaluated the immediate effects of respiratory muscle stretching on chest wall kinematics and electromyographic activity in COPD patients. 28 patients with COPD were randomized into two groups: 14 to the treatment group (TG) and 14 to the control group (CG). The TG underwent a stretching protocol of the rib cage muscles, while the CG remained at rest under similar conditions. After a single session, TG increased the tidal volume of the pulmonary rib cage (Vrcp) (p = 0.020) and tidal volume of abdominal rib cage (Vrca) (p = 0.043) variations and their percentages in relation to the thoracic wall, Vrcp% (p = 0.044) and Vrca% (p = 0.022). Also, TG decreased the end-expiratory Vrcp (p = 0.013) and the end-inspiratory Vrcp (p = 0.011) variations. In addition, there was a reduction in respiratory rate (RR) (p = 0.011) and minute volume (MV) (p = 0.035), as well as an increase in expiratory time (Te) (p = 0.026). There was also an immediate reduction in sternocleidomastoid (p = 0.043) and upper trapezium (p = 0.034) muscle electrical activity. Then, the study supports the use of stretching to improve COPD chest wall mobility with positive effects on chest wall mechanics, on volume distribution and electromyography.

The design development of a small, hand held, battery operated, breath actuated inhaler as a drug/device platform for inhaled insulin posed a number of technical challenges. Our goal was to optimize lung deposition and distribution with aerosol generators producing 3–6 μm particle size distribution. In silico modeling with computational fluid dynamics (CFD) and in vitro testing of device components were assessed using an Alberta idealized adult airway (Copley, UK) to optimize mouthpiece and aerosol path design for dose delivered distal to the trachea. Human factors use testing was designed to determine the ability to perform inspiratory manuevers with LED guidance within target flow limits. In vivo testing with healthy normal subjects of radiolabeled aerosol compared 2 breathing patterns for lung deposition efficiency, distribution, and subject preference. CFD demonstrated that flows ≤5 L/min and ≥15 L/min reduced the delivery efficiencg. Prototypes tested with inspiratory flow of 10 L/min provided up to 70% of dose delivered distal to the model throat with aerosols of 3 to 6 μm. Users guided by LED were able to inhale for 8–24 s with 5 s breath hold. Lung dose >70% with peripheral to central ratios >2.0 were achieved, with subject preference for the longer inspiratory time with breath hold. The device design phase integration led to a novel design and inspiratory pattern with greater levels of peripheral deposition than previously reported with commercial inhalers. The rationale and process of the application of these methods are described with implications for use in future device development.

Objective To evaluate the effect of noninvasive ventilation (NIV) on exercise performance in individuals with heart failure (HF). Design Crossover, blind, randomized controlled trial with allocation concealment. Setting University-based research laboratory. Participants Participants (N=24) with New York Heart Association class II and III left heart failure and with a mean age of 51.8±10.2 years (women: n=8; men: n=16). Interventions Ventilatory support attached to the face of the individual via a facemask prior to cardiopulmonary exercise test (CPET) was administered at 2 pressure levels for 30 minutes. Inspiratory pressure of 15cmH 2 O and expiratory pressure of 5cmH 2 O were applied. Main Outcome Measures Maximal oxygen uptake, maximum heart rate, variation between the initial and maximum heart rates, CPET duration, and recovery time oxygen consumption. Results Differences were observed in maximal oxygen consumption (nonintervention phase: 18.3±4.4mL·kg −1 ·min −1 vs NIV phase: 20.6±4.9mL·kg −1 ·min −1 , P =.01), heart rate (nonintervention phase: 127.3±20.9 beats per minute vs NIV phase: 134.7±19.5 beats per minute, P =.04), and heart rate variation (nonintervention phase: 63.3%±19.3% vs NIV phase: 69.7%±16.6%, P =.02). Moreover, differences in cardiopulmonary exercise time (nonintervention phase: 7.4±1.5min vs NIV phase: 8.3±1.7min, P =.01) and oxygen consumption recovery time (nonintervention phase: 2.8±1.0min vs NIV phase: 2.4±0.8min, P =.01) were observed. Conclusions NIV elicited beneficial effects in the HF population that included increased exercise tolerance, recovery time optimization, and improved chronotropic and respiratory reserves.

Aims: The purpose of this research is to evaluate the effectiveness of upper limb exercises to improve arteriovenous fistula maturation in patients with chronic kidney disease. Methods: A bibliographic search was carried out from February to August 2015 in the following databases: PUBMED, CINAHL, Web of Science, SCOPUS, LILACS, SCIELO and CENTRAL. Results: Three studies were included, involving 134 participants (total). According to the total effect estimation, a mean difference of 0.36 (-0.95–1.67) was found for vein diameter, meanwhile a mean difference of 107.87 (-3.90–219.64) was found for blood flow. Conclusion: It was not possible to determine the effect size of the treatment due to a high bias risk of all included studies. Given this, the available evidence is still insufficient to support the prescription of upper limb exercises in order to improve arteriovenous fistula maturation. Therefore, randomised and controlled clinical trials monitored by methodological rigour should be developed in order to verify if the AVF maturation process can be evidenced through exercise.

RESUMO Avaliou-se a eficácia do treinamento resistido (TR) na melhoria da capacidade funcional (CF) e na qualidade de vida (QV) de pacientes com insuficiência cardíaca (IC). Uma busca eletrônica foi realizada em bancos de dados (PubMed, MEDLINE, Scopus, Web of Science, CINAHL, LILACS e Cochrane), sem restrições de linguagem ou ano de publicação, utilizando como descritores “heart failure”, “resistance training”, “exercise tolerance”, “quality of life”, “fatigue”, “dyspnea” e “muscle strength”. Foram incluídos ensaios clínicos, com amostra composta por indivíduos com IC, classe funcional I, II ou III da New York Heart Association; idade média

Background: Mucopolysaccharidosis type VI (MPS VI) is a metabolic rare disease with impact on the respiratory system. Ultrasound is a method used to evaluate the mobility and thickness of the diaphragm muscle. However, no previous studies have been performed on MPS VI. Objectives: To correlate the diaphragm mobility (DM) and thickness (DT) with antropometric variables in MPS VI. Method: Cross-sectional study with 12 MPS VI carriers. DM and DT was acquired with portable ultrassound. DM was measured from total lung capacity (TLC) on M mode at supine position (45°); and DT from TLC and functional residual capacity (FRC) at lateral position. Ultrasound variables (DM and DT) were correlated with the anthropometric variables, using Pearson’s correlation. Normality was calculated with Shapiro Wilk test (parametric distribution of all outcomes), considering p>0.05. Results: From 12 pacients with MPS VI, 58% were male and aged 10±3,86 years old. There was positive correlation of anthropometric variables [height (p=0.003, r=0.766), weight (p=0.004,r=0.757), muscle mass (p=0.007;r=0.785), fat free mass (p=0.002;r=0.805), waist circumference (p=0.006;r=0.736)] and DM. The DT in the FRC maneuver presented moderate positive correlation (p=0.047;r=0.583) with the height of the patients, whereas the DT in the TLC maneuver showed good correlation with all variables (except free fat mass), with muscle mass being the highest positive correlation (p=0.016;r=0.677). Conclusion: In this group evaluated, DM and DT in the TLC presented strong positive correlations with the anthropometric variables, the fat free mass being a stronger correlation in DM, and muscle mass stronger in DT in the TLC.

Pre-frail olders present a decrease in brain derived neurotrophic factor (BDNF) that precedes the clinical manifestations of sarcopenia, therefore non-pharmacological interventions for control and prevention are recommended. The aim of the study was to evaluate the efficacy of the combination of inspiratory muscle training (IMT) and whole body vibration (WBV) on BDNF, thickness and muscle mass. 42 volunteers divided into 3 groups: IMT+WBV(G1), IMTsham+WBV(G2) and IMTSham +WBVSham(G3) were training for 12 weeks. BDNF and lean mass were evaluated. Ultrasonography was used to evaluate the muscle thickness of the femoral rectus (FR), vastus intermedius (VI) and anterior quadriceps (QA); the diaphragm thickness in the resting (TFRC) and maximal contraction (TTLC); thickening ratio (TR) and diaphragmatic mobility (DM). There were no differences in BDNF levels (p = 0.229) between G1 (1244.07 ± 936.86), G2 (2353.88 ± 1612.10) and G3 (1816.39 ± 1490.07) after intervention. G1 showed an increase of about 9% in DM (p

Pre-frail olders are at increased risk for falls, functional disabilities and death, so the prescription of new training modalities may mitigate these findings more effectively. The aim of the study was to evaluate the efficacy of the association of inspiratory muscle training (IMT) and whole body vibration (WBV) on respiratory and peripheral muscle strength, functionality, balance, physical performance and muscle metabolism in pre-frail older women. A randomized double-blind clinical trial was conducted for 12-weeks with 42 volunteers divided into 3 groups: IMT + WBV (G1), IMTsham + WBV (G2) and IMTSham + WBVSham (G3). Hand grip strength (HGS), maximal inspiratory pressure (MIP), Timed UP and Go Test (TUG), Tinetti Test (TT) scores, distance walked in the 6-minute walk test (DW6M), muscle metabolism through the variation of lactate and glucose post-physical exertion were evaluated. The results showed a shorter time in TUG (P = 0.002) in the G1 (9.98 ± 1.8) and G2 (11.04 ± 1.98) in relation to G3 (12.87 ± 1.63). It was observed that G1 increased the MIP (p = 0.005), the TT scores (p = 0.046) and the DW6M (p

Prolonged immobilization induce a reduction in muscle mass during of mechanical ventilation (MV) requiring an accurate and viable diagnosis for rapid and effective clinical intervention. The aim of this study was to evaluate the muscle thickness of the anterior quadriceps (QA) and gastrocnemius muscles (GTN) in critically ill patients over 10 days of MV. A prospective cohort study was conducted with 267 subjects in MV with a final sample of 66 patients with more than 72 hours of MV. Muscle thickness evaluation was performed on the 3rd, 5th, 7th and 10th day of MV by bilateral ultrasonography of the femoral rectus (RF), vastus intermedius (VI), QA and GTN. PERME scale scores were used to observe functional mobility in the same period. The results showed that on the 3rd day there is a decrease in muscle thickness (right-left side) around 7-11% in VI (p = 0.001), 1-7% in RF (p = 0.02), 8-9% in QA (p = 0.001 ) and 10-18% in GTN (p

Introduction Cardiac rehabilitation programs reduce the risk of death and acute events related to the disease through the association of various modalities of exercise. When implemented in high-intensity interval training (HIIT) programs, it may allow for gradual adaptation of the skeletal muscles to greater exercise intensities. The present systematic review aimed to determine whether HIIT promoted a greater increase in exercise tolerance in comparison with continuous aerobic training in individuals with heart failure. Methods A systematic search for articles indexed in the PubMed/MEDLINE, LILACS, SciELO, PEDro, Scopus, and Web of Science databases was carried out. The descriptors used for the search followed the description of the MeSH/DeCS terms with no language or year of publication restrictions. When possible, a meta-analysis was performed and the quality of the evidence was evaluated using the GRADE scale. Results The broad search strategy resulted in 5258 titles, and a total of 7 articles were included in the qualitative synthesis. A low quality of evidence was observed demonstrating that interval training is superior to continuous aerobic training for improving peak oxygen uptake, which reflects an increase in functional capacity of these individuals and moderate quality of evidence regarding improved quality of life and left ventricular ejection fraction. Conclusion High-intensity interval training and continuous training provide benefits for patients, however, the quality of evidence still does not allow us to indicate whether there is a superiority of HIIT over conventional continuous exercise training using the variables analyzed.

Background: Left ventricular global longitudinal strain value (GLS) can predict functional capacity in patients with preserved left ventricular ejection fraction (LVEF) heart failure (HF) and to assess prognosis in reduced LVEF HF. Objetive: Correlate GLS with parameters of Cardiopulmonary Exercise Test (CPET) and to assess if they could predict systolic HF patients that are more appropriated to be referred to heart transplantation according to CPET criteria. Methods: Systolic HF patients with LVEF < 45%, NYHA functional class II and III, underwent prospectively CPET and echocardiography with strain analysis. LVEF and GLS were correlated with the following CPET variables: maxVO2, VE/VCO2 slope, heart rate reduction during the first minute of recovery (HRR) and time needed to reduce maxVO2 in 50% after physical exercise (T1/2VO2). ROC curve analysis of GLS to predict VO2 < 14 mL/kg/min and VE/VCO2 slope > 35 (heart transplantation’s criteria) was performed. Results: Twenty six patients were selected (age, 47 ± 12 years, 58% men, mean LVEF = 28 ± 8%). LVEF correlated only with maxVO2 and T1/2VO2. GLS correlated to all CPET variables (maxVO2: r = 0.671, p = 0.001; VE/VCO2 slope: r = -0.513, p = 0.007; HRR: r = 0.466, p = 0.016, and T1/2VO2: r = -0.696, p = 0.001). GLS area under the ROC curve to predict heart transplantation’s criteria was 0.88 (sensitivity 75%, specificity 83%) for a cut-off value of -5.7%, p = 0.03. Conclusion: GLS was significantly associated with all functional CPET parameters. It could classify HF patients according to the functional capacity and may stratify which patients have a poor prognosis and therefore to deserve more differentiated treatment, such as heart transplantation. Resumo Fundamento: O strain longitudinal global (SLG) é capaz de predizer a capacidade funcional dos pacientes com insuficiência cardíaca (IC) e fração de ejeção do ventrículo esquerdo (FEVE) preservada, e avaliar o prognóstico na IC com FEVE reduzida. Objetivo: Correlacionar o SLG com parâmetros do teste de exercício cardiopulmonar (TECP), e avaliar se o SLG seria capaz de predizer quais pacientes com IC sistólica deveriam ser encaminhados ao transplante cardíaco de acordo com os critérios do TECP. Métodos: Os pacientes com IC sistólica com FEVE 35 (critérios para transplante cardíaco). O nível de significância adotado na análise estatística foi de p < 0,05. Resultados: Vinte e seis pacientes foram selecionados para o estudo (idade, 47±12 anos, 58% homens, FEVE média LVEF = 28 ± 8%). A FEVE correlacionou-se somente com o maxVO2 e o T1/2VO2. O SLG correlacionou-se com todas as variáveis do TECP (maxVO2: r = 0,671; p = 0,001; inclinação de VE/VCO2: r = -0,513; p = 0,007; RFC: r = 0,466; p = 0,016; e T1/2VO2: r = -0,696, p = 0,001). A área sob a curva ROC para o SLG para predizer os critérios para transplante cardíaco foi de 0,88 (sensibilidade 75%, especificidade 83%) para um ponto de corte de -5,7%, p = 0,03. Conclusão: O SLG apresentou associação significativa com todos os parâmetros funcionais do TECP. O SLG foi capaz de classificar os pacientes com IC segundo capacidade funcional e possivelmente pode identificar quais pacientes têm um prognóstico ruim e, portanto, se beneficiariam de um tratamento diferenciado, tal como o transplante cardíaco.

Background Transcutaneous electrical muscle stimulation (TEMS) has been progressively used as add-on therapy to reduce muscle atrophy in adults unable to carry out active mobilization in the intensive care unit (ICU). There are no studies addressing TEMS in the pediatric ICU. Therefore, we decided to develop a scoping review, a type of knowledge synthesis, which unlike systematic review, identify gaps in the literature to aid the planning and commissioning of future research. Objective To provide current perspectives on the application of TEMS for combating pediatric intensive care unit acquired weakness (PICUAW). Methods Online databases were used to identify papers published 2006-2016, from which we selected those used musculoskeletal and cardiorespiratory performance as a primary or secondary outcome variable in participants under 18 years. Results The publications reported six clinical trials from 218 outpatients with 9.5 ± 8 years old. There were differences in current modulation and duration of TEMS sessions, with a predominance of high intensity and short duration in which a muscle contraction is triggered. The main use of TEMS was in pediatric neurological disorders. TEMS was more effective when compared with SHAM on spasticity, bone mineral density, disability, and gait. One study regarding spine injury showed improvement in VO2 (P = 0.035) when combined cycling with TEMS. Conclusion TEMS was an effective and safe treatment for musculoskeletal impairments and cardiorespiratory performance in children with neurological disorders. Although the physiopathology is different in outpatients, an individualized protocol with TEMS might be promising for preventing PICUAW. Its effectiveness, however, deserves further investigation.

Background: Trans-nasal pulmonary aerosol delivery using high flow nasal cannula (HFNC) devices is described with the administration of high gas flows exceeding patient inspiratory flow (HF) and with lower flows (LF). The aim of this pilot clinical trial was to compare deposition and distribution of radiolabeled aerosol via nasal cannula in healthy adults across three rates of gas flow delivered with active heated humidification, and to further identify the impact of aerosol administration without heated humidity. Methods: Twenty-three (23) healthy adults (16F) were randomized to receive aerosol with active heated humidification or unheated oxygen at gas flows of 10 L/min (n = 8), 30 L/min (n = 7), or 50 L/min (n = 8). Diethylenetriaminepentaacetic acid labeled with 1 millicurie (37 MBq) of Technetium-99m (DTPA-Tc99m) was mixed with NaCl to a fill volume of 1 mL, and administered via mesh nebulizer placed at the inlet of the humidifier. Radioactivity counts were performed using a gamma camera and the regions of interest (ROIs) were delimited with counts from the lungs, upper airways, stomach, nebulizer, circuit, and expiratory filter. A mass balance was calculated and each compartment was expressed as a percentage of the total. Results: Lung deposition (mean &plusmn, SD) with heated humidified gas was greater at 10 L/min than 30 L/min or 50 L/min (17.2 &plusmn, 6.8%, 5.71 &plusmn, 2.04%, and 3.46 &plusmn, 1.24%, respectively, p = 0.0001). Using unheated carrier gas, a lung dose of aerosol was similar to the active heated humidification condition at 10 L/min, but greater at 30 and 50 L/min (p = 0.011). Administered gas flow and lung deposition were negatively correlated (r = &minus, 0.880, p &lt, 0.001). Conclusions: Both flow and active heated humidity inversely impact aerosol delivery through HFNC. Nevertheless, aerosol administration across the range of commonly used flows can provide measurable levels of lung deposition in healthy adult subjects (NCT 02519465).

Objective: To assess thoraco-abdominal kinematics, respiratory muscle strength and electromyographic activity of the diaphragm (EAdi) in moderate-severe allergic rhinitis (AR) patients. Met...

RESUMO Objetivo: Comparar o impacto de duas estrategias de fast track quanto ao momento de extubacao e retirada da ventilacao mecânica invasiva de adultos no pos-operatorio cardiaco em desfechos clinicos e hospitalares. Metodos: Estudo de coorte retrospectivo com pacientes submetidos a cirurgia cardiaca. Os pacientes foram classificados de acordo com o tempo de extubacao em Grupo Controle (extubados apos 6 horas de admissao na unidade de terapia intensiva, com tempo maximo de ventilacao mecânica de 18 horas), Grupo 1 (extubados em sala de operacao apos termino da cirurgia) e Grupo 2 (extubados em ate 6 horas pos-admissao na unidade de terapia intensiva). Os desfechos primarios analisados foram: capacidade vital no primeiro dia de pos-operatorio, tempo de internamento hospitalar e na unidade de terapia intensiva. Os desfechos secundarios foram reintubacao, pneumonia adquirida no hospital, sepse e obito. Resultados: Para os 223 pacientes avaliados, a capacidade vital foi menor nos Grupos 1 e 2 comparados ao Controle (p = 0,000 e p = 0,046, respectivamente). Os dias de internamento em unidade de terapia intensiva foram significativamente menores nos Grupos 1 e 2 quando comparados ao Controle (p = 0,009 e p = 0,000, respectivamente), ja os dias de internamento hospitalar foram menores no Grupo 1 quando comparado ao Controle (p = 0,014). Houve associacao entre a extubacao na sala de operacao (Grupo 1) com reintubacao (p = 0,025) e complicacoes pos-cirurgicas (p=0,038). Conclusao: Pacientes submetidos ao fast track com extubacao em ate 6 horas apresentaram menor tempo de internamento em unidade de terapia intensiva sem aumentar complicacoes pos-cirurgicas e obito. Pacientes extubados em sala de operacao tiveram menor tempo de internamento hospitalar e em unidade de terapia intensiva, mas apresentaram aumento na frequencia de reintubacao e complicacoes pos-cirurgicas.

Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.

OBJECTIVE To investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score, FRS) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS). MATERIAL AND METHODS This cross-sectional study used data from the IMIAS, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). A total of 1724 older adults aged 65-74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. The FRS was calculated to estimate the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high-density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Confounders included measures of childhood social and economic adversity, as well as mid-life and adult adversity. RESULTS After adjustment for adversities which occurred during in early, adult or current life, frail individuals presented higher FRS values (β = 3.81, 95 %CI: 0.97-6.65, p-value

The intracellular redox state of alveolar cells is a determining factor for tolerance to oxidative and pro-inflammatory stresses. This study investigated the effects of intratracheal co-administration of antioxidants encapsulated in liposomes on the lungs of rats subjected to sepsis. For this, male rats subjected to sepsis induced by lipopolysaccharide from Escherichia coli or placebo operation were treated (intratracheally) with antibiotic, 0.9% saline and antioxidants encapsulated or non-encapsulated in liposomes. Experimental model of sepsis by cecal ligation and puncture (CLP) was performed in order to expose the cecum. The cecum was then gently squeezed to extrude a small amount of feces from the perforation site. As an index of oxidative damage, superoxide anions, lipid peroxidation, protein carbonyls, catalase activity, nitrates/nitrites, cell viability and mortality rate were measured. Infected animals treated with antibiotic plus antioxidants encapsulated in liposomes showed reduced levels of superoxide anion (54% or 7.650±1.263 nmol/min/mg protein), lipid peroxidation (33% or 0.117±0.041 nmol/mg protein), protein carbonyl (57% or 0.039 ± 0.022 nmol/mg protein) and mortality rate (3.3%), p value

Objective: Evaluate the relationship between functionality and level of physical activity in women with fibromyalgia and migraine. Methods: An observational study was conducted with 22 women diagnosed with fibromyalgia and migraine. To evaluate the functionality, we used the function domain of the fibromyalgia impact questionnaire - revised version (FIQR). For the classification of the level of physical activity were used the short version of the International Physical Activity Questionnaire (IPAQ) and the classification of the Brazilian Society of Cardiology (SBC) based on oxygen consumption (VO2 max), by ergospirometry. Migraine Disability Assessment Test - MIDAS was used to assess the degree of disability of headache. Results: Participants were women with a mean age of 46 ± 7 years, whose first episode of headache occurred since childhood age to the young-adult stage. Women classified as active (n = 4), physically active (n = 14) and sedentary (n = 4) by IPAQ, all were considered sedentary by SBC (n = 22). No difference between the level of function and level of physical activity among patients in this study, which can be explained by the small sample size was observed. Conclusion: This study was not able to see the difference between physical activity level and functionality.entillness or worsening of the individual's health status.

Tidal breathing measurements by Opto-Electronic Plethysmography (OEP) has been reported for infants limited to protocols with two chest wall compartments. Standard protocol for the analysis of adults, with three compartments of chest wall, has been unavailable for analysis of infants. We aimed to study the agreement of simultaneous measurements of tidal volume by OEP (VT,OEP ) and a heated pneumotachograph (PNT) (VT,PNT ) performed during sleeping in 20 infants (gestational age 35.1 ± 4.6 weeks) at 3-4 months postconceptual age with a three compartment protocol. From PNT and OEP measurements, tidal volume corrected (VT,PNT ) for ambient conditions were calculated with a total number of 200 breaths. The two methods were in good agreement with tidal volume mean difference of 0.02 ml and limit of agreement -4.11 to 4.08 ml (95%CI), no relationship was found between differences and means of OEP and PNT measurements. Pulmonary rib cage, abdominal rib cage and abdomen contributed by 12.4 ± 9.7%, 5.2 ± 5.1%, and 82.4 ± 11.4% to VT,OEP , respectively. The OEP experimental protocol based on 52 markers and a three-compartment model of the chest wall could be used in spontaneously sleeping infants. Pediatr Pulmonol. 2016;51:850-857. © 2016 Wiley Periodicals, Inc.

Obesity is a highly prevalent condition worldwide that aggravates symptoms of already existing conditions such as asthma and COPD. The limited effectiveness of inhaled medications in these individuals may be related to anatomic characteristics of their upper airways, mainly due to compressive factors.Controlled clinical trial with obese and nonobese individuals. The following variables were evaluated: anthropometric characteristics, Lung and airway deposition of radiolabeled aerosol (pulmonary scintigraphy), upper airways anatomy (CT scans), and modified Mallampati score.29 subjects (17 nonobese and 12 obese) participated. Obese volunteers presented 30% lower aerosol lung deposition compared to nonobese. Moreover, obese subjects Mallampati classification of 4 presented an aerosol lung deposition two times lower than nonobese subjects (p = 0.021). The cross-sectional area of the retropalatal region and retroglossal region were lower in obese patients (p 0.05), but no correlation to aerosol lung deposition was observed. BMI was associated with 32% of the variance of lung deposition (p 0.001; β -0.28; 95% CI -0.43 to -0.11).High BMI correlated to reduced percentage lung deposition. Also, modified Mallampati class 4 was even more detrimental to aerosol delivery into the lungs. Obese subjects have narrower upper airways, compared to nonobese, but this is not reflected in higher radiolabeled aerosol impaction into their oropharynx and does not predict the percentage of lung deposition in this group.NCT03031093 (clinicaltrials.org).

Introduction: Noninvasive ventilation has been widely used to prevent pulmonary complications after cardiac surgery. Electrical Impedance Tomography(EIT) has been highlighted as a tool to monitor the distribution of regional pulmonary ventilation. However, there are few studies available on the use of this tool in evaluating the effects of noninvasive ventilation(NIV). Objectives: To compare the effects of noninvasive ventilation with oxygen therapy(OT) on pulmonary aeration and ventilation in patients in the immediate postoperative period of cardiac surgery; Hypothesis: the use of non-invasive ventilation in patients in the postoperative period of cardiac surgery results in greater ventilation and greater aeration during and after intervention compared to the control group. Methods: Patients were randomized into two groups: NIV and OT (control). The evaluation was performed through EIT. Results: 16 patients were randomized, 9 in NIV group and 7 in OT group. Greater global end expiratory lung impedance (pulmonary aeration) was observed during NIV when compared to OT group (0,20±0,08 and 0,23±0,10 vs. -0,14±0,01 and -0,21±0,02, p value 0,009 and 0,013 respectively); but there was no maintenance of this improvement after intervention. There was also a greater variation of global impedance (ventilation) change during intervention (7,96 vs. 4,17, p value 0,03). Conclusion: There was increased global aeration and ventilation during noninvasive ventilation in patients in post-operative cardiac surgery, but there was no maintenance of aeration improvement after its interruption. Grants: FACEPE, CNPq and CAPES.

Background: Floor and ceiling effects of functional status (FS) and peripheral muscle strength (PMS) assessment scales are reported in patients under mechanical ventilation at Intensive Care Unit (ICU) (Parry, S.M. et al. Critical Care 2015; 19:127). These effects can influence sensibility and responsiveness of those scales to clinical changes of different health conditions. Objective: To evaluate the frequency of floor and ceiling effects of FS and PMS scales in non-intubated patients during ICU stay. Methods: 40 patients (26 men). Functional Independence Measure (FIM), Functional Status Score for the Intensive Care Unit (FSS-ICU), Physical Function ICU Test Score (PFIT-s), Basic Mobility Scale (ICF-BMS) and Medical Research Council score (MRC-s) were assessed at ICU admission and discharge. Floor and ceiling effects were calculated by percentage frequency of highest and lowest scores, respectively. Results: Mean age was 55.1(19.2) years old and SAPSIII was 41.7(11.0) points. The following results are all in Table 1. Conclusion: High magnitude of ceiling effect for FIM, FSS-ICU, PFIT-s and MRC-s as well as floor effect for ICF-BMS suggest that using these tools may be insufficient to detect changes in the FS and PMS of non-intubated critically ill patients during ICU stay. Table 1. Floor and ceiling effects in FS and PMS scores at ICU admission and discharge.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Outra Agência Individuals post-stroke may present restrictive ventilatory pattern generated from changes in the functionality of respiratory system due to muscle spasticity and contractures. Objective was to assess the acute effects after respiratory muscle stretching on the ventilatory pattern and volume distribution of the chest wall in stroke subjects. Ten volunteers with right hemiparesis after stroke and a mean age of 60 ± 5.7 years were randomised into the following interventions: respiratory muscle stretching and at rest (control). The ventilatory pattern and chest wall volume distribution were evaluated through optoelectronic plethysmography before and immediately after each intervention. Respiratory muscle stretching promoted a significant acute increase of 120 mL in tidal volume, with an increase in minute ventilation, mean inspiratory flow and mean expiratory flow compared with the control group. Pulmonary ribcage increased 50 mL after stretching, with 30 mL of contribution to the right pulmonary rib cage (hemiparetic side) in comparison to the control group. Respiratory muscle stretching in patients with right hemiparesis post-stroke demonstrated that acute effects improve the expansion of the respiratory system during tidal breathing.

CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Aim: To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall tidal volume (VT,CW), breathing pattern and cough peak flow (CPF). Methods: Phase angle (θ) between upper (RCp) and lower ribcage (RCa) and abdomen (AB), as well as percentage of inspiratory time for the lower ribcage (IPRCa) and abdomen (IPAB) moving in opposite directions were quantified using optoelectronic plethysmography in 12 ALS patients during quiet breathing and coughing. Paradoxical motion of the compartments was based on threshold values of θ and IP, obtained in twelve age and sex matched healthy persons. Results: During quiet breathing, significantly higher RCa and AB θ (p

Introduction: Manual analysis of two-dimensional (2D) scintigraphy to evaluate aerosol deposition is usually subjective and has reduced sensitivity to quantify regional differences between central and distal airways. Aims: (1) To present a method to analyze 2D scans based on three-dimensional (3D)-linked anatomically consistent regions of interest (ROIs); (2) to evaluate peripheral-to-central counts ratio (P/C(2D)) and penetration indices (PIs) for a set of 16 subjects with moderate-to-severe asthma; and (3) to compare the reproducibility of this method against one with manually traced ROIs. Methods: Two-dimensional scans were analyzed using custom software that scaled onto 2D-projections' 3D anatomical features, obtained from population-averaged computed tomography (CT) chest scans. ROIs for a rectangular box (bROI) and an anatomically shaped ROI (aROI) were defined by computer and by manually tracing the standard rectangular box (manual ROI [mROI]). These ROIs were defined five nonconsecutive times for each scan and average value and variability of the P/C(2D) were estimated. Based on CT estimates of lung and airways, volumes lying under the bROI and aROI, a 2D penetration index (PI(2D)) and a 3D penetration index (PI(3D)), were defined as volume-normalized ratios of aerosol deposition in central and peripheral ROIs and in central and distal airways, respectively. Results: P/C(2D) values and their variability, were influenced by the shape and method to define the ROIs: The P/C(2D) was systematically greater and more variable for mROI versus bROI (p

OBJECTIVE: We evaluated the effects of posture, sex, and age on breathing pattern and chest wall motion during quiet breathing in healthy participants. METHODS: Eighty-three participants aged 42.72 (SD = 21.74) years presenting normal pulmonary function were evaluated by optoelectronic plethysmography in the seated, inclined (with 45° of trunk inclination), and supine positions. This method allowed to assess the chest wall in a three dimensional way considering the chest wall as three compartments: pulmonary rib cage, abdominal rib cage and abdomen. RESULTS: Posture influenced all variables of breathing pattern and chest wall motion, except respiratory rate and duty cycle. Chest wall tidal volume and minute ventilation were reduced (p

To assess the variations of end-expiratory volume of chest wall (EEVcw) measured by optoelectronic plethysmography (OEP) as a diagnostic tool in exercise-induced asthma (EIA) among asthmatic preschool children.Forty children diagnosed with asthma were included in the study. Spirometry was used as a gold standard test for comparison with OEP. A 10% decline in forced expiratory volume in 1 second was considered positive for EIA. OEP was performed with 8 cameras at a frequency of 60 Hz and 89 markers were placed on the thoraco-abdominal surface of participants. Following bronchoprovocation testing on a treadmill, series of OEP and spirometry were conducted between 5 and 30 minutes after exercise. To obtain the ideal cut-off point, a receiver operating characteristic (ROC) curve was constructed for the largest EEVcw. The highest Youden index was used as criteria to obtain the cut-off point with the best sensitivity and specificity.Of the 40 children studied, 16 had EIA. According to the ROC curve, the cut-off point of 0.185% for EEWcw provided mean sensitivity (95% confidence interval) of 93.75% (0.69-0.99), for a specificity of 83.33% (0.63-0.95), when using the largest increase in the period of 5-30 minutes post-exercise. The low area of the ROC was 0.93 (0.85-1.00) for p0.001.OEP can be accurately used to replace spirometry in asthmatic children unable to adequately execute the required manoeuvres.

Questions: In people with chronic obstructive pulmonary disease, does the Manual Diaphragm Release Technique improve diaphragmatic mobility after a single treatment, or cumulatively? Does the technique also improve exercise capacity, maximal respiratory pressures, and kinematics of the chest wall and abdomen? Design: Randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinding of participants and assessors. Participants: Twenty adults aged over 60 years with clinically stable chronic obstructive pulmonary disease. Intervention: The experimental group received six treatments with the Manual Diaphragm Release Technique on non-consecutive days within a 2-week period. The control group received sham treatments following the same regimen. Outcome measures: The primary outcome was diaphragmatic mobility, which was analysed using ultrasonography. The secondary outcomes were: the 6-minute walk test; maximal respiratory pressures; and abdominal and chest wall kinematics measured by optoelectronic plethysmography. Outcomes were measured before and after the first and sixth treatments. Results: The Manual Diaphragm Release Technique significantly improved diaphragmatic mobility over the course of treatments, with a between-group difference in cumulative improvement of 18mm (95% CI 8 to 28). The technique also significantly improved the 6-minute walk distance over the treatment course, with a between-group difference in improvement of 22 m (95% CI 11 to 32). Maximal expiratory pressure and sniff nasal inspiratory pressure both showed significant acute benefits from the technique during the first and sixth treatments, but no cumulative benefit. Inspiratory capacity estimated by optoelectronic plethysmography showed significant cumulative benefit of 330ml (95% CI 100 to 560). The effects on other outcomes were non-significant or small. Conclusion: The Manual Diaphragm Release Technique improves diaphragmatic mobility, exercise capacity and inspiratory capacity in people with chronic obstructive pulmonary disease. This technique could be considered in the management of people with chronic obstructive pulmonary disease. Trial registration: NCT02212184. [Rocha T, Souza H, Brandao DC, Rattes C, Ribeiro L, Campos SL, Aliverti A, de Andrade AD (2015) The Manual Diaphragm Release Technique improves diaphragmatic mobility, inspiratory capacity and exercise capacity in people with chronic obstructive pulmonary disease: a randomised trial. Journal of Physiotherapy 61: 182–189]

Cystic Fibrosis (CF) is a multisystem disorder. The involvement of the respiratory system is frequent and culminates in dyspnea and exercise intolerance. Functional capacity is an important diagnostic tool, because it reflects the cardiorespiratory status, quality of life and prognosis. This systematic review aims to assess the reproducibility and validity of the six minute walk test (6MWT) to reflect the functional capacity of children and adolescents with cystic fibrosis, and also the correlation between 6MWT and lung function. Searches for articles were performed in eight databases using MeSH/DeCS keywords. A total of 695 articles were found and, after verifying all eligibility criteria, six articles were included for analysis and scoring regarding the methodological quality according to the QUADAS scale (Quality Assessment of Diagnostic Accuracy Studies). All articles had good methodology (QUADAS between 9 and 11 points). The 6MWT is not correlated with lung function. There is a strong indication that the 6MWT is a reproducible test to assess the functional capacity of children and adolescents with CF. The validity assessment could not be reached because the studies included in this systematic review did not use adequate statistical tools to carry out such an evaluation.

Patients with Parkinson's disease often exhibit respiratory disorders and there are no Respiratory Therapy protocols which are suggested as interventions in Parkinson's patients. The aim of this study is to evaluate the effects of Breathing-Stacking (BS) and incentive spirometer (IS) techniques in volume variations of the chest wall in patients with Parkinson's Disease (PD). 14 patients with mild-moderate PD were included in this randomized cross-over study. Volume variations of the chest wall were assessed before, immediately after, then 15 and 30 min after BS and IS performance by optoelectronic plethysmography. Tidal volume (VT) and minute ventilation (MV) significantly increased after BS and IS techniques (p 0.05). There was greater involvement of pulmonary and abdominal compartments after IS. The results suggest that these re-expansion techniques can be performed to immediately improve volume.

Establish reference values and propose prediction equations for Maximum Respiratory Pressure- MRP and Maximal Voluntary Ventilation- MVV for healthy Brazilian population aged 20-80 years. We study 243 subjects (111 males, 45,2 ± 18,1 years, FVC: 92,1 ± 10% do pred., FEV1: 95,5 ± 11,3% pred., and 132 females, 48,2 ± 17,8 years, FVC 95,2 ± 13,6% pred., FEV1 99,1 ± 14,3% pred. All subjects were evaluated in relation to anthropometric data, physical activity level, spirometry, MRP and MVV in 3 research centers (Natal-RN, Recife-PE, Piracicaba-SP). The mean values of MRP and MVV were significantly higher in males (MIP 111,0 ± 28,0 cmH2O; MEP 149,6 ± 40,3 cmH2O; MVV 150,6 ± 35,2 L/min) when compared with females (MIP 87,9 ± 17,6 cmH2O; MEP 106,7 ± 25,2 cmH2O; MVV 103,4 ± 23,2 L/min) p

Aim: To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion (P+) in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall volume (V CW ), breathing pattern and cough peak flow (CPF). Methods: Phase shift (θ) between upper (RCp) and lower rib cage (RCa) and abdomen (AB) as well as the percentage of inspiratory time the RCa (IP RCa ) and AB (IP AB ) moved in opposite directions were quantified using optoelectronic plethysmography during quiet breathing and cough, using control data to define the normal range of movement. Results: Twelve ALS (7 males) were recruited (Age: 46±12 ;FVC %pred : 53±18; MIP %pred : 33±10; MEP %pred : 44±18.4; SNIP %pred : 39±8.4). At rest, significantly higher RCa and AB θ (p=.01), IP RCa (p AB (p=.02) were found in ALS as well as correlation between RCa and RCp θ with CPF (r=-0.582, p CW (r=0.608, p %pred (p 1 (p Conclusion: The presence of TAA and P+ in middle stage ALS indicates diaphragm impairment and increased thoracic effort. In this population, not only static respiratory function but dynamics chest wall measurements could be taken into account when monitoring disease progression.

Background: Prolonged bedridden patients are prone to both respiratory and peripheral muscle strength deficits as well as functional capacity. AIM: To verify the correlations among respiratory muscle pressures, peripheral muscle strength and functionality from critically ill bed-bound non-ventilated patients within the first 48 hours after ICU admission. Methods: A cross-sectional study with 82 patients (47 men), mean age was 57.8±19.54 years, and the following variables were analysed and correlated: maximal respiratory pressures (MIP and MEP) measured by manovacuometry, peripheral muscle strength by MRC score, hand grip strength (HGS) by dynamometry, and functionality by the Functional Independence Measure (FIM) and the Basic Mobility Scale (BMS) scales. The sample was classified by clinical and surgical characteristics and the correlations were verified through the Pearson test with p Results: MIP presented correlation with HGS (r=0.76, p Conclusion: In up to 48 hours of ICU stay, correlation of maximum respiratory pressures with hand grip strength was found and only MIP negatively and significantly correlated with the functional capacity found through BMS.

Background: Respiratory muscle function may impact dyspnea and quality of life in patients with asthma. Aim: To investigate if high-intensity home-based inspiratory muscle training (IMT) is effective in improving strength and endurance of the inspiratory muscles, functional capacity and quality of life in patients with asthma. Methods: Randomised trial. 28 patients with controlled mild-severe asthma [no smokers, 8 males, 43(13) years old] were assessed. Patients were randomised to IMT group: 5 days/week for 8 weeks with a load ≥50% of maximal inspiratory pressure-MIP adjusted weekly (PowerBreathe® K3, Hab, UK) in 6 sets of 30 breaths/day, divided into 2 sessions/day, plus two sessions of educational program or to Control group: 2 sessions of educational program only. Inspiratory endurance time, functional capacity (Incremental Shuttle Walking Test-ISWT) and quality of life (Asthma Quality of Life Questionnaire-AQLQ) were evaluated before and after interventions. ANOVA 2x2 and LSD post-hoc used for statistics (α=0.05). Results: Table shows improvements on strength, endurance and quality of life in IMT group. No differences were observed on functional capacity. Conclusions: Our data suggest that inspiratory muscle training can improve inspiratory strength and endurance, as well as quality of life in patients with asthma.