The objective of this study was to verify self-care guidelines together with lower limb home exercises alter ankle and foot plantar pressure and alignment in patient with Type 2 Diabetes Mellitus (DM) measuring health and sociodemographic factors. The health factors analyzed were sensitivity and circulation aspects, risk rating, and neuropathy symptom score, ankle and foot alignment (photogrammetry), plantar pressures, and postural stability (baropodometry) before and after administering these guidelines and home exercises in 97 patients type 2 DM during 10 months. The self-care guidelines and exercises changed the forefoot alignment (Right Foot – Initial vs Final, p = 0.04; Left Foot, P<0.01), the center of the force displacement in the mediolateral (Right Foot - Initial versus Final, p = 0.02; Left Foot, P<0.01), and the anterior-posterior (Right foot - Initial versus Final, p = 0.01) direction, and body balance (Initial versus Final, p = 0.02). There was no change in the remaining assessed parameters. Self-care associated with the guidelines for home exercises for the lower limbs in patients with type 2 DM are effective in maintaining and improving the alignment of the feet, mediolateral stability and prevention of complications.Trial RegistrationThe Brazilian Clinical Trials Registry RBR-8854CD

Introduction and Objective: Maximal inspiratory and expiratory pressures (PI max and PE max ) are used to assess the integrity of respiratory muscles by measuring their strength. The aim of this study was to assess the immediate influence of hemodialysis (HD) on respiratory muscle strength by measuring PI max and PE max , investigating the integrity of that musculature and/or the presence of muscular weakness. Method: A prospective, crosssectional study was carried out on a convenience sample of 35 patients with chronic kidney disease (26 men and 9 women; mean age, 51.7 ± 14.7 years) at the Nephrology Division of the Hospital Universitário Alzira Vellano, in the city of Alfenas, in the state of Minas Gerais, Brazil. Patients had their PI max and PE max taken in the seated position (at 90°) by using a digital manovacuometer (MVD 300®) attached to a notebook for reading and recording data obtained before and after the HD session. Results: Both PI max and PE max were lower than the values predicted for pre-and post-HD (p < 0.0001). Comparing the values obtained pre-HD and post-HD, PImax showed a slight improvement (p = 0.0420), evidenced only in patients with pre-HD values below 60 cmH 2 O (Wilcoxon; p = 0.0480). Post-HD PE max did not differ from the pre-HD measure (p = 0.4987). Conclusion: The CKD patients showed a serious impairment of their respiratory muscle function, and only one isolated HD session could not significantly improve their maximum respiratory pressures. A slight improvement in the inspiratory strength was observed in patients whose PI max was lower than 60 cm-H 2 O before the procedure.

A fraqueza da musculatura respiratória é a principal respon¬sável por insuficiência respiratória na Distrofia Muscular de Duchenne (DMD). Objetivo. Avaliar os efeitos do treinamento muscular inspi­ratório na força respiratória de pacientes com DMD. Método. Série de casos com cinco crianças portadoras da DMD, idade de 11,4±2,6 anos, avaliados pela Manovacuometria e Pico de Fluxo Expiratório (PFE) nos momentos inicial (basal), quinta e décima sessão. Realizou­-se treino muscular inspiratório, com 30% da PImáx em dispositivo de carga linear (Threshold®), com cinco séries de 10 repetições, totali­zando 10 sessões, três vezes por semana. Resultados. Valores médios inicial, quinta e décima sessão, respectivamente: PImax (cmH2O): -64, -69,8 e -86,8 (p=0,006) melhora de 29% inicial para 10 sessões; PEmax (cmH2O): 64, 67 e 73,6 (p=0,003) melhora de 25% inicial para 10 sessões e PFE (L/min): 210, 218 e 232 (p=0,012) melhora de 9% inicial para 10 sessões. Conclusão. O programa de treinamento muscular inspiratório proposto mostrou-se eficaz tanto no ganho de força inspiratória quanto expiratória, proporcionando também o au­mento do pico de fluxo expiratório.