The aim of this study was to verify the influence of physical and respiratory muscular training (PT/RMT), associated to the use of noninvasive mechanical ventilation (NMV) through the bilevel positive airway pressure (biPAP), on maximal inspiratory and expiratory pressure (MIP and MEP), walk distance (WD) and Borg scale (BS) during the 6-minute walk distance (6MWD) and test of effort (TE) to evaluate all the treatment. 24 patients with severe COPD (FEV1 < 40%) were included, clinically stable and with dyspnea to physical effort. They were randomized in 4 groups of 6 patients, named: G1, accomplishing PT and RMT associated to biPAP; G2, accomplishing PT associated to biPAP; G3, accomplishing RMT and biPAP; and G4, accomplishing biPAP only for 30 minutes, in a medium pressure level set in 12 cmH2O to inspiration and 4 cmH2O to expiration. The treatment occurred in one-hour duration sessions, three times a week, with duration of 6 consecutive weeks. The TF took place on treadmill for 30 minutes with intensity of 80% of the maximal heart rate (HR) obtained during the TE. The RMT was accomplished with load of 40% of the MIP. A significant increase (test t p <= 0.05) of the MIP and MEP was verified for the groups G1 and G3, and for G1 and G2 there was a WD increase in the 6MWD, with a BS decrease for the group 4. In relation to TE, a significant WD increase for the groups G1, G2, G3 was noticed. Although significant BS and WD alterations in all the groups have not been observed, a biggest tolerance to physical exercise and respiratory muscular force were noticed when techniques were used all together.

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