The IMT program consisted of supervised and domiciliary exercises.

1. - The supervised exercises was performed in the presence of physiotherapist. This consisted of 30 min 2 days for 4 weeks using the threshold device (Powerbreathe classic level 1, Gaiam Ltd; Southam, Warwickshire, UK). This program involve 5 sets of 5 repetitions with 30 seconds rest between each one. The load of the training was distributed as follow:

   • First week: 30% Maximum Inspiratory Pressure (MIP)
   • Second week: 40% MIP
   • Third week: 50% MIP
   • Fourth week: 60% MIP

2. - The domiciliary exercises consisted of Yoga Breathing Exercises (Pranayama) that combines the inspiration and expiration through one or both nostrils, and requires the activation of chest and abdomen

The protocol for this group is identical to the previous group with the sole difference that is added a manual therapy (MT) and a motor control exercises (MCE). The MT protocol was performed for 15min, whereas the MCE was 10min. Below it described both protocols:

1. - MT:

   • Upper cervical region mobilization in flexion
   • Lower cervical postero-anterior mobilization + maintained traction
   • Costovertebral joint postero-anterior mobilization
   • Thoracic vertebral posteroanterior mobilization
   • Thrust dorsal

2. - MCE:

   • Isometric contraction of the deep neck flexors.
   • Isometric contraction of the neck extensors.
   • Neural self-mobilization.
   • Cervical retraction with theraband.
   • Sphinx.
   • Scapular adduction exercises in prone.
   • Scapular adduction exercises in sitting position with theraband.

This protocol will be performed using the Powerbreathe classic level 1 device and Yoga Respiratory Exercises (Pranayama)

The maximum inspiratory pressure (MIP) was measured with a device called Kinetic KH1 Powerbreath (HAB International Ltd., England, UK). This device applies an inspiratory load which provides a resistance. The maneuver was performed in a sitting position. Measuring a minimum of 3 times was performed, recording the highest value.

The head posture was measured through the Cervical Range of Motion (CROM) device. This instrument measures physiological movements of the cervical spine and head position. It´s a reliable method of measuring, providing a range of intra-meter reliability from 0.7 to 0.9 and a range of inter-meter reliability from 0.8 to 0.87. The evaluator instructed the patient to sit in a standardized position and assume a natural position of the head and the goniometer was placed over his head to measure the head posture.