¿Cuánto tiempo de oclusión es necesario para evaluar la presión inspiratoria máxima por el método de la válvula espiratoria unidireccional en sujetos sin vía aérea artificial?

O objetivo desse estudo foi determinar o tempo de oclusão necessário para avaliar a pressão inspiratória máxima (PIMáx) obtida pelo método da válvula expiratória unidirecional em sujeitos sem via aérea artificial. Foram avaliados 31 sujeitos, com idade entre 18 e 60 anos. A PIMáx foi avaliada pelo método convencional (PIMáxconv) e pelo método da válvula expiratória unidirecional (PIMáxuni), sendo a ordem de avaliação definida por meio de sorteio. Para a medida da PIMáxuni, um manovacuômetro digital foi acoplado a uma válvula expiratória unidirecional e máscara orofacial por 20 segundos de oclusão. Nesse período, todos os sujeitos foram encorajados a realizar esforços inspiratórios máximos. Para definir a ótima duração da manobra, o tempo de esforço foi dividido a cada intervalo de 5 segundos (0-5s, 0-10s, 0-15s, 0-20s). Os intervalos de tempo para obtenção da PIMáxuni foram comparados por meio do teste de ANOVA One-way. Para comparação das médias dos valores de PIMáxconv e PIMáxuni, foi utilizado o teste t de Student. O nível de significância foi de 5%. A média dos valores da PIMáxconv foi de -102,5±23,9 cmH2 O, enquanto que a PIMáxuni foi de -117,3±24,8 cmH2 O (p<0,001). O valor absoluto máximo da PIMáxuni foi alcançado dentro do intervalo de 0-20 segundos, que foi significativamente superior ao valor absoluto máximo obtido nos primeiros 5 segundos (p=0,036). O tempo de oclusão necessário para avaliar a PIMáx pelo método da válvula expiratória unidirecional em sujeitos colaborativos sem via aérea artificial deve ser de pelo menos 20 segundos.The aim of this study was to determine how much occlusion time is necessary to obtain maximal inspiratory pressure (MIP) by the unidirectional expiratory valve method in subjects without artificial airway. Thirty-one subjects aged 18-60 years were evaluated. MIP was evaluated by the standard method (MIPstan) and by the unidirectional expiratory valve method MIPuni, with the order of evaluation determined randomly by lot. For MIPuni measurement, a digital vacuum manometer was attached to a unidirectional expiratory valve and an orofacial mask for 20 seconds of occlusion. During this period, all subjects were encouraged to make maximal respiratory efforts. To define the optimum duration of the maneuver, the 20 seconds of effort were partitioned at every five-second interval (0-5s, 0-10s, 0-15s, 0-20s). The time intervals for obtaining MIPuni were compared with the one-way ANOVA test. The mean values of the standard method and the unidirectional expiratory valve method were compared using the paired Student’s t-test. The significance level was established at 5%. The mean values for the MIPstan (-102.5±23.9 cmH2O) presented a statistically significant difference as compared to the mean values for MIPuni (-117.3±24.8 cmH2O; p<0.001). Maximal peak values for MIPuni were achieved within the 20-second time window, which differed significantly from the peak values obtained during the first five seconds (p=0.036). The occlusion time necessary to record MIP by the unidirectional expiratory valve method in collaborative subjects without artificial airway should be of at least 20 seconds

Comparison between the measures of thoracoabdominal cirtometry in supine and standing

Con el objetivo de evaluar posibles diferencias en los valores obtenidos en la realización de la cirtometría tóraco-abdominal en ortostatismo comparados con los resultados medidos en decúbito dorsal, fueron evaluados 30 participantes con media de edad de 27,8±4,4 años, por medio de los siguientes parámetros: antropometría, prueba de función pulmonar y movilidad tóraco-abdominal por la cirtometría. El test de Shapiro-Wilk fue utilizado para verificar la normalidad de los datos y el test t pareado para la comparación entre las mediciones obtenidas por la cirtometría tóraco-abdominal en decúbito dorsal y en ortostatismo. No hubo diferencias significativas en la movilidad axilar y xifoidea entre las medidas en decúbito dorsal y ortostatismo. La movilidad abdominal medida en ortostatismo (2,54±1,39 cm) fue significativamente menor (34,35%) en comparación a la movilidad obtenida en decúbito dorsal (3,71±1,78 cm; pCom o objetivo de avaliar possíveis diferenças nos valores obtidos na realização da cirtometria tóraco-abdominal em ortostatismo comparado com os resultados aferidos em decúbito dorsal, foram avaliados 30 participantes com média de idade de 27,8±4,4 anos, por meio dos seguintes parâmetros: antropometria, prova de função pulmonar e mobilidade tóraco-abdominal pela cirtometria. O teste de Shapiro-Wilk foi utilizado para verificar a normalidade dos dados e o teste t pareado para a comparação entre as mensurações obtidas pela cirtometria tóraco-abdominal em decúbito dorsal e em ortostatismo. Não houve diferenças significativas na mobilidade axilar e xifoidea entre as medidas em decúbito dorsal e ortostatismo. A mobilidade abdominal mensurada em ortostatismo (2,54±1,39 cm) foi significativamente menor (34,35%) em comparação à mobilidade obtida em decúbito dorsal (3,71±1,78 cm; pWith the objective to evaluate possible differences in the values obtained in the thoracoabdominal cirtometry in orthostatism compared with the results in supine, 30 subjects with mean age 27.8±4.4 years were evaluated according to the following parameters: anthropometry, pulmonary function test and thocacoabdominal cirtometry. Shapiro-Wilk test was used to verify data normality and the t test was performed in order to compare the thoracoabdominal cirtometry measurements in supine and in orthostatism positions. There were no significant differences in axillar and xiphoid mobility between measurements obtained in supine and orthostatism. The abdominal mobility measured in orthostatism (2.54±1.39 cm) was significantly lower (34.35%) when compared to the mobility obtained in supine (3.71±1.78 cm;

Exercício em pacientes oncológicos: reabilitação

Este estudo revisou artigos nas bases de dados do MEDLINE (Pub-Med) e outras fontes de pesquisa, sem limite de tempo. Para tanto, adotou-se a estratégia de busca baseada em perguntas estruturadas na forma (P.I.C.O.) das iniciais: "Paciente"; "Intervençao"; "Controle" e "Outcome". Como descritores utilizaram-se:(Neoplasms OR Carcinogens OR Tumors OR Cancer) AND (Fatigue OR Asthenia OR Lassitude OR Muscle Fatigue OR Fatigue OR Muscles OR specific muscle OR Mental Fatigue OR Fatigue, Mental OR Cancer-related fatigue) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance); (Neoplasms OR Carcinogens OR Tumors OR Cancer) AND (Fatigue OR Asthenia OR Lassitude OR Muscle Fatigue OR Fatigue OR Muscles OR Specific Muscle OR Mental Fatigue OR Fatigue, Mental OR Cancer-related Fatigue) AND (Chemotherapy, Adjuvant OR Combined Modality Therapy OR Drug Therapy,combination OR Antineoplastic Combined Chemotherapy Protocols) AND (Exercise Tolerance OR Oxigen Consumption* OR Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Physical Fitness OR Physical Conditioning OR Physical Endurance); (Neoplasms OR Carcinogens OR Tumors OR Cancer) AND (Fatigue OR Asthenia OR Lassitude OR Muscle Fatigue OR Fatigue OR Muscles OR specific muscle OR Mental Fatigue OR Fatigue, Mental OR cancer-related fatigue) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance OR Intensity exercise); (Neoplasms OR Carcinogens OR Tumors OR Cancer) AND (Fatigue OR Asthenia OR Lassitude OR Muscle Fatigue OR Cancer-related fatigue) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance); Neoplasm AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance) AND Quality of Life ; (Bone Neoplasms OR Neoplasms Metastasis) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance) AND (Fracture Bone OR Fractures, Bone) AND (Exercise OR Physical Therapy) AND Fracture AND Neoplasm; (Bone Neoplasms OR Neoplasms Metastasis) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance) AND (Fracture Bone OR Fractures, Bone) AND (Exercise OR Physical Therapy) AND Fracture AND Neoplasm; (Neoplasms OR Carcinogens OR Tumor OR Cancer) AND (Signs and Symptoms Respiratory OR Dyspnea) AND (Breathing Exercise OR Exercise Therapy); (Neoplasms OR Carcinogens OR Tumor OR Cancer) AND (Oxygen Inhalation Therapy OR Positive Pressure Respiration OR PEEP); Neoplasms OR Cancer OR Tumor OR Carcinogens AND Terminally ill OR Terminal Care OR Palliative Care AND Oxygen Inhalation Therapy; Neoplasm AND (Muscle OR Muscle Strength OR Muscle Weakness OR Cachexia) AND (Androgens OR Anabolic Agents OR Nandrolone OR Oxandrolone) AND (Exercise OR Physical Therapy OR Rehabilitation); (Anthracyclines OR Trastuzumab OR Ciclofosfamide) AND (Physical Activity OR Exercise) AND (Cardiotoxicity); Neoplasm AND Thrombocytopenia AND (Exercise OR Rehabilitation OR Physical Therapy). Analisado esse material, selecionou-se os artigos relativos às perguntas e, por meio do estudo dos mesmos, originou-se as evidências que fundamentaram as diretrizes do presente documento.This study revised articles from the MEDLINE (PubMed) databases and other research sources, with no time limit. To do so, the search strategy adopted was based on (P.I.C.O.) structured questions (from the initials "Patient"; "Intervention"; "Control" and "Outcome". As keywords were used: (Neoplasms OR Carcinogens OR Tumors OR Cancer) AND (Fatigue OR Asthenia OR Lassitude OR Muscle Fatigue OR Fatigue OR Muscles OR specific muscle OR Mental Fatigue OR Fatigue, Mental OR Cancer-related fatigue) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance); (Neoplasms OR Carcinogens OR Tumors OR Cancer) AND (Fatigue OR Asthenia OR Lassitude OR Muscle Fatigue OR Fatigue OR Muscles OR Specific Muscle OR Mental Fatigue OR Fatigue, Mental OR Cancer-related Fatigue) AND (Chemotherapy, Adjuvant OR Combined Modality Therapy OR Drug Therapy,combination OR Antineoplastic Combined Chemotherapy Protocols) AND (Exercise Tolerance OR Oxigen Consumption* OR Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Physical Fitness OR Physical Conditioning OR Physical Endurance); (Neoplasms OR Carcinogens OR Tumors OR Cancer) AND (Fatigue OR Asthenia OR Lassitude OR Muscle Fatigue OR Fatigue OR Muscles OR specific muscle OR Mental Fatigue OR Fatigue, Mental OR cancer-related fatigue) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance OR Intensity exercise); (Neoplasms OR Carcinogens OR Tumors OR Cancer) AND (Fatigue OR Asthenia OR Lassitude OR Muscle Fatigue OR Cancer-related fatigue) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance); Neoplasm AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance) AND Quality of Life ; (Bone Neoplasms OR Neoplasms Metastasis) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance) AND (Fracture Bone OR Fractures, Bone) AND (Exercise OR Physical Therapy) AND Fracture AND Neoplasm; (Bone Neoplasms OR Neoplasms Metastasis) AND (Exercise OR Physical Fitness OR Exertion OR Exercise Therapy OR Sports OR Exercise Movement Techniques OR Physical Fitness OR Physical Conditioning OR Physical Endurance) AND (Fracture Bone OR Fractures, Bone) AND (Exercise OR Physical Therapy) AND Fracture AND Neoplasm; (Neoplasms OR Carcinogens OR Tumor OR Cancer) AND (Signs and Symptoms Respiratory OR Dyspnea) AND (Breathing Exercise OR Exercise Therapy); (Neoplasms OR Carcinogens OR Tumor OR Cancer) AND (Oxygen Inhalation Therapy OR Positive Pressure Respiration OR PEEP) ; Neoplasms OR Cancer OR Tumor OR Carcinogens AND Terminally ill OR Terminal Care OR Palliative Care AND Oxygen Inhalation Therapy; Neoplasm AND (Muscle OR Muscle Strength OR Muscle Weakness OR Cachexia) AND (Androgens OR Anabolic Agents OR Nandrolone OR Oxandrolone) AND (Exercise OR Physical Therapy OR Rehabilitation); (Anthracyclines OR Trastuzumab OR Ciclofosfamide) AND (Physical Activity OR Exercise) AND (Cardiotoxicity); Neoplasm AND Thrombocytopenia AND (Exercise OR Rehabilitation OR Physical Therapy). With the above keywords crossings were performed according to the proposed theme in each topic of the (P.I.C.O.) questions. After analyzing this material, articles regarding the questions were selected and, by studying those, the evidences that fundamented the directives of this document were established

Physiotherapy Care of Patients with Coronavirus Disease 2019 (COVID-19) - A Brazilian Experience

Some patients with coronavirus disease (COVID-19) present with severe acute respiratory syndrome, which causes multiple organ dysfunction, besides dysfunction of the respiratory system, that requires invasive procedures. On the basis of the opinions of front-line experts and a review of the relevant literature on several topics, we proposed clinical practice recommendations on the following aspects for physiotherapists facing challenges in treating patients and containing virus spread: 1. personal protective equipment, 2. conventional chest physiotherapy, 3. exercise and early mobilization, 4. oxygen therapy, 5. nebulizer treatment, 6. noninvasive ventilation and high-flow nasal oxygen, 7. endotracheal intubation, 8. protective mechanical ventilation, 9. management of mechanical ventilation in severe and refractory cases of hypoxemia, 10. prone positioning, 11. cuff pressure, 12. tube and nasotracheal suction, 13. humidifier use for ventilated patients, 14. methods of weaning ventilated patients and extubation, and 15. equipment and hand hygiene. These recommendations can serve as clinical practice guidelines for physiotherapists. This article details the development of guidelines on these aspects for physiotherapy of patients with COVID-19

Diaphragm mobility in COPD patients: ultrasound assessment of the craniocaudal displacement of the left branch of the portal vein

O objetivo desse estudo foi avaliar a relação da mobilidade diafragmática com a função pulmonar e a força muscular respiratória em indivíduos com DPOC, utilizando a mensuração ultra-sonográfica do deslocamento crânio-caudal do ramo esquerdo da veia porta. Foram estudados 54 pacientes portadores de DPOC com hiperinsuflação pulmonar e 20 sujeitos saudáveis. Os parâmetros avaliados foram: mobilidade diafragmática, função pulmonar e as pressões respiratórias máximas. Pacientes com DPOC apresentaram menor mobilidade do diafragma (36,46 ± 10,90 mm) quando comparados a indivíduos saudáveis (46,33 ± 9,47) (p = 0,001). Nos indivíduos portadores de DPOC foram verificadas uma forte correlação com os parâmetros da função pulmonar que quantificam o aprisionamento de ar (VR: r = -0,60; p < 0,001; VR/CPT: r = -0,72; p < 0,001), uma moderada correlação com a obstrução de vias aéreas (VEF1: r = 0,55, p < 0,001; resistência das vias aéreas: r = -0,32, p = 0,02) e uma fraca correlação com a hiperinsuflação pulmonar (CPT: r = -0,28, p = 0,04). Não foi observada relação entre a mobilidade do diafragma e a força muscular respiratória (PImax: r = -0,11 e p = 0,43; PEmax: r = 0,03 e p = 0,80). Nossos resultados sugerem que a redução da mobilidade do diafragma em pacientes com DPOC ocorre principalmente devido ao aprisionamento de ar, não sendo influenciada pela hiperinsuflação pulmonar ou pela força muscular respiratória.The purpose of this study was to use ultrasound to measure the craniocaudal displacement of the left branch of the portal vein in order to evaluate the relationship between pulmonary function and diaphragm mobility, as well as that between respiratory muscle strength and diaphragm mobility, in COPD patients. We studied 54 COPD patients with pulmonary hyperinflation, together with 20 healthy subjects. Pulmonary function, maximal respiratory pressures, and diaphragm mobility were evaluated. COPD patients presented less diaphragm mobility than did healthy individuals (36.46 +/- 10.90 mm vs. 46.33 +/- 9.47 mm, respectively) (p = 0.001). In COPD patients, we found that diaphragm mobility correlated strongly with pulmonary function parameters that quantify air trapping (RV: r = -0.60; p < 0.001; RV/TLC: r = -0.76; p < 0.001), moderately with airway obstruction (FEV1: r = 0.55, p < 0.001; airway resistance: r = -0.32, p = 0.02), and weakly with pulmonary hyperinflation (TLC: r = -0.28, p = 0.04). No relationship was observed between diaphragm mobility and respiratory muscle strength (maximal inspiratory pressure: r = -0.11 and p = 0.43; maximal expiratory pressure: r = 0.03 and p = 0.80). The results of this study suggest that the reduction in diaphragm mobility in COPD patients occurs mainly due to air trapping and is not influenced by respiratory muscle strength or pulmonary hyperinflation

Effects of a short-term diaphragmatic breathing program on respiratory mechanics and functional capacity of COPD patients: a randomized controlled trial

Introdução: As alterações da mecânica diafragmática e a alta atividade dos músculos da caixa torácica estão associadas com maior sensação de dispnéia em pacientes com DPOC. Tem sido demonstrado que a respiração diafragmática (RD) aumenta a mobilidade abdominal durante o padrão diafragmático voluntário, porém, até o presente momento, nenhum estudo investigou as mudanças na mobilidade abdominal adotadas naturalmente. O objetivo desse estudo foi investigar os efeitos de um programa de treinamento de respiração diafragmática (PTRD) na mobilidade tóraco-abdominal, mobilidade diafragmática e capacidade funcional de pacientes com DPOC. Método: Trinta pacientes com DPOC (VEF1 42 +/- 13% do predito) foram alocados aleatoriamente para o grupo treinamento (GT) ou grupo controle (GC). O GT completou um PTRD supervisionado de 4 semanas (3 sessões semanais individualizadas). A efetividade do treinamento foi avaliada por meio da mensuração da relação da amplitude de movimento da caixa torácica pelo abdômen (CT/ABD; variável primária) e da mobilidade diafragmática (variável secundária). A relação CT/ABD foi quantificada utilizando a pletismografia respiratória por indutância durante RD voluntária e respiração natural (RN) e a mobilidade diafragmática foi determinada por avaliação ultra-sonográfica. O teste de caminhada em 6 minutos (TC6min) e os fatores de saúde relacionados à qualidade de vida (FSRQV) também foram avaliados. Resultados: Apenas os pacientes do GT apresentaram uma melhora na mobilidade diafragmática (18,8%) e uma redução na relação CT/ABD durante RN (26,1%) e RD voluntária (28,3%), sugerindo que a mobilidade abdominal aumentou em ambas as condições. Também foram observadas melhoras no TC6min e nos FSRQV no GT. Não foi observada diferença no GC para nenhuma variável mensurada. Conclusões: O PTRD para pacientes com DPOC induziu um aumento do recrutamento diafragmático durante a respiração natural resultando em melhora da capacidade funcionalBackground: Impairment of diaphragm mechanics and enhanced activity of the chest wall muscles are associated with increased dyspnea in COPD patients. Diaphragmatic breathing (DB) has been suggested to improve abdominal motion but only during voluntarily DB, and no controlled studies have investigated the naturally adopted change in abdominal motion. The aim of this study was to investigate the effects of a diaphragmatic breathing training program (DBTP) on thoracoabdominal motion, diaphragmatic mobility and functional capacity in COPD patients. Methods: Thirty subjects (FEV1 42+/-13% predicted) were randomly allocated to either training (TG) or control group (CG). TG completed a 4-week supervised DBTP (3 individualized weekly sessions). Effectiveness was assessed by amplitude of the rib cage to abdominal motion ratio (RC/ABD ratio; primary outcome) and diaphragmatic mobility (secondary outcome). The RC/ABD ratio was measured using respiratory inductive plethysmography during voluntarily DB and natural breathing (NB). Diaphragmatic mobility was measured by ultrasonography. A 6-minute walk test (6MWT) and health-related quality of life (HRQoL) were also evaluated. Results: Only COPD patients from the TG demonstrated an improvement in diaphragmatic mobility (18.8%) and a reduction of the RC/ABD ratio during both NB (26.1%) and voluntarily DB (28.3%), suggesting that the abdominal motion improved in both conditions. An improvement in the 6MWT and in HRQoL was also observed in the TG. No differences were found in the CG for any measured outcome. Conclusions: We concluded that DBTP for COPD patients induced increased diaphragm recruitment during natural breathing resulting in an improvement in functional capacit

Six-minute stepper test in hospitalized elderly patients: Convergent validity, test-retest reliability and safety.

ObjectiveTo evaluate the convergent validity of the six-minute stepper test (6MST) with the variables used in the diagnosis of sarcopenia (appendicular muscle mass, handgrip strength and six-meter gait speed test), as well as to evaluate test-retest reliability and safety when applied to hospitalized elderly patients. Finally, we aimed to compare the performance in the 6MST between hospitalized elderly patients and healthy elderly from the community.Materials and methodsObservational and cross-sectional study. Elderly patients admitted to a private hospital and healthy elderly from the community were recruited. On the first day, the patients included underwent the following assessments: anthropometric, handgrip strength (HGS), six-meter gait speed test (6GST) and 6MST. On the second day, before breakfast, patients underwent body composition assessment. The healthy elderly were evaluated on a single day and performed only anthropometric assessment and 6MST.Results30 hospitalized patients (age 71.0±7.9 years) and 15 healthy elderly (age 68.1±5.8 years) were included. There was a high correlation of 6MST with 6GST (r = 0.78; pConclusion6MST showed convergent validity with the functional variables used in the diagnosis of sarcopenia. In addition, excellent test-retest reliability was observed, which indicates the need for a single assessment in hospitalized elderly patients. The prevalence of adverse events during the application of the test is low, without resulting in clinical symptoms; therefore, the test is considered safe for this population. In addition, hospitalized elderly patients perform worse in the 6MST compared to healthy elderly from the community

The phase angle cut-off point capable of discriminating hemodialysis patients with reduced exercise tolerance: a cross-sectional study

Abstract Background Phase angle (PhA) is a prognostic marker of all-cause mortality in chronic kidney disease. However, no study has investigated this marker as a predictor of exercise intolerance in hemodialysis (HD) patients. The aim of this study was to determine a cut-off point for the PhA capable of discriminating HD patients with reduced exercise tolerance. Methods Thirty-one patients (80.6% men, median age 69 years) were included. The evaluations were performed on three different days, before the HD session. The outcomes evaluated were: biochemical markers, inflammatory and nutritional status, body composition, peripheral muscle strength and exercise tolerance. Performance ≤50% of the predicted value in the six-minute step test (6MST) was defined as reduced exercise tolerance. Results Patients presented an average of 67.6 steps (50.5% of predicted) in the 6MST. Fifteen patients (48.4%) were classified with reduced exercise tolerance. The receiver operating characteristic curve indicated a cut-off point of 3.73° for the PhA (sensitivity = 87%, specificity = 81%, and area under the curve = 0.88 [95% CI: 0.76–1.00]; p < 0.001). Patients with reduced exercise tolerance had worse inflammatory and nutritional status, lower PhA and greater impairment of peripheral muscle strength. Conclusion The cut-off point of 3.73° for the PhA is sensitive and specific to discriminate HD patients with reduced exercise tolerance. Trial registration This study was registered in the Clinical Trials database (no. NCT03779126, date of first registration 19/12/2018)