Reduced exercise capacity in post-tuberculosis lung disease using the six-minute walk test

Abstract

Post-tuberculosis lung disease (PTLD) is an increasingly recognised global health burden. Reduced functional exercise capacity, assessed via the six-minute walk test (6MWT), is an important yet understudied dimension of PTLD in sub-Saharan Africa. We examined the prevalence of and factors associated with suboptimal 6MWT performance among recent pulmonary tuberculosis (TB) survivors in Kampala, Uganda. We enrolled adults (≥18 years) within 4 weeks of completing treatment for pulmonary TB. All participants underwent a standardised 6MWT; suboptimal performance was defined as walking less than 400 m. Multivariable logistic regression identified factors associated with suboptimal performance, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Between May 2024 and April 2025, 213 survivors were enrolled (median age 36 years; 48.4% women; 44.1% HIV-co-infected). Female sex (aOR 3.26, 95% CI: 1.80–6.00), HIV-positive status (aOR 2.13, 95% CI: 1.13–4.07), and productive cough (aOR 2.18, 95% CI: 1.08–4.53) were associated with suboptimal performance. Age, body mass index, education, and other symptoms were not. Female sex, HIV co-infection, and productive cough are key determinants of reduced functional exercise capacity among recent TB survivors in Uganda. Post-TB rehabilitation should prioritise these vulnerable subgroups to mitigate long-term PTLD morbidity.