In 552 hospitalized HF patients aged ≥65 years, the study examined whether maximal inspiratory pressure (PImax) — a measure of respiratory muscle strength — is independently associated with 6-minute walking distance (6MWD) and whether it adds predictive value beyond the Short Physical Performance Battery (SPPB) for identifying exercise intolerance (6MWD <300 m).
PImax was independently linked to 6MWD (coefficient +5.622 m per 5 cmH₂O increase, 95% CI 4.135–7.109, P<0.001), regardless of lower-extremity function status. Adding PImax to SPPB modestly improved prediction of exercise intolerance (AUC 0.886 → 0.909, P=0.005).
Single-center or registry-based inpatient cohort limits generalizability to outpatient or community-dwelling HF populations. HF subtype (HFpEF vs. HFrEF) stratification of the primary result is not reported. The cross-sectional design precludes causal inference or assessment of whether improving PImax changes exercise outcomes.
Consider measuring PImax alongside SPPB when assessing exercise tolerance in older, hospitalized HF patients — especially when lower-extremity function appears preserved but exercise intolerance persists. Weak inspiratory muscles may be an additional, actionable rehabilitation target in this population.
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