Reduced Functional Exercise Capacity in Post-Tuberculosis Lung Disease: A Cross-Sectional Study in Uganda

Abstract Background Post-Tuberculosis Lung Disease (PTLD) is an increasingly recognized 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 TB survivors in Kampala, Uganda. Methods We enrolled adults (≥ 18 years) within four weeks of completing treatment for pulmonary TB. All participants underwent a standardized 6MWT; suboptimal performance was defined as walking less than 400 metres. Multivariable logistic regression identified factors associated with suboptimal performance, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Between May 2024 and April 2025, 213 survivors were enrolled (median age 36 years; 48.4% female; 44.1% HIV-coinfected). 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. Conclusions 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 prioritize these vulnerable subgroups to mitigate long-term PTLD morbidity.