Rehabilitacion (Madr). 2026 Jun 9;60(3):100992. doi: 10.1016/j.rh.2026.100992. Online ahead of print.
ABSTRACT
INTRODCTION: Dyspnea and other exertional symptoms are cornerstone elements in clinical practice, essential for diagnostic processes, risk stratification, and the effective management of respiratory diseases.
OBJECTIVES: To investigate the intensity of dyspnea and leg discomfort during physical exercise and their relationships with multi-organ functional variables.
METHODS: A multicenter study involving 948 adult patients evaluated via integrated cardiopulmonary exercise testing (CPET).
RESULTS: Dyspnea at peak exercise showed a mean value of 6.1±3.1 and a median of 7 (IQR, 5). Leg discomfort presented a mean value of 6.3±3.1 and a median of 7 (IQR, 5). Symptoms of dyspnea and leg discomfort reached maximal intensity (i.e., 10 points) in 23% and 30% of patients, respectively, while the remaining participants exhibited submaximal symptom levels. Four phenotypes were identified at peak exercise: paucisymptomatic, peripheral, mixed, and dyspneic. These phenotypes were associated with a sequential and progressive impairment of peak work rate (W) and peak oxygen consumption (VO), initially exhibiting a bimodal trend for leg discomfort and a subsequent linear inverse relationship with dyspnea.
CONCLUSIONS: Four distinct phenotypes exist based on predominant exertional symptoms: paucisymptomatic, peripheral, mixed, and dyspneic. These are sequentially associated with increasingly severe grades of functional impairment. These findings warrant the orientation of rehabilitation strategies toward the specific limiting system predominantly responsible for the symptoms, thereby enhancing the therapeutic value of the intervention.
PMID:42263328 | DOI:10.1016/j.rh.2026.100992