Functional Thresholds Derived from Dynamometry and 6-Minute Walk Test with Morphofunctional Assessment to Guide Individualized Exercise Prescription in Cardiac Rehabilitation.

Background/Objectives: To evaluate the associations and concurrent validity between baseline functional and morphofunctional assessments in patients with cardiovascular disease participating in a Phase II cardiac rehabilitation program, as a basis for informing individualized exercise prescription. Methods: We conducted an observational retrospective cross-sectional study of patients enrolled in a Phase II outpatient cardiac rehabilitation program (January 2021-December 2023, Málaga). Functional assessments included handgrip strength (HGS), isometric biceps and quadriceps dynamometry, and direct assessment of 20-repetition maximum (20RM) through dynamic resistance exercises using external loads (defined as the maximum load allowing approximately 20 repetitions to near muscular fatigue). Aerobic capacity was evaluated using the 6-min walk test (6 MWT) and a modified Bruce exercise stress test with estimated METs. Morphofunctional assessment included vector bioimpedance analysis (phase angle [PhA], fat-free mass [FFM], body cell mass [BCM]) and rectus femoris ultrasound (cross-sectional area [RF-CSA] and contracted diameter [RF-CON]). Correlation and linear regression analyses were performed. Results: The sample included 223 participants (78.0% male; age 57.7 ± 8.6 years). HGSmax correlated strongly with 20RM biceps (r = 0.89) and moderately with quadriceps (r = 0.72). 6 MWT distance and speed correlated with ergometry-derived METs (r = 0.38-0.40; p < 0.001), whereas Borg ratings correlated inversely with METs and exercise time (r = -0.32 to -0.34; p < 0.001). PhA, BCM, FFM, and rectus femoris ultrasound measures correlated with both strength and aerobic outcomes (ρ ≈ 0.33-0.50; all p < 0.001). In regression analyses, HGSmax was the main predictor of 20RM biceps (R2 = 0.792) and showed moderate predictive capacity for quadriceps performance (R2 = 0.521). The MET model demonstrated limited explanatory capacity (R2 = 0.288). Conclusions: The integration of simple, accessible, and reproducible tools such as HGS and the 6 MWT with morphofunctional parameters may provide a pragmatic approach to support individualized exercise prescription in cardiac rehabilitation. While stronger associations were observed for upper-limb resistance performance, the predictive capacity for lower-limb strength and aerobic exercise intensity was more moderate and should be interpreted cautiously. These findings support the potential clinical utility of combining functional and morphofunctional assessments in routine cardiac rehabilitation practice.