Table of ContentsView AllTable of ContentsSigns and SymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Signs and Symptoms
Causes
Diagnosis
Treatment
Exercise intolerance (EI) is the reduced capacity or inability of someone’s body to perform physical activities typical for their age. People with exercise intolerance often experience debilitating fatigue when they engage inmoderate-to-vigorous physical activity, but EI can also prevent people from doing light exercise and everyday activities. Although various medical conditions can cause exercise intolerance, it is the primary symptom ofdiastolic heart failure.
This article discusses the signs, symptoms, and causes of exercise intolerance. It also covers how the inability to engage in physical activity due to exercise intolerance is diagnosed and treated.
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Post-exertional malaise(PEM) and severe exhaustion are the most common symptoms of exercise intolerance. People with EI typically experience a feeling of tiredness and shortness of breath when they engage in physical exercise of any intensity, including mild exertion during everyday activities.
In those who experience disproportionate fatigue to the energy exerted during physical activity, exercise triggers what scientists call post-exertional exacerbation of fatigue.This term refers to people with exercise intolerance experiencing a “crash” in their energy levels after engaging in physical activity.
Below are some typical signs and symptoms of exercise intolerance:
Left-sided heart failureis a leading cause of exercise intolerance.However, any medical condition that prevents oxygen-rich blood from being delivered to working muscles during physical activity (likemitochondiral diseasesor metabolic disorders) can cause exercise intolerance.
For example,respiratory conditionssuch as chronic obstructive pulmonary disease (COPD),asthma,emphysema,and other chroniclung diseasesthat reduce someone’s ability to take deep breaths significantly reduce the amount of oxygen available to fuel muscle contractions.
People withchronic fatigue syndrome(ME/CFS) are prone to exercise intolerance. This condition is also calledsystemic exertion intolerance disease(SEID). As the name suggests, chronic fatigue and “exertion intolerance” make it extremely challenging for people with ME/CFS or SEID to perform strenuous activities. Even mild exertion levels can make symptoms worse.
Although researchers aren’t completely sure why ME/CFS and SEID cause severe exercise intolerance, a 2019 Norwegian study found thatchronic fatigue syndromeis associated with abnormal blood lactate accumulation during physical activity, significantly reducing exercise tolerance.
The SARS-CoV-2 (COVID-19) virus can also cause exercise intolerance. An October 2022 systematic review and meta-analysis found that among those withlong COVIDsymptoms, exercise capacity was significantly reduced more than three months after SARS-CoV-2 infection.
Cardiopulmonary exercise testing (CPET), also known as VO2 (maximal oxygen consumption) testing, is a highly effective way to assessaerobic capacityand to measure how someone’s body responds to physical activity at varying intensities.
CPET is used to diagnose exercise intolerance. In addition to quantifying someone’s exercise tolerance, non-invasive cardiopulmonary exercise testing can identify which of multiple medical conditions are causing exercise intolerance alone or in combination.
Cardiac stress testsare a common in-office diagnostic tool that uses an electrocardiogram (ECG) to assess how the heart responds to physical activity. These cardiac exercise tests are non-invasive and don’t require any injections, but they don’t provide a window into the inner workings of the heart.
Anuclear stress testis more advanced than a cardiac stress test. It lets your healthcare provider see what’s happening inside your heart during exercise using different imaging technologies (e.g.,PET scan,SPECT scan, myocardial perfusion imaging). They inject trace amounts of radioactive material that the machines look for to see how the heart is functioning.
Other exercise tolerance tests (ETT) include:
Summary
A Word From Verywell
Before you start beating yourself up or blaming your inability to exercise on a “lack of willpower,” talk to a healthcare provider about the debilitating symptoms you experience during or after physical activity. Once you’ve treated the issue that makes exercise so unbearable, daily physical activity can be you feel better, not something that makes you feel like you’ve been put through the wringer.
12 Sources
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