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Activity Intolerance

What Is It, Causes, Interventions, and More

Author:Maria Emfietzoglou, MD

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN

Illustrator:Jessica Reynolds, MS

Copyeditor:David G. Walker


What is activity intolerance?

Activity intolerance refers to the inability to endure or complete activities of daily living. This can be due to a variety of physical causes, such as advanced age and pain, or psychological causes, such as depression, which can ultimately lead to weakness and discomfort when performing daily regular tasks. Nonetheless, there are several interventions that can be used to enhance tolerance and endurance. 

Illustration of a nurse helping a fatigued patient with a cane ambulate.

What causes activity intolerance?

Various physical and psychological factors can cause activity intolerance. Physical factors include advanced age; malnutrition; obesity; and sleep disturbance, which includes either lack of sleep or prolonged bed rest. Additionally, activity intolerance can occur due to severe pain or bone and joint problems, such as osteoporosis and osteoarthritis, and may also be a  side effect of certain medications, like sedatives (e.g. benzodiazepines). Moreover, chronic conditions that can cause inadequate oxygen supply, such as anemia or heart failure, or cognitive disorders, such as dementia, can prevent an individual from enduring physical activity. Additionally, psychological factors, like stress and depression, can cause a generalized weakness and lack of motivation, decreasing tolerance for various activities. 

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What are the signs and symptoms of activity intolerance?

The most common signs and symptoms of activity intolerance include weakness, fatigue, and dizziness when performing daily activities. Individuals might also have a feeling of discomfort, shortness of breath, as well as abnormal heart rate and blood pressure upon exertion. Over time, activity intolerance can gradually reduce self-esteem and motivation, which can ultimately lead to sleep disturbances and depression

What are interventions for activity intolerance?

There are various interventions that can lead to an increase in activity tolerance. It may be useful to assess an individual’s capabilities and energy levels in order to prepare a personalized exercise routine that is consistent with each individual’s abilities and needs. Also, it may be helpful to plan activities during times of the day the individual has maximum energy levels, which is usually during the morning. It may also be important to start with easier tasks (e.g. performing exercises in bed, sitting, or walking) and gradually increasing one’s activity level by progressing to more complex tasks, such as running. Monitoring the individual’s responses to activity is imperative during the transition from easier to complex tasks. Performing an activity slowly with regular breaks for rest or with assistance and assistive equipment can also increase endurance. Endurance can also be enhanced by performing repetitive activities over a longer period of time. Exercise tolerance can also be improved by establishing a good breathing rhythm (i.e. inhaling on relaxation and exhaling on exertion). Finally, a healthy sleep routine and a balanced diet can also help deal with activity intolerance. 

A nursing intervention that can restore an individual’s ability to perform regular activities is to encourage individuals to express their concerns and limitations with regards to the activities they can and cannot perform. Providing them with appropriate emotional and physical support can help in maintaining a positive attitude towards their abilities.

Finally, specific treatments may be required to resolve the underlying cause or condition (e.g. treating osteoporosis, heart failure, and cognitive problems or discontinuing sedative medications).  

What are the most important facts to know about activity intolerance?

Activity intolerance is defined as the inability to perform or endure regular activities. There are various physical factors that can reduce activity tolerance, including advanced age, pain, bone and joint problems, heart disease, and dementia. Psychological factors, such as stress and depression, can also decrease the ability to endure daily activities. Common signs and symptoms of activity intolerance include weakness, fatigue, dizziness, difficulty breathing, and abnormal blood pressure and pulses. It can also lead to sleep problems and depressive symptoms. Several interventions can be used to enhance activity tolerance, including planning an individualized exercise routine, encouraging the individual to express their concerns, providing support, as well as addressing the underlying cause. 

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Related links

Immobility - Positioning & alignment: Nursing skills
Mobility - Ambulation: Nursing skills
Mobility - Assistive devices: Nursing skills

Resources for research and reference

Activity Intolerance. Elsevier Health Care Plans. Accessed April 8, 2022. https://elsevier.health/en-US/preview/activity-intolerance-cpg

‌Cremers T, Zoulfi Khatiri M, van Maren K, Ring D, Teunis T, Fatehi A. Moderators and Mediators of Activity Intolerance Related to Pain. Journal of Bone and Joint Surgery. 2021;103(3):205-212. doi:10.2106/JBJS.20.00241

Rodrigues CG, Moraes MA, Sauer JM, Kalil RA, de Souza EN. Nursing diagnosis of activity intolerance: clinical validation in patients with refractory angina. International Journal of Nursing Terminology Classification. 2011;22(3):117-122. doi:10.1111/j.1744-618X.2011.01182.x

Thibault P, Loisel P, Durand MJ, Catchlove R, Sullivan MJL. Psychological predictors of pain expression and activity intolerance in chronic pain patients. Pain. 2008;139(1):47-54. doi:10.1016/j.pain.2008.02.029