Activity Intolerance

Activity Intolerance

Activity Intolerance

Related to Insufficient Knowledge of Adaptive Techniques Needed Secondary to COPD

Related to Insufficient Knowledge of Adaptive Techniques Needed Secondary to Impaired Cardiac Function

Defining Characteristics

Major (Must Be Present)

An altered physiologic response to activity


Exertional dyspnea*

Shortness of breath

Excessively increased rate

Decreased rate




Excessively increased

Failure to return to preactivity level after 3 minutes

Rhythm change

EKG changes reflecting arrhythmias or ischemia*

Blood Pressure

Abnormal blood pressure response to activity

Increased diastolic pressure greater than 15 mm Hg

Failure to increase with activity

Minor (May Be Present)

Verbal report of weakness*

Verbal report of fatigue*

Pallor or cyanosis


Verbal reports of vertigo

Related Factors

Any factors that compromise oxygen transport, physical conditioning, or create excessive energy demands that outstrip the individual’s physical and psychological abilities can cause activity intolerance. Some common factors follow.


Related to deconditioning secondary to prolonged immobilization and pain

Related to imbalance between oxygen supply/demand*

Related to compromised oxygen transport system secondary to:



Congestive heart failure



Myocardial infarction (MI)

Valvular disease

Congenital heart disease


Chronic obstructive pulmonary disease (COPD)


Bronchopulmonary dysplasia



Peripheral arterial disease


Related to increased metabolic demands secondary to:

Acute or chronic infections


Viral infection


Endocrine or metabolic disorders


Chronic Diseases






Related to inadequate energy sources secondary to:


Inadequate diet


Treatment Related

Related to increased metabolic demands secondary to:



Diagnostic studies

Treatment schedule/frequency

Related to compromised oxygen transport secondary to:



Bed rest* (related to inactivity secondary to assistive equipment [walkers, crutches, braces])

Situational (Personal, Environmental)

Related to inactivity secondary to:


Sedentary lifestyle*

Inadequate social support

Related to increased metabolic demands secondary to:

Climate extremes (especially hot, humid climates)

Atmospheric pressure (e.g., recent relocation to high-altitude living)

Air pollution (e.g., smog)

Environmental barriers (e.g., stairs)

Related to inadequate motivation secondary to:

Fear of falling





Generalized weakness*


Older adults may have decreased muscle strength and flexibility, as well as sensory deficits. These factors can undermine body confidence and may contribute directly or indirectly to activity intolerance.

Key Concepts

General Considerations

  • “Consensus Guidelines for Physical Activity and Public Health from the American Heart Association and American College of Sports Medicine call for at least 150 minutes per week of moderate ET or 75 minutes per week of vigorous ET in the general adult population. Those guidelines also suggest that larger doses of ET may be necessary in some groups, such as those with or at risk for CHD (30 to 60 minutes daily), adults trying to prevent the transition to overweight or obesity (45 to 60 minutes per day), and formerly obese individuals trying to prevent weight regain (60 to 90 minutes per day). These guidelines also caution that high-intensity ET increases risk of musculoskeletal injuries and adverse CV events” (*Haskell et al., 2007; La Gerche, Robberecht, & Kuiperi, 2010).

  • The effects of bed rest and the supine position are illustrated in Figure II.1.

  • The effects of bed rest deconditioning develop rapidly and may take weeks or months to reverse. All people confined to bed are at risk for activity intolerance as a result of bed rest-induced deconditioning.

  • Early mobility has been linked to decreased morbidity and mortality as inactivity has a profound adverse effect on the brain, skin, skeletal muscle, pulmonary, and cardiovascular systems (Zomorodi, Darla Topley, & McAnaw, 2012).

  • Delirium, decubitus ulcers, muscular atrophy, and deconditioning may occur in the immobile patient, as a result of atelectasis, pneumonia, orthostatic hypotension, and deep venous thrombosis (Zomorodi et al., 2012).

  • Endurance is the ability to continue a specified task; fatigue is the inability to continue a specified task. Conceptually, endurance and fatigue are opposites. Nursing interventions, such as work simplification, aim to delay task-related fatigue by maximizing efficient use of the muscles that control motion, movement, and locomotion.

  • The ability to maintain a given level of performance depends on personal factors, strength, coordination, reaction time, alertness, and motivation, and on activity-related factors, frequency, duration, and intensity.

  • “Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week. Over months to years of repetitive injury, this process, in some individuals, may lead to patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, creating a substrate for atrial and ventricular arrhythmias” (O’Keefe et al., 2012, p. 588).

FIGURE II.I Effects of Bedrest on Body Systems

Focus Assessment Criteria

Subjective Data

Assess for Defining Characteristics




Dec 6, 2019 | Posted by in NURSING | Comments Off on Activity Intolerance
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