Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review

Marco Giuseppe Del Buono, Ross Arena, Barry A. Borlaug, Salvatore Carbone, Justin M. Canada, Danielle L. Kirkman, Ryan Garten, Paula Rodriguez-Miguelez, Marco Guazzi, Carl J. Lavie, Antonio Abbate

Research output: Contribution to journalReview article


Exercise intolerance is the cardinal symptom of heart failure (HF) and is of crucial relevance, because it is associated with a poor quality of life and increased mortality. While impaired cardiac reserve is considered to be central in HF, reduced exercise and functional capacity are the result of key patient characteristics and multisystem dysfunction, including aging, impaired pulmonary reserve, as well as peripheral and respiratory skeletal muscle dysfunction. We herein review the different modalities to quantify exercise intolerance, the pathophysiology of HF, and comorbid conditions as they lead to reductions in exercise and functional capacity, highlighting the fact that distinct causes may coexist and variably contribute to exercise intolerance in patients with HF.

Original languageEnglish
Pages (from-to)2209-2225
Number of pages17
JournalJournal of the American College of Cardiology
Issue number17
Publication statusPublished - May 7 2019



  • aging
  • cardiorespiratory fitness
  • comorbidities
  • exercise capacity
  • exercise intolerance
  • exercise training
  • fatigue
  • heart failure
  • HFpEF
  • HFrEF

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Del Buono, M. G., Arena, R., Borlaug, B. A., Carbone, S., Canada, J. M., Kirkman, D. L., Garten, R., Rodriguez-Miguelez, P., Guazzi, M., Lavie, C. J., & Abbate, A. (2019). Exercise Intolerance in Patients With Heart Failure: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 73(17), 2209-2225. https://doi.org/10.1016/j.jacc.2019.01.072