Activity intolerance is a significant nursing diagnosis that affects patients across all age groups and healthcare settings. This comprehensive guide explores the definition, causes, symptoms, and evidence-based nursing interventions for managing activity intolerance effectively. As healthcare providers, understanding and properly addressing activity intolerance is crucial for optimal patient outcomes and recovery.
What is Activity Intolerance?
Activity intolerance is defined as a state in which an individual has insufficient physiological or psychological energy to perform or complete necessary or desired daily activities. This condition can significantly impact a person’s quality of life and ability to maintain independence in activities of daily living (ADLs).
Common Causes of Activity Intolerance
The following factors commonly contribute to activity intolerance:
Physiological Causes:
- Cardiovascular conditions (heart failure, coronary artery disease)
- Respiratory disorders (COPD, asthma)
- Neuromuscular conditions
- Anemia
- Electrolyte imbalances
- Chronic fatigue syndrome
Psychological Causes:
- Depression
- Anxiety disorders
- Sleep disorders
- Chronic stress
Environmental Factors:
- Prolonged bed rest
- Limited mobility
- Poor conditioning
- Inadequate nutrition
- Medication side effects
Signs and Symptoms
Subjective Indicators
Patients may report:
- Fatigue during or after activities
- Shortness of breath with exertion
- Weakness or exhaustion
- Dizziness during activity
- Chest pain or discomfort
- Difficulty completing daily tasks
Objective Indicators
Nurses may observe:
- Abnormal vital sign responses to activity
- Increased work of breathing
- Unusual heart rate or blood pressure changes
- Decreased oxygen saturation
- Pallor or cyanosis
- Difficulty maintaining activity levels
- Decreased performance in physical therapy
Nursing Assessment
Primary Assessment Components
Activity Level Assessment
- Current activity tolerance
- Baseline activity level
- Recent changes in activity capacity
- Impact on daily living
Vital Signs Monitoring
- Heart rate response to activity
- Blood pressure changes
- Respiratory rate and pattern
- Oxygen saturation levels
Physical Assessment
- Cardiopulmonary status
- Muscle strength
- Range of motion
- Energy levels
- Nutritional status
Psychological Assessment
- Motivation levels
- Emotional state
- Understanding of limitations
- Support system
General Nursing Interventions
Activity Planning and Management
- Schedule activities during peak energy periods
- Implement gradual activity progression
- Incorporate adequate rest periods
- Monitor response to activity
Energy Conservation
- Teach pacing techniques
- Prioritize essential activities
- Implement energy-saving strategies
- Position items within easy reach
Environmental Modifications
- Ensure proper lighting
- Remove obstacles
- Provide assistive devices
- Maintain comfortable temperature
Educational Interventions
- Teach activity modification techniques
- Explain energy conservation methods
- Demonstrate proper use of assistive devices
- Provide lifestyle modification guidance
Nursing Care Plans
Care Plan 1: Cardiovascular-Related Activity Intolerance
Nursing Diagnosis Statement:
Activity intolerance related to decreased cardiac output as evidenced by dyspnea on exertion and abnormal heart rate response to activity.
Related Factors/Causes:
- Congestive heart failure
- Decreased cardiac output
- Compromised oxygen delivery
Nursing Interventions and Rationales:
- Monitor vital signs before, during, and after activity
Rationale: Provides baseline data and identifies early signs of cardiac compromise - Implement a graduated activity program
Rationale: Prevents overexertion while building tolerance - Teach energy conservation techniques
Rationale: Helps maintain activity while preventing exhaustion
Desired Outcomes:
- The patient will demonstrate improved activity tolerance.
- Vital signs remain within normal limits during activity
- Patient verbalizes understanding of activity limitations
Care Plan 2: Respiratory-Related Activity Intolerance
Nursing Diagnosis Statement:
Activity intolerance related to impaired gas exchange as evidenced by shortness of breath and decreased oxygen saturation during activity.
Related Factors/Causes:
- Chronic obstructive pulmonary disease
- Impaired gas exchange
- Increased work of breathing
Nursing Interventions and Rationales:
- Administer prescribed oxygen therapy
Rationale: Ensures adequate oxygenation during activity - Teach pursed-lip breathing
Rationale: Improves ventilation and reduces dyspnea - Position for optimal lung expansion
Rationale: Maximizes respiratory efficiency
Desired Outcomes:
- Patient maintains oxygen saturation >92% during activity
- The patient demonstrates effective breathing techniques
- The patient reports decreased dyspnea during activities
Care Plan 3: Muscular Weakness-Related Activity Intolerance
Nursing Diagnosis Statement:
Activity intolerance related to muscle weakness as evidenced by the inability to complete ADLs independently.
Related Factors/Causes:
- Prolonged immobility
- Deconditioning
- Neurological impairment
Nursing Interventions and Rationales:
- Implement progressive resistance exercises
Rationale: Builds muscle strength and endurance - Provide appropriate assistive devices
Rationale: Supports independence while maintaining safety - Schedule regular physical therapy sessions
Rationale: Improves muscle strength and coordination
Desired Outcomes:
- The patient demonstrates increased muscle strength.
- The patient performs ADLs with minimal assistance
- The patient shows improved endurance in daily activities
Care Plan 4: Pain-Related Activity Intolerance
Nursing Diagnosis Statement:
Activity intolerance related to chronic pain as evidenced by reluctance to participate in activities and verbal reports of pain during movement.
Related Factors/Causes:
- Chronic pain condition
- Fear of movement
- Muscle guarding
Nursing Interventions and Rationales:
- Administer pain medication before planned activities
Rationale: Prevents pain exacerbation during activity - Teach pain management techniques
Rationale: Empowers patient to control pain during activity - Implement a gentle range of motion exercises
Rationale: Maintains joint mobility while managing pain
Desired Outcomes:
- The patient reports decreased pain during activity
- The patient demonstrates increased participation in activities
- The patient uses pain management strategies effectively
Care Plan 5: Psychological-Related Activity Intolerance
Nursing Diagnosis Statement:
Activity intolerance related to depression as evidenced by decreased motivation and reduced participation in daily activities.
Related Factors/Causes:
- Clinical depression
- Lack of motivation
- Social isolation
Nursing Interventions and Rationales:
- Establish realistic activity goals
Rationale: Provides achievable targets and builds confidence - Implement a reward system for activity completion
Rationale: Reinforces positive behavior and motivation - Encourage social interaction during activities
Rationale: Improves mood and increases activity participation
Desired Outcomes:
- Patient demonstrates increased initiative in activities
- Patient reports improved mood with activity
- Patient engages in regular social activities
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Laoutaris ID. Exercise intolerance and skeletal muscle metaboreflex activity in chronic heart failure: Do we need to recruit more muscle in exercise training? Eur J Prev Cardiol. 2020 Nov;27(17):1858-1861. doi: 10.1177/2047487320912623. Epub 2020 Mar 25. PMID: 32212843.
- Okita K, Kinugawa S, Tsutsui H. Exercise intolerance in chronic heart failure–skeletal muscle dysfunction and potential therapies. Circ J. 2013;77(2):293-300. doi: 10.1253/circj.cj-12-1235. Epub 2013 Jan 19. PMID: 23337207.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
