NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00298 |
|---|---|
| Label | Decreased activity tolerance |
| Spanish label | Disminución de la tolerancia a la actividad |
| Domain | 4. Activity / rest |
| Class | 3. Energy balance |
| Type | Problem-focused |
| Status | Current |
What it means
The patient cannot handle the effort their daily activities require. When they move, the heart and lungs cannot keep up with what the body demands, and dyspnea, tachycardia or exhaustion force them to stop before finishing.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Pneumonia, COPD or asthma during recovery, when dyspnea appears with movement.
- Heart failure, ischemic heart disease or arrhythmias with symptoms on exertion.
- Moderate or severe anemia, when oxygen delivery to the tissues falls short during exertion.
- Prolonged bed rest, an ICU stay or recent major surgery.
- Frail or malnourished older adults who become exhausted with self-care.
What to assess
- Vital signs at rest, during activity and 3-5 minutes after: HR, BP, RR and SpO2.
- Dyspnea or perceived exertion with the Borg scale (0-10 for dyspnea, 6-20 for exertion).
- Which specific activities are tolerated and which are not: distance walked, whether they bathe on their own, whether they can climb stairs.
- Symptoms that force them to stop: chest pain, dizziness, pallor, diaphoresis, palpitations.
- How long it takes HR and SpO2 to return to baseline.
- NYHA functional class in cardiac patients.
- Hemoglobin, nutritional status and hours of sleep.
- Days on bed rest and muscle strength.
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- HR rises more than 20 bpm above baseline with light activity, such as walking around the room.
- SpO2 drops below 90% with movement.
- RR above 24 breaths/min or dyspnea that keeps them from speaking in full sentences during exertion.
- Reports tiredness or shortness of breath when bathing, dressing or walking.
- Needs rest breaks to finish tasks they used to do without stopping.
- Takes more than 5 minutes to return to baseline HR after activity.
- Palpitations or arrhythmias on the monitor that appear with exertion.
- Dizziness, pallor or cold sweats when getting up or walking.
- Systolic BP drops with exertion instead of rising.
- Borg dyspnea score of 5 or higher with light activity.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Prolonged bed rest and physical deconditioning.
- Inadequate oxygenation during exertion: no supplemental oxygen when needed or a flow rate that falls short.
- Activities clustered together without rest periods.
- Insufficient or interrupted sleep.
- Energy and protein intake below requirements.
- Fear of moving or of the dyspnea coming back.
- Unfamiliarity with energy conservation techniques.
At-risk populations
- Adults over 65.
- Hospitalized patients on bed rest for more than 3 days.
- People who were sedentary before becoming ill.
- Patients recently discharged from the ICU.
- People with malnutrition.
Associated conditions
- Pneumonia and other respiratory infections.
- COPD.
- Heart failure.
- Anemia.
- Recent major surgery.
- Cancer and its treatments.
How to write it (PES)
Decreased activity tolerance related to prolonged bed rest and inadequate oxygenation during exertion as evidenced by HR increase of 32 bpm when walking 10 meters, SpO2 of 87% while ambulating, and Borg dyspnea score of 6/10.
Decreased activity tolerance (00298).
What limits endurance and what nursing acts on: deconditioning from bed rest and oxygen that falls short during exertion. Pneumonia is the associated condition, not the related factor.
The responses measured during activity: how much HR rises, how much SpO2 drops, the Borg score and which activity triggers the symptoms. "Gets tired" is not enough.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Walks 30 meters on prescribed oxygen with SpO2 ≥ 90% and HR no more than 20 bpm above baseline within 72 hours.
- Returns to baseline HR and SpO2 within 5 minutes after activity within 48 hours.
- Reports Borg dyspnea ≤ 3/10 when bathing seated within 48 hours.
- Bathes and dresses without help, with planned rest breaks, before discharge.
- Explains and uses three energy conservation techniques before discharge.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Measure HR, BP, RR and SpO2 before, during and 3-5 minutes after each activity. | The response to exertion tells you how far to progress and when to stop. |
| Stop the activity if SpO2 drops below target (generally 90%; 88% in COPD if ordered), HR rises more than 20-30 bpm above baseline, systolic BP drops, or chest pain, dizziness or severe dyspnea appear. Notify the provider if it does not resolve with rest. | These are signs the heart or lungs cannot meet the demand. |
| Increase activity in stages: sitting on the edge of the bed, transferring to the chair, standing, walking in the room and then in the hallway. | Moving up one step at a time builds endurance without decompensating the patient. |
| Alternate activities with rest periods and avoid scheduling bathing, dressing changes and tests back to back. | It keeps effort from piling up and exhausting the patient by mid-morning. |
| Give the prescribed oxygen during activity and titrate it as ordered to keep SpO2 at target. | Oxygen demand rises with movement; the resting flow rate may fall short. |
| Teach energy conservation techniques: doing tasks seated, keeping items within reach, pursed-lip breathing during exertion. | They lower energy expenditure and help the patient stay independent. |
| Coordinate an exercise and ambulation program with physical therapy. | Early, structured mobilization shortens deconditioning. |
| Monitor intake, sleep and hemoglobin, and report abnormalities. | Without energy, rest or adequate hemoglobin, tolerance will not improve even if the patient exercises. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0002Energy Conservation
- 0001Endurance
- 0005Activity Tolerance
NIC interventions
- 0180Energy Management
- 4310Activity Therapy
- 0221Exercise Therapy: Ambulation
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Recovering from pneumonia
Patient. 72-year-old man on day 3 of a hospital stay for community-acquired pneumonia. He spent two days in bed and today is trying to walk to the bathroom.
Assessment
- At rest: HR 86 bpm, BP 128/76 mmHg, RR 20 breaths/min, SpO2 94% on 2 L/min oxygen.
- After walking 10 meters: HR 118 bpm, RR 30 breaths/min, SpO2 87%.
- Borg dyspnea 6/10; he stops and leans on the door frame.
- Takes 7 minutes to return to baseline HR.
- Before getting sick he walked 20 minutes a day.
- Hemoglobin 13.2 g/dL; eats half of each meal tray.
Nursing diagnosis
Decreased activity tolerance related to prolonged bed rest and inadequate oxygenation during exertion as evidenced by HR increase of 32 bpm when walking 10 meters, SpO2 of 87% while ambulating, and Borg dyspnea score of 6/10, in a patient with community-acquired pneumonia (associated condition).
Goal
Walks 30 meters on prescribed oxygen with SpO2 ≥ 90% and HR ≤ 106 bpm (20 above baseline) within 72 hours.
Interventions
- Vital signs before, during and 5 minutes after each walk.
- Progression: up to the chair three times on day 1, walking in the room on day 2 and in the hallway on day 3.
- Oxygen titrated during ambulation per provider order to keep SpO2 ≥ 90%.
- Pursed-lip breathing while walking.
- 30-minute rest between bathing and physical therapy.
Evaluation
At 72 hours he walks 30 meters with a peak HR of 104 bpm, SpO2 of 91% and dyspnea 3/10, and returns to baseline HR in 4 minutes. The goal was met. The diagnosis stays active with a new goal: walking 60 meters before discharge.
How it differs from similar diagnoses
- Risk for decreased activity tolerance (00299): This is the risk version: the patient still tolerates activity but has factors (prolonged bed rest, heart disease) that could reduce it.
- Excessive fatigue burden (00477): Fatigue is exhaustion that rest does not relieve and that appears even without exertion. With decreased activity tolerance, symptoms appear with activity and ease when the patient stops.
- Impaired physical mobility (00085): The problem is movement itself (strength, range of motion, coordination), not cardiopulmonary endurance. A patient can have both.
Common mistakes
- Writing "related to pneumonia" or "related to heart failure": those are associated conditions; the related factor is deconditioning, bed rest or inadequate oxygenation on exertion.
- Recording only resting vital signs: the diagnosis is supported by the response during activity.
- Confusing it with fatigue when the patient rests well and only becomes exhausted when moving.
- Keeping the patient in bed "so they don't get tired": prolonged bed rest makes tolerance worse.
Used in these conditions
Other diagnoses in the Energy balance class
Domain 4, Activity / rest. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for decreased activity tolerance?
00298. It belongs to Domain 4 (Activity/rest), Class 3 (Energy balance), and remains current in the 2024-2026 edition.
Is decreased activity tolerance the same as activity intolerance?
Yes. Earlier editions called it Activity intolerance (00092). Since the 2021-2023 edition it has been Decreased activity tolerance (00298), and the 2024-2026 edition keeps the same name and code.
What scale do I use to measure activity tolerance?
The Borg scale for dyspnea or perceived exertion, together with HR, BP and SpO2 before, during and after activity. For cardiac patients, add the NYHA functional class.
When should I stop the activity?
If chest pain, dizziness or severe dyspnea appear, if SpO2 drops below target, or if HR rises much more than expected. Have the patient rest, reassess and notify the provider if they do not recover.
Can a patient have decreased activity tolerance and fatigue at the same time?
Yes, for example in anemia or advanced heart failure. If the exhaustion persists even at rest, add Excessive fatigue burden (00477).
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Decreased activity tolerance (00298) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1. Reviewed November 2, 2026.