Tired and short of breath after exercise: what is usually behind it, when your heart plays a part and when to see a doctor

In this article you will read why you can feel tired and short of breath after exertion, what may be behind it, how heart failure can show itself and when to see a doctor. This matters, because shortness of breath is common, and in older adults who get out of breath on exertion, the heart turns out to play a role more often than many people think.⁠^5,1 BioProfile’s energy scan measures how much fatigue you carry and gives you an indication of where you stand in this area today. It is the first of the 11 health areas the full scan assesses. This is not a diagnosis. It is insight, to see where you stand today and to help you make better choices in your diet and lifestyle. What this scan does not do: point to a cause or make a diagnosis. Only a doctor can do that.

Why you are tired and short of breath after exertion

One overarching review brought together 10 reviews covering 315 studies in total. In recent studies, about one in eight adults in the general population had clear breathlessness on a standard scale, and more than one in three in patient groups.⁠⁵ The researchers found six groups of factors linked to breathlessness: social and demographic, physical, disease-related, psychological, environmental, and findings on scans or tissue tests.⁠⁵

What this means for you: getting out of breath when you exert yourself is common, and it can come from several directions at once. Later in life, the heart is one of those directions.

How often the heart is behind it

In Dutch GP practices, researchers examined 585 people aged 65 and over who were short of breath on exertion and had no known heart failure. Of them, 92 turned out to have heart failure, about one in six. Most had the form in which the heart still pumps out a normal share of the blood with each beat: heart failure with preserved ejection fraction. In far fewer of them was the pumping itself weaker.⁠¹

This fits a wider picture. A review of 25 study groups of adults aged 60 and over living at home found heart failure in about one in nine, again more often the preserved type.⁠⁶ In the Rotterdam Study, heart failure rose from 0.9% in the 55 to 64 age group to 17.4% at 85 and over. For people aged 55, the lifetime risk was 33% for men and 29% for women.⁠⁷ In 2024, an estimated 256,400 people in the Netherlands were known to a doctor to have heart failure.⁠⁸

Put simply: heart failure becomes much more common with age, and around one in three people aged 55 will develop it at some point. Breathlessness on exertion later in life therefore deserves a closer look.

How tiredness feels with heart failure

According to Thuisarts, these signs bring people with a question about heart failure to their GP: you get tired quickly when you exert yourself and you may get out of breath, your feet and ankles get thicker, and you get heavier because your body holds on to fluid.⁠⁹

What this means for you: these are the signs Thuisarts names. They are getting tired and out of breath more quickly when you exert yourself, thicker ankles, and extra kilos from fluid.

Why shortness of breath that stays matters

The Dutch Vlagtwedde/Vlaardingen study followed people from 1965 and, at the end of 2008, 43 years later, looked at who was still alive. Of 7,360 people, those with moderate shortness of breath had a slightly higher risk of dying over that period than people without shortness of breath, and those with severe shortness of breath had an even higher risk. That held after the researchers had taken age, sex, lung function, smoking and body mass index into account. Among people who were measured more often, those whose shortness of breath went away had about the same risk as people who never had it. Shortness of breath that stayed went with about twice the risk, and shortness of breath that newly appeared with about one and a half times the risk.⁠²

In plain words: in this study, shortness of breath that went away went with a different risk than shortness of breath that stayed or was new. This is a pattern in a large group. It does not predict what will happen to you.

When to see a doctor

If you have heart failure, call your GP, the out-of-hours GP service or 112 straight away if you suddenly breathe very fast or with difficulty, suddenly feel very short of breath, or cannot lie down at all because you are so breathless.⁠³ Call 112 straight away if you have pain or a heavy, pressing feeling in your chest that does not go away when you sit still. Sweating or nausea can come with it, but they do not have to. Also call 112 straight away if the pain spreads to your arm, neck or jaw, or to between your shoulder blades. Call your GP or the out-of-hours GP service straight away if you are breathing fast or with difficulty, or if your heart keeps beating very fast.⁠⁴

Make an appointment with your GP if you get tired or out of breath more quickly when you exert yourself, are short of breath at night when lying down, gain 2 or more kilos within 3 days, or notice that your feet and ankles are getting thicker. Thuisarts gives these signs to people who already have heart failure.⁠³

For you, it comes down to two rules: sudden or severe means calling now, and a gradual change means making an appointment.

What the GP looks at

At your GP’s, your weight, height, blood pressure and heart rate are measured, and you have a blood test and a heart tracing (ECG), sometimes also an ultrasound of the heart. In hospital, more tests may follow: an ultrasound of the heart, a chest X-ray, an exercise test, an MRI or a CT scan.⁠⁹ With these tests the doctor looks for possible causes. The ultrasound and the X-ray look more directly at the heart and the lungs. A questionnaire does not do that.

What the energy scan measures

The energy scan asks five questions about the past two weeks and turns your answers into an energy score from 0 to 100, where higher is better. The score shows how much tiredness you are carrying and gives you a starting value to compare against later. The scan does not look at your heart, lungs or blood, and cannot tell whether the cause of breathlessness lies in your fitness, your lungs or your heart. If your tiredness comes mainly in the afternoon rather than with exertion, that is a different pattern, explained in why your energy drops after lunch.

In summary

Feeling tired and short of breath after exertion is common and can have many causes.⁠⁵ In older adults the heart is involved more often than expected, usually as the preserved form of heart failure.⁠¹ In a Dutch study, shortness of breath that stayed or was new went with a higher risk of dying than shortness of breath that went away.⁠² Sudden or severe shortness of breath, or chest pain that does not go away, means calling straight away. A gradual change means making an appointment with your GP.⁠^3,4 The energy scan shows how much tiredness you are carrying today. Finding the cause is work for a doctor.