Clarifying Exercise Intolerance in Cardiovascular Disease: Protocol for a Scoping Review and Evolutionary Concept Analysis.

Background/Objectives: Exercise intolerance is clinically important but conceptually unstable in cardiovascular care. Its relationship with exercise tolerance, exercise capacity, functional capacity and the nursing concept of activity intolerance remains unclear, and the term entered nursing from other disciplines without corresponding conceptual scrutiny. This protocol will examine how these concepts are used in adults with cardiovascular disease, how use varies across conditions, care settings, pathway phases and time, and which attributes, antecedents, consequences and related concepts are reported, to determine what these concepts can mean for nursing. Methods: The study has two interconnected phases: a scoping review following Joanna Briggs Institute methodology and PRISMA-ScR and PRISMA-S reporting, followed by Rodgers' evolutionary concept analysis. Searches will cover MEDLINE, CINAHL, Embase, Web of Science and Scopus, complemented by gray literature and standardized nursing terminologies. Expected Results: The review will map how exercise intolerance, activity intolerance and neighboring terms are used and will chart which defining attributes and empirical referents are recognizable through routine nursing assessment, require instrumented testing or both. Whether a stable nursing formulation can be derived is treated as an open question: convergence, divergence, instability and insufficient evidence are all possible, and attributes recognizable only through instrumented testing will be reported as a null result for nursing operationalization. Conclusions: The review will determine how the concept has evolved for the discipline of nursing and whether nursing assessment can operationalize it. It will not establish professional consensus, diagnostic thresholds, measurement validity or device specifications. Registration: This study was registered in the Open Science Framework (OSF) Registries before screening and data charting commenced.