Impaired exercise capacity is an independent risk factor for poor prognosis in patients with cardiovascular disease (CVD). The vicious cycle triggered by CVD, centered on cardiac dysfunction, progressively compromises pulmonary ventilation/gas exchange, skeletal muscle metabolism, and skeletal function, collectively leading to exercise intolerance. The “cardio-pulmonary-muscular-skeletal” functional axis theory is proposed to elucidate this multisystem deterioration. Within the framework, this review systematically discusses the mechanisms by which traditional Chinese medicine (TCM) interventions synergistically reverse exercise intolerance. These mechanisms include improving cardiac and vascular function, enhancing pulmonary ventilation and oxygenation, increasing muscle mass and metabolic function, and maintaining bone quality and mechanical function, thereby leveraging the multi-targeted and holistic regulatory advantages of TCM. Although the overall quality of clinical evidence remains moderate, a multidimensional evidence system centered on exercise tolerance has been established. This evidence confirms the consistent benefits of TCM formulas on core indicators across the functional axis. The functional axis theory provides an innovative framework for understanding the multisystemic underlying mechanisms of exercise capacity decline in CVD patients and for guiding holistic TCM-based interventions, highlighting the unique value of TCM in cardiac rehabilitation.

cardiovascular diseases  /  traditional Chinese medicine  /  exercise capacity  /  “cardio-pulmonary-muscular-skeletal” functional axis  /  mechanism of action  /  clinical evidence