Feeling out of breath after climbing a few flights of stairs is common, but it isn’t always just a sign of poor fitness. According to fitness coach Sumit Dubey, breathlessness can have several causes, ranging from lifestyle factors to underlying medical conditions.

“Being out of breath when climbing stairs can happen due to multiple reasons. It can be conditioned by a number of factors unrelated to a person’s level of physical activity,” Dubey said.

Common reasons include being overweight, anaemia, dehydration, poor sleep, stress, smoking, recent illness and age-related muscle loss. Reduced heart or lung function can also make climbing stairs more difficult.

Dubey said becoming breathless after climbing two or three flights of stairs is generally normal. However, if you struggle after climbing only a few steps or notice a sudden change despite exercising regularly, it is worth getting checked.

“If one begins to be out of breath when climbing stairs suddenly or more persistently than usual despite exercising five or six times per week, it is advisable to consult a doctor nonetheless,” he said.

He said breathlessness can sometimes signal heart conditions such as high blood pressure, coronary artery disease, heart failure or irregular heartbeat. Lung problems, including asthma, chronic obstructive pulmonary disease (COPD), allergies or damage after a lung infection, can also be responsible. Other possible causes include obesity, thyroid disorders, anxiety and uncontrolled diabetes.

Medical attention should be sought immediately if breathlessness is accompanied by chest pain, dizziness, fainting, palpitations, swelling in the legs, or blue lips or fingernails. Shortness of breath that lasts for more than two weeks should also be evaluated.

While a pulse oximeter and heart-rate monitoring can help people keep track of their fitness at home, Dubey stressed that they cannot replace a medical assessment.

Dubey recommended staying physically active through regular aerobic exercise and muscle-strengthening activities, while maintaining a healthy diet, getting enough sleep and avoiding smoking to improve stamina. “A healthy balanced diet with adequate levels of iron and protein as well as sufficient sleep and absence of harmful habits such as smoking can also improve stamina,” he said.

Research backs the expert’s claims

Research backs up much of what Dubey describes. A study published in ERJ Open Research in 2022 examined people with unexplained breathlessness and found that their breathing pattern itself may be at fault, not just their fitness. 

“It is estimated that dysfunctional breathing is present in up to 10% of the general population” and that “tasks that typically cause breathlessness include a change in posture, such as when bending forward or starting to climb stairs,” the study noted.

As part of the study, people with the condition and a matched group of healthy volunteers climbed four flights of stairs while wearing monitoring equipment. Although both groups reached almost the same heart rate and oxygen consumption by the end of the climb, patients felt much more breathless.

The researchers found that “the end-stair climb VʹO2 (rate of oxygen consumption) and heart rate at the end of the challenge were similar between patients and controls.” Despite this, “at end-exercise, patients reported a higher Borg dyspnoea rating, with 91% reporting the challenge as moderate to severe, in contrast, only 8% of controls reported the same severity rating.”

Breathing rate also stood out, with the study finding that “breathing frequency was around 10 breaths per minute higher in patients but with a similar tidal volume, when compared with controls.” It concluded that “patients with dysfunctional breathing experience dyspnoea and an abnormal breathing pattern when faced with undertaking everyday exercise challenges, such as climbing stairs.”

A separate review in Current Opinion in Supportive and Palliative Care in 2021 found breathlessness is far from rare in the general population, stating that it “is common and associated with several underlying conditions,” and that “respiratory disease is the most commonly reported underlying condition.” 

Drawing on nine earlier studies, it noted that “asthma was the most common” respiratory cause, and that “chronic obstructive pulmonary disease was particularly strongly associated with breathlessness.” It added that “other conditions prevalent among breathless individuals included heart diseases, anxiety, depression, and obesity, and several conditions often co-existed.” The review called for further research, noting that “more studies with refined methods such as machine learning are needed” to understand this further.

Taken together, experts and research point to the same message: stairs may be simple, but the breathlessness they trigger is not always about fitness. 

Sometimes, it is the body’s early warning system doing its job.

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