It has been well documented that for heart transplant recipients (HTrecipient) post transplantation exercise capacity does not exceed 60% of healthy age-matched controls. Few studies have been undertaken to determine the cause of exercise limitations following heart transplantation (HT) for an elite athlete. Participant was a 39 year old elite male cyclist who suffered an acute myocardial infarction after a cycling race and received a heart transplant (HT) four months later. Six weeks prior to his AMI fitness testing was completed and a predicted VO₂max of 58 mL·kg^-1·min^-1 and HR_max of 171 bpm was achieved. The participant underwent maximal exercise testing 6 and 12 months post transplant to determine exercise limitations. His results 6 and 12 months post transplant were a VO₂max of 33.8 and 44.2 mL·kg^-1·min^-1 respectively, and a HR max that was 97% and 96% of HR_max measured. The participant showed an increase in both HR_max and VO₂max 12 months post HT compared to previous testing. Results suggest that the limiting factors to exercise following HT are likely due to peripheral function, which became diminished as a result accumulated from 4 months of congestive heart failure, the strain of HT, and immunosuppressive therapy leading up to the exercise testing. Lifestyle before HT and a more aggressive approach to HT recovery should be considered necessary in the improvement of peripheral functioning following HT.

• Physical work capacity following heart transplantation is not limited by cardiac denervation.

• Heart transplant rehabilitation should focus efforts on endothelial and muscular limitations.