BACKGROUND: It has been well documented that for heart transplant recipients (HTR) post transplantation exercise capacity does not exceed 60% of healthy age matched controls. Few, if any studies have been undertaken to determine the cause of exercise limitations following heart transplantation (HTx) for an elite athlete who has received a new heart. CASE SUMMARY: The participant in this study is a 39 year old professionally trained male cyclist who suffered an acute myocardial infarction after a cycling road race and received a heart transplant (HT) four months after the AMI. The participant underwent maximal graded exercise testing six and 12 months post transplant to assess recovery and exercise capacity in an attempt to determine the causes of exercise limitations following HT. RESULTS: The participant showed an increase in both HR and VO2max 12 months post HT compared to previous testing (six months post) and those of healthy age matched controls. His results six months and 12 months post transplant were a VO2max of 33.8 and 44.2 mL·kg- 1·min-1 respectively, and HR max that was 97% and 96% of HR max measured prior to his AMI. CONCLUSION: Results suggest that the limiting factors to exercise following HTx are likely due to peripheral function in this case, which became diminished as a result accumulated from four months of CHF, the strain of HTx, and possibly the effects of the 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 HTx.