Many people engage in physical activity to reduce their cardiovascular risk associated with smoking. These people should be made aware of the metabolic and cardiorespiratory changes induced by chronic and acute smoking and, in particular, the exercise ramifications of increased levels of blood carbon monoxide (CO). Smoking-induced elevations in the CO content of the blood can reduce exercise tolerance and maximal aerobic capacity. Smoking also increases the reliance upon glycolytic metabolism during exercise. Together, these factors contribute to earlier fatigue in smokers compared with nonsmokers who exercise. Similar effects upon exercise tolerance are noted in those who inhale environmental tobacco smoke.