Rochester, Minnesota




The research interests of Joshua R. Smith, Ph.D., are centered on identifying therapeutic targets within the nervous and cardiovascular systems that can improve responses to physical stress (such as exercise) in healthy adults and patients with cardiovascular disease. Specifically, he is interested in how the respiratory muscles negatively influence exercise responses in patients with heart failure as well as what interventions might improve these impaired responses.

Dr. Smith is also interested in how sex-specific mechanisms such as menopause impact the cardiovascular response to physical stress in health and cardiovascular disease. Lastly, Dr. Smith has a special interest in investigating sex differences in cardiac rehabilitation outcomes.

Focus areas

  • Respiratory muscle dysfunction in heart failure. Dr. Smith is identifying how the respiratory muscles negatively impact cardiovascular control in heart failure, which ultimately contributes to exercise intolerance in these patients. He also investigates interventions to improve respiratory muscle function and the associated impairments contributing to exercise intolerance in patients with heart failure.
  • Impact of menopause on cardiovascular control during exercise. Dr. Smith is studying how the menopause transition influences blood pressure during exercise in both healthy women and women with cardiovascular disease. He incorporates novel methodology to perform bench-to-bedside science to better understand how menopause impacts cardiovascular function in women.
  • Sex differences in cardiac rehabilitation outcomes. Cardiac rehabilitation is a class 1 (strong recommendation) indication for patients with cardiovascular disease and represents a mainstay of therapy to improve cardiovascular disease risk factors while reducing rehospitalization and mortality. However, significant sex-specific disparities exist in cardiac rehabilitation participation and outcomes. Dr. Smith investigates how improvements in cardiovascular risk factors, novel risk-enhancing factors and exercise capacity following cardiac rehabilitation are modified by sex, as well as strategies to improve cardiac rehabilitation efficacy for women.

Significance to patient care

The goal of Dr. Smith's research is to improve symptomology, exercise tolerance and quality of life for patients with heart failure by contributing to a better understanding of respiratory muscle dysfunction and associated cardiovascular consequences. He investigates novel interventions that aim to improve respiratory muscle function as well as identify the mechanistic underpinnings of worsened neural and cardiovascular control in patients with heart failure. Dr. Smith also seeks to elucidate how sex- and menopause-specific mechanisms both impact cardiovascular responses to physical stress and mediate improvements following cardiac rehabilitation.

Professional highlights

  • Named, Building Interdisciplinary Research Careers in Women's Health (BIRCWH) K12 Scholar, National Institutes of Health, Office of Research on Women's Health, Mayo Clinic, 2020
  • Recipient, Mary Kathryn and Michael B. Panitch Career Development Award in Hypertension Research Honoring Gary Schwartz, M.D., Center for Clinical and Translational Science, Mayo Clinic, 2020


Administrative Appointment

  1. Associate Consultant I-Research, Division of Preventive Cardiology, Department of Cardiovascular Medicine
  2. Associate Consultant I-Research, Department of Physiology & Biomedical Engineering

Academic Rank

  1. Assistant Professor of Medicine


  1. Ph.D. - Exercise Physiology Kansas State University
  2. MS - Exercise Physiology Kansas State University
  3. BSc - Biology Indiana University
  4. Postdoctoral Research Fellowship - Clinical Integrative Human Physiology Mayo Clinic

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