From the Guidelines
Intense exercise can potentially alleviate Postural Orthostatic Tachycardia Syndrome (POTS) symptoms, but it must be approached with caution and as part of a carefully structured program. A well-designed exercise regimen, specifically tailored for POTS patients, can improve cardiovascular conditioning, increase blood volume, and reduce symptom severity over time 1. The key is to start with low-intensity, short-duration exercises that minimize orthostatic stress, such as recumbent exercises like rowing, cycling, or swimming, and gradually increase duration and intensity as tolerated 2.
Key Considerations for Exercise in POTS
- Begin with recumbent exercises to minimize orthostatic stress
- Start with short durations (5-10 minutes) and gradually increase as tolerated
- Exercise intensity should be at a submaximal level, allowing for conversation in full sentences
- Gradually transition to upright exercises as orthostatic intolerance improves
- Always consult with a healthcare provider before starting an exercise program for POTS
Additional Management Strategies
- Increased fluid intake (2-3 liters daily) to help maintain blood volume
- Increased salt consumption (5-10g daily, unless contraindicated) to support blood volume expansion
- Use of compression garments to help improve venous return
- Any prescribed medications should be continued alongside exercise
It's crucial to approach exercise with caution in POTS patients, as improper structuring can initially worsen symptoms. A healthcare provider should be consulted to develop an individualized exercise plan that balances the benefits of exercise with the risk of exacerbating symptoms 1, 2.
From the Research
Exercise and POTS Symptoms
- Intense exercise may alleviate Postural Orthostatic Tachycardia Syndrome (POTS) symptoms, as studies have shown that physical reconditioning with exercise training can improve cardiovascular function and reduce symptoms in patients with POTS 3, 4, 5.
- A study published in 2018 found that exercise training, particularly horizontal exercise, can help patients with POTS to improve their functional capacity and reduce symptoms 3.
- Another study published in 2024 found that an individualized exercise program can be effective in managing POTS symptoms, especially in patients with severe orthostatic intolerance and fatigue 6.
Types of Exercise
- Horizontal exercise, such as rowing, swimming, or recumbent bike, is recommended for patients with POTS, especially in the initial stages of treatment 3.
- Upright exercise can be gradually added as patients become more fit and tolerant 3.
- A study published in 2021 found that a 6-month outpatient cardiovascular exercise program can improve cardiovascular function and quality of life in patients with POTS 4.
Comparison with Other Treatments
- Exercise training has been shown to be superior to propranolol, a commonly used medication for POTS, in improving symptoms, hemodynamics, and quality of life in patients with POTS 5.
- A scoping review published in 2024 found that exercise-based management can be effective in reducing POTS symptoms and improving quality of life, especially when individualized to meet the needs of patients with joint hypermobility and related conditions 7.
Limitations and Future Directions
- More research is needed to fully understand the effects of intense exercise on POTS symptoms and to develop personalized exercise programs for patients with POTS 3, 6, 7.
- Large, well-designed clinical studies are needed to explore the effectiveness of exercise-based management for POTS in patients with joint hypermobility and related conditions 7.