From the Guidelines
For a 21-year-old female with postural syncope, a gradual exercise program focusing on recumbent activities is recommended, starting with horizontal exercises like swimming, recumbent biking, or floor-based strength training for 15-20 minutes, 3 times weekly, gradually increasing to 30-45 minutes as tolerated, as supported by the most recent guidelines 1. This approach is based on the principle of minimizing blood pooling in the lower extremities while gradually improving cardiovascular conditioning and autonomic nervous system regulation. The key components of the workout include:
- Starting with recumbent activities to minimize orthostatic stress
- Gradually increasing exercise duration and intensity as tolerated
- Incorporating strength training, particularly of the lower body, to improve venous return and blood pressure regulation
- Avoiding exercises that involve quick position changes, prolonged standing, or extreme heat
- Ensuring proper hydration with 16-20 oz of water with electrolytes before workouts
- Wearing compression garments for the lower body to improve orthostatic tolerance
- Exercising with a partner and taking regular breaks to monitor for symptoms of presyncope or syncope, as recommended by recent guidelines 1. It is essential to consult with a healthcare provider before starting this program, as they may recommend specific heart rate targets or additional precautions based on individual circumstances, and to prioritize the single most recent and highest quality study, which in this case is the 2019 American Heart Association and American Red Cross focused update for first aid 1.
From the Research
Workout for a 21-year-old female with postural syncope
There is no specific workout recommended for a 21-year-old female with postural syncope. However, some studies suggest that treatment with certain medications can help alleviate symptoms of postural syncope and related conditions.
- The study 2 found that treatment with bisoprolol and fludrocortisone improved symptoms in patients with postural tachycardia syndrome (POTS), a condition characterized by excessive orthostatic sinus tachycardia, lightheadedness, tremor, and near-syncope.
- Another study 3 found that fludrocortisone was effective in treating severe and otherwise intractable postural hypotension secondary to therapy with levodopa.
- A study 4 found that fludrocortisone increased mean blood pressures and decreased dizziness and leg cramping in patients with familial dysautonomia.
- A review article 5 highlights the importance of considering a broad differential diagnosis when evaluating syncope in young women, including postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension, and neurally mediated syncope (NMS).
Management of postural syncope
- A study 6 suggests that most patients with postural syncope can be managed in an outpatient setting, and hospital admission or emergency department assessment is rarely warranted.
- The same study 6 notes that treatment is challenging and compounded by a lack of evidence, and that a detailed history, examination, blood pressure assessment, and electrocardiography are necessary to diagnose the underlying cause of postural syncope.