Exercise

Exercise is a vital part of dysautonomia symptom management.

It is recommended that exercise programs include aerobic reconditioning and resistance or strength training. ¹ ² ³ ⁴

Initially, exercise should start in the recumbent position (supine or reclined position) to avoid orthostatic stress. ⁵ Recumbent exercises can include using a rowing machine, a recumbent bike, or swimming. ⁶

Swimming can be well tolerated due to the added benefit of buoyancy, reducing pressure on joints, and creating resistance and hydrostatic pressure helping maintain central blood volume. ⁷

Exercise can eventually progress to upright positioning as tolerance is developed. ⁸

Strength training should also be incorporated with a gradual increase in frequency, duration, and weight. ⁹ Leg and core strengthening should be prioritized as the lower extremity muscles help to pump the blood back up to the rest of the body while standing.

Before initiating any exercise program, you should speak with your medical provider about any considerations you might have related to other medical conditions and your current state of health.

No one exercise protocol has been clinically proven superior to others.

Several protocols can be found online or prescribed by various providers

For example, the Children’s Hospital of Philadelphia has instructions for a POTS exercise program. This is a progressive 8-month program and includes comprehensive instructions, exercise diagrams, and a calendar. The specific protocol is less important than the exercise itself. It is important that exercise is incorporated as a continual lifestyle change to promote symptom improvement and management.

Reviewed by Medical Content Experts, 2021

REFERENCES

Bryarly, M., Philips, L. T., Fu, Q., Vernino, S., & Levine, B.D. (2019). Postural orthostatic tachycardia syndrome: JACC focus seminar. Journal of the American College of Cardiology, 73(10). 1207-1222. {1}

Fedorowski, A. (2019). Postural orthostatic tachycardia syndrome: Clinical presentation, aetiology and management. Journal of Internal Medicine, 285(4), 352–366. {2}

Fu, Q., & Levine, B. D. (2018). Exercise and non-pharmacological treatment of pots. Autonomic Neuroscience: Basic and Clinical, 215, 20–27. {3, 5, 10}

George, S.A., Bivens, T.B., Howden, E.J., Saleem, Y., Galbreath, M.M., Hendrickson, D., Fu,Q., & Levine, B.D. (2016). The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting. Heart Rhythm, 13(4), 943–950. {8, 9}

Raj, S.R., Guzman, J.C., Harvey, P., Richer, L., Schondorf, R., Seifer, C., Thibodeau-Jerry, N., & Sheldon, R.S. (2020). Canadian cardiovascular society position statement on postural orthostatic tachycardia syndrome (POTS) and related disorders of chronic orthostatic intolerance. Canadian Journal of Cardiology, 36(3), 357-372. {4, 6}

Tito, C., & Burton Hess, J. (2017). Aquatic therapy for a patient with postural orthostatic tachycardia syndrome: A case report. Internet Journal of Allied Health Sciences & Practice, 15(3), 1–11. {7}