Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Nov 9;13(22):6747.
doi: 10.3390/jcm13226747.

Exercise in Postural Orthostatic Tachycardia Syndrome: Focus on Individualized Exercise Approach

Kristine Zeznick Trimble  1 , Jennifer N Switzer  1 , Svetlana Blitshteyn  1   2
Affiliations
Review

Exercise in Postural Orthostatic Tachycardia Syndrome: Focus on Individualized Exercise Approach

Kristine Zeznick Trimble et al. J Clin Med. .

Abstract

Exercise is a vital component of health and is commonly utilized as a non-pharmacologic therapy for many disorders, including postural orthostatic tachycardia syndrome (POTS). However, exercise intolerance is a key feature of POTS and other autonomic disorders and, therefore, presents a major barrier for many patients. Despite exercise being uniformly recommended as a therapeutic intervention, a majority of patients with POTS, especially those with severe orthostatic intolerance and fatigue, are unable to complete or sustain rigorous exercise programs or successfully integrate them into their daily routine. In this narrative review, we discuss the current literature on exercise and POTS and our clinical experience with a home-based exercise approach developed at the Dysautonomia Clinic. We conclude that individualized exercise programs that are delivered remotely by a certified physical therapist may be convenient, easily accessible, and safe for patients with POTS, especially those with severe symptoms who may be home- or bedbound. Future randomized controlled studies are needed to quantify and characterize the benefits of home-based exercise programs delivered remotely compared to standard therapy.

Keywords: dysautonomia; exercise; hypermobile Ehler–Danlos syndrome; hypermobility spectrum disorders; long COVID; mast cell activation syndrome; orthostatic intolerance; physical therapy; postural orthostatic tachycardia syndrome; rehabilitation; remote.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The goals of exercise progression from supine to standing (A) and factors that may affect the ability to exercise (B) in patients with POTS. (B) Pictured are the brain, the heart, the skeletal muscle, blood flow through a capillary, and a mitochondrion, all of which may play a role in POTS-associated exercise intolerance, one may affect the function of the other.
Figure 2
Figure 2
Pathophysiology of exercise intolerance in POTS: factors which may cause or contribute to reduced ability to exercise.
See this image and copyright information in PMC

References

    1. Blitshteyn S., Whitelaw S. Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: A case series of 20 patients. Immunol. Res. 2021;69:205–211. doi: 10.1007/s12026-021-09185-5. - DOI - PMC - PubMed
    1. Shaw B.H., Stiles L.E., Bourne K., Green E.A., Shibao C.A., Okamoto L.E., Garland E.M., Gamboa A., Diedrich A., Raj V., et al. The face of postural tachycardia syndrome—Insights from a large cross-sectional online community-based survey. J. Intern. Med. 2019;286:438–448. doi: 10.1111/joim.12895. - DOI - PMC - PubMed
    1. Sheldon R.S., Grubb B.P., II, Olshansky B., Shen W.-K., Calkins H., Brignole M., Raj S.R., Krahn A.D., Morillo C.A., Stewart J.M., et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12:e41–e63. doi: 10.1016/j.hrthm.2015.03.029. - DOI - PMC - PubMed
    1. Fu Q., VanGundy T.B., Galbreath M.M., Shibata S., Jain M., Hastings J.L., Bhella P.S., Levine B.D. Cardiac origins of the postural orthostatic tachycardia syndrome. J. Am. Coll. Cardiol. 2010;55:2858–2868. doi: 10.1016/j.jacc.2010.02.043. - DOI - PMC - PubMed
    1. Oldham W.M., Lewis G.D., Opotowsky A.R., Waxman A.B., Systrom D.M. Unexplained exertional dyspnea caused by low ventricular filling pressures: Results from clinical invasive cardiopulmonary exercise testing. Pulm. Circ. 2016;6:55–62. doi: 10.1086/685054. - DOI - PMC - PubMed

LinkOut - more resources