Managing POTS Through Movement and Therapy

What is POTS (Postural Orthostatic Tachycardia Syndrome)

The Postural Tachycardia Syndrome (POTS) is an abnormality of the autonomic nervous system (ANS) (a malfunctioning ANS is sometimes called ‘dysautonomia’). The autonomic nervous system controls all bodily functions that we don’t have to think about, such as:

• Heart rate and blood pressure regulation
• Digestion
• Bladder control
• Sweating
• Stress response

• An infection such as a bacterial or viral infection (including COVID -19)
• A life stressor, such as pregnancy or surgery
• A traumatic event

Why movement and therapy matter for symptom management

It could be useful to think of exercise as a form of medicine for POTS. It has the potential to reduce our symptoms over time, just like with medicine, we know that different types, doses, and frequencies may be suitable for different people. Movement doesn’t have to be overwhelming — when done correctly, it can be empowering.

Why Movement is Helpful for POTS

1. Improving Blood Flow and Circulation

POTS affects blood pooling in the lower body. Aerobic exercise is the most encouraged form of exercise for the management of POTS, as studies have shown that it can assist with the improvement of symptoms over time and may not require as much effort on the circulatory system as weight training. Types of aerobic exercise include walking, swimming, rowing, and cycling/biking.

It is recommended that resistance training still be included in an exercise regimen, but that it may be completed less frequently than aerobic exercise.

2. Gentle exercise promotes venous return

Lower body exercises are favoured for the management of POTS as strengthening muscles in the legs can assist with improving circulation and reducing blood pooling. Increased muscle mass in your legs means more blood is returned with each step you take. Examples include seated marches and recumbent cycling.

3. Increase Endurance Gradually

Gradual cardiovascular conditioning matters. You can use a heart rate monitor set (a watch with a chest strap) to monitor your heart rate during cardio exercise training, so you can exercise in the proper heart rate zones. Avoiding symptom flare-ups from overexertion by:

1. 1. 1. Most adults should increase their salt and fluid intake to boost blood volume.
      2. Wear compression garments during exercise.
      3. Eat smaller meals and snacks throughout the day.

It can take 6-12 weeks of exercising before noticing a change, and it’s normal that we may experience setbacks or delays with our exercise.

Supporting Overall Health

• • Muscle strengthening and postural stability
  • Reduced fatigue over time
  • Enhanced confidence and functional independence

Safe Exercise Progression for POTS

1. Starting Where You Are
   • Seated or recumbent exercises for beginners
     • Months 1-4, you should only exercise in a horizontal position. Here are examples: Recumbent biking, Rowing Ergometer, Swimming laps, or kicking laps with a kickboard
     •  In Month 4, you can begin to use the upright bike if it is available
     •  Month 5 is when you can begin further upright training (elliptical or treadmill)
   • Importance of monitoring heart rate and symptoms
2. Gradual Increase in Intensity

Start with 5-10 minutes of light exercise and slowly increase by a few minutes each week. Don’t get frustrated if you can’t increase your time each week; listen to your body and adjust based on what it needs. Listen to your body and adjust as needed

3. Incorporating Rest and Recovery

Keep the workouts spread out throughout the week. This is more beneficial than bunching them up and then taking several days off from exercising. Balance activity and rest to prevent crashes

 How Physical Therapy Tailors Programs for POTS

1. Individual Assessment
   • PT evaluates heart rate response, fatigue, and functional capacity.
   • Understanding symptom triggers and limitations
2. Personalized Exercise Plans
   • Low-impact aerobic exercises
   • Strengthening the core and lower body
   • Gentle resistance and flexibility training
3. Symptom Control Strategies
   • Positioning and pacing guidance
   • Breathing techniques to support circulation
   • Education on activity modification for daily life

Tips for Success

• Consistency over intensity: small, manageable sessions
• Tracking symptoms to adjust exercises safely
• Combining movement with hydration and nutrition strategies
• When to seek professional guidance

Takeaways for POTS

1. Movement + PT = improved circulation, endurance, and symptom management

2. When dealing with POTS, even small steps make a difference!

3. Consult a PT to start a safe, tailored program.