Many of us have felt light-headed when we stand too quickly from a lying down position, but if you have postural orthostatic tachycardia syndrome (POTS), this simple movement can make your heart race.
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This condition most frequently affects young women, who may struggle to stay active. We all know that fitness is important for good health, but when people with POTS exercise, they may feel dizzy — or they may even pass out.
Dealing with challenges from POTS
Although it may be more difficult to exercise, there are ways to help offset these challenges, says exercise physiologist Michael Crawford, Manager of Cardiac Rehabilitation at Cleveland Clinic. He says it’s important to find ways to exercise because it increases blood volume, the size and strength of the heart and its pumping action.
“Most people I work with see some sort of improvement with exercise; they may still have symptoms, but they occur less frequently,” he says. “However, I see mixed results. I have had young college students return to competitive athletics after treatment. Other people make minimal progress.”
He says the important thing is to follow all of your treatment strategies if you have POTS. This includes taking prescribed medication, increasing fluids, wearing compression stockings and adding in some kind of physical activity.
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Best and worst exercises to do
Newer research suggests that aerobic exercises that are not as gravitationally challenging are best for people with POTS.
“We use semi-recumbent cycling, rowing machines and a seated stair-stepper to decrease the risk of syncope (passing out),” Mr. Crawford says.
If weightlifting, he says it’s best to mainly work the lower body in seated positions with a leg press or seated abdominal exercises. “When you strengthen the lower body, it reduces blood pooling in the legs.”
The ultimate goal is to progress over time to fully upright exercises so you can manage symptoms; staying in a semi-recumbent position doesn’t do that.
To work toward this, Mr. Crawford suggests that for the first three to four weeks, do semi-recumbent work at a moderate intensity level. You can gradually increase that intensity, then progress to something more upright like a stationary cycle. Use that for three to four weeks.
“If that is well-tolerated, I transition people to a treadmill or elliptical machine. At this point, you just need to make sure you are not working too intensely. Once you are feeling better, you can do pretty much whatever you want,” he says.
On the other hand, he suggests that you stay away from free weights because a dizzy spell can increase chances you might drop the weight. Also, avoid high-intensity work or exercises with a rapid change in position.
How often to exercise, for how long
Here is how people with POTS can build up their workout schedule:
- Start out working three days a week, resting between days
- Add in a fourth day after about three weeks
- After a few more weeks, add a fifth day
“You should work for 20 minutes a day and add five minutes to that every two to three weeks. Eventually, you can exercise about 40 to 45 minutes most days, which falls in line with what everyone should do,” Mr. Crawford says.
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When you are planning for exercise when you have POTS, remember these tips:
- Hydrate, hydrate, hydrate. You need to prehydrate 30 minutes before you go to the gym with about 8 ounces of fluid. You should typically drink water unless your doctor encourages you to have a sports drink. For every 15 minutes of exercise, drink 4 ounces of fluid.
- Don’t skimp on warm ups and cool downs. People with POTS need to warm up and cool down very slowly for five minutes each. “For the warm up, you need to steadily/progressively increase your exercise over the first five minutes until you get to your conditioning phase, and then for the cool down, you should steadily decrease your exercise over five minutes prior to stopping,” Mr. Crawford says.
- Watch your target heart rate. While exercising, be sure you are staying in your target heart rate where you feel comfortable. POTS patients don’t fall into typical exercise heart-rate levels, so testing determines what they can tolerate. They should have very specific parameters and stay within those levels.
“If you need help getting into exercise, start with getting an evaluation from a cardiologist or neurologist to make sure there aren’t underlying issues causing the condition,” Mr. Crawford says. “Once that’s sorted out, you should see an exercise physiologist who knows about POTS.”